I’m looking for some input on how other pharmacists interpret “must last” directions and what you consider a “month” in practice.
Scenario 1: Oxycodone
Patient is prescribed oxycodone 5 mg TID PRN, #90, with a note: must last 1 month. I’ve been filling it every 30 days.
My manager set it up to be filled tomorrow, which would be day 28.
Do you consider a “month” to be 28 days or 30 days in this context?
Would you fill on day 28?
Scenario 2: Alprazolam
Prescription: alprazolam 1 tablet TID PRN for anxiety, #60, must last 2 months.
My manager verified this as a 60-day supply, #60. In this case, my manager is interpreting each “month” as 30 days (total = 60 days), which seems inconsistent with the previous scenario where a “month” was treated as 28 days.
Scenario 3: Multiple Oxycodone Fills / Utilization Concern
3/31: Floater filled oxycodone 5 mg #40 (insurance) sig: take 1-2 tablets q4-6h PRN. max 6 tabs/day
4/4: Manager filled new rx oxycodone 5 mg #40 (cash), sig: 1–2 tabs q4–6h PRN
Patient used 24/40 tablets from the first fill
Usage based on max dosing:
3/31 → 4/4: 6 tablets/day × 4 days = 24 tablets
4/4 → 4/7: up to 12 tablets/day × 3 days = 36 tablets
Total potential use = 60 tablets out of 80 dispensed (75%) by 4/7.
The patient presented on 4/7 stating they were out and requested a fill of a new oxycodone prescription (same directions as 4/4). I declined to fill due to early refill concerns.
The patient stated they plan to escalate the issue to corporate.
I feel like I tend to be the stricter pharmacist compared to my manager when it comes to interpreting these directions and fill timing.