FAQs/Video Examples

Receiving prescriptions from new or unknown prescribers might happen more often as the number of X-waivered prescribers increases. You may be able to quickly establish the provider’s legitimacy by checking their DEA-X waiver, and/or by checking the SAMHSA database. Then, on a day that isn’t so busy, you can use our example fax sheet, email template, or phone script to establish a line of communication with the provider. (See the Resources tab for these tools.)

In the past, overprescribing of opioids made it hard for a lot of people to trust doctors. We’re trying to fix that by following the evidence and prescribing buprenorphine for opioid use disorder. I can’t do it without the pharmacists who also take care of my patients.” OUD treatment provider

Receiving a prescription from an unknown patient might occur more frequently as the number of qualified prescribers who can write prescriptions for buprenorphine increases. Established buprenorphine patients may be turned away from pharmacies they’ve gone to before if that pharmacy encounters a wholesaler threshold. Pharmacies might reach thresholds more often as more people are newly prescribed buprenorphine products and more providers are eligible to prescribe. The goal is to ensure that every patient is able to fill their medication; treatment delays can increase the chance of return to use, “relapse,” and overdose.

Check the patient’s information in the CSRS.

In some pharmacies you may be able to fill for a specific minimum number of days to ensure that the patient does not have a gap in continuity of care while you initiate a validation process. Examples of how some pharmacists determine length of fill while verifying the prescriber are described in the table below. Remember: A positive experience with filling can encourage a patient to continue in treatment.

How to Determine Length of Fill While Verifying Prescriber

Circumstance	If You Can’t Reach Prescriber, Consider Filling For:	Next Steps
Patient brings in new script or script from unknown prescriber on a Friday	3 days minimum – prevent treatment gap through weekend	Ask patient to call prescriber on Monday and ask them to contact the pharmacy Contact prescriber on Monday to verify Document reasons why you filled a bridge script in the patient’s record. Example: Checked CSRS. Attempted to contact patient’s provider and could not reach them. Left a message. In order to reduce overdose risk, provided 3 days of rx so they did not experience a treatment gap over the weekend.
New patient brings in one-week script, or patient brings in one-week script  from unknown prescriber	7 days – prevent a treatment gap until patient’s next appointment	Ask patient to have the prescriber get in touch with the pharmacy at their next appointment Clarify that pharmacy won’t fill again until prescriber contacts pharmacy Document reasons why you filled 1-week script in the patient’s record. Example: Checked CSRS. Attempted to contact patient’s provider and could not reach them. Left a message. In order to reduce overdose risk, provided 7 days of rx so they did not experience a treatment gap before their next scheduled appointment. Stated that we would not fill another script until their prescriber contacts the pharmacy.
Patient missed or needed to reschedule an appointment with prescriber (e.g., childcare or transportation fell through; work schedule changed, etc.)	Dispense bridge script if prescriber authorizes	Encourage patient to ask provider to prescribe a few days of extra medication to prevent a treatment gap until rescheduled appointment Document reasons why you filled bridge script in the patient’s record. Example: Checked CSRS. Attempted to contact patient’s provider and could not reach them. Left a message. Patient had transportation issues and missed scheduled appointment. In order to reduce overdose risk, provided X days of rx so they did not experience a treatment gap before their next rescheduled appointment. Stated that we would not fill another script until their prescriber contacts the pharmacy.

 

Patients report travelling long distances to get their buprenorphine filled when their local pharmacy has encountered a wholesaler threshold. Wholesaler thresholds are especially problematic for people who live in rural areas and do not have many local options. The goal is to ensure that every patient is able to fill their medication, as treatment delays can increase the chance of return to use (relapse) and overdose. Check the patient’s information in the CSRS, and fill the script. Document reasons for filling the script in the patient’s record. (See the Resources tab.)

Receiving a prescription for the same patient for more than a year is normal. As recognized by the American Pharmacists Association,²² evidence-based guidelines for OUD treatment recommend that patients be prescribed buprenorphine products for at least a year, and in some cases longer—even life-long. Each patient’s circumstance is different; the provider will work with each patient on an individual basis to decide the appropriate duration of treatment. Patients should remain on buprenorphine for as long as it is beneficial.

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22. American Pharmacists Association. Increasing Access to and Advocacy for Medications for Opioid Use Disorder (MOUD).; 2020. Accessed August 10, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440871/

Advocate with your wholesale distributor to increase your pharmacy’s order size. You can seek support from local prescribers to document their number of OUD patients for whom they regularly send you scripts. How to advocate for wholesaler thresholds. Consider establishing a contract or dispensing agreement with a nearby prescribing entity, such as the health department or an OBOT program to ensure stable demand. (See example contract in the Resources tab.)

Keep in mind that you can affirm a patient’s choice to seek OUD treatment with each and every script fill. Filling their buprenorphine reduces stigma and may encourage someone to remain in treatment. By helping a person who uses drugs access buprenorphine, you may prevent an overdose and save a life. (Information about harm reduction resources for your area are included in the Resources tab.)

People who are taking this medication are doing so to try to make their lives better… I’ve had friends who said, ‘Why should I even try to stop using drugs if I’m still going to be judged?’ So, they have returned to using drugs instead of staying on the Suboxone. My suggestion is for pharmacists to be supportive of buprenorphine.OUD patient, 2020

“Hello, I’m calling from ______ Pharmacy. Is Dr. ______ available? I’m hoping to verify a prescription for buprenorphine we just received…
I don’t think we’ve filled for your office before. We’d like to connect whenever the provider has time so we can be sure to meet your patients’ medication needs. If they could call us when they have time, that would be great. Thank you!”

When the prescriber or their staff call back:

• Introduce yourself and the pharmacy where you work
• Mention the specific patient and any questions about the script
• If time allows, let the prescriber know you will be best able to meet their patients’ needs if you have some idea how many patients they are writing bupe scripts for, how often, etc. Let them know you want to work with them to keep the medication in stock

Attn. Dr. ___________ Re: (patient, DOB) Hello. My name is _______ and I work at ________ Pharmacy. Meeting your patients’ medication needs is a priority for us. We’d like to connect soon and talk with you about the number of OUD patients for whom you anticipate routinely prescribing buprenorphine products. It would also help to know what formulations and dosages you’ll most often prescribe. This information will help us be in the best position to ensure we can maintain enough medication in stock.

1. When calling a wholesale distributor for anything, enter the pharmacy account number in the phone system. This helps them pull up the account before answering any questions.
2. A representative from the wholesale distributor may call the pharmacy regularly (at some locations, as often as every 2 weeks) to check in about special pricing, rebate totals, and answer any questions that may arise from the last call. — This is an opportunity to bring up any anticipated increase in buprenorphine demand, if you are aware of an increase in prescribers in your area, for example.
3. Be aware that wholesale distributors will be cautious when it comes to increasing orders of controlled substances such as buprenorphine. Pharmacists that have succeeded in increasing a buprenorphine order size suggest you end an email to the wholesale distributor representative with:
   • Reasons for the increase
   • How much of an increase
   • From which prescriber(s) the increase arises; information such as prescriber(s)’ DEA number; practice location address(es)
4. This is an opportunity to communicate with prescribers you’ve noticed are newly prescribing, sending more buprenorphine prescriptions than before, or otherwise contributing to increased dispensing demand.
5. Ask them to provide a letter documenting their increased patient panel or that they are beginning to treat OUD patients.
6. If possible, see if a prescriber will indicate how many patients they expect to send scripts to your pharmacy for, and how often, and if they will document that for your wholesale distributor.