Insurance companies and pharmacies are entitled to refuse to fill prescriptions for a variety of reasons. One state's guidelines note “there is no legal obligation to disperse a prescription, especially one of doubtful, questionable or suspicious origin.” A pharmacist can politely refuse to fill the prescription and suggest that the patient contact his doctor.
One state's guidelines recommend that the pharmacist should check the state's Prescription Drug Monitoring Program before filling a prescription for a controlled substance, particularly for new or unknown patients, for weekend and late-day prescriptions, and because of suspicious behavior by the patient, such as nervousness, agitation or evasiveness. The pharmacist should contact the prescribing physician if he suspects that the prescription is forged or counterfeit, and he should not fill the prescription without this verification. A pharmacist who denies a prescription should alert other area pharmacists. Because it is against the law to knowingly dispense a controlled substance for anything other than a “legitimate medical purpose,” doing so could violate federal and state laws about addiction, and the pharmacist could be held liable for injury to the patient or to others.
Attempting to refill a prescription too far ahead of its refill date can be a reason to deny the request. Habitual requests for early refills can suggest that the patient is exceeding the proper dosage or is stockpiling medication. Insurance companies may allow up to seven days ahead of the date for a 30-pill prescription, or 21 days for a 90-day supply. In cases when an insurance company refuses the request, a pharmacist can contact the physician or insurance company directly. Some physicians may limit the number of refills by requiring a doctor’s visit before the prescription can be refilled. In this case, the pharmacist must decline the refill request and notify the patient to contact his doctor.
Insurance companies may require prior authorization before a patient can get certain medications. Very expensive medications, for example, may require approval in advance from the insurance company. Others needing an advance OK are brand-name medicines that are prescribed instead of their generic equivalents; age-related medications such as the acne treatment Retin-A; cosmetic medications such as hair-regrowth treatments; and drugs to treat erectile dysfunction and other non-life-threatening conditions.
Controversy continues over the right of a pharmacist to refuse to fill a prescription because of moral objections. The emergency “Plan B” contraceptive, for instance, drew objections from some pharmacists with anti-abortion beliefs. While some pharmacists believe they should be allowed to refuse any prescription for any reason, including religious, others maintain that such refusal is unprofessional and an imposition of personal convictions on patients.