Frequently Asked Questions
This section answers frequently asked questions identified by pharmacists about buprenorphine dispensing. Keep in mind that your pharmacy may have different policies; each situation is unique. The following evidence-based guidelines were developed with input from pharmacists and policy experts.
Receiving prescriptions from new or unknown prescribers might happen more now due to recent legislative changes. To verify the prescriber, you can call and request additional information if you are uncomfortable with the dose, or frequency of administration, similar to all other medications. You can also 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.
Patients report traveling 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. 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. 1, 30, 31 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.
Advocate with your wholesale distributor (via the compliance officer) 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. 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 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
Tools for Communicating with Prescribers and Advocating with Wholesale Distributors
Don’t be afraid to reach out to prescribers! Open lines of communication can help ensure patient access and ensure proper administration. Document encounters with prescribers on the script for DEA agents. This section is also available in Resources.
Hello, I'm calling from ______ Pharmacy. Is Dr. ______ available? I'm hoping to verify a prescription for buprenorphine we just received for patient: _____ date of birth: _______.
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 by having enough buprenorphine in stock. 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.
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When calling a wholesale distributor, enter the pharmacy account number in the phone system. This helps them pull up the account before answering any questions.
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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. If you would like to increase your order threshold, you can request the contact information for the compliance officer at your wholesaler. Follow up directly with the compliance officer to increase ordering thresholds.
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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 their buprenorphine order size suggest that you send 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
Communicate with prescribers you've noticed are newly prescribing, sending more buprenorphine prescriptions than before, or otherwise contributing to increased dispensing demand.
Ask prescribers to provide a letter documenting their increased patient panel or that they are beginning to treat OUD patients.
If possible, see if a prescriber will indicate how many patients they expect to send scripts to your pharmacy for, how often, and if they will document that for your wholesale distributor.
Your email should address why you may be experiencing an increase in buprenorphine prescribing. Examples may include: increased prescribers, increased need in the community, et cetera.
Your email should also describe the red flag that was identified, reasons why the red flag occurred and why the red flag was not a cause for diversion concern. In the example below, the identified “red flag” was increased dispensing of buprenorphine monoproduct. In this paragraph, explain how intolerance to naloxone is common, and list any efforts you have undertaken to ensure legitimate use.
Example email for wholesaler identification of 'Red Flags'
Hello,
This email is in response to *insert wholesaler* notification that *insert pharmacy* has been purchasing an elevated volume of single ingredient buprenorphine compared to combination buprenorphine formulations. The request from *insert wholesaler* has requested an explanation of what is driving the usage of the single ingredient formulations, any specific population served, and steps taken to ensure legitimate use. Additionally in response to the request for the top 5 prescribers, I have attached a document that provides our top 5 prescribers of buprenorphine.
We have been in close communication with local prescribers to ensure that the needs of patients are met. One local provider has called our pharmacy and told us that he actually sends his patients to our pharmacy, because when they come into our pharmacy we treat the patients with respect and do not discriminate or treat them any differently than someone that does not suffer from opioid use disorder. Also, with the recent removal of the X-waiver requirement local prescribers have been able to treat more patients in need of therapies for opioid use disorder.
The rationale for more dispensing of the monoproduct over the naloxone-containing product is due to side effects from naloxone-containing products. Many patients cannot tolerate naloxone-containing products. Naloxone has a lot of nausea associated with use of this medication. For that reason many prescribers will place patients on monoproduct buprenorphine with documentation on the hard copy of the prescription that the patient cannot tolerate naloxone.
Opioid use disorder is unfortunately very prevalent in our county and surrounding counties. With increased access to care for patients suffering from opioid use disorder through removal of the X-waiver and increased use of telehealth for treatment I anticipate that many pharmacies will have an increase in dispensing of medications used to treat the disorder.
Please let me know if any further documentation is required.
Thank you,
Pharmacy manager