Calculating Qty for albuterol nebulizer soln.

[tompharm]

Can someone explain to me how I get the proper written qty and dispensed qty for the .083% albuterol soln if box of 25 vials with 3 ml

also albuterol 5mg /ml sol if 30 vials with 0.5 ml

qty prescribed is 180 for both

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[DASicari]

You'll have to check with your software vendor, but it's usually calculated in mLs:

Albuterol 0.083%: 1 box= 25 vials x 3mL= 75mL

And don't break the boxes!

 

[trailerpark]

I love how the doctors write for 1 box and patient bitches it's only enough for 1 week.

 

[alternate]

Can someone explain to me how I get the proper written qty and dispensed qty for the .083% albuterol soln if box of 25 vials with 3 ml

also albuterol 5mg /ml sol if 30 vials with 0.5 ml

qty prescribed is 180 for both

Most software is by mL. So for albuterol 0.083% vials: 1 box=25 vials x 3 mL=75 mL total per box.

So if quantity prescribed is 180 VIALS (and not mL which brings up the point of having someone smart send over the e-RX with this valuable piece of information). Here's how I would input the RX:

Written quantity= 540 mL (180 vials x 3 mL per vial)
Dispensed quantity= 525 mL (as poster above states don't break a box so 7 boxes x 25 vials per box x 3 mL in each vial).

 

[zelman]

I love how the doctors write for 1 box and patient bitches it's only enough for 1 week.

I love how CVS and Walgreens stock different size boxes (or at least they did when I rotated across the street)

 

[BenJammin]

You'll have to check with your software vendor, but it's usually calculated in mLs:

Albuterol 0.083%: 1 box= 25 vials x 3mL= 75mL

And don't break the boxes!

Huh? Always break the boxes if it's an odd quantity. Just like you should always break boxes of insulin pens.

 

[FarmD711]

Huh? Always break the boxes if it's an odd quantity. Just like you should always break boxes of insulin pens.

We don't open either

 

[owlegrad]

Huh? Always break the boxes if it's an odd quantity. Just like you should always break boxes of insulin pens.

I knew the master of breaking boxes was going to chime in with this! We are discussing albuterol boxes so of course we need to talk about insulin pens again!

 

[BenJammin]

I knew the master of breaking boxes was going to chime in with this! We are discussing albuterol boxes so of course we need to talk about insulin pens again!

But of course! If the prescription is for 20 vials, why is it appropriate for you to dispense 25? Why do you feel that defrauding insurance is just "the thing to do"?

 

[trailerpark]

In my retail job we would never open a box of insulin pens, albuterol, duoneb, etc... In my home store we won't even open tamiflu boxes.

 

[Rouelle]

And when 94 mL amoxicillin susp is prescribed, it is also important to pour out 6 mL from the 100 mL reconstitute so that we don't dispense more than is prescribed

 

[BenJammin]

And when 94 mL amoxicillin susp is prescribed, it is also important to pour out 6 mL from the 100 mL reconstitute so that we don't dispense more than is prescribed

Apples and oranges. You can't break a bottle of amoxicillin unlike insulin pens or albuterol soln.

 

[zelman]

Apples and oranges. You can't break a bottle of amoxicillin unlike insulin pens or albuterol soln.

So, you mark the individual vials with a 7 day expiration date after removing them from the foil, right?

 

[BenJammin]

Now you're just splitting hairs. It's still apples and oranges to compare a foiled box of albuterol soln to insulin pens. If a 30 day supply of Lantus is 3.9 pens, you dispense 4. You certainly don't dispense the entire box like most of you are advocating.

 

[Prepharm1214]

We never use to break insulin boxes until about 2 years ago..Express scripts did an audit and charged back about $4000 worth of scripts which quickly changed our dispensing practices and attentiveness to days supply.

 

[maria1oh]

A box of albuterol 0.083% used to be on the $4 list. Not sure anymore though. the stereo isomer xopenex is expensive though and usually has a Prior Auth

 

[wucool33]

Now you're just splitting hairs. It's still apples and oranges to compare a foiled box of albuterol soln to insulin pens. If a 30 day supply of Lantus is 3.9 pens, you dispense 4. You certainly don't dispense the entire box like most of you are advocating.

Huh? But you just said you would break a albuterol soln... I've never seen anyone be this extreme...

 

[BenJammin]

Huh? But you just said you would break a albuterol soln... I've never seen anyone be this extreme...

I also said I break boxes of insulin pens because that is what you're supposed to do.

 

[Ackj]

Huh? Always break the boxes if it's an odd quantity. Just like you should always break boxes of insulin pens.

When they write for 30g of bactroban ointment, give them a full tube, and then squeeze 8g from another tube into an ointment jar for the patient.

For patients who test their glucose once daily, only give them 30 strips and 30 lancets. Can't let them have extra.

 

[BenJammin]

When they write for 30g of bactroban ointment, give them a full tube, and then squeeze 8g from another tube into an ointment jar for the patient.

What is wrong with you people? Use an example that makes sense! Quit trying to shy away from the fact that you guys are cheating when you don't break boxes of insulin pens. If a 30 day supply is 4 pens, you better be dispensing 4 pens.

 

[Old Timer]

What is wrong with you people? Use an example that makes sense! Quit trying to shy away from the fact that you guys are cheating when you don't break boxes of insulin pens. If a 30 day supply is 4 pens, you better be dispensing 4 pens.

Nothing is wrong with us. No, you are not cheating. The proof of the pudding is in the over 30 years I have been doing this not one insurance company or PBM has ever taken a single cent back from me. If it was fraud, they would be collecting millions. I don't break Insulin Pens, Albuterol for the nebulizer, topicals or anything that should be dispensed as a unit.

 

[FarmD711]

Insulin pens are not intended to be opened. They contain patient information paperwork that must be dispensed with the pens and only comes one per box.

 

[BidingMyTime]

Insulin pens are labeled to be sold as an individual unit, they are not to be broken up. I would be willing to bet PrePharm pharmacy got chargebacks, because they were dispensing TWO boxes of pens as a 30 day supply, when in reality TWO boxes was say a 40 day supply, so they should have only dispensed ONE box as a 20 day supply. Giving more boxes and rounding down the days supply is considered fraud and will get charge-backs. I have never, ever, heard of a pharmacy getting a chargeback for a single insulin pen box. Insurance companies recognize when boxes are labeled to be dispensed as an entire unit (such as insulin pens, eye drop bottles, amoxicillin bottles, etc.) and pharmacies are not penalized for rounding down the day supply on a single package.

 

[RX2090]

I've had MANY pbms audits over the years. NOT ONE has said anything about breaking boxes. That is just insane. How can you have the time to do that?

If this was an actual "thing", pbms would be taking back millions every day, because 99.9% of pharmacies dispense the entire box/insulin box.

My money is on the fact that Benjammin is just one of those crazy nerdy detailed RPhs who take everything literally.

 

[farmadiazepine]

CVS we used to never break the box of insulin pens. At my independent we do. To each his own. I actually prefer opening up the box and dispensing a true one month supply. And yes, insurance companies will try to charge back. You will not believe what they try to charge back money for.

 

[SClENCE]

Insulin pens are labeled to be sold as an individual unit, they are not to be broken up. I would be willing to bet PrePharm pharmacy got chargebacks, because they were dispensing TWO boxes of pens as a 30 day supply, when in reality TWO boxes was say a 40 day supply, so they should have only dispensed ONE box as a 20 day supply. Giving more boxes and rounding down the days supply is considered fraud and will get charge-backs. I have never, ever, heard of a pharmacy getting a chargeback for a single insulin pen box. Insurance companies recognize when boxes are labeled to be dispensed as an entire unit (such as insulin pens, eye drop bottles, amoxicillin bottles, etc.) and pharmacies are not penalized for rounding down the day supply on a single package.

What do you do if the insurance company will only cover a 30 day supply (with the insulin pen example)? Serious question. I'v seen it where some plans will only cover 30/90 day supply of some drugs (not sure if this has ever been the case for insulin).

 

[BidingMyTime]

What do you do if the insurance company will only cover a 30 day supply (with the insulin pen example)? Serious question. I'v seen it where some plans will only cover 30/90 day supply of some drugs (not sure if this has ever been the case for insulin).

Well, like the example I gave, your round down 1 box to 30 day supply. If 2 boxes go over 30 day supplies, they can only get 1 box (which sucks if 1 box is 16 day supply, because they have to come back every 16 days.) If 1 box is 50 days, then it gets rounded down to 30 day supply. The only chargebacks I've seen is when someone will dispense 2 boxes which should have been a 50 day supply, and then round down to 30. Only 1 single box can rounded down, this has been the standard at every insurance I've worked with. These packages are NOT labeled to be broken apart, so insurances can not require you to break them apart.

 

[trailerpark]

What is wrong with you people? Use an example that makes sense! Quit trying to shy away from the fact that you guys are cheating when you don't break boxes of insulin pens. If a 30 day supply is 4 pens, you better be dispensing 4 pens.

Nope, that's 1 box. 15 mL, 5 pens

 

[Sparda29]

WTF? If 2 boxes comes out to 35 days supply, I'm gonna give them 2 boxes and round down to 30.

 

[Ackj]

WTF? If 2 boxes comes out to 35 days supply, I'm gonna give them 2 boxes and round down to 30.

Enjoy your audit. We just got hit by a pretty big one with lots of chargebacks. Most of it is due to old staff/floaters, but now we're double checking the hell out of all refills in case those were entered wrong too. Fair amount of blowback from patients "but I always used to get 2 boxes.... but last time my copay was $10, not $20..." but what can you do?

 

[BenJammin]

Nope, that's 1 box. 15 mL, 5 pens

No that's 4 pens, 12 mL.

 

[trailerpark]

What a mess having to open boxes and repackage them and having open boxes in the fridge, increases chance of error.

 

[BenJammin]

Lol no. Not at all.

 

[trailerpark]

Lol no. Not at all.

What do you put the pens in? A zip lock bag with the label on the bag or do you label each pen? I like dispensing the whole box so they have all the original packaging and insert. Even if 1 box is a 40 day supply if I round down to 30 if that's the max ins day's supply it's not like they will be refilling in 30 days anyway.

 

[trailerpark]

I always put the exact day's supply and only round down if the insurance rejects and says max 90 or something.

 

[BidingMyTime]

Enjoy your audit. We just got hit by a pretty big one with lots of chargebacks.

This. Yeah, patients don't like it (I don't blame them), but billing a 2 box-32 day supply of insulin as a 30 day supply is what gets chargebacks. The same auditor giving us chargebacks for this, never said anything about billing a 1 box-32 day supply of insulin as a 30 day supply. Because the boxes are not supposed to be broken.