changing amount dispensed

[wagrxm2000]

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I have mds who always write for things that we dispense the entire box like pulmicort for short day supplys. If they write for ten do you call or iust give one box? What about documentation?

 

[zelman]

Legally, you must call.

Practically, just give whatever is appropriate.

 

[SELDANE]

Nebulizer vials, insulin pens, Restasis vials, Lidoderm patches, etc... I don't call the MD I simply scratch out the prescribed quantity and write "Stock size" and dispense the full box. In 20 years I've never had a prescriber question or complain about my dispensing practices with regards to quantity.

 

[KidPharmD]

Nebulizer vials, insulin pens, Restasis vials, Lidoderm patches, etc... I don't call the MD I simply scratch out the prescribed quantity and write "Stock size" and dispense the full box. In 20 years I've never had a prescriber question or complain about my dispensing practices with regards to quantity.

I've been in several pharmacies that hold the policy that some containers are just not breakable and we treat them like you treat a cream or ointment. If someone writes an rs for 10g of an ointment that only comes as 50g, you go ahead and give the 50g tube. In the same way, insulin pens, nebulizer meds, restasis, lidoderm, etc were all dispensed as a "container."

 

[PharmdA07]

Make sure you at least document on the rx as "changed to stock size per MD" or something similar for insurance audit purposes.

 

[wagrxm2000]

So do you round up or down?

 

[Ackj]

So do you round up or down?

Has to be up. If they want the patient to have 10 days worth, and they can only get either 7 or 14 day packaging, 7 won't be enough for the course of treatment.

 

[zelman]

So do you round up or down?

Most appropriate. Sometimes up, sometimes down and often nearest. Act like a clinician and use clinical judgement.

 

[Wheresmyaricept]

Has to be up. If they want the patient to have 10 days worth, and they can only get either 7 or 14 day packaging, 7 won't be enough for the course of treatment.

So you give 2 packs of birth control when they write for #30???

 

[Ackj]

So you give 2 packs of birth control when they write for #30???

If the "full course of treatment" was going to be 30 days, and they would not need any further treatment therafter, sure. I am positive you know better than that.

 

[boriqua]

what about insulin pens. if they write lantus 30 units hs 30 day supply and dispense "3" do you guys give 3 pens or a box of 5

 

[owlegrad]

We do not break insulin boxes.

 

[zelman]

what about insulin pens. if they write lantus 30 units hs 30 day supply and dispense "3" do you guys give 3 pens or a box of 5

Also might mean a single 3mL pen or a 3 month supply. Use the clairvoyance skills we all learned in pharmacy school to divine the intent of the prescriber.

 

[BenJammin]

We do not break insulin boxes.

You better. If not you're ripping your patients off and asking to lose money from an audit.

 

[wagrxm2000]

I simply document, one box per md with date and time

 

[FarmD711]

You better. If not you're ripping your patients off and asking to lose money from an audit.

They are not intended to be open. In fact they have paperwork and informational brochures inside that can't be given to multiple patients....

 

[BenJammin]

They are not intended to be open. In fact they have paperwork and informational brochures inside that can't be given to multiple patients....

So does every single bottle of prescription medication. What's your point?

 

[Carboxide]

I have NEVER broken a box of insulin pens. I have also never had it be an issue in an audit.

 

[FarmD711]

So does every single bottle of prescription medication. What's your point?

I'm not talking about package inserts, I'm talking about "how to use" type things. Like you would find in an inhaler box or something like that.

 

[Old Timer]

So does every single bottle of prescription medication. What's your point?

No every drug does not contain specific patient instruction sheets. I'm not talking about PI or Med Guides. In the 32+ years I have been doing this I have never had an audit charge back for that. By your logic if a cream comes in a 50 gm tube and the doctor orders 30gm, you better get the ointment jar out and dispense 30gm.

 

[BenJammin]

No every drug does not contain specific patient instruction sheets. I'm not talking about PI or Med Guides. In the 32+ years I have been doing this I have never had an audit charge back for that. By your logic if a cream comes in a 50 gm tube and the doctor orders 30gm, you better get the ointment jar out and dispense 30gm.

Apples and oranges. If the insurance only pays for a 30 day supply and that ends up being 2 pens, you are screwing your patients by making them take the whole box. As to your audit comment, it happens all the time. Just because it never happened to you doesn't mean it does not happen.

 

[SELDANE]

Apples and oranges. If the insurance only pays for a 30 day supply and that ends up being 2 pens, you are screwing your patients by making them take the whole box. As to your audit comment, it happens all the time. Just because it never happened to you doesn't mean it does not happen.

All being said, do you actually break open boxes of Lantus Solostar, Novolog, etc.... and dispense single pens? Because if you do then you must break open boxes of pen needles and dispense according to exact day supply for the respective pens. Your argument takes you on a bit of a slippery slope.

 

[BenJammin]

All being said, do you actually break open boxes of Lantus Solostar, Novolog, etc.... and dispense single pens? Because if you do then you must break open boxes of pen needles and dispense according to exact day supply for the respective pens. Your argument takes you on a bit of a slippery slope.

Yours is going in the wrong direction. Comparing Lantus solostar to pen needles? Seriously? More apples to oranges.

 

[Old Timer]

Apples and oranges. If the insurance only pays for a 30 day supply and that ends up being 2 pens, you are screwing your patients by making them take the whole box. As to your audit comment, it happens all the time. Just because it never happened to you doesn't mean it does not happen.

I have 32 years of experience in volumes from 600 per week to 5000 per week and it HAS NEVER happened. In fact our district tech who is present for every audit for all 21 stores says she has never seen it either. So unless it's happened to you, it is theoretical BS.

 

[Old Timer]

Yours is going in the wrong direction. Comparing Lantus solostar to pen needles? Seriously? More apples to oranges.

It is not apples to oranges. There is no reason why you could not split a box of pen needles. It's apples to apples.....

 

[wagrxm2000]

Call.any insurance and tell them you can't open a box and if the insurance only allows 30 day supply they will tell you bill the whole box but change the day supply and document the actual supply.

 

[Ackj]

Call.any insurance and tell them you can't open a box and if the insurance only allows 30 day supply they will tell you bill the whole box but change the day supply and document the actual supply.

I have never gotten one to outright say this. I have tried to bait them into it a few times, but they won't do it. They'll just repeat "the member can only receive up to a 30 day supply."

 

[BidingMyTime]

I've been through several audits, and never have we got a charge back for not splitting a single use product. As has been noted, insulin pens are NOT supposed to be sold separately, they are to be sold in a box. Just document (if needed, call the dr to get the OK for the higher qty, and document on the RX that the package can not be split. Easy peasy) As others have pointed out, there is no more justification for breaking up pens, then there would be for repackaging creams or eye drops or anything else (would you measure out Combigen eye drops to keep someone from getting more than a 30 day supply????)

 

[owlegrad]

I am confused why anyone would break a box of insulin pens but not pen needles. They go together like hot dogs and hot dog buns. If the argument is you are cheating the patient by requiring them to get more than they need, is that not exactly the same as forcing them to buy a whole box of pen needles?

 

[wagrxm2000]

I don't think our system will even allow us to enter a quantity less then one box.

I have gotten the insurance to ok changing the day supply. I always demand a reference number to document.

 

[maria1oh]

What about the readyfills? The first rph runs one box of Lantus pens for a 30 day supply on a rx for 10 unit a day script. Then the readyfill service fills it every month that way and the other rphs verify it each month like that assuming since it is a refill it has already been checked.

 

[Old Timer]

What about the readyfills? The first rph runs one box of Lantus pens for a 30 day supply on a rx for 10 unit a day script. Then the readyfill service fills it every month that way and the other rphs verify it each month like that assuming since it is a refill it has already been checked.

That will get you in trouble unless the item expires. Lantus for example is only good for 28 days. If you get an rx for Lantus 10 ml 10 units hs. The day's supply is 28 and you can place that on readyfill. The pens however are different. at 10 units at bedtime that box will last 140 days and should not be placed on readyfill.

 

[All4MyDaughter]

We break boxes of pens and pen needles all the time in LTC.

 

[BidingMyTime]

We break boxes of pens and pen needles all the time in LTC.

Yes, but that would be under the supervision of nursing staff. It wouldn't be any different than a hospital breaking up pens or having a pharmacist draw up insulin doses out of the same vial for a patient. Dispensing such directly to the patient for self-administration is a different situation.

 

[SClENCE]

If it's an antibiotic suspension you can add "discard remainder" on label.

Idk what you would do about the pen situation, especially if it is on readyfill.

Technically you would have to verify that you are dispensing 1 box with doctor. Because its one whole box, the day supply would increase to above 30 days. So if the insurance doesn't pay THEN you have to call them. If they say that they will only pay 30 day supply regardless, then I guess the patient gets extra insulin? I'v never seen the boxes broken up