CHanging direction/ days supply in refills

[ZakMeister]

---

Members don't see this ad.

Might be a rookie question so I apologize in advance.

So I know that we need new rx for dose change or even frequency etc. However, there was a rx of tresiba which went thru with direction (use as directed) for 150 ds

For this third fill, pt called and told us that he takes 30 units bid. So i went ahead and changed the day supply accordingly. Wondering if I just should have taken a verbal from the MD rather than just changing the day supply from the original rx.

 

[Sine Cura]

Don't take UAD scripts to begin with for insulin or GLP-1s etc

Tell prescriber to send a new script

 

[ZakMeister]

Don't take UAD scripts to begin with for insulin or GLP-1s etc

Tell prescriber to send a new script

I didnt in the first place. I dont take it unless it’s for DME monitors or spacers etc.

 

[CetiAlphaFive]

Might be a rookie question so I apologize in advance.
So I know that we need new rx for dose change or even frequency etc. However, there was a rx of tresiba which went thru with direction (use as directed) for 150 ds
For this third fill, pt called and told us that he takes 30 units bid. So i went ahead and changed the day supply accordingly. Wondering if I just should have taken a verbal from the MD rather than just changing the day supply from the original rx.

As mentioned, It's always best to document actual directions.
Medicare will ding you for any Rx with "UAD"

Furthermore, I would've reassigned the prescription to a new Rx number and cancelled the old one. That's a Target habit, though. Not sure if it's correct.

 

[Old Timer]

As mentioned, It's always best to document actual directions.
Medicare will ding you for any Rx with "UAD"

Furthermore, I would've reassigned the prescription to a new Rx number and cancelled the old one. That's a Target habit, though. Not sure if it's correct.

This would be the correct thing to do. You will get audited and the claim could be denied unless you have the documentation. BTW: What plan allows 150 days supply?

 

[maria1oh]

I billed a medicare part d plan once for 180 day supply on prolia (injection once every 6 months). The copay would have been cheaper as 90 day.

 

[ZakMeister]

This would be the correct thing to do. You will get audited and the claim could be denied unless you have the documentation. BTW: What plan allows 150 days supply?

some state medicaid.

 

[Digsbe]

I would have never changed a sig based on what a patient reported. I would only also require actual directions for anything not in a packaged pack (Z-pak, Medrol) or like a nebulizer or medical device.

 

[grumpyRph]

i find myself wanting to do it more with like topical steroids. how do you feel about that? seems more like gray area right?

 

[ZakMeister]

i find myself wanting to do it more with like topical steroids. how do you feel about that? seems more like gray area right?

I think it’s safe to just reassign another rx in lieu of the original as a verbal rx and document the sig change from the MD. It is not wise to take a patient’s word for it but then you know some patients who are smart enough to kno what they are doing or if they are on sliding scale for insulin

 

[pharm B]

... or if they are on sliding scale for insulin

How does the audience handle sliding scale sigs for insulin? Our local providers are trained to basically say something like "per medium sliding scale, max of 20 units a day" so we keep insurance happy, and the patient goes home with a copy of the scale from their doctor visit.

 

[CetiAlphaFive]

How does the audience handle sliding scale sigs for insulin? Our local providers are trained to basically say something like "per medium sliding scale, max of 20 units a day" so we keep insurance happy, and the patient goes home with a copy of the scale from their doctor visit.

That's what I do now.

I used to force them to fax me the sliding scale and I'd note it