SCCpharm

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Doc writes for Lidex #15 grams. You look on your shelf and you see only 30gram and 60 gram tubes. No 15 gram tubes. Do you call the doctor to change to #30 grams or are you okay with dispensing the 30gram tube?
 

kern07

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I was taught to always verify with the provider or his/her assistant and document, document, document with name/date/time.

Although calling the provider on that may seem trivial, but it's always good to communicate any changes you make. :)
 
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museabuse

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I always wondered about this... Can you squeeze out 30 grams into a jar from a 60 gram tube and dispense that?
 

Quiksilver

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I always wondered about this... Can you squeeze out 30 grams into a jar from a 60 gram tube and dispense that?
Even though this would be compounding, I am under the impression you cannot compound a product that is available commercially.
 
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Quiksilver

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I don't think it's compounding. If anything, it's repackaging.
I've sat for the last 10 minutes thinking bout this and I've changed my response and stance a couple times.

You might be right. I mean after all we pour liquids and repackage them for dispensing if a full bottle isn't being dispensed.

But practically, you'd have to weigh these things to the appropriate weight, and those $#$%@ stupid torsion balances suck so badly. Honestly, when is pharmacy going to join the 21st century?
 

Farmercyst

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I've sat for the last 10 minutes thinking bout this and I've changed my response and stance a couple times.

You might be right. I mean after all we pour liquids and repackage them for dispensing if a full bottle isn't being dispensed.

But practically, you'd have to weigh these things to the appropriate weight, and those $#$%@ stupid torsion balances suck so badly. Honestly, when is pharmacy going to join the 21st century?
I'm not sure how the insurance company would see it. Technically it is repackaging, but which NDC do you bill? The 60gm you took it out of or the 30gm you're dispensing. I would think legally, the 60gm, but that would mess up the software, at least most of the ones I've dealt with would reject saying you can't split the tube.

(Yes, I tend to overthink things)
 

g40631

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This is one of those "gray areas" where technically, yes, you should be contacting the doctor. Legally speaking, there isn't any justification in changing a prescription without notifying/getting approval from the doctor. For instance, combining refills so a patient requests a larger supply, or using higher/lower strength tablets and changing the directions on a script because you're out of stock of the strength the doctor wrote for. In real life practice, we just make the changes ourselves because we're 99.9 % sure the prescriber will approve (and maybe roll their eyes). It's that 0.1 % where you MAY get into trouble (and even that may be a stretch).

As for dispensing a larger quantity of a cream/ointment then the doctor wrote because you're out....that seems dangerous kind of. I would definitely call. The prescriber may have wanted the patient to be limited to the length of therapy of the steroid/antibiotic cream to a certain amount of time, and estimated the size of the tube based on that. Dispensing a greater quantity then prescribed (if the prescribed quantity exists) seems to be risky. Just my opinion.
 

kvl1027

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Doc writes for Lidex #15 grams. You look on your shelf and you see only 30gram and 60 gram tubes. No 15 gram tubes. Do you call the doctor to change to #30 grams or are you okay with dispensing the 30gram tube?
We will dispense the size in stock to the patient, fax the Doc saying we gave a larger tube size and then document on the back of the script. We that being said you usually don't get audited for inexpensive items. But, so long as you document it on the script then your ass is covered.
 

kvl1027

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I've sat for the last 10 minutes thinking bout this and I've changed my response and stance a couple times.

You might be right. I mean after all we pour liquids and repackage them for dispensing if a full bottle isn't being dispensed.

But practically, you'd have to weigh these things to the appropriate weight, and those $#$%@ stupid torsion balances suck so badly. Honestly, when is pharmacy going to join the 21st century?
Torsion Balance!! We have two of them and they sit on the shelves for decoration. We have an Ohaus Electronic Balance, you guys need to get with the times.
 

Quiksilver

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This is one of those "gray areas" where technically, yes, you should be contacting the doctor. Legally speaking, there isn't any justification in changing a prescription without notifying/getting approval from the doctor. For instance, combining refills so a patient requests a larger supply, or using higher/lower strength tablets and changing the directions on a script because you're out of stock of the strength the doctor wrote for. In real life practice, we just make the changes ourselves because we're 99.9 % sure the prescriber will approve (and maybe roll their eyes). It's that 0.1 % where you MAY get into trouble (and even that may be a stretch).

As for dispensing a larger quantity of a cream/ointment then the doctor wrote because you're out....that seems dangerous kind of. I would definitely call. The prescriber may have wanted the patient to be limited to the length of therapy of the steroid/antibiotic cream to a certain amount of time, and estimated the size of the tube based on that. Dispensing a greater quantity then prescribed (if the prescribed quantity exists) seems to be risky. Just my opinion.
You always have to tell the patient the duration of the therapy. You certainly can't give em a tube of some cream and say, take it until its finished. That far more dangerous and bad medical practice then dispensing a larger tube. That doesn't work because some people apply gobs of it while others place a thin layer, duration should be more of a priority.
 

g40631

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You always have to tell the patient the duration of the therapy. You certainly can't give em a tube of some cream and say, take it until its finished. That far more dangerous and bad medical practice then dispensing a larger tube. That doesn't work because some people apply gobs of it while others place a thin layer, duration should be more of a priority.
I agree, but how many Rx's do you get for topicals that list the duration of therapy in the sig? Not many.....If the doc doesn't tell them, the patient may be inclined to use the whole product.
 

owlegrad

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I agree, but how many Rx's do you get for topicals that list the duration of therapy in the sig? Not many.....If the doc doesn't tell them, the patient may be inclined to use the whole product.

I wa thinking the same thing. Pretty rare for that to be specified. If it's not in the sig, I assume the patient should use it until it is gone or that the doctor told the patient how long to use it. If the doc had a specific length of time in mind he should have shared it with me. ;)
 

Sparda29

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I agree, but how many Rx's do you get for topicals that list the duration of therapy in the sig? Not many.....If the doc doesn't tell them, the patient may be inclined to use the whole product.
Honestly, I've never seen my dermatologist write duration on any of the acne prescriptions he's prescribed for me. He told me how long he wants me to use it for, or to just continue using it until the next appointment when he'd decide whether to continue or not.
 

PharmDstudent

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I wa thinking the same thing. Pretty rare for that to be specified. If it's not in the sig, I assume the patient should use it until it is gone or that the doctor told the patient how long to use it. If the doc had a specific length of time in mind he should have shared it with me. ;)
I see the duration on topical steriods. But that's about it.
 

SomeGuy

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For those topical RXs that say M: x days, I love pulling out a bunch of containers and asking the patient what size they'd like (within reason) of course.
 

bp2313

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This reminds that at Wal-mart, triamcinolone cr is $4/tube regardless of the size (15 or 80). Many patients requested us to call their Dr to change from 60 to 80, what a pain!
 

Farmercyst

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This reminds that at Wal-mart, triamcinolone cr is $4/tube regardless of the size (15 or 80). Many patients requested us to call their Dr to change from 60 to 80, what a pain!
This reminds me. Do you see Triamcinolone abbreviated Tac? We get scripts for it frequently. Tac 0.1%. I'm thinking it could be a little iffy given that Protopic is Tac(rolimus)0.1%
 

Quiksilver

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So how long do you tell them to use it for if the doctor didn't say?
When in doubt, "as directed"? :shrug:
On some things you can assume its going to be indefinitely such as products for acne and psoriasis, obviously chronic conditions are just, well, chronic. The doctor is probably making sure products and refills last until the next time they are seen. Psoriasis is not curable and outside of very mild acne, people are usually on a topical retinoids which take forever to work effectively. So perhaps duration is not the issue in these cases. Its acute problems that this is far more important.

Using "ut dict" is not all that appropriate either if the patient doesn't know duration. Any time this is in question, the best practice would be to call and ask. If the doctor writes good progress notes, you should be able to get a duration of therapy even from a MA or RN. Now how many people do that, well thats a better question
 
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