emergency fill of Proair: free or charge or bill insurance?

[chicagoboy1984]

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If you had someone come into your pharmacy wanting a refill of Proair, but there were no refills remaining, would you advance the patient one while waiting for the MD to respond to your fax request, or would you write up a prescription, bill the insurance, dispense the Proair while charging the copay, and when the refill authorization from MD comes in, subtract 1 fill from the total number of refills authorized?

Normally, for generic drugs, we all just give them a few to tie them over, but since Proair is not cheap, I wonder what other pharmacists would do……

What would be the worse thing that could happen if the insurance audited us and found out what we did?

Any input would be appreciated. Thanks.

 

[lactonerx]

you write up a prescription, bill the insurance, dispense the Proair while charging the copay, and when the refill authorization from MD comes in, subtract 1 fill from the total number of refills authorized?

^^😱

Take care of the patient and give him or her a ProAir, call the MD and tell him or her what you did, and document it. Do not charge the patient or create a fake prescription because then you are just committing insurance fraud...and violating company policy + state law. If the board of pharmacy wants to take action against you for dispensing a med without a refill, it will look better if there's not also a fake prescription that can be held against you.

 

[ravingrabbid]

I'd give the doctor's office a call and see if I can get the on-call physician. Worse case scenario, if the patient's completely out of ProAir and I can't contact them, I'd authorize a one-time emergency fill i.e., write a script and document that it's an emergency fill, and contact the doctor's office.

And I'd charge them cash for the fill, it's not gonna be free. Once you get the doctor's authorization, then go ahead and subtract it from total. I'm not sure about the logistics for charging the insurance - it could result in a chargeback or worse. For these types of meds, it's at your discretion though.

 

[bob1234]

If its such a big emergency, the patient should be calling the physician's after hours line like mad or be seen at an urgent care etc etc. I also understand things do happen. I could see if the pharmacy dropped the ball because they were supposed to fax the physician's office a week before and blew it off, then give out an inhaler and contact the office when they next open to obtain a new rx, then call the patient back in to charge them and so on.

Whatever example you set is what your patients will come to expect. If you bail them out with fake scripts continually, they won't ever feel the responsibility to contact the office before they run out of refills or ask you to fax their MD. Sometimes you have to put your foot down and let them know you have a professional license and its on the line, you can't be giving out a 20 day supply of medicine without a prescription. You are there to help, but when you are always on the short end it gets old very quickly. I would suggest you consider alternative measures when it comes to "dispensing" "emergency" supplies

 

[Ackj]

Whatever example you set is what your patients will come to expect. If you bail them out with fake scripts continually, they won't ever feel the responsibility to contact the office before they run out of refills or ask you to fax their MD. Sometimes you have to put your foot down and let them know you have a professional license and its on the line, you can't be giving out a 20 day supply of medicine without a prescription. You are there to help, but when you are always on the short end it gets old very quickly. I would suggest you consider alternative measures when it comes to "dispensing" "emergency" supplies

Completely agree with this. I once worked in a store that constantly was giving out 5 of this, 10 of that, a few here and there. Probably 75% were squared up when the actual rx came in, the remaining 25% got the written 30 + the 5 for free. I can't imagine how much shrink/lost inventory that store had because of this.

 

[Carboxide]

If you had someone come into your pharmacy wanting a refill of Proair, but there were no refills remaining, would you advance the patient one while waiting for the MD to respond to your fax request, or would you write up a prescription, bill the insurance, dispense the Proair while charging the copay, and when the refill authorization from MD comes in, subtract 1 fill from the total number of refills authorized?

Normally, for generic drugs, we all just give them a few to tie them over, but since Proair is not cheap, I wonder what other pharmacists would do……

What would be the worse thing that could happen if the insurance audited us and found out what we did?

Any input would be appreciated. Thanks.

Uh, I would tell them to get a freaking Rx. Patient is NOT having an asthma attack, this is NOT an emergency, I am NOT risking my license over that.

If patient is having an attack, that is different....but this patient is NOT.

 

[PharMed2016]

Uh, I would tell them to get a freaking Rx. Patient is NOT having an asthma attack, this is NOT an emergency, I am NOT risking my license over that.

If patient is having an attack, that is different....but this patient is NOT.

I'm inclined to agree with you. If hypothetically I was the patient and I'm having an attack with no inhaler, I think I would have other thoughts than driving to the pharmacy which could be 10 minutes away from my house.

 

[Wheresmyaricept]

Would you do the same thing for someone who takes Xanax and is all out and suggesting they would become suicidal without it?

 

[eagles22]

Would you do the same thing for someone who takes Xanax and is all out and suggesting they would become suicidal without it?

1) Xanax is a controlled substance which makes it pretty hard to give an "emergency supply". Huge legal implications to just giving some out.

2) If someone is suggesting that he/she is suicidal, the pharmacist is going to call 911.

 

[JoBreeze]

Uh, I would tell them to get a freaking Rx. Patient is NOT having an asthma attack, this is NOT an emergency, I am NOT risking my license over that.

If patient is having an attack, that is different....but this patient is NOT.

I read the OP as an actual "emergency." when they say "emergency supply" in the context of pharmacy do they not actually mean that the situation is emergent? More like urgent?

Even so I guess I'd send them to the ED.

 

[Carboxide]

I read the OP as an actual "emergency." when they say "emergency supply" in the context of pharmacy do they not actually mean that the situation is emergent? More like urgent?

Even so I guess I'd send them to the ED.

If you read the thread it just says the patient wants a fill and doesn't have one.

Even if the patient is having an asthma attack, I would call 911. What if they're actually having a heart attack?

 

[BidingMyTime]

Proair is generally PRN....I personally, do not do emergency supplies of drugs on PRNs. I have given out emergency supplies of insulin, as that is PRN. I did so to regular customers that I was certain would come back to pay the co-pay (and they all had insurance, so at worst the pharmacy would be out their co-pay, not the entire cost). But as others have mentioned, writing up a fake script & billing insurance would not be legal.or justifiable.

 

[eagles22]

This hypothetical is thrown out all the time, and it's completely unrealistic. If you've ever had an asthma attack, you know your first thought (if you don't have albuterol on you) is not, let's go to the pharmacy. What are the odds someone has a spontaneous full blown asthma attack right in the pharmacy?

 

[Wheresmyaricept]

1) Xanax is a controlled substance which makes it pretty hard to give an "emergency supply". Huge legal implications to just giving some out.

2) If someone is suggesting that he/she is suicidal, the pharmacist is going to call 911.

I had changed this to different scenario but I must have pasted the original one back. Oooops. I suck.


Anyway, OP: check with your state laws. Some states allow a whole package to be dispensed as an emergency supply.

 

[kvl1027]

It's not that complicated. Even if it outside the relm of "legal" do what you have to do to keep your patient safe. There is no BOP out there that is going to ding you for forwarding an MDI.

With that being said, I agree that if you constantly enable your patients they will never be pro-active about their healthcare. When I forward meds I just print an old label and dispense the product. For an Albuterol MDI I would charge the patient due to the cost, but I'm at an independent. If I was working for a big chain I would write up an emergency script and bill the insurance. Who cares if wags, cvs, walmart, etc gets a charge back? Not to mention insurance companies primarily audit big ticket items and would likely not invest the time and money recouping on an MDI.

 

[JoBreeze]

If you read the thread it just says the patient wants a fill and doesn't have one.

Even if the patient is having an asthma attack, I would call 911. What if they're actually having a heart attack?

I read the title of the thread.

I guess by emergency they mean not an emergency?

 

[SHC1984]

Proair is generally PRN....I personally, do not do emergency supplies of drugs on PRNs. I have given out emergency supplies of insulin, as that is PRN. I did so to regular customers that I was certain would come back to pay the co-pay (and they all had insurance, so at worst the pharmacy would be out their co-pay, not the entire cost). But as others have mentioned, writing up a fake script & billing insurance would not be legal.or justifiable.

I agree with this, but I would charge the patient cash price as I would never give anything out for free. Plus what if the doctor denys the refills? Then won't you be out on the entire thing? Emergency supplies are needed from time to time sure, but it's def not free and if you want it you should pay cash for it.

 

[Corpseman]

I read the title of the thread.

I guess by emergency they mean not an emergency?

Correct.

 

[amox]

We can give an RX without a physician’s approval? Yes it's an emergency, but my impression is that the patient should go to an ER not the pharmacy.

The patient should be in charge of making sure there is enough medication to last, there are puff counters, always has it on hand, and annual physician visits for refills.

What if the bronchospasm is induced by other medications say anaphylaxis? The albuterol offers temporary relief and when the patient realizes it's not helping. Too late? Who's fault?

 

[Seeker5]

I agree the patient should go to ED if they need the refill. They should also see their PCP again to make sure their asthma is under controlled. The patient is probably also on other meds and exacerbation will occur soon or later with the way the patient using the albuterol.

 

[chuckle beast]

We can give an RX without a physician’s approval? Yes it's an emergency, but my impression is that the patient should go to an ER not the pharmacy.

The patient should be in charge of making sure there is enough medication to last, there are puff counters, always has it on hand, and annual physician visits for refills.

What if the bronchospasm is induced by other medications say anaphylaxis? The albuterol offers temporary relief and when the patient realizes it's not helping. Too late? Who's fault?

Have you worked retail?

 

[amox]

Have you worked retail?

For 4 years

Crude statement... Natural selection perhaps?

Can anyone answer my questions above?