Ethical or not?

[ndearwater]

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Scenario:
A cash-paying patient brings an Rx for Lovenox syringes, 0.7 ml, #14 to your pharmacy. Lovenox is expensive, comes in boxes of #10 pre-measured syringes and you only have the 1.0 ml in stock.
Rather than order the #20 (2 boxes) of 0.8 ml syringes (they come in even number multiples) and dispense #14 leaving the inventory with #6 remaining, you bill for #14 of the 1.0ml syringes and tell the patient to discard 0.3ml before injecting.
This method saves the pharmacy from ordering anymore Lovenox and depleting what is onhand currently. The method, unfortunately, costs this patient approximately $225.00 more than ordering the 0.8ml size.

I am asking because this is what happened to my grandmother today. My mother dropped off and picked up the prescription and I noticed that the 1ml syringes had directions to inject 0.7ml. My grandmother paid $1097 instead of the $874 it would have cost to get the smaller dose (0.8ml). To top it off, they actually dispensed 13 while the label said QTY 14.

 

[sdn1977]

Actually this is a pretty common problem. You can argue both sides of the issue and still come up right. For myself, I'd tell the pt (or your mom) my situation of only have the larger strength. If I order on Sat, I don't get the delivery until Mon afternoon - your grandmother would miss potentially 4 doses. So...in this situation, I'd order #10 80mg syringes, bill for #14 80mg syringes, but dispense #4 100mg today with instructions on how to give 0.7ml until the closer strength arrives on Monday. So...I deplete some of my excess 100mg stength, the pt starts the therapy promptly, I lose no money really (the 100mg just sits there anyway) & everybody is as happy as they can be given the situation. Good will goes a long way, IMO.

 

[dgroulx]

I would actually call around to other stores and see if they had the correct dosage. This happened to me once at Eckerd and we sent the patient to the Walgreens down the block who had the correct dosage in stock.

 

[ndearwater]

Yeah I agree. If this would have happened at Publix we would have called around to other stores. My mom even asked the pharmacy if they had it in stock before leaving, because she was advised by the hospital they it maybe be somewhat difficult to find on a Saturday. The pharmacist said they did.
She's going up there today to see if they can fix this, rebill it for the 0.8 or something.
I know that if a person has private insurance that covers Lovenox and they were to be audited, the insurance company could refuse to pay the claim because the smallest possible package size was not used.
I hate when I see patients without rx coverage pay more than they have to.

 

[28657]

Sounds to me like the pharmacist was completely slimy and lazy. Tell your grandma to find a new pharmacy!

 

[ndearwater]

So today my mom goes back to Walgreens and explains the situation to a different pharmacist. They were actually really nice to her and refunded her the difference and gave her 8 of the 0.8 ml syringes and are ordering the rest. So they did have SOME in stock but I guess the pharmacist yesterday didn't want to bother with ordering anymore or else wanted to move that 1.0ml outta there.
Oh well at least they didn't give her any trouble with it. 🙂 (Maybe my grandma will give me a % of her savings! haha)