“I only want the norco, not the antibiotic”

[a student]

Today a patient without insurance brought in two separate scripts, one for norco one for antibiotic. After finding out the antibiotic is over 50 dollars, he said he only wanted norco. I told him that we had to fill both, and he replied what if I never showed you the antibiotic? Then he left, likely to another pharmacy to show them just the norco. This got me thinking, how do you prevent patients from skipping out on antibiotics?

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[BigBoss]

Contact their doctor and let them know.

 

[a student]

Contact their doctor and let them know.

I mean when they just show you the norco script how would you know to call?

 

[BigBoss]

In that case there's nothing you can do except fill.

 

[johnpharm01]

Today a patient without insurance brought in two separate scripts, one for norco one for antibiotic. After finding out the antibiotic is over 50 dollars, he said he only wanted norco. I told him that we had to fill both, and he replied what if I never showed you the antibiotic? Then he left, likely to another pharmacy to show them just the norco. This got me thinking, how do you prevent patients from skipping out on antibiotics?

Ultimately, even if the customer filled the anbx rx, they could not take it when they bring it home so you really can't prevent patients from skipping out on anbx. Our first reaction is that this person may be a narcotics abuser, but I would still try to call and get a more affordable antibiotic and then make sure they buy both it may be an affordability issue.

 

[Sine Cura]

Where I used to work one of the EDs would number the individual Rx "X of Y" so you could tell if they weren't presenting all of the Rx. You could then ask them but nothing to prevent them from lying.

 

[BidingMyTime]

This is why all ER's should write on the Norco RX, "must fill antibiotic."

 

[maria1oh]

I would have written on the script saying "filled but given back because patient refused abx".
When I worked overnights people would say they just wanted the norco and they want to go to grocery store when it opens to get abx for $4. I fell for it at first seeing on goodrx the abx was $4 at walmart and $40 at cvs. I eventually caught on to this BS and refused to fill for them.

My favorite was the idiot ER doc telling patients the antibiotic should be free. (kroger or giant eagle ran a free abx promotion a while back). I even called the ER to tell them to stop saying this but they insisted the abx they prescribe are on the free formulary list.

 

[Apotheker2015]

Today a patient without insurance brought in two separate scripts, one for norco one for antibiotic. After finding out the antibiotic is over 50 dollars, he said he only wanted norco. I told him that we had to fill both, and he replied what if I never showed you the antibiotic? Then he left, likely to another pharmacy to show them just the norco. This got me thinking, how do you prevent patients from skipping out on antibiotics?

Did you mention goodrx? I find that people generally give themselves away. I also have no reservations on writing whatever on your script. Declined to fill rx. Patient did not want abx.
There are many things you can do. You can call the prescriber and ask if he/she wants to invalidate that script. Then I'd fax or call a few of the local pharmacies to give the heads up. And if the patient is in the system, I definitely enter a note on their profile summarizing the nonsense.

 

[PharmDBro2017]

Maybe they’ll get septic... one less addict.


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[wagrxm2000]

Let's be honest, most don't even need that antibiotic anyways. They went because of the pain and in general I don't see a bunch of ER scripts on their PDMP.

Just let the customer relieve the pain. Now if the report shows a bunch of recent fills, sure decline it. You should be declining those anyways.

 

[CetiAlphaFive]

I would have written on the script saying "filled but given back because patient refused abx".
When I worked overnights people would say they just wanted the norco and they want to go to grocery store when it opens to get abx for $4. I fell for it at first seeing on goodrx the abx was $4 at walmart and $40 at cvs. I eventually caught on to this BS and refused to fill for them.

My favorite was the idiot ER doc telling patients the antibiotic should be free. (kroger or giant eagle ran a free abx promotion a while back). I even called the ER to tell them to stop saying this but they insisted the abx they prescribe are on the free formulary list.

I always leave notes on any Rx I refuse and I stamp the back

 

[ExpressMaiL]

Which antibiotic and what quantity?

 

[a student]

Which antibiotic and what quantity?

Can’t remember for sure but I think cefuroxime #20

 

[a student]

Let's be honest, most don't even need that antibiotic anyways. They went because of the pain and in general I don't see a bunch of ER scripts on their PDMP.

Just let the customer relieve the pain. Now if the report shows a bunch of recent fills, sure decline it. You should be declining those anyways.

Why don’t they need the antibiotic?

 

[SELDANE]

In these cases I just look at the patient's profile and it tells me all I need to know.

 

[Deja]

to be fair, you gave a pretty bad example... the antibiotic was over $50 which can be pretty expensive for some people... I assume the pain med was a lot less, should've called the office to change the antibiotics to something else

 

[PolarPop]

Why don’t they need the antibiotic?

Because up to half of all the antibiotics in the US are not even necessary. At this time of year the guy probably had a cough which the norco will take care of better than some cefuroxime.

Should still ask what it’s for and offer to call though.

 

[wagrxm2000]

Why don’t they need the antibiotic?

Because up to half of all the antibiotics in the US are not even necessary. At this time of year the guy probably had a cough which the norco will take care of better than some cefuroxime.

Should ask still what it’s for and offer to call though.

Because of what this guy said

 

[Deja]

Because up to half of all the antibiotics in the US are not even necessary. At this time of year the guy probably had a cough which the norco will take care of better than some cefuroxime.

Should still ask what it’s for and offer to call though.

you would dispense Norco for cough?

 

[maria1oh]

I have seen norco prescribed for cough. Also because the cough syrups won't be covered but norco tablets will be covered by one of the insurance plans. Hycodan tablets were not in stock.

 

[Nguyen]

you would dispense Norco for cough?

Yes

 

[Son_Goku]

You should have dispensed the Norco.

It's not that serious.

 

[VA Hopeful Dr]

I have seen norco prescribed for cough. Also because the cough syrups won't be covered but norco tablets will be covered by one of the insurance plans. Hycodan tablets were not in stock.

I'm thinking about changing my prescribing patterns for that exact problem. Of the Dozen pharmacies within 5 miles of my office, only one of them ever seems to have hycodan tussigon or whatever name its going by

 

[CetiAlphaFive]

I'm thinking about changing my prescribing patterns for that exact problem. Of the Dozen pharmacies within 5 miles of my office, only one of them ever seems to have hycodan tussigon or whatever name its going by

I remember the days when the thick, shiny yellow goop flowed freely

 

[Sine Cura]

Writing and dispensing Norco tablets for cough is iffy as doesn't meet the vague "generally accepted medical practice" and "reasonable pharmacist" standards. It's off-label use unlike with Tussionex/Hycodan/Hycofenix/Zutripro whatever even though we all deny Promethazine/codeine + Norco combos day and night as what is the point of codeine if pt already has hydrocodone on board

It would be similar to practicing long-term pain management out of the ED. "No one" does it so it stands out when it happens.

 

[zelman]

Writing and dispensing Norco tablets for cough is iffy as doesn't meet the vague "generally accepted medical practice" and "reasonable pharmacist" standards. It's off-label use unlike with Tussionex/Hycodan/Hycofenix/Zutripro whatever even though we all deny Promethazine/codeine + Norco combos day and night as what is the point of codeine if pt already has hydrocodone on board

It would be similar to practicing long-term pain management out of the ED. "No one" does it so it stands out when it happens.

No it isn’t. Prescribing hycodan and telling them to take OTC Tylenol for fever is the same as prescribing norco and telling them to take Benadryl for congestion. Use your pharmacology knowledge.

 

[Sine Cura]

Use your reading comprehension. It just isn't generally accepted medical practice, i.e., no one writes for it even though it would be covered by Medicare versus labeled cough & cold preps, independent of basic pharmacology. To be fair, it may depend on area. My N = 2, one micropolitan area of 100k and one metro area of 2 million people.

 

[zelman]

Use your reading comprehension. It just isn't generally accepted medical practice, i.e., no one writes for it even though it would be covered by Medicare versus labeled cough & cold preps, independent of basic pharmacology. To be fair, it may depend on area. My N = 2, one micropolitan area of 100k and one metro area of 2 million people.

I won’t deny scientifically sound reasoning out of fear of regulatory bodies. Anyone who does is steering us toward an Orwellian dystopia.

 

[owlegrad]

I won’t deny scientifically sound reasoning out of fear of regulatory bodies. Anyone who does is steering us toward an Orwellian dystopia.

We have an opioid epidemic in America but you are advocating that treating cough with Norco tablets is acceptable? I am going to have to side with the Orwellian dystopia on this one. We should be discouraging opioid use as much as possible.

 

[zelman]

We have an opioid epidemic in America but you are advocating that treating cough with Norco tablets is acceptable? I am going to have to side with the Orwellian dystopia on this one. We should be discouraging opioid use as much as possible.

No. I’m saying hydrocodone is hydrocodone and thinking hycodan is any safer is just fooling yourself into a dangerous sense of security.