Lets get real. All C-II drugs do not have the same potential for abuse. Oxycodone is more abused than methylphenidate. Adderall IR is more abused than Methylphenidate ER.
Sure... appeal the C-II status to your legislators or the DEA. It's a C-II. Read the package insert and compare to any other stimulant's package insert. I would ask you to read through it all but I doubt you would know what to do with one. It's unlikely that you ever look at package inserts after all you've been doing this for 35 years.
First, I was not addressing the appropriateness of the dosage. I agree it is a high dose and I would probably check that out before dispensing. That is not what I am addressing. What I am auguring is assuming the dosage is safe an appropriate, what do you do when there is a dosage increase.
Meh... You can't tell someone to fill it
without addressing the appropriateness of the dosage. That should have been the first thing that jumped at you. THE DOSE! The only other person who jumped on the dosage issue was
@idiot. You're acknowledging it now because I called you out on it. Others dismissevalid question with "you're over complicating it
You are not accurately stating my position. I also noted, that an individual state may have more restrictive rules but the Federal Law is not only silent, it comes right out and says there is no qty limit. I am also pointing there are times when you dispense more than the insurance limit if you are dealing with sealed packages. I do not condone giving an extra full package. But if the 3 bottles is 36 days and 2 bottles are 24 days, I would give three bottles as long as the rx was for 3 bottles. I also noted I would not have an issue with giving 2 bottles.
You said "I would give three bottles as long as the rx was for 3 bottles." Who talks about bottles these days? You can't rely on physicians to tell you how many bottles. Where are you getting the total quantity from?
From the SIG or from the "dispense 3 bottles" part the physician wrote on the script that Swatchgirl is talking about?
The initial prescription was for a volume of 450mL. That's what should be dispensed
if the dose were actually appropriate. Any volume over 450 mL is being sold without a prescription. You get the total quantity from the SIG. And I know that you are about to hop on your
"35 years of experience" horse... Do it. If a prescription for a C-II is for 450 mL, I dispense 450 mL and record the rest as waste with a witness. I'm not giving anyone anything extra regardless of what total quantity the physician wrote. Total quantity and SIG have to match. When they do not match, the SIG overrides the total quantity in most cases (unless of course, the physician only wants a 7 day supply. Sure, you would not dispense a 30 day supply if the prescription clearly says "dispense a 7 day supply".
This is where I am getting that you would dispense in "full packages" a 36 day supply and "put in" a 30 days supply. I am assuming that the 30 day supply you "put in" is the quantity that you record on the patient profile, bill insurance for, and report to the PDMP. This quantity also gets subtracted from your inventory.
"If the quantity does not exceed what the prescriber ordered and the package should not be broken, it is not a big deal to dispense the product in full packages and put in a 30 day supply. If you document on the face of the rx why you did it, you will never have an issue on audit. If you want to gave one less bottle and bill for less than 30 days, I have no issue with that, though I wouldn't do it. The same with Trileptal Susp. I only dispense full bottles."
I never said she should not question any of this. She needs to determine when the dosage changed and then determine id the patient has any left and decide to dispense or not based on that information. DO NOT assume the date of the new rx is the date the therapy changed. I would never split a bottle and damage the rest. Too many years as an independent. You can go broke doing that. Also, plan may not reimburse enough if there is a price differential between the smaller and larger size. There may not be. It's just another consideration. I just had an incident last with test strips 100 1 per day. Thirty day limit so I billed for a box of 25 and it was rejected. Smallest size they pay for is 50. Go figure......
I never assumed that the date of the new prescription is the date the therapy changed. I've said over and over that she should check with the prescriber. I also mentioned that often times physicians will give patients the green light over the phone to increase the dose way before the new script is issued.
You love to make wild assumptions. You assume it has no legitimate medical purpose. A decision you do not have the ability to make witjout a discussion withe the prescriber. I have never advocated dispensing more units than the prescriber allowed. Where you got that from I have not the slightest clue. There is no shortage. Nothing like that.
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I am not making any wild assumptions. You like to say that a lot to people and then pull out the 35 years of experience card. When I said that
"it has no legitimate medical purpose" I was referring to the extra volume being dispensed. It's blatant that is what I am referring to.That volume represents additional doses.
Those have no legitimate purpose because the patient is not supposed to get those doses. They're not covered by the SIG. That is the case in the two states I am licensed in. Whatever leaves the pharmacy has to match the total quantity on the face of the prescription; i.e., the total quantity as calculated by the SIG. So yes, there is a shortage. Of course, there is. When you do inventory, you are comparing what you purchased from your supplier vs the quantities you dispensed. The quantity dispensed is determined by the SIG or the total quantity written on the prescription, whichever is less. If what you purchased does not equal what you have on the shelves + the quantity that you should have dispensed, then you should have a record of waste somewhere. If you do not, then you were over-dispensing. Thus, your inventory is short. Otherwise, how do you think an inventory is done?
What comes in has to match what goes out and if it does not, then it needs to be documented. "Did not want to split a bottle and damage the rest" is not valid documentation for any company, board of pharmacy or DEA.
You have your reasons to practice your way. Go ahead.
"Doing this for 35 years" does not mean you have been or that you are doing it right. I go by the book. If a prescription calls for 450 mL for 30 days and insurance only pays for 30 days and the closest I can get to that quantity is with three 180 mL bottles. I have two choices: 1. dispense 450 mL and waste 90 mL. 2. Not break up the bottles and not dispense it at all. Done.
There is no "Did not want to split a bottle and damage the rest." So I gave the patient the extra volume even though that adds up to an additional 6 doses". All that documenting here and there, little exceptions here and there, that creates confusion and problems and will eventually get someone in trouble. And that is why I will never go to an independent pharmacy. Give me streamlined processes, rules and I'll make sure they're enforced.
