Metoprolol tart vs ER

[Tiger Wong]

If rx only says Metoprolol 50 mg 1 BID..

Do you automatically dispense tart or do you call Dr to verify which formulation that meant??

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[Corpseman]

Why wouldn't you verify (unless this is a refill the patient has been getting for years)?

 

[Jibby321]

If rx only says Metoprolol 50 mg 1 BID..

Do you automatically dispense tart or do you call Dr to verify which formulation that meant??

You call...

 

[owlegrad]

Look at their history or ask the patient if they know. If not, go with tartrate. If the prescriber wanted ER they should have specified.

 

[Sugoi Travis]

Look at their history or ask the patient if they know. If not, go with tartrate. If the prescriber wanted ER they should have specified.

I was gonna say the same exact thing.

 

[Vain Brother]

Look at their history or ask the patient if they know. If not, go with tartrate. If the prescriber wanted ER they should have specified.

yup.

 

[npage148]

If you call and they say ER, ask them to justify bid dosing and see how much the flounder for a legit answer

 

[PumpkinSmasher]

Not hard to find legit answer. Many of my CHF pts do not tolerate optimized metoprolol succinate as one dose and need it split to BID.

 

[zelman]

Not hard to find legit answer. Many of my CHF pts do not tolerate optimized metoprolol succinate as one dose and need it split to BID.

And they can't split tablets because...

 

[PharmNerdMatt]

Not hard to find legit answer. Many of my CHF pts do not tolerate optimized metoprolol succinate as one dose and need it split to BID.

Except it isn't optimized dosing then. The studied dose was once a day.

 

[sosoo]

since doctors are not drug experts, and they didn't specify, i don't think they knew. so why bother calling them? if u work for other companies, fill it for tartrate. the direction says BID. and if u work for CVS, give the prescription back to the customer and say the drug does not exist, or we don't have it, go away. go far away. the patient already has cardiovascular issue. its not healthy for them to come back.. cvs will ruin their health further..

 

[Tiger Wong]

This happens on a daily basis on written rx and it's quite frustrating to be honest. Most RPh I have worked with do tart in this situation without calling. I called once and Dr actually told me they wanted ER..

I just wanna know how people on here handle it normally. Also what if rx says 1 QD instead of BID? Do you guys still go with tart since they didn't specify it if pt is new?

 

[Tiger Wong]

If you call and they say ER, ask them to justify bid dosing and see how much the flounder for a legit answer

They do it all the time..

 

[npage148]

That's not justification and a poor excuse that perpetuates sloppy practice

 

[owlegrad]

I just wanna know how people on here handle it normally. Also what if rx says 1 QD instead of BID? Do you guys still go with tart since they didn't specify it if pt is new?

I don't particularly recall ever seeing this happen (I have seen the reverse), but I would go with succ in this case. Do what makes sense.

 

[Ackj]

I have seen tart qd and succ bid, so you really can't make the assumption. Generally just give them what they had last time, and if you have no record, you've gotta call.

 

[rxkrafted]

And they can't split tablets because...

You can split some metoprolol succinate tablets, well atleast the generic that i've seen in my pharmacy because its already scored and manufacturer says it can be split

 

[Ackj]

And they can't split tablets because...

That has nothing to do with it. Why not split the tartrate then? Why not split everything that's dosed bid?

 

[trailerpark]

For me I would see what they had last time and go with that, otherwise tart for bid and er if it's qd.

 

[SClENCE]

I'd call unless they already have one on their profile.

 

[D.U.R.]

In case of an insurance audit, would there be issues filling a script for "metoprolol" without clarifying and annotating tartrate vs succinate ?

I've wondered this too with doxycycline hyclate vs monohydrate.

Technically I've heard that the pharmacist is even supposed to clarify fluticasone nasal spray as propionate vs furoate (Flonase vs Veramyst). For the latter two examples, I've never seen a pharmacist call or validate -- in my experience it's always filled as hyclate for the doxy and propionate for fluticasone. But I've always wondered if an insurance company can legitimately chargeback during an audit for failing to clarify/annotate -- and I'm pretty sure insurance auditors would not be ok with "______ per patient profile"?

 

[FarmD711]

In case of an insurance audit, would there be issues filling a script for "metoprolol" without clarifying and annotating tartrate vs succinate ?

I've wondered this too with doxycycline hyclate vs monohydrate.

Technically I've heard that the pharmacist is even supposed to clarify fluticasone nasal spray as propionate vs furoate (Flonase vs Veramyst). For the latter two examples, I've never seen a pharmacist call or validate -- in my experience it's always filled as hyclate for the doxy and propionate for fluticasone. But I've always wondered if an insurance company can legitimately chargeback during an audit for failing to clarify/annotate -- and I'm pretty sure insurance auditors would not be ok with "______ per patient profile"?

Well in the case of fluticasone the strengths are different so I've never run into that problem.

Monohydrate is significantly more expensive than hyclate I believe so I wouldn't be shocked if insurance companies griped at that.

 

[zelman]

Monohydrate is significantly more expensive than hyclate I believe so I wouldn't be shocked if insurance companies griped at that.

But not paying you is cheaper than both.

 

[D.U.R.]

Well in the case of fluticasone the strengths are different so I've never run into that problem.

Monohydrate is significantly more expensive than hyclate I believe so I wouldn't be shocked if insurance companies griped at that.

Even if the strengths are different, it won't stop an MD from writing "fluticasone ii puffs each nostril qd" for instance.

And like zelman said, it's cheaper not to pay you at all if possible. Aren't the auditors looking for any excuse to get money back for their company?

 

[Lnsean]

If rx only says Metoprolol 50 mg 1 BID..

Do you automatically dispense tart or do you call Dr to verify which formulation that meant??

You don't have to call on these things. If nothing in the patient's profile indicates otherwise, you dispense the tartrate. IF the MD wanted succinate, he would have to indicate so. Same thing with Depakote. It is assumed DR unless the doctor writes for ER.

 

[ancienbon]

You don't have to call on these things. If nothing in the patient's profile indicates otherwise, you dispense the tartrate. IF the MD wanted succinate, he would have to indicate so. Same thing with Depakote. It is assumed DR unless the doctor writes for ER.

I agree with you. i never called on those things . It looks like most people on here do call though. If they dont specify , it is always the tartrate

 

[Lnsean]

I agree with you. i never called on those things . It looks like most people on here do call though. If they dont specify , it is always the tartrate

It's like pharmacists these days can't make a clinical decision to save their lives. They like to make more work for themselves.

 

[ancienbon]

Last week i floated a a store where the pharmacist did not fill a script for sertraline 200 mg because it does not come in 200 . There was a note to call the md. I just filled it for 2 tabs of 100 mg. did not call

 

[HelpfulPharmer1]

Last week i floated a a store where the pharmacist did not fill a script for sertraline 200 mg because it does not come in 200 . There was a note to call the md. I just filled it for 2 tabs of 100 mg. did not call

I like what you did.
I want to do what you did.
I am afraid of LEGAL consequence.

Any input? Any one got audit? Anyone got problem legally? Please share.
Thank you for sharing...

 

[D.U.R.]

It's like pharmacists these days can't make a clinical decision to save their lives. They like to make more work for themselves.

It's not about making a clinical decision. It's about not getting charged back as well as liability.

And what happens if you filled metoprolol tartrate because the script didn't specify, but the patient or doctor call irate because they intended for succinate? Sure, you can say the doctor didn't specify, but ultimately it was your responsibility as the pharmacist to ensure the product dispensed was absolutely clear and accurate.

 

[ancienbon]

I like what you did.
I want to do what you did.
I am afraid of LEGAL consequence.

Any input? Any one got audit? Anyone got problem legally? Please share.
Thank you for sharing...

There should not be legal consequence as i dispensed what the doctor wrote. They want the patient to take 200 mg which is not available in one tablet so i dispensed 2 100 mg

 

[Lnsean]

It's not about making a clinical decision. It's about not getting charged back as well as liability.

And what happens if you filled metoprolol tartrate because the script didn't specify, but the patient or doctor call irate because they intended for succinate? Sure, you can say the doctor didn't specify, but ultimately it was your responsibility as the pharmacist to ensure the product dispensed was absolutely clear and accurate.

Please leave these debates for real practitioners

 

[Lnsean]

I like what you did.
I want to do what you did.
I am afraid of LEGAL consequence.

Any input? Any one got audit? Anyone got problem legally? Please share.
Thank you for sharing...

Well, you know what the MD wants. He wants 200mg of sertraline. You dispense 2 X100mgs. I have never had problem with audits on this. If you want to be sure, you can always annotate.

 

[Carboxide]

I like what you did.
I want to do what you did.
I am afraid of LEGAL consequence.

Any input? Any one got audit? Anyone got problem legally? Please share.
Thank you for sharing...

I honestly can't think of any situation in which anyone would have any legal grounding to protest over filling it with 2 x 100 mg.

I mean no one calls on metoprolol succinate 12.5 mg, do they?? No, you just say to do 1/2 tab....

I don't understand some people...and I honestly don't understand what you would ask if you called on this.

 

[D.U.R.]

Please leave these debates for real practitioners

No need to be a jerk about it - this forum is intended for both students and "real" practitioners. And you didn't answer my question - after all, I was asking one in order to better understand perspectives on the issue, which clearly are varied.

Personally I have seen a metoprolol prescription dispensed in the 'incorrect' form for the patient due to assumption. The patient came back to the store upset, the doctor contacted to verify the form, a refund had to be issued, and an error report filed. It's a huge pain that could have been avoided by clarifying the prescription.

 

[owlegrad]

Personally I have seen a metoprolol prescription dispensed in the 'incorrect' form for the patient due to assumption. The patient came back to the store upset, the doctor contacted to verify the form, a refund had to be issued, and an error report filed. It's a huge pain that could have been avoided by clarifying the prescription.

I wouldn't have issued a refund or filled out an error report.

 

[D.U.R.]

I wouldn't have issued a refund or filled out an error report.

A lot of pharmacists wouldn't as far as I can tell.

One of the pharmacists I work with however is very thorough with such reports and will file them for just about anything, including miscounts, which the other pharmacists I've worked with will correct without documenting.

 

[Lnsean]

No need to be a jerk about it - this forum is intended for both students and "real" practitioners. And you didn't answer my question - after all, I was asking one in order to better understand perspectives on the issue, which clearly are varied.

Personally I have seen a metoprolol prescription dispensed in the 'incorrect' form for the patient due to assumption. The patient came back to the store upset, the doctor contacted to verify the form, a refund had to be issued, and an error report filed. It's a huge pain that could have been avoided by clarifying the prescription.

You weren't asking questions. Those were rhetoric in structure. You are a student trying to give advices to real practitioners regarding a real practice setting scenario. You don't have the experience nor the credentials to make claims the way that you are making, let alone try to sound smart about it.

 

[Lnsean]

I wouldn't have issued a refund or filled out an error report.

Me neither; the pharmacy didn't make an error and that scenario was probably all made-up anyways.

 

[D.U.R.]

You are a student trying to give advices to real practitioners regarding a real practice setting scenario. You don't have the experience nor the credentials to make claims the way that you are making.

I was asking questions as well as recalling an encounter, not giving advice. I asked if there would be issues regarding an insurance audit for specific instances where clarification was neither given nor annotated. I asked this because I have seen different pharmacists approach the issue in different ways as well as seen issues arise. I'd definitely appreciate if you could provide a cogent explanation to these questions.

 

[Lnsean]

I was asking questions as well as recalling an encounter, not giving advice. I asked if there would be issues regarding an insurance audit for specific instances where clarification was neither given nor annotated. I asked this because I have seen different pharmacists approach the issue in different ways as well as seen issues arise. I'd definitely appreciate if you could provide a cogent explanation to these questions.

You weren't asking questions. Those were rhetoric in structure. See how you followed up your questions with sarcastic answers at the end? You were trying to sound smart. That's why people ignored it.

 

[D.U.R.]

You weren't asking questions. Those were rhetoric in structure. See how you followed up your questions with sarcastic answers at the end? You were trying to sound smart.

Sorry if it came across that way. Not my intention, nor is it my intention to argue. My example was not made-up either.

If not issuing a refund, what would you do? Inform the patient that because the doctor did not originally indicate succinate/tartrate, you are unable to issue a refund?

I don't intend this as sarcasm nor were my previous posts intended as sarcastic.

 

[Lnsean]

Sorry if it came across that way. Not my intention, nor is it my intention to argue. My example was not made-up either.

If not issuing a refund, what would you do? Inform the patient that because the doctor did not originally indicate succinate/tartrate, you are unable to issue a refund?

I don't intend this as sarcasm nor were my previous posts intended as sarcastic.

In this scenario, the pharmacist was not wrong for filling for tartrate (I am assuming that the script says "metoprolol") and should not have to fill out an error report or anything of the like. The pharmacist can explain to the patient that it was filled correctly according to what the MD originally wrote for. If the MD calls back and wants the succinate then the patient would have to pay another copay for the second prescription.

If you value your customers and if she has a big account (lots of drugs), I would try to refund her as a courtesy but not as an acceptance of fault. This is just a customer service issue.

 

[BidingMyTime]

Assumptions will work with insurance companies, *if* the doctors records match up what you fill. 0If they don't, then expect charge backs. And yes, ins companies can do charges back for filling "incomplete" prescriptions such as for "metoprolol" when the tartrate vs succinate is not specified. In reality, they are going to be looking at big ticket items and aren't going to pay their adjuster to be going through auditing metoprolol scripts. I have seen chargebacks when an insulin pen was dispensed instead of vials on an unclear script.

 

[SClENCE]

In case of an insurance audit, would there be issues filling a script for "metoprolol" without clarifying and annotating tartrate vs succinate ?

I've wondered this too with doxycycline hyclate vs monohydrate.

Technically I've heard that the pharmacist is even supposed to clarify fluticasone nasal spray as propionate vs furoate (Flonase vs Veramyst). For the latter two examples, I've never seen a pharmacist call or validate -- in my experience it's always filled as hyclate for the doxy and propionate for fluticasone. But I've always wondered if an insurance company can legitimately chargeback during an audit for failing to clarify/annotate -- and I'm pretty sure insurance auditors would not be ok with "______ per patient profile"?

I think they could. Just today I called a doctor to change a script because caresource covers doxy mono but not hyclate oddly enough

 

[SClENCE]

I wouldn't have issued a refund or filled out an error report.

I think it's stupid to fill out error reports for miscounts and stuff of that nature but in this case I would simply because the doctor was involved. If he wants to file a complaint to the state board and you never filed an incidence report you would land yourself into some trouble. The chance of them filing a complaint? Not likely but I'v seen complaints filed by doctors for far lesser things (for what reason is still beyond me).

 

[SClENCE]

Last week i floated a a store where the pharmacist did not fill a script for sertraline 200 mg because it does not come in 200 . There was a note to call the md. I just filled it for 2 tabs of 100 mg. did not call

Our staff pharmacist usually has a pile of 5-10 scripts for the PIC every morning to call on lol.

Flexeril 1t;po;tid for 3 days quantity #15... calls to verify days supply/quantity after acting like I killed a patient for putting a days supply of 5. Doctor wanted 5 anyways. Rinse and repeat 20 minutes later...

 

[owlegrad]

I think it's stupid to fill out error reports for miscounts and stuff of that nature but in this case I would simply because the doctor was involved. If he wants to file a complaint to the state board and you never filed an incidence report you would land yourself into some trouble. The chance of them filing a complaint? Not likely but I'v seen complaints filed by doctors for far lesser things (for what reason is still beyond me).

I cannot imagine a doctor filling a complaint with the BOP for his error. I could just as easily file a complaint to the BOM.

I will say I agree with Lnsean about the refund - I might give a refund if it is a patient I like; it's not their fault the doctor wrote the script wrong.

 

[owlegrad]

Our staff pharmacist usually has a pile of 5-10 scripts for the PIC every morning to call on lol.

Flexeril 1t;po;tid for 3 days quantity #15... calls to verify days supply/quantity after acting like I killed a patient for putting a days supply of 5. Doctor wanted 5 anyways. Rinse and repeat 20 minutes later...

Haha, I have worked with so many RPh's like that. On one hand, I actually admire the commitment to accuracy/patient care. OTOH, who has time for that?! Just fill the script and more on. Almost every time I float I find scripts set aside that I just have to shake my head over.

 

[Lnsean]

I think it's stupid to fill out error reports for miscounts and stuff of that nature but in this case I would simply because the doctor was involved. If he wants to file a complaint to the state board and you never filed an incidence report you would land yourself into some trouble. The chance of them filing a complaint? Not likely but I'v seen complaints filed by doctors for far lesser things (for what reason is still beyond me).

Doesn't matter if he complained....it was his fault for not specifying. I can easily file a complaint with his board. In reality, none of this will happen.