Oseltamivir 6mg/ml shortage

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ericn2k3

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For CVS particularly,

Cardinal is currently OOS/BO on generic Tamiflu suspension. There is a dramatic increase in demand this week. I remember the last time it was this bad and it went on short supply and we were able to compound. When does a need for med outweigh the law about compounding commercially available drug? Is anyone compounding?
 
This drug always seem to be on backorder during peak flu times...even when it was brand only. Not sure how the manufacturer wouldn't account for it year after year with the same problems. Yes you can compound when its on backorder.
 
Hint: capsules can be opened & sprinkled on food. Be sure to stock up on 30 & 45mg capsules for wt. based ped. dosing.
RPh have compounded during times of shortage; I fortunately have not had to do this yet (I would be really hesitant to do so due to the law issue & if you do it for 1 person, you have to for everyone (not the time or resources available in this day and age); In the past, I believe there was some protocol/corporate email message passed by CVS giving the ok to cmpd)
 
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Order the brand and call the patient's insurance plan for an override. It's more work but I've gotten every single one to pay for it, even Medicaid HMOs. I'm in NJ.

Also, I don't think you can compound this drug if the brand is still available commercially. I guess no one is going to stop you, but make sure you don't fuk up when making it cuz you're giving 50 flu shots and verifying 300 scripts on your shift and document every thing.
 
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ericn2k3 said:
For CVS particularly,

Cardinal is currently OOS/BO on generic Tamiflu suspension. There is a dramatic increase in demand this week. I remember the last time it was this bad and it went on short supply and we were able to compound. When does a need for med outweigh the law about compounding commercially available drug? Is anyone compounding?
Click to expand...
You may compound. Print out the availability info and attach to your compounding record.
 
ericn2k3 said:
For CVS particularly,

Cardinal is currently OOS/BO on generic Tamiflu suspension. There is a dramatic increase in demand this week. I remember the last time it was this bad and it went on short supply and we were able to compound. When does a need for med outweigh the law about compounding commercially available drug? Is anyone compounding?
Click to expand...

order the 30/45mg. you can have the patients open up the capsules and mix with liquid.
 
Just to further hammer home the point - you may compound it when it is on back order. Probably because in order to be a "commercially available product" it actually has to, you know, be available.
 
I'll transfer to a competitor that has it vs compounding. (That takes forever and we fill about 10 to 20 susp per Day ). Too much to do this time of year
 
Lnsean said:
brand is readily available though...so technically you cannot compound this right now.
Click to expand...

Hmm...I actually think I am going to have to agree with you. I was under the impression the brand suspension was unavailable, my bad.
 
txpharmguy said:
I'll transfer to a competitor that has it vs compounding. (That takes forever and we fill about 10 to 20 susp per Day ). Too much to do this time of year
Click to expand...

It takes forever? It takes like 2 minutes to open some capsules and poor some cherry syrup. Depending on your company policy/state law you might even be able to have the techs do it. I bet it takes longer to find a competitor that has it (although I assume you make the patient do that part anyway).
 
owlegrad said:
Hmm...I actually think I am going to have to agree with you. I was under the impression the brand suspension was unavailable, my bad.
Click to expand...

It's kool. I just wanted people to know there's an easier way than compounding 10 tamiflu suspensions on your shift this time of the year. Order the brand...call the insurance for an override. None of them has given me a problem yet. I've talked to Horizon, Aetna, and a couple of others. They're all aware of the shortage on the generic one. Horizon takes longer because they want to forward the claim to their "clinical" team. They usually call me back in 2-3 hours. I dispensed like 20 scripts this past weekend. I'm in NJ.
 
owlegrad said:
It takes forever? It takes like 2 minutes to open some capsules and poor some cherry syrup. Depending on your company policy/state law you might even be able to have the techs do it. I bet it takes longer to find a competitor that has it (although I assume you make the patient do that part anyway).
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Just call local stores in morning to see who has in stock and proactively transfer if we're out. Hit or miss when we get some. Faster for me to fax transfer than compound. I have a good working relationship with competitors. Brand copays are high given most people have high deductibles.
 
CetiAlphaFive said:
I usually take the opportunity to tell the idiots asking for it

"I guess they ran out of ducks to decapitate so they can make it."
Click to expand...

The “educated” homeopathic consumer might realize that, due to the dilution, one duck can produce the entire world’s supply of the product.
 
Chrissystone said:
What if you change the concentration and not 6mg/ml?
Click to expand...

The most recent CE I took on the topic of compounding said that changing the strength in order to get around the commercially available regulation is sketchy at best and probably would not hold up. According to the presenter it’s only valid if the prescriber has some justification for needing a different strength besides what is commercially available. And it would need to be patient specific.

I think in reality we all realize that no one is monitoring compounds that closely but if you want to follow the letter and spirit of the law, there you go.
 
owlegrad said:
The most recent CE I took on the topic of compounding said that changing the strength in order to get around the commercially available regulation is sketchy at best and probably would not hold up. According to the presenter it’s only valid if the prescriber has some justification for needing a different strength besides what is commercially available. And it would need to be patient specific.

I think in reality we all realize that no one is monitoring compounds that closely but if you want to follow the letter and spirit of the law, there you go.
Click to expand...

Central Texas is *rife* with gee-whiz doctors that prescribe all kinds of weird, barely-not-the-comm-product so that their rich white middle aged female patients can post about the "specialized" medicine they get.

Literally nobody cares here, and TSBP doesn't wanna deal with PCCA and TPA going full blown RRRRREEEEEEE if they were to sanction a compounding pharmacy
 
CetiAlphaFive said:
Central Texas is *rife* with gee-whiz doctors that prescribe all kinds of weird, barely-not-the-comm-product so that their rich white middle aged female patients can post about the "specialized" medicine they get.

Literally nobody cares here, and TSBP doesn't wanna deal with PCCA and TPA going full blown RRRRREEEEEEE if they were to sanction a compounding pharmacy
Click to expand...

I had a friend in KY show me an advertisement from a local compounding pharmacy that literally advertised specific drug products they would compound, like "generic" Viagra. My mind was blown. Direct to consumer advertisements for specific compounded drug products. Obviously no one (who matters) cares.
 
trailerpark said:
All the insurances in my area are accepting DAW 2 for brand. No call to anyone.
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Yup....we DAW 2 ours and have had no issues with insurance providing coverage. No more additional work other than stamping the Rx with "patient prefers brand" and having the patient sign off on it.
 
Daw 2 does not always work. There is a daw code specific for "generic not available in marketplace"
 
RxVampire said:
*There is a DAW for commercially not available...drawing a blank (not @ work right now)
Beat me to it Owlegrad...I do think it is 8 (definately not 9)
Click to expand...

I don't even do adjudication at my current job! I guess it is like riding a bike, you never really lose the skill. *tries to get on bike, immediately falls over*
 
DAW 8 never works. I just go straight to DAW 2. I don't stamp the rx with anything.
 
trailerpark said:
DAW 8 never works. I just go straight to DAW 2. I don't stamp the rx with anything.
Click to expand...

Like a boss!

I remember I had an intern who asked me why we didn’t have the patient sign off on the face of DAW 2 scripts. I literally had no idea what she was asking me. Up until that point in my career I had never even heard of doing such a thing. Apparently whatever CVS she had worked out before mine did that. Who makes up this crap?
 
Our company policy is to stamp and have signed if there's a generic option and no DAW 1 on the script. They've had insurance audits in the past try to come back and claim brand was improperly dispensed/we are supposed to provide generic if MD or pt doesn't specifically ask....quoting law that pharmacies are obligated to fill cheaper generics unless told otherwise. It just provides a layer of documentation in case insurance tries to be a dick.[/QUOTE]
 
Caresource medicaid in ohio will not pay for daw 2 but pays for the daw code of "brand unavailable"
 
We turned away all tamiflu patients today. Transferred all the scripts out. Our wholesaler is out of the generic liquid, the 75 mg capsules and the 30 mg capsules. Only the 45 mg is available in limited quantities.
 
Last Friday night was amazing. I've never seen as many people calling or just wandering around from pharmacy to pharmacy looking for something since that Adderall shortage back in like 2015 or so. I had to have told 20 people I didn't have tamiflu liquid for their kid. And I work 9p-9a. Day shift must just be a travelling horde of tamiflu seekers.
 
Can we dispense 30mg or 45mg capsules in place of suspension and have the patient mix in chocolate pudding? I remember something in the Package Insert that this is an option for not being able to shallow capsules. Would you do this for children if the insurance covered It and patient/MD were okay with this option?
 
CountBy5s said:
Can we dispense 30mg or 45mg capsules in place of suspension and have the patient mix in chocolate pudding? I remember something in the Package Insert that this is an option for not being able to shallow capsules. Would you do this for children if the insurance covered It and patient/MD were okay with this option?
Click to expand...

Yes
 
Our store compounded so much oseltamivir suspension in the past few days. It seem like all the surrounding pharmacy, other CVS included, doesn't want to compound and/or too lazy to do it for their patients. Its been certainly busy with the flu pandemic, giving us all time high Rx count.
 
It is too time consuming to compound when you are the only rph there. If you have rph overlap or intern then I would be willing to compound.
what is the wait time you give for tamiflu compound?
 
Dispensing caps with instructions to get with pudding seems less time consuming and way easier than compounding it .

Haven't had a problem as our store is all Medicaid so they prefer brand name.

We haven't had a problem yet.
 
ericn2k3 said:
It seem like all the surrounding pharmacy, other CVS included, doesn't want to compound and/or too lazy to do it for their patients. Its been certainly busy with the flu pandemic, giving us all time high Rx count.
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It's easier for 24 hour stores.

Because my day shift pharmacists say pretty much the same exact thing...

...while handing the label to me at 9PM to do during night shift...
 
I made the mistake of reading a flu thread on Facebook this morning. I'm already starting my day off strong with a bunch of Dr. Mom types explaining that pharmacists are know nothing idiots and homeopathic medicine is the light.
 
Yeah, I'm at that point where I am anticipating oseltamivir Rxs for dogs & cats; it's been ridiculous enough so far this season. Only thing that could top that would be a MD of vet writing for zanamivir/relenza for a cat with a face mask (><)
 
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gwarm01 said:
I made the mistake of reading a flu thread on Facebook this morning. I'm already starting my day off strong with a bunch of Dr. Mom types explaining that pharmacists are know nothing idiots and homeopathic medicine is the light.
Click to expand...

Facebook is pretty much the root cause of most of our problems.
 
owlegrad said:
Like a boss!

I remember I had an intern who asked me why we didn’t have the patient sign off on the face of DAW 2 scripts. I literally had no idea what she was asking me. Up until that point in my career I had never even heard of doing such a thing. Apparently whatever CVS she had worked out before mine did that. Who makes up this crap?
Click to expand...

They can't sign an e-script, so what then?

"The patient wants this particular NDC that happens to be the only one covered by Medicaid" like the prescriber always wants amoxicillin capsules dispensed instead of tablets. All day every day
 
WVUPharm2007 said:
It's easier for 24 hour stores.

Because my day shift pharmacists say pretty much the same exact thing...

...while handing the label to me at 9PM to do during night shift...
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Our daytime Rph have been making multiple large batches nearly everyday. Some even stay after shift when overnight comes in to make more. It all depends on who you work with.
 
This is what 296 boxes of generic tamiflu looks like .(source reddit pharmacy)
 

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Sine Cura said:
They can't sign an e-script, so what then?

"The patient wants this particular NDC that happens to be the only one covered by Medicaid" like the prescriber always wants amoxicillin capsules dispensed instead of tablets. All day every day
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I just dispense whatever is covered md or patient never ever care, also banophen caps/tabs. Exception would be serious maintenance meds or controls tho (like seizure or opioids for example)
 
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