Questions about what to do in certain situations.

[tompharm]

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Hi I was wondering if someone can tell me about what to do with 3 day (emergency supply). I have only been working like 2 months and I only had someone ask me if I can give them an emergency supply about 2 times. I don't remember learning about it on my rotations so I just guessed that it was ok. The first instance was a blood pressure med and I didn't think twice about giving them a supply until their doctor wrote a script. However, I had someone ask me if I can give them an emergency supply of a cIII and I didn't think it was such as big deal. However, I talked to another pharmacist and he told me not to give any partial (emergency) supply to anyone for controls. Is this the accepted theory?


Is it never ok to change someone to pens from vials if they have been getting pens (for sumatriptan) without calling the doctor? Or should I always call the doctor when something like that happens and what to do if I'm working on the weekends and we can't reach the doctor. Also if I did change it do I have to write something on the original script to indicate a change?

 

[KidPharmD]

Hi I was wondering if someone can tell me about what to do with 3 day (emergency supply). I have only been working like 2 months and I only had someone ask me if I can give them an emergency supply about 2 times. I don't remember learning about it on my rotations so I just guessed that it was ok. The first instance was a blood pressure med and I didn't think twice about giving them a supply until their doctor wrote a script. However, I had someone ask me if I can give them an emergency supply of a cIII and I didn't think it was such as big deal. However, I talked to another pharmacist and he told me not to give any partial (emergency) supply to anyone for controls. Is this the accepted theory?

As with the other recent post, the best thing is to check the laws in your state on emergency supplies, or at least tell us where you practice so we can help you look. Without knowing, I would say that the BP med was OK, but the control will probably not ever be. I am unaware of a state that allows emergency fills on controls.

Is it never ok to change someone to pens from vials if they have been getting pens (for sumatriptan) without calling the doctor? Or should I always call the doctor when something like that happens and what to do if I'm working on the weekends and we can't reach the doctor. Also if I did change it do I have to write something on the original script to indicate a change?

I would say it depended on how the Rx was written. If it was written for Sumatriptan injectable, then you could choose the form. If it was written for Sumatriptan pens, then you would probably need authorization.

 

[tompharm]

I'm in Florida but I don't remember seeing anything about this. Also what can happen to me if I did do it?

 

[tompharm]

I'm in Florida but I don't remember seeing anything about this. Also what can happen to me if I did do it?

I just checked florida board rules and it says I can only do up to a 72 hour supply and I cant do CII but everything else is ok.

 

[confettiflyer]

The monkey wrench is a potential insurance audit. Can anyone comment if dispensing a pen could render the reimbursement null and void?

 

[zelman]

...I would say that the BP med was OK, but the control will probably not ever be. I am unaware of a state that allows emergency fills on controls...

It might have been illegal, but I've absolutely done it for a patient with a severe seizure disorder who needed a benzo that they had been taking regularly. Use your professional decision making skills. If someone refills a controlled substance 5 days early every month, and they need an emergency supply, but can't explain where the extra 30 days supply they've gotten over the last 6 refills went to, say no. They should have plenty. If someone needs an emergency supply of a non-controlled substance they should have run out of 6 weeks ago, say no. They aren't taking the medication as it is, and skipping a few days more won't make any difference.

 

[KidPharmD]

It might have been illegal, but I've absolutely done it for a patient with a severe seizure disorder who needed a benzo that they had been taking regularly. Use your professional decision making skills. If someone refills a controlled substance 5 days early every month, and they need an emergency supply, but can't explain where the extra 30 days supply they've gotten over the last 6 refills went to, say no. They should have plenty. If someone needs an emergency supply of a non-controlled substance they should have run out of 6 weeks ago, say no. They aren't taking the medication as it is, and skipping a few days more won't make any difference.

As the OP stated, it probably wasn't illegal. Florida law only excepts C-II's from the process. After all the discussion on this topic here lately, I have started doing a little research on the subject and am going through the laws of each state looking for the "Emergency Fill" statute. Several states already only exempt CII and/or CIII medications instead of all controls. It looks like several states have realized that there are situations when controlled substances are just as important for life/health as blood pressure meds.

I still cannot advocate breaking the law because you think your professional judgement exempts you from the law. Now, if you break the law knowingly for the sake of your patient, that is something between you and the BOP/DEA. As for me, I will not risk my license for any patient now matter the circumstances.