Apr 9, 2012
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Patient comes in with a Rx for lipitor 20 mg tablets take 1 t po qd #30. The patient was requesting the 10 mg tab instead of the 20. Is it appropriate to the change it strength, the directions to 2 t po qd and then the quantity to 60? Or it is required that we get a new script for the 10 mg?

I want some clarification on when we can change the strength and quantity of a medication or if we always need dr approval
 

zelman

7+ Year Member
Nov 27, 2009
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Patient comes in with a Rx for lipitor 20 mg tablets take 1 t po qd #30. The patient was requesting the 10 mg tab instead of the 20. Is it appropriate to the change it strength, the directions to 2 t po qd and then the quantity to 60? Or it is required that we get a new script for the 10 mg?

I want some clarification on when we can change the strength and quantity of a medication or if we always need dr approval
You always need a new RX. Also, that request is either wasting healthcare dollars (taking 2 daily) or defrauding an insurance company (taking 1 daily).
 

wucool33

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Jun 22, 2006
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You always need a new RX. Also, that request is either wasting healthcare dollars (taking 2 daily) or defrauding an insurance company (taking 1 daily).
Really? I always just changed it if I didn't have the strength that was asked in stock. Like prednisone 20 was on back order, we just switched to 10 without asking for a new RX... Seems like a waste of time and money to always ask if it's not a control.
 

StellargalS

lollipop! POP!
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Oct 5, 2013
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Run the claim and see if it pays. Take it from there. My state law allows me to alter the form if it helps the patient. Further, they (PBMs) force us the other way (tab splitting) w/c is way less ethical IMO. The call for this is so infrequent it should't make a splash. Disclaimer: this is coming from a shortage era indie raised pharmacist. MO: tis better to ask for forgiveness than permission. :shrug:
 
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type b pharmD

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Feb 24, 2009
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Really? I always just changed it if I didn't have the strength that was asked in stock. Like prednisone 20 was on back order, we just switched to 10 without asking for a new RX... Seems like a waste of time and money to always ask if it's not a control.
Its different if you are changing the ultimate meaning and intent of the script. If you are, you need to call the dr.

Ex: dr writes a specified drug, specified dosage form, at a specified frequency, dose, and duration .. as long as you aren't changing these in a way that substantially deviates from the prescriber's order .. you don't have to call.

Like changing qty on nasal spray, topicals (sometimes) , liquids, inhalers, etc... you know the dr just wants one package or one months worth, you use your professional judgment and change it in order to dispense.

On a script that has qty 90 of one strength and you want to change it to 180 of half strength .. that seems to vary by pharmacist .. but myself and everyone else I've worked with would do this without calling first. Prescriber's medical intent and order is still being followed.

If its a script for 30 of one strength and you want to dispense 90 of the same strength, obviously you call.


On the other hand, if dr writes for one month supply of something but doesn't specify quantity.. you are allowed to just calculate the quantity . You don't have to go and ask the md office if one month x QD really meant to dispense #30 lol.
 

Old Timer

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May 16, 2007
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You must document what you are doing on the face of the prescription and why. In many cases the insurance company will ding you on audit especially if the two 10mg tablets cost more than the one 20 mg tablets.
 
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Mar 20, 2010
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Patient comes in with a Rx for lipitor 20 mg tablets take 1 t po qd #30. The patient was requesting the 10 mg tab instead of the 20. Is it appropriate to the change it strength, the directions to 2 t po qd and then the quantity to 60? Or it is required that we get a new script for the 10 mg?

I want some clarification on when we can change the strength and quantity of a medication or if we always need dr approval

I think it's considered a misfill if you don't have the documentation to back up your changes because you did not fill what the prescription called for. Why does the patient want it this way? I would question the patient and if reasonable call the Dr for a new script and tell the patient that next time they need to have the Dr write the script that way.