Testosterone Cyp Days Supply Limit Question (Texas especially)

[BenJammin]

Day supply doesn't affect legality

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[CetiAlphaFive]

Day supply doesn't affect legality

Yup.

CDC and its 28 day recommendation can eat sheet
I'm not dispensing a 10mL vial written by anyone whose DEA # starts with M.

 

[Sharkzfanz]

Easy.
Ask the patient if their "low T" is due solely to age. *Don't ask the clinics. They're probably gonna lie to you.

If they say yes, refuse to fill and cite "not prescribed for a legitimate medical use. Old men have Low testosterone, and the FDA/CDC advises against using test cyp in elderly males. Risk of heart disease/cancer"
^ this makes you bullet proof with corporate ^


That is MUCH more significant than any risk for infection.

There is no single fill days supply limit in Texas except for NP/PA.

Don't be scared of roided up geezers.

I used to make PAs and NPs at the "male health" clinics furious because I'd refuse to fill 10mL vials from them because they're limited to 90 days in Texas.

EDIT:

Aseptic technique?
How do you think that will help?

With all due respect are you a doctor? Pharmacist? Or neither? My presumption is neither as you have a duty to protect patients but your duty is NOT to over rule a doctor and decide when a doctor is wrong. Even if it’s old age couldn’t there be other reasons for treatment?

How about deny a pain patient pain pills? Heart patient heart medicine? Do you dispense viagra? Cialis? Wouldn’t that make you a hipocrit as using your own thinking an elderly individual is using viagra due to non medical reasons so no dispensing.

I’m not saying I disagree with you but where do you draw the line? Pharmacists (in most jurisdictions) is not there to prescribe but is there to dispense (within reason) and on valid prescriptions. You should determine if a prescription is valid but seriously to go that extra step to determine if its medical needed is going overboard. Why have doctors then? Why have PA’s then?

I’m sorry to everyone for the rant but I’m shocked someone would go that far. It is not the pharmacists job to determine what a doctor should do.

With that said as a patient id want 10ml but as a pharmacist I’d dispense what’s legally correct. In most cases (notice I say most) that’s 10ml. If that’s an issue tell them to go on 100/ml 10ml vial as that’s only made in 10ml or Test E as that’s only in a 5ml vial.

 

[CetiAlphaFive]

With all due respect are you a doctor? Pharmacist? Or neither? My presumption is neither as you have a duty to protect patients but your duty is NOT to over rule a doctor and decide when a doctor is wrong. Even if it’s old age couldn’t there be other reasons for treatment?

How about deny a pain patient pain pills? Heart patient heart medicine? Do you dispense viagra? Cialis? Wouldn’t that make you a hipocrit as using your own thinking an elderly individual is using viagra due to non medical reasons so no dispensing.

I’m not saying I disagree with you but where do you draw the line? Pharmacists (in most jurisdictions) is not there to prescribe but is there to dispense (within reason) and on valid prescriptions. You should determine if a prescription is valid but seriously to go that extra step to determine if its medical needed is going overboard. Why have doctors then? Why have PA’s then?

I’m sorry to everyone for the rant but I’m shocked someone would go that far. It is not the pharmacists job to determine what a doctor should do.

With that said as a patient id want 10ml but as a pharmacist I’d dispense what’s legally correct. In most cases (notice I say most) that’s 10ml. If that’s an issue tell them to go on 100/ml 10ml vial as that’s only made in 10ml or Test E as that’s only in a 5ml vial.

You're flat out wrong in every way.

If you'd like me to take the time to teach you why, I'll send you my PayPal address and you can pay me $150/hr until you understand why you're wrong.

 

[beautifulrobot]

With all due respect are you a doctor? Pharmacist? Or neither? My presumption is neither as you have a duty to protect patients but your duty is NOT to over rule a doctor and decide when a doctor is wrong. Even if it’s old age couldn’t there be other reasons for treatment?

If their low T is "due solely to old age," which is exactly what CetiAlphaFive stated, that means there are no other reasons for treatment.

And overruling a doctor and deciding when a doctor is wrong is intrinsically part of protecting patients. Doctors make mistakes all of the time, and our job is to catch those mistakes. Not to mention, one of the main responsibilities of pharmacists is to determine that a prescription is appropriate for the patient. Your post clearly indicates you have no idea what a pharmacist's duties are.

How about deny a pain patient pain pills? Heart patient heart medicine? Do you dispense viagra? Cialis? Wouldn’t that make you a hipocrit as using your own thinking an elderly individual is using viagra due to non medical reasons so no dispensing.

Those aren't the same situations because those drugs do not specifically state that they are not indicated for the treatment of those conditions. If you look at the prescribing information for testosterone (i.e. the package insert or product labeling), the section under indications specifically states that efficacy and safety of testosterone has not been established in "age-related hypogonadism."

I’m not saying I disagree with you but where do you draw the line?

That's why we go to school for 6+ years and spend a year interning - to figure out where to draw the line. We have to use our clinical judgment with each prescription to determine whether the benefits outweigh the risks. Some pharmacists are more prudent than others, but we generally have to draw the line wherever a reasonably prudent pharmacist would draw the line.

Pharmacists (in most jurisdictions) is not there to prescribe but is there to dispense (within reason) and on valid prescriptions. You should determine if a prescription is valid but seriously to go that extra step to determine if its medical needed is going overboard.

Part of determining whether a prescription is valid is assessing whether the potential benefits of the prescription outweigh the potential harm. If a dangerous substance provides no benefit (i.e. is not medically needed) to the patient, a pharmacist shouldn't dispense that substance to the patient.

Why have doctors then? Why have PA’s then?

To diagnose the patient to begin with... The pharmacist isn't questioning the diagnosis, but rather questioning whether the treatment is appropriate for the diagnosis (which is definitively one of our responsibilities). Testosterone is not appropriate for "treating" age-related hypogonadism. In other words, a prescription for testosterone solely for the "treatment" of age-related hypogonadism is not valid and dispensing it could result in harm to the patient that the pharmacist may be liable for.

I’m sorry to everyone for the rant but I’m shocked someone would go that far. It is not the pharmacists job to determine what a doctor should do.

You should be sorry because your rant is severely misinformed.

With that said as a patient id want 10ml but as a pharmacist I’d dispense what’s legally correct. In most cases (notice I say most) that’s 10ml. If that’s an issue tell them to go on 100/ml 10ml vial as that’s only made in 10ml or Test E as that’s only in a 5ml vial.

There are many factors (several that were discussed in this thread already) that a pharmacist needs to consider before determining that the 10 ml vial is appropriate - the 28-day beyond use date issue, day supply restrictions, insurance restrictions, concerns for diversion/abuse/misuse, indication for use, patient preference, cost, availability, etc. If what you need is a 10 ml vial, I would urge you to have a candid but respectful conversation with a pharmacist you trust, and hopefully they will be able to help you out and accommodate your needs. A pharmacist is taking liability for each prescription they verify and dispense, and they have an obligation to protect the safety of patients from harm, as well as protecting their communities and the public health by preventing drug diversion. If dispensing testosterone needlessly increases harm to the patient and/or to the community, the pharmacist has an obligation to not dispense the medication. If you have concerns that the pharmacist doesn't have all the information they need to correctly judge the situation, then talk to them. You, your pharmacist, and your prescriber should be working together to ensure you get the best outcome from your medications. If you think that the pharmacist is incompetent or rude and not willing to work with you, then complain to the state board of pharmacy. But ranting about how you think pharmacists should do their job when you don't even have a basic understanding of what the practice of pharmacy entails is not helpful to anyone, especially not to you.