When to open/not open a sealed package on prescriptions?

Rxnupe

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Ok here's my point let's say an MD writes a prescription for Mucinex-D which is covered by Medicaid in Texas. The MD writes for 1 tab every 12 hours #30- the boxes come in 18, 24, and 42 count packages- Would you guys dispense the closes qty(24) or give them the minimum or greater qty(42) or simply dispense a full box of 24 plus open up a new box and add 6 tabs?
Also, I got a prescription for Fentora which called for 1 bid qty 60- the Fentora is an expensive C2 but comes in boxes of 28- would you as a Pharmacist order 2 boxes and dispense 56 even thought it calls for 60 or would you order 3 boxes and take 4 out of the 3rd box?

Now obviously there are some medications that you can't break- years ago I saw an MD write a prescription for Birth control and put qty 30- when it obviously comes in packages of 28- for auditing person could they(insurance) penalize you if you didn't dispense the exact qty in the above examples?
 

genesis09

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I thought you can't break up a Fentora package. I would contact physician and then adjust dispensing.

With Mucinex D and related OTC drugs, most of the time we adjust quantity to packaging size.
 
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Rxnupe

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I thought you can't break up a Fentora package. I would contact physician and then adjust dispensing.

With Mucinex D and related OTC drugs, most of the time we adjust quantity to packaging size.
Thanks for the info- but to avoid audits I assume it would be safe to call the MD and document before auto switching any package size?
 

Carboxide

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Thanks for the info- but to avoid audits I assume it would be safe to call the MD and document before auto switching any package size?
Not necessary. You can always dispense less than the written quantity - just not more (which is why, by the way, if you want to bill insurance you better not round the Mucinex up to 42).
 

MountainPharmD

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I would not put it past any company auditing today to take back a claim if you dispensed for more than the written amount. Same thing on diabetic test strips. Patients throw a fit When you do not give them a 30 day supply and seem incapable of understanding you can't break a box so you are only getting 100 not 120.



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owlegrad

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I would not put it past any company auditing today to take back a claim if you dispensed for more than the written amount. Same thing on diabetic test strips. Patients throw a fit When you do not give them a 30 day supply and seem incapable of understanding you can't break a box so you are only getting 100 not 120.



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But Mountain, they need their strips! Are you trying to kill them?! :smuggrin:
 

Ackj

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I frequently break boxes of C-II's (fentanyl patches, etc), since I know the remainder will definitely be dispensed before expiring.
If it's something that moves, like fentanyl patches, I'd be okay with it. On the other hand Fentora is pretty rare and expensive, so no way would I want to break that one. But ymmv, you may have some doc in the area who sleeps with the Fentora rep and throws all his patients on it. I was at a 1000rx/day store that was comfortable with breaking packs of insulin pens, since they dispensed enough that they wouldn't outdate.

Then again, you can get some fool who will "loan" 5 tablets from a sealed Januvia, Nexium, Bystolic, etc. And the guy never returns, or the doc changes their script, and the broken bottle of #25 will sit there for the next 5 years.
 
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Rxnupe

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I would not put it past any company auditing today to take back a claim if you dispensed for more than the written amount. Same thing on diabetic test strips. Patients throw a fit When you do not give them a 30 day supply and seem incapable of understanding you can't break a box so you are only getting 100 not 120.



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MPD you must be a fly on my wall at my pharmacy lol- I have an MD that is notorious for writing scripts with Test 4 times daily and either QS for 30 or 90 days- well that's either 120 or 360 test strips- when it's 120 I give the a box of 100 and when he writes for 90 days supply I round off to 400- gosh I hope an auditor doesn't penalize me for the extra 40 test strips- but wouldn't I technically be correct since the MD wants enough to last for 90 days and 300 strips would only last 75 days????
 

Ackj

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MPD you must be a fly on my wall at my pharmacy lol- I have an MD that is notorious for writing scripts with Test 4 times daily and either QS for 30 or 90 days- well that's either 120 or 360 test strips- when it's 120 I give the a box of 100 and when he writes for 90 days supply I round off to 400- gosh I hope an auditor doesn't penalize me for the extra 40 test strips- but wouldn't I technically be correct since the MD wants enough to last for 90 days and 300 strips would only last 75 days????
How about this one: test strips, test once daily. Insurance limits to 30 day supply. Box of either 100 or 50, so you're getting a 50 day supply, but I can only possibly bill it for 30 days. Stay away auditor, I have no choice.
 

gtpederson

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Then again, you can get some fool who will "loan" 5 tablets from a sealed Januvia, Nexium, Bystolic, etc. And the guy never returns, or the doc changes their script, and the broken bottle of #25 will sit there for the next 5 years.
my old RXM broke open a bottle of Tarceva for one tablet. Just expired the rest of the bottle this week. Such a waste.