When would you fill this control in ny?

[icekitsune]

Hi all, me and several interns was debating on this situation and we're not getting anywhere so I decide to post this scenario and see what your thoughts on it

Patient has history of taking control drug x 1qid but stopped it for a month. A month later the drug is started again, different md wrote the same drug 1tid #90 on for example 12/1. Same md wrote another rx on 12/14 same drug but 1qid. Insurance will allow it to go thru on 12/18 and md gave the ok to fill on 12/16. Patient says he's taking it qid even on the tid rx.When can the second rx be filled if it's to the day and when it can it be filled including the 7day rule in ny?
How do you calculate if there is a change in direction but the same drug? Do we start adjusting the qid on when the new rx arrives? Any advice from long practicing pharmacist will be appreciated.

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[zelman]

Hi all, me and several interns was debating on this situation and we're not getting anywhere so I decide to post this scenario and see what your thoughts on it

Patient has history of taking control drug x 1qid but stopped it for a month. A month later the drug is started again, different md wrote the same drug 1tid #90 on for example 12/1. Same md wrote another rx on 12/14 same drug but 1qid. Insurance will allow it to go thru on 12/18 and md gave the ok to fill on 12/16. Patient says he's taking it qid even on the tid rx.When can the second rx be filled if it's to the day and when it can it be filled including the 7day rule in ny?
How do you calculate if there is a change in direction but the same drug? Do we start adjusting the qid on when the new rx arrives? Any advice from long practicing pharmacist will be appreciated.

You need to know when the MD instructed the patient to increase their dose.

 

[Ackj]

This scenario happens pretty much weekly with metformin, which thankfully there's no rules about filling early. 05 override and most plans are cool with it.

If they had #90 on 12/1, even taking the "incorrect" qid would be 90/4=22.5 days. So no way they would be getting it any sooner than 12/23. I suppose you could really dig in and say it was 13 days of tid, and go #90 - 39 = #51 remaining, then 51/4 = 12.75 more days, which puts it on the 26th. Realistically, they took qid from the start, so pushing it out to the 26th they are going to have to skip some doses to catch up. Fortunately 23 or 26 aren't drastically far apart, and depending on other circumstances, I would be ok with filling the 23rd.

 

[icekitsune]

This scenario happens pretty much weekly with metformin, which thankfully there's no rules about filling early. 05 override and most plans are cool with it.

If they had #90 on 12/1, even taking the "incorrect" qid would be 90/4=22.5 days. So no way they would be getting it any sooner than 12/23. I suppose you could really dig in and say it was 13 days of tid, and go #90 - 39 = #51 remaining, then 51/4 = 12.75 more days, which puts it on the 26th. Realistically, they took qid from the start, so pushing it out to the 26th they are going to have to skip some doses to catch up. Fortunately 23 or 26 aren't drastically far apart, and depending on other circumstances, I would be ok with filling the 23rd.

One of interns said it would be ok to fill it on the 12/20, since md gave the ok for 12/16, plus 7 day rule since its a control 23-7, would be 16th earliest which is what md okayed .does that sound reasonable in practice?

 

[icekitsune]

You need to know when the MD instructed the patient to increase their dose.

If md doesn't call back, should we or can we calculate the qid based on when the new txt came in?

 

[zelman]

If md doesn't call back, should we or can we calculate the qid based on when the new txt came in?

Yes.

 

[Lnsean]

If md doesn't call back, should we or can we calculate the qid based on when the new txt came in?

no...go from the original date on the TID script. This scenario isn't that hard. Give the patient the benefit of the doubt...unless you have time to play phone tag with the MDs on the exact date he told the pt to increase the dosage...it could be a formal discussion...it could had been mentioned briefly during one of the visits. If the patient is regular...give him the benefit of the doubt. It's from the same MD....same office..the patient is coming back to you and not hopping to another pharmacy....it's probably the first time this is happening...he's a regular...no need to bombard the MD's office with endless calls over this---they already have alot of things they need to do like us.

I'd count QID from 12/1 with #90 pills---that's a 22 day supply. It should last until 12/23-----we fill it 2 days early at my store---so that would put it at 12-21. You're a healthcare provider---don't create unnecessary obstacles for good patients and doctors who are trying to provide care for their patients.