Here's the situation:
A woman picked up a brand new prescription for Byetta today. Before leaving the pharmacy, she asked me to show her how to set up the pen. I took out the pen to show her and realized that she would need pen needles to use it. I asked if she had a box of pen needles at home, and she, of course, said no.
Well, the doctor never phoned in a prescription for the pen needles. To me... if a doctor writes for byetta, then the RX for the pen needles is inferred. Afterall, the Byetta pen wouldn't be much good if you don't have the needles for it. Therefore, I simply wrote up a prescription for pen needles instead of wasting time calling the doctor.
Is this the right thing for a pharmacist to do in this situation? My gut tells me that it is, but I have a few doubts. I'm just looking for other opinions.
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12 comments:
I've seen this one a couple times, and I've seen it handled several different ways.
- The way you did, just writing an Rx for the pen needles.
- Call the doctor's office for a quick verbal okay for the needles (provided the office is open)
- Fax the doctor's office for an prescription for the needles (if they're closed) and authorize one fill - "Emergency Supply"
- Have patient return later when doctor gives an Rx for the needles (not the easiest if you have a 'vocal' patient, but least of a risk to take)
Honestly, I wouldn't have any problem with any of these. Delaying therapy for one day won't kill the patient - especially if she hasn't started yet - but providing a prescription (probably just a one-time fill) in this situation isn't anything extreme.
I would have done the same thing in that situation, then the next day, fax for a signed document to satisfy any insurance auditor.
Yeah Mike, you did the right thing. Why waste your time calling the doc. if he/she prescribed the byetta, he/she should know it needs pen needles to actually work. I mean, you could have called the doc, but then you know how that could turn out and you could end up waiting on hold for a while or waiting for his call back when he is just going to agree with you anyway. Good call, I bet you have another patient that loves you.
I would've done the same thing, then later left a message on the doctor's refill line or miscellaneous line, as they all seem to have now, and let them know what you did. We've had things like this overlooked and done this, and sometimes they'll call in extra refills to add to the prescription.
It was after the office was closed. I forgot to add that crucial bit of info. I tried calling for authorization first, but got the answering service. Therefore, I quickly wrote out the RX for it.
I'll call today to get authorization for it... just in case.
As they beat into us in school... do what's best for the patient. Then call and get the paperwork filled out :)
I have done it several ways, just write it up and call the next business day, or I have also just given them a couple to get them started, and then when the office is open, get an Rx for it and take out what I gave them, not a big deal either way.
What we usually do is get the patient to pay cash for the needles, then get a script fill it ( but she doesn't get another box of needles) - bill insurance, and the patient gets a refund for the difference if insurance picks up the cost
I'd fill the needles then call the doctor's office and let them know that I had also written up a script for the needles and asked if they wanted any refills on it. I still have this starry eyed thought that if I point out their idiotic mistakes enough they'll stop making them. Hey at least I recognize that it's starry-eyed.
I'm just a tech but my fave RX Manager, who by the way has been filling scripts since before I was born would have done the same. His favorite thing to say when a doc forgot the needle for insulin be it vials are pens was "Rubbing it in doesn't work".
This is along the same idea of that RX for an inhale to be used with a spacer... with no RX for a spacer in sight! In either case, I would just write up an RX as if it were phoned-in, but without refills. I either tell the patient to get me an RX for next time or we fax in a refill request when the time comes. Whichever is more convenient for ME, not the idiot prescriber who overlooks writing complete orders! In other words, you did the right thing chief... keep up the good work.
My dad (also a pharmacist) always used to say to me "It's the spirit of the law, not the letter of the law that is important." I would have done the same thing then called or faxed the next day for an rx to satisfy insurance requirements.
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