Insulin pen, box: open box or not? Rite Aid Old Memo of 2013?

[Lnsean]

Actually you can bill and take those vials out. Here it is. If the box can’t be broken, why do they say the package size is 3 ml ?? 10 ml for vials. Game , set , match. Its over. Point proven. Now go back to your GED class.

Of course you can. You can do whatever you want. It's your license.

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[Pharmanut]

Of course you can. You can do whatever you want. It's your license.

So what do you have to say about the manufacturer claiming the 3 ml pen is the package size???? Can you now admit you were wrong??

 

[wagrxm2000]

This has been entertaining, I'm curious about the opinion on the albuterol vials.

 

[Lnsean]

So what do you have to say about the manufacturer claiming the 3 ml pen is the package size???? Can you now admit you were wrong??

That's how the manufacturer describes it...so what? That's not standard of practice to break them. I'd go even further to say that you are not giving the patient the counseling insert that is in each package of Levemir that the manufacturer includes in there for the patient. That is probably more of a violation than anything else we have discussed here.

 

[Pharmanut]

This has been entertaining, I'm curious about the opinion on the albuterol vials.

In regards to albuterol vials, the question is why not? Hospitals open those boxes as well and bill per vial. Walgreens has turned you guys into robots who can’t function outside of what they allow you to do. Anywhere else, you can bill for whatever you want as long as there is no issue legally.

 

[Pharmanut]

That's how the manufacturer describes it...so what? That's not standard of practice to break them. I'd go even further to say that you are not giving the patient the counseling insert that is in each package of Levemir that the manufacturer includes in there for the patient. That is probably more of a violation than anything else we have discussed here.

We print out and keep them on the side. Put them with every single bag. Nice try though. So it is standard of practice for Walgreens but that does not make it right.

 

[Lnsean]

We print out and keep them on the side. Put them with every single bag. Nice try though. So it is standard of practice for Walgreens but that does not make it right.

Umm no. You cannot print your own and past them off as the manufacturer's. Those are FDA approved labelling. LOL. I think you are definitely in violation here. Like for Nuvaring, they have 3 separate inserts in there provided by the manufacturer. You are bypassing this and pritning your own? lol

 

[wagrxm2000]

In regards to albuterol vials, the question is why not? Hospitals open those boxes as well and bill per vial. Walgreens has turned you guys into robots who can’t function outside of what they allow you to do. Anywhere else, you can bill for whatever you want as long as there is no issue legally.

Seriously calm down, I'm not a robot. I just wanted an opinion. So you open those?

 

[Pharmanut]

Seriously calm down, I'm not a robot. I just wanted an opinion. So you open those?

We don’t because MD always writes per box and the day supply is always 30 so its never an issue

 

[Pharmanut]

We don’t because MD always writes per box and the day supply is always 30 so its never an issue

*less than 30

 

[wagrxm2000]

We don’t because MD always writes per box and the day supply is always 30 so its never an issue

But you would if you had to and I assume at a retail pharmacy?

What are your thoughts on giving out different lot numbers? I assume that comes up a lot if you open them

 

[Pharmanut]

But you would if you had to and I assume at a retail pharmacy?

Yes, I have seen stores do it if it’s a large amount and uneven qty

 

[wagrxm2000]

Yes, I have seen stores do it if it’s a large amount and uneven qty

What about different lot numbers? Do you bill each individually in case of recalls?

 

[Pharmanut]

But you would if you had to and I assume at a retail pharmacy?

What are your thoughts on giving out different lot numbers? I assume that comes up a lot if you open them

Shouldn’t matter. No difference when you open different bottles of tablets right?

 

[Pharmanut]

What about different lot numbers? Do you bill each individually in case of recalls?

Billing is the same when you pull two bottles of any tablets and continue counting right? Both bottles may have different lot numbers

 

[wagrxm2000]

Billing is the same when you pull two bottles of any tablets and continue counting right? Both bottles may have different lot numbers

I'm just wanting your thought.

 

[Pharmanut]

I'm just wanting your thought.

Right and my thought is it wouldn’t matter. Same as it wouldn’t matter with any other drugs in the pharmacy

 

[wagrxm2000]

Right and my thought is it wouldn’t matter. Same as it wouldn’t matter with any other drugs in the pharmacy

Alright sounds good. You have interesting thoughts on different situations.

 

[CetiAlphaFive]

It always cracks me up to see people post paragraphs and paragraphs of crap claiming doom & license destruction as a result of common, every day practices.

If these practices were such a FWA problem, then they wouldn't be every day occurrences.

Josh/pharmanut's assertions that this costs the system *more* is laughable.
The cost per box stays the same. Days supply can dictate copays, but it has nothing to do with reimbursement amount
I've been yelled at by people who "don't need it yet!" enough times to realize that mail order is more of a problem.

Tell me, @Pharmanut ; do you allow people with Medicare/.gov insurance to fill their prescriptions 4-6 days early, as allowed by their insurance plans?

EDIT:

We could get into the legal definition of "common practice", but I'd hate to see the huge paragraphs of opinions about that

 

[Abby Atwood]

Umm no. You cannot print your own and past them off as the manufacturer's. Those are FDA approved labelling. LOL. I think you are definitely in violation here. Like for Nuvaring, they have 3 separate inserts in there provided by the manufacturer. You are bypassing this and pritning your own? lol

When I worked retail, the pharmacy I worked for did not break boxes. That said, I’m assuming that they print the FDA approved labeling and provide that to the patient. It’s available online through the FDA website.

 

[Pharmanut]

It always cracks me up to see people post paragraphs and paragraphs of crap claiming doom & license destruction as a result of common, every day practices.

If these practices were such a FWA problem, then they wouldn't be every day occurrences.

Josh/pharmanut's assertions that this costs the system *more* is laughable.
The cost per box stays the same. Days supply can dictate copays, but it has nothing to do with reimbursement amount
I've been yelled at by people who "don't need it yet!" enough times to realize that mail order is more of a problem.

Tell me, @Pharmanut ; do you allow people with Medicare/.gov insurance to fill their prescriptions 4-6 days early, as allowed by their insurance plans?

EDIT:

We could get into the legal definition of "common practice", but I'd hate to see the huge paragraphs of opinions about that

It does indeed cost the system. Whether it be insurance or the patient. Why would you think otherwise? Who cares about the copayment. The more pens, the higher the reimbursement per fill

 

[CetiAlphaFive]

It does indeed cost the system. Whether it be insurance or the patient. Why would you think otherwise? Who cares about the copayment. The more pens, the higher the reimbursement per fill

Yes. It costs the system.
It does not cost the system more unless something goes wrong.
It only costs the system more if the pharmacist or patient fills it before the Patient actually runs out of insulin.

Your entire argument is predicated on the assumption that patients who have TDD <50 will intentionally refill their prescriptions early.

That is the only way more reimbursement per time period gets paid.

Please don't ignore parts of questions or modify the questions people ask you so that they're more convenient for you.
It's intellectually dishonest.

 

[Pharmanut]

Yes. It costs the system.
It does not cost the system more unless something goes wrong.
It only costs the system more if the pharmacist or patient fills it before the Patient actually runs out of insulin.

Your entire argument is predicated on the assumption that patients who have TDD <50 will intentionally refill their prescriptions early.

That is the only way more reimbursement per time period gets paid.

Please don't ignore or modify the questions people ask you so that they're more convenient for you.
It's intellectually dishonest.

Do you know how many times insulin pens get filled early because of auto fill or because they have Medicaid and it’s free? If you work in retail, next time look at the patient’s profile and see how much overage there is over the entire year. You will be surprised. Also, you do realize people waste pens, lose pens, give pens to family members and even have their whole therapy changed to another insulin. At 90 bucks a pen, how do you argue that there is no cost to the system. If there wasn’t cost, then why are insulin pens the most audited prescriptions due to days supply in the pharmacy? Your whole theory that it wont get filled early is naive and untrue.

 

[CetiAlphaFive]

Do you know how many times insulin pens get filled early because of auto fill or because they have Medicaid and it’s free? If you work in retail, next time look at the patient’s profile and see how much overage there is over the entire year. You will be surprised. Also, you do realize people waste pens, lose pens, give pens to family members and even have their whole therapy changed to another insulin. At 90 bucks a pen, how do you argue that there is no cost to the system. If there wasn’t cost, then why are insulin pens the most audited prescriptions due to days supply in the pharmacy? Your whole theory that it wont get filled early is naive and untrue.

Again, your problem lies with patient abuse of the system, yet you're claiming it's a problematic practice by pharmacists.

Very bizarre logic.

I'll repeat the question you intentionally ignored: do you ever refill any prescriptions early?

Thanks

EDIT:
You also seem to be ignorant of what Lantus actually costs.
Acquisition cost for my pharmacy is $334 per box.
Medicare rarely pays us more than $350 per box. That's not $90 per pen.

What else are you unaware that you're wrong about, since you're just a corporate retail rph?

 

[Abby Atwood]

Do you know how many times insulin pens get filled early because of auto fill or because they have Medicaid and it’s free? If you work in retail, next time look at the patient’s profile and see how much overage there is over the entire year. You will be surprised. Also, you do realize people waste pens, lose pens, give pens to family members and even have their whole therapy changed to another insulin. At 90 bucks a pen, how do you argue that there is no cost to the system. If there wasn’t cost, then why are insulin pens the most audited prescriptions due to days supply in the pharmacy? Your whole theory that it wont get filled early is naive and untrue.

It might be cost saving though. That may be a sign that insulin has been titrated to a higher dose per provider instructions. That artificial decrease in days supply could be preventing a second provider visit for an updated script.

 

[Pharmanut]

Again, your problem lies with patient abuse of the system, yet you're claiming it's a problematic practice by pharmacists.

Very bizarre logic.

I'll repeat the question you intentionally ignored: do you ever refill any prescriptions early?

Thanks

EDIT:
You also seem to be ignorant of what Lantus actually costs.
Acquisition cost for my pharmacy is $334 per box.
Medicare rarely pays us more than $350 per box. That's not $90 per pen.

What else are you unaware that you're wrong about, since you're just a corporate retail rph?

I fill what the insurance allows because on previous fills, the day supply is correct. When you are billing for insulin and submitting the wrong day supply, you just comitted fraud- plain and simple. In terms of cost, I said 90 per pen and you say 70 with Lantus- who is the ignorant one here? Do you want to give me the prices of the other pens like Toujeo and levemir too?

Now that i answered that question, lets use your same logic. MD orders 100 tablets of A medication but said to take it one a day. Under your logic, there is no damage to give 100 tablets at 30 day supply as long as the patient does not come early. In this case, the Pharmacist is not responsible? Its the same thing. You and these other fools need to wake up and stop making excuses.

 

[Pharmanut]

It might be cost saving though. That may be a sign that insulin has been titrated to a higher dose per provider instructions. That artificial decrease in days supply could be preventing a second provider visit for an updated script.

Not when you are getting more money from the insurance company than you are allowed. Also, Md needs to send in a new rx with new directions if therapy changes.

 

[CetiAlphaFive]

I fill what the insurance allows because on previous fills, the day supply is correct. When you are billing for insulin and submitting the wrong day supply, you just comitted fraud- plain and simple. In terms of cost, I said 90 per pen and you say 70 with Lantus- who is the ignorant one here? Do you want to give me the prices of the other pens like Toujeo and levemir too?

Now that i answered that question, lets use your same logic. MD orders 100 tablets of A medication but said to take it one a day. Under your logic, there is no damage to give 100 tablets at 30 day supply as long as the patient does not come early. In this case, the Pharmacist is not responsible? Its the same thing. You and these other fools need to wake up and stop making excuses.

You fill what insurance allows?

What if you call and the insurance says they allow you to fill 1 box of 5 pens as 30 days supply?

How is that different from filling a prescription for Jardiance 5 days early 6 months in a row.

A pharmacist who fills early based on correct days supply just dispensed #30 tablets for free.
Why is that ok for you, yet dispensing 1 box with approval from insurance is not?

It sounds like you lack perspective.

 

[Pharmanut]

You fill what insurance allows?

What if you call and the insurance says they allow you to fill 1 box of 5 pens as 30 days supply?

How is that different from filling a prescription for Jardiance 5 days early 6 months in a row.

A pharmacist who fills early based on correct days supply just dispensed #30 tablets for free.
Why is that ok for you, yet dispensing 1 box with approval from insurance is not?

It sounds like you lack perspective.

When did I say that calling the insurance and getting the approval is incorrect? Stop making things up. The problem is that they do not call the insurance, bill the wrong days supply, end up filling months early and overcharging the insurance. Plain and simple.

 

[Abby Atwood]

Not when you are getting more money from the insurance company than you are allowed. Also, Md needs to send in a new rx with new directions if therapy changes.

I don’t totally disagree with you, but it will increase healthcare costs if patients are forced to have more frequent provider visits to obtain updated insulin directions. It wouldn’t be cost saving.

Like other people have pointed out, patients aren’t going to just toss that extra insulin. Impact on healthcare system costs is not a very compelling argument from my perspective.

 

[CetiAlphaFive]

When did I say that calling the insurance and getting the approval is incorrect? Stop making things up. The problem is that they do not call the insurance, bill the wrong days supply, end up filling months early and overcharging the insurance. Plain and simple.

You seem to have a problem with declaring that "they" do things and assuming it's a real world example instead of just a theoretical.

It's a problem because you want us to accept tⁿhis fabrication as fact just because you do.

Like I said, it's SOP at every major company to call on TDD <50u.

Your concerns with patient abuse of the system has no bearing on what is or isn't fraud. You seem to not understand what fraud is.

 

[Pharmanut]

You seem to have a problem with declaring that "they" do things and assuming it's a real world example instead of just a theoretical.

It's a problem because you want us to accept tⁿhis fabrication as fact just because you do.

Like I said, it's SOP at every major company to call on TDD <50u.

Your concerns with patient abuse of the system has no bearing on what is or isn't fraud. You seem to not understand what fraud is.

First of all, no company in retail has that SOP. If they do, show me.
Secondly , let me show you what fraud looks like since you can’t understand this simple subject. The pharmacy knowingly submits the wrong day supply. On refills, the early fill DUR will not prompt thus creating a false claim that should not have gone through. The corporation knows this but does nothing because of the amount of sales. The Pharmacist allowing the patient to abuse the system by falsifying claims is FRAUD.

By your standards, if a patient brings in an rx for Januvia and you bill 1000 tablets for them each month with a 30 day supply, it is not fraud if they come back early 30 days later and you allow 1000 more to go through. It’s scary that you can’t grasp your brain around what fraud is.

 

[CetiAlphaFive]

First of all, no company in retail has that SOP. If they do, show me.
Secondly , let me show you what fraud looks like since you can’t understand this simple subject. The pharmacy knowingly submits the wrong day supply. On refills, the early fill DUR will not prompt thus creating a false claim that should not have gone through. The corporation knows this but does nothing because of the amount of sales. The Pharmacist allowing the patient to abuse the system by falsifying claims is FRAUD.

By your standards, if a patient brings in an rx for Januvia and you bill 1000 tablets for them each month with a 30 day supply, it is not fraud if they come back early 30 days later and you allow 1000 more to go through. It’s scary that you can’t grasp your brain around what fraud is.

Sorry, every major corporation does have that SOP. You can choose not to believe it if you like.

So, let me see if I understand you correctly.

If a patient is taking 45 units daily, and it's billed as 30 days supply, the pharmacist has committed an unethical, fraudulent act.

However, if a patient is taking 50 units daily, and it's billed for 30 days supply, but the patient picks it up 6 days early every single month for a few years, that's totally fine and not a problem.

Are you remembering to account for the 2 units lost during priming in each new pen?

 

[zelman]

Actually you can bill and take those vials out. Here it is. If the box can’t be broken, why do they say the package size is 3 ml ?? 10 ml for vials. Game , set , match. Its over. Point proven. Now go back to your GED class.

If you remove them from the foil, how do you deal with the product’s photosensitivity?

 

[Lnsean]

First of all, no company in retail has that SOP. If they do, show me.
Secondly , let me show you what fraud looks like since you can’t understand this simple subject. The pharmacy knowingly submits the wrong day supply. On refills, the early fill DUR will not prompt thus creating a false claim that should not have gone through. The corporation knows this but does nothing because of the amount of sales. The Pharmacist allowing the patient to abuse the system by falsifying claims is FRAUD.

By your standards, if a patient brings in an rx for Januvia and you bill 1000 tablets for them each month with a 30 day supply, it is not fraud if they come back early 30 days later and you allow 1000 more to go through. It’s scary that you can’t grasp your brain around what fraud is.

It's not fraud if the payors are telling you to do it. What you are doing by splitting those boxes is violating patient safety. You are dispensing insulin pens outside of their tamper evident boxes and not giving the patient the box and included material for the patient. This is clearly a violation, and that's why you don't see anyone doing it. Just you. You are part of the small minority that does this. It's your license, but don't come on here and say that it's to save healthcare money. lol. No one here is going to risk giving a new patient some lose levemir pens....I could see it in LTC or hospital...but not retail. It's clearly a patient safety issue.

 

[zelman]

Sorry, every major corporation does have that SOP. You can choose not to believe it if you like.

So, let me see if I understand you correctly.

If a patient is taking 45 units daily, and it's billed as 30 days supply, the pharmacist has committed an unethical, fraudulent act.

However, if a patient is taking 50 units daily, and it's billed for 30 days supply, but the patient picks it up 6 days early every single month for a few years, that's totally fine and not a problem.

Are you remembering to account for the 2 units lost during priming in each new pen?

Pens should be overfilled to allow for priming. The thing people forget to account for is that when there is less than one whole dose in a pen, that amount is discarded.

 

[Pharmanut]

It's not fraud if the payors are telling you to do it. What you are doing by splitting those boxes is violating patient safety. You are dispensing insulin pens outside of their tamper evident boxes and not giving the patient the box and included material for the patient. This is clearly a violation, and that's why you don't see anyone doing it. Just you. You are part of the small minority that does this. It's your license, but don't come on here and say that it's to save healthcare money. lol. No one here is going to risk giving a new patient some lose levemir pens....I could see it in LTC or hospital...but not retail. It's clearly a patient safety issue.

It is not TAMPER RESISTANT. THERE IS NO VIOLATION! No where on the box or PI does it say you cannot open it! Seriously, you should not be practicing as a Pharmacist because the lack of knowledge and information is scary. You are making things up and I am not going to sit here and argue with some imbecile. My license? I have talked to the MAKERS of the product and they said it’s OK. People like you make my blood boil so I am done. *****...

 

[Pharmanut]

Pens should be overfilled to allow for priming. The thing people forget to account for is that when there is less than one whole dose in a pen, that amount is discarded.

Most pens don’t need priming. Secondly, it isn’t a significant amount to warrant the overfills

 

[Lnsean]

It is not TAMPER RESISTANT. THERE IS NO VIOLATION! No where on the box or PI does it say you cannot open it! Seriously, you should not be practicing as a Pharmacist because the lack of knowledge and information is scary. You are making things up and I am not going to sit here and argue with some imbecile. My license? I have talked to the MAKERS of the product and they said it’s OK. People like you make my blood boil so I am done. *****...

Tamper-evident...there is a difference between tamper-evident and tamper-resistant. Apparently you did not know that. I said if you take it out of the box it is no longer tamper evident....that's what the box is for. This clearly a major patient safety issue and that's why no one is doing this. No one is taking your advice...have you not noticed? Try to convince someone here to dispense lose humalog pens to their patients....I challenge you. Even your colleagues at CVS have told you they don't do it. You are clearly misfiling these scripts and violating patient safety. No wonder no one is doing it.

 

[Pharmanut]

Tamper-evident...there is a difference between tamper-evident and tamper-resistant. Apparently you did not know that. I said if you take it out of the box it is no longer tamper evident....that's what the box is for. This clearly a major patient safety issue and that's why no one is doing this. No one is taking your advice...have you not noticed? Try to convince someone here to dispense lose humalog pens to their patients....I challenge you. Even your colleagues at CVS have told you they don't do it. You are clearly misfiling these scripts and violating patient safety. No wonder no one is doing it.

Don’t just claim “patient safety”. How is patient safety being violated? If it was not possible to be split, the box would have “tamper” language per FDA labeling genius. I don’t need to convince anyone here as many have already said they open boxes. I have been opening boxes for over 6 years and no one’s safety has been violated. In fact, if you dispense more than what the prescription calls for ie: 1 pen per md Qty, you are violating patient safety.

 

[CetiAlphaFive]

LOL, God have mercy on this guy's soul when he moves to another district or a new RxSup takes over and finds out what they've been doing

 

[Pharmanut]

Don’t just claim “patient safety”. How is patient safety being violated? If it was not possible to be split, the box would have “tamper” language per FDA labeling genius. I don’t need to convince anyone here as many have already said they open boxes. I have been opening boxes for over 6 years and no one’s safety has been violated. In fact, if you dispense more than what the prescription calls for ie: 1 pen per md Qty, you are violating patient safety.

Another question. This is for both you and the other guy at Walgreens. If the Md wants one pen and the patient wants one pen, what do you do?

 

[Pharmanut]

LOL, God have mercy on this guy's soul when he moves to another district or a new RxSup takes over and finds out what they've been doing

I have worked under multiple supervisors. None have stopped me

 

[CetiAlphaFive]

I have worked under multiple supervisors. None have stopped me

...hmmm...

How do you feel about expiration dates on RTS vials?

Do Script Pro cells cause you grief?

 

[Pharmanut]

...hmmm...

How do you feel about expiration dates on RTS vials?

Do Script Pro cells cause you grief?

I feel wonderful about both

 

[josh6718]

And, that response was for Josh not you...why are you responding? Forgot to log in as josh? LMAO

and he created a new account and started jumping all over everyone and then expects everyone to believe that it's not him on a different account. jesus, how immature do you have to be to even think of doing something like this.

8 hours later and I come back and still accusing me of making a second separate account. Gotta love it.

 

[josh6718]

...hmmm...
How do you feel about expiration dates on RTS vials?

I don't want to risk my pharmacist license. Everything prescription bottle gets dispensed in its tamper evident package...

 

[Pharmanut]

8 hours later and I come back and still accusing me of making a second separate account. Gotta love it.

Hahahhahaha

 

[zelman]

Most pens don’t need priming. Secondly, it isn’t a significant amount to warrant the overfills

Kwikpens, Flexpens, and Solostar pens do. Which ones don’t?

 

[josh6718]

This has been entertaining, I'm curious about the opinion on the albuterol vials.

So question- does the Walgreens computer system not allow you to put in a quantity for insulin pens less than 15 mL? The CVS system will reject for other quantity issues (i.e. get a M/I quantity dispensed for 6.7 g for a Proair inhaler, birth controls, and a few others).