Would you break an original manufacturer’s packaging to fill a prescription for a patient? Do we even have a choice in this pharmacy benefit manager (PBM) dominated world of community pharmacy?
It was an interesting question from another pharmacist. He asked me if I would break a box of Lantus Solostar pens to fill a prescription. There is more to that simple hypothetical question than meets the eye.
We live in an era of pharmacy practice like no other. It’s a time when PBMs dictate many aspects of prescription drug sales.
And part of what PBMs demand from pharmacies is precise directions and days supply on every prescription. The basic question with any prescription is how long should this prescription last?
If we don’t dispense in the exact amount allowed in one fill on a patient’s prescription insurance plan (typically a 30-days supply), pharmacies could get audited and denied partial or full payment for an individual claim. There is a financial incentive to get the billing correct.
But this is where the problem arises. Some medications aren’t packaged for pharmacies to break a product down in quantities other than original packaging. They are meant to be sold as is.
What do we do with products like Lantus pens that aren’t individually packaged? Would you break a box of five pens to appease an insurance company’s demands?
I don’t know if I want to give out insulin pens that aren’t sealed in the original box. What if something happens and there are questions of product tampering? What about inventory issues resulting from open stock boxes that can’t be sold as is?
Should pharmacies do these sorts of things or should we insist that everything leave the pharmacy in sealed packaging to help ensure patient safety? Are insurance companies demanding too much from pharmacies if they are asking us to break packages to fill prescriptions?
There are some products that only come one way. How about an ophthalmic product that only comes in say a 10 ml bottle. What is a pharmacy to do if the prescription directions are say one drop in one eye once daily? That is clearly over a month’s worth of medication but the drug only comes one way.
I think insurance companies are looking for any excuse to not pay for medicine or cover a product for a patient. If that means haggling with pharmacies over days supply issues then so be it. They can more than pay for their auditor’s salary by finding issues that they decide warrants zero reimbursement to the pharmacy.
Sometimes it is a moot point. Certain insulin vials are only good for say 28 days after the patient first uses them. But in other cases, the pharmacy is put in a difficult position by the insurance industry. Do we break packages to meet insurance demands or not?
And what would a board of pharmacy say about this issue? Would they want pharmacists dispensing insulin pens not in their original packaging? I sent an email to my state’s BOP yesterday asking just such a question. As of this writing I am still waiting for their reply.
What are you doing at your store? Are you opening packages you normally wouldn’t to appeal to the insurance demands? Are you simply adjusting the numbers to make existing packages work for a given insurance claim? Should pharmacies be required to break packages? What do you think?
The Redheaded Pharmacist