Duragesic and Tegaderm

I would also argue this is unsafe practice. How come the MD can not write a letter to the powers that be and explain the situation b/c this certainly seems odd that they will only pay for the drug in only selected strengths. I would write the order for the 25mcg but than request they dispense it in 2 12.5 mcg patch (might work). I agree with you that since Tegaderm does breath and can wick moisture from the skin and is semi-permeable there is the good chance the pt is getting some of that drug. Also what if a patient or caregiver decides to take the tegaderm off and stick the remainder to the skin or the tegaderm loosens with bathing or sweating and a portion off the supposed blocked off area sticks on the skin. I would not do this.....there has to be a better solution than this.

I agree! I think this an unsafe practice and I would not place the patch on the patient using this method. I think your solution of applying for 25mcg patches, dispensed as 12.5mcg is a great idea.

That doesn't sound safe. The tegaderm could be removed accidentally or on purpose. And do we even know if the patch would have an even concentration/distribution of medication throughout the patch. You could not be sure of the dose your patient recieves.

Can't you also ask the doctor if you can cut the patch in half?

ABSOLUTELY NOT!!!!!!! Duragesic patches are made to dispense the medication transdermally over a period of time usually 72hrs. Cutting the patch will never ensure that the patient is getting the correct dosage. Also some duragesic manufacturers make the patches with the liquid medication visible in the patch and cutting it would release this med. The solution to the problem would be fill the RX for the 12.5 mcg patches. Apply 2 patches in the same area so as not to froget to remove them and change both at the same time. Cover the entire patches with the tegaderm to ensure that the patches do not fall off.

I have recently heard that the manufacturer does not recommend the use of tegaderm whatsoever. I lothe duragesic patches anyway!

I worked in pharmacy for 15 years. Although the pharmacy can dispense 2 x 12.5mcg/hr boxes rather than 1 x 25, they must still bill for the product they are dispensing so that won't solve the insurance problem. The dr just needs to submit for prior authorization through the insurance company. That process is a pain but is usually successful.

Good luck!

You are correct that this is not a safe practice and you should not participate. If the doctor wants to assume responsibility for that...okay...but not on your license! As well, you must not cut the patches!

The entire issue of the physician ordering one thing and the insurance company deciding that they won't pay for that prescription is an excellent example of profit getting between doctors and patients. The insurance decision to refuse the 12mcg patches is based exclusively upon cost and profit and has nothing to do with what is safer or more appropriate for the patient.

We need health insurance reform to make this common situation very uncommon. Can you imagine anything more sickening than the pain management of an 8 year old being manipulated to insure the profits of the insurance company rather than to insure the safe provision of comfort for the child?!?