Rx Writing - HELP

[LandySue]

My pharm teacher is a bear - and she keeps changing our assignment instructions. So I need some help!

I need to write a sample Rx for Lantus Solostar pens. The issue I have is the dose requires a total of 6 pens for a 90 day supply, but pens come 5/box. I have heard real-life situations where pharmacies DO break boxes and give just the 6 pens, but my instructor says NO - they will not.

So! Since Insurance won't pay for an "early" refill if I only write for 1 box (5 pens), does that mean they WILL cover the four extra pens in the second box and I just write for two boxes? Or do I just write for 6 pens and let the pharmacy deal with it (def not the answer my instructor wants to hear, lol)? And if insurance doesn't cover the second box, does the patient pay out of pocket for the difference?

I'm so confused at this point from looking at it for 2 straight days. Any insight would be great!

[ThePsychWhisperer, BSN, MSN, APRN, NP]

Many pharmacies will not break a "pre-packaged medication" such as insulin pens, birth control patches, and many others. In this case of insulin pens, let's say for argument's sake that the pharmacy in question will not break a box of insulin pens, and 5 pens will last the patient 75 days. It would be insurance fraud to bill the insurance company for 10 insulin pens for a 90 day supply, and pharmacies will get charged back for this when the insurance company starts reviewing claims. In this case, the pharmacy will provide the patient five pens for 75 days to remain compliant with insurance billing practices. In the case of the pharmacy breaking the box, they will bill 6 pens for 90 days. One way to get out of trying to do the hard math is to write something as follows:

Lantus Solostar Pen
30 units subcutaneously BID
Dispense QS for 90 day supply
(These are just made up numbers, by the way. Too tired to do the actual math for units per ml, ml per pen, pen per day supply, etc.)

Yes, the above prescription is cheating a little bit, but when I worked in pharmacy, I never minded a little math. Oh, and I was a senior certified pharmacy technician before becoming a nurse. So you can take what I'm telling you to the bank.