Sharing prescriptions of non narcotic medications

[LadyMonteCarlo]

If you work in a doctor's office you know that you are the one that writes the prescriptions, fills out all of the disability paper work, etc., and the doctor simply signs on the dotted line. I would like to throw out this scenario that happened recently in my office.

Patient calls and reported that both she and hubby take the same medication, same strength and wanted a new prescription. However, she only wanted one prescription with double the strength so the both of them could split the pills. This way they only needed to pay for one prescription. Now, granted, this at first appears to be a reasonable request.

If a doctor writes a prescription knowing the strength is double the prescribe amount to save the patient money, is it legal? But wait, the doctor never writes the prescription they only sign it, the nurse writes the prescription. I am all for helping saving patient's money, but not at the cost of potentially jeopardizing my license in the process. To go one further, if the doctor writes the prescription for one patient at double the strength knowing that this prescription will be shared by two patient's ???????????

It is against the law to take medication that is not prescribed for you. I really dislike being put in the position to say NO, but ethically / legally I feel this isn't right. What say you all?

[roser13, ASN, RN]

Go with your gut. Don't do it. You could get yourself and your MD in big trouble.

[traumaRUs, MSN, APRN]

Nope, don't do it.

[ACute RN]

Legally, I'm not sure what prohibits this, but I am sure there is something... But ethically, it is definitely not right!

[mentalhealthRN]

Absolutely not okay. Two SEPARATE PATIENTS--married or twins or what. THIS IS TWO SEPARATE PATIENTS and the scripts need to legally be separate too. I would tell the pt that while you can sympathize with this problem and wish that there was some way you could help it would be illegal for both you and the doctor to do this sort of thing. And I believe this would be medicaid and possibly medicare fraud as well making it either a state and/or federal offense.....so no way. DON'T do it.

[usalsfyre]

Legally, I'm not sure what prohibits this, but I am sure there is something... But ethically, it is definitely not right!

How is this ethically wrong? Is looking after the finical well being of the patient not "holistic care"? I'm not advocating doing it, but why not let the physician make the decsion on it?

[CrunchRN, ADN, RN]

It is up to the MD - tell him/her and let them decide and write it.

[usalsfyre]

I see a lot of people who are worried about the legal consequences and "their license" but I see none who have thought about socioeconomic factors. Inform the physician, let him make the decision.

[BabyLady, BSN, RN]

It is against the law to take medication that is not prescribed for you. I really dislike being put in the position to say NO, but ethically / legally I feel this isn't right. What say you all?

This is all you need to know.

Ethically, it is not right because the insurance company is paying for a stronger dose than what is necessary for the insured.

Legally, it is not right because you know the patient is not taking the dose prescribed and someone, who the physician has no medical records for, nor has treated/examined, is taking the medication.

Better idea:

I have a friend who has a laundry list of health problems that recently lost her prescription coverage. She printed off the Walmart website their entire list of $4 prescriptions and told her physician if it was not on the list..she was not taking it. Other pharmacies have similar programs.

Sometimes physicians do not look at these options...and they need to. Granted, they may not get the "best prescription" available..but it may be manageable or something they can afford.

[nursel56]

Well that's a big change from the norm since my years in doctor's office/outpatient clinics. We never wrote out all the doctor's prescriptions for them to sign. It seems as if there is confusion about who actually writes the prescription if a nurse's written instruction would vary from what the doctor thought he was ordering when he signed the Rx. Why can't they write their own prescriptions? Normally it takes less than a minute to fill it out.

Another problem would be that even though the med is the same strength, the frequency and reason for the med are different, so one of the two is essentially without a valid prescription, and the pharmacist would be affected, too.

[Halinja, BSN, RN]

I'm sure we all see how it would benefit the patients to save money. Maybe nothing would ever happen and the patients would be happily saving money for years. Let's consider a scenario. Let's say the doc writes it. And for some reason, one or the other actually takes the prescription as written rather than as intended. Or even if the two patients take it as intended. Then lets say an adverse event for either patient, whether or not it was truly related to the medication. The doctor would be sued. Big-time. This would not be a case of an honest error. This would be considered deliberate, no matter that his intentions are to be helpful. Legally he would be wrong. Ethically he would be wrong. Morally he would be wrong.

Today on Allnurses there was a post regarding the number of people who take their medications incorrectly. That's with prescriptions written for one patient. With the correct dose on them. And people still make mistakes in taking their meds.

There is no way I would do it. And yes, I know what it is like to have very little money, to scrimp and save to get to the end of the month. I would sympathize. But this is a matter of law. The law seldom makes allowances for good intentions.

JMHO

[heron, ASN, RN]

I wonder if writing 2 scripts for double-strength, 1/2 the #dispensed and sig:take 1/2 pill ... one for each patient ... would do the trick of lowering the cost.

Anyhow, I feel that we need to be much more conscious of how much a script or other recommendation really costs the patient, especially the elders.