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?

[Whispera, MSN, RN]

i wonder if 2 prescriptions were taken to a pharmacy such as heron suggests, at the same time, if the pharmacy would charge for the total number dispensed rather than charge for each bottle? this would be something for the patients to ask their pharmacist.

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.

is the medication something the patients take continuously? do they get 90 days' worth at a time or another large amount? do they get it through the mail? i'd be concerned that one or the other patient wasn't getting appropriate followup related to the medication, if it's prescribed as the patients want it to be prescribed. would they alternate who gets his name on the prescription next time? would the record show who got what? there are so many complications that could come up in this.

i'm also concerned about you writing the prescriptions and having the doctor sign them. what if you misunderstood what the doctor said? what if you make an error and the doctor doesn't catch it when he signs it, or doesn't read what you wrote carefully? what if something goes wrong? i'm not sure you writing the prescriptions is legal. i think at the least it's questionable.

[StrwbryblndRN]

I agree with a previous post in regards to maybe finding a cheaper alternative. I have always referred my md to cheaper solutions. i.e. Target $4 scripts. Pt's do not always realize what is available out there.

[SpEdtacular, MSN, RN, EMT-P]

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.

While I disagree with your argument regarding the insurance company, there are a multitude of dangers to everyone involved in trying to split a medication between two people so I would not suggest, recommend, or encourage that. I don't think there is anything wrong with the physician prescribing a stronger dose for a patient when affordability is an issue as long as the dosing instructions allow the person to take the medicine safely and as prescribed i.e. take 1/2 a pill of double strength instead of take 1 pill of regular strength or because sometimes they'll only fill the script in the lowest strength needed take 1/2 to 1 pill (as long as it would be safe to do so). In the long run it's good for the insurance company because people who take their medication are less likely to end up in the hospital.

Generics are an excellent suggestion but sometimes there is no generic equivalent for a medication and other similar medications (generics included) don't work. I don't know the couples insurance situation but without prescription coverage even generics can be costly. Another thing to consider is sometimes a drug's original preparation is available in generic but the extended release form the pt was prescribed isn't so if it's feasible switching to an immediate release might work. 90 day supplies seem to be becoming more popular and although the upfront cost is sometimes more it's cheaper than it would be had you gone to the pharmacy monthly.

Free samples from the doctor might be an option. In addition, since drug companies want you to take their newest most expensive pill, some offer discount/rebate cards which you present to the pharmacy for a considerable discount. Two that I know of are Nuvigil and venlafaxine ER (original generic for Effexor ER).

In the end I think it comes down with discussing your concerns with your physician because many don't consider cost when prescribing and some are into prescribing the new popular drugs for whatever reason. You may not know what other options are available unless you ask and asking is free.

[CrunchRN, ADN, RN]

Y'all are endlessly paranoid!:smokin::smokin:

Let the doc know you aren't comfortable and let them either write it themselves or decline the request. It will be on the MD. You give info and they made the decision and wrote it so there is no way you would be liable.

And remember that if there is no harm there is no law suit.

Your risk of getting in trouble is 1 million times higher for not documenting proper follow up for a abnormal lab result that results in a worsening condition. I wonder how many times that happens in your office?

[VivaRN]

This could cause huge problems if the patient was ever hospitalized and the hospital providers requested the patient's pharm records to do med reconciliation. There is enough confusion about meds without introducing this.

The decision ultimately rests with the prescriber, who should write his/her own script if the RN disagrees... but as a prescriber I would not agree to it. Too risky, even if both persons on the script were patients (meaning info about allergies and health hx).

I'm all for helping out the uninsured and do so on a daily basis. There are just better ways to save.

[MunoRN, RN]

It's not uncommon for a patient to get higher dose pills/tabs and cut them to get the correct dose since this saves money (There should be a law that a 20mg lisinopril tab has to cost the same as 2-10mg tabs). But writing a script that is secretely meant for 2 people to share isn't a good idea or probably legal since you would be falsifying the script.

When patients come in unable to tell us what meds they are on, we call their pharmacy, which would tell us that one of these patients was not on the med at all and the other was on twice what there real dose was.

If money is the issue, both Target and Wal-Mart have many common meds for $4/month or $10/3 months.

[CoffeeRTC, BSN, RN]

I would say no.

I kinda did something like this for myself tho. I was taking Zofran 4mg for nausea.

30 tabs cost $50 with the insurance. Sometimes I would need the 8mg or need to take it more often. Finally wized up and asked the doc to order me the 8mg tabs that were the same price, but I got 2 times the doses for the $50.

Your question isn't the same since it deals with two people sharing the same prescription. Now days there are cheaper meds at different pharms for alot of the meds ordered. They would need to split the meds too. Would they be able to do that?

[CathyLew]

This could cause huge problems if the patient was ever hospitalized and the hospital providers requested the patient's pharm records to do med reconciliation. There is enough confusion about meds without introducing this. .

was thinking the same thing--a lot of times if someone is unsure of med list, we get it from the Pharm records --and if one of the couple was hospitalized, and the doctor just writes the admission meds from the med list that the pharmacy gave them-- the patient would possibly get double the dose, or none of the medication. And a lot of patients would not even question it, since the meds they get in the hospital often times look different than the brand they take at home.

[CrunchRN, ADN, RN]

The point I have tried to make is it not up to the nurse.

She should not write it and give the request to the provider. Whether they do it or not is up to them.

And this has been common practice (higher dose and take 1/2 tablet) for years and years and I have never seen any actual repercussions ever.

[alabamaparamedic]

Just a suggestion:

I had a ridiculously expensive not-available-in-generic prescription...the dosage came in 10mg and 20mg concentrations...although I was prescribed the 10mg dosage, my physician was kind enough to write for the 20 mg dosage and specify on the script that it was 1/2 tab a day.

An odd thing about most medications, is that the higher dosage is usually only a wee bit more expensive (in my case $10 more). This way, I was able to divide the 20mg pills in half and 30 pills lasted me for 2 months. I saved about $50 a month this way, and since the dosage on the bottle was written correctly, the physician felt that it was perfectly OK.

Of course, this only works if there is a higher dosage available, if the pills aren't timed release, and if the patient can be trusted to remember to break the pills in half. But, it's an idea to save your patient money :)

[BabyLady, BSN, RN]

while i disagree with your argument regarding the insurance company, there are a multitude of dangers to everyone involved in trying to split a medication between two people so i would not suggest, recommend, or encourage that. i don't think there is anything wrong with the physician prescribing a stronger dose for a patient when affordability is an issue as long as the dosing instructions allow the person to take the medicine safely and as prescribed i.e. take 1/2 a pill of double strength instead of take 1 pill of regular strength or because sometimes they'll only fill the script in the lowest strength needed take 1/2 to 1 pill (as long as it would be safe to do so). in the long run it's good for the insurance company because people who take their medication are less likely to end up in the hospital.

yes, it is defrauding the insurance company. if sally only needs a 100 mg pill for xyz drug and the prescription is written for 200 mg so sally and split it with her husband tom...who is not insured, then the insurance company is covering medication for tom when tom did not contribute to the insurance premiums. this isn't about one person splitting a pill for themselves to get the correct dose...this is about splitting a pill with a person who is not a patient of the physician, who is also, not examined by the physician.

generics are an excellent suggestion but sometimes there is no generic equivalent for a medication and other similar medications (generics included) don't work. i don't know the couples insurance situation but without prescription coverage even generics can be costly. another thing to consider is sometimes a drug's original preparation is available in generic but the extended release form the pt was prescribed isn't so if it's feasible switching to an immediate release might work. 90 day supplies seem to be becoming more popular and although the upfront cost is sometimes more it's cheaper than it would be had you gone to the pharmacy monthly.

please go back and read my post. i clearly stated that it may not be the best prescription but may be close to something that they can financially manage vs not taking anything at all. not everyone has the same access to healthcare and sometimes we have to learn to manage what we can afford and what we have access to.

we have no idea of what the patient was on...so we have no idea if a cheaper option is available.

[color=#a0522d]everyone here on the board has had pharmacology, so i think everyone is aware of the generic vs nongeneric issues.

[color=#a0522d]the pharmacokinetics of a drug is taken into consideration when a drug is prescribed..that is how a physician knows what frequency in which to prescribe it. physicians, to increase compliance, typically always defer to the lowest number of pills in a day...however, the drug may not be available for them to prescribe it in that manner or the side effects may be undesirable.

[color=#a0522d]

[color=#a0522d]as far as the cost of the generics goes...that is why i referred to bringing the physician a list. generics are always cheaper than the name brand drug...that is why every insurance company in america will cover a generic if it is available...thus, why they are called generics.

free samples from the doctor might be an option. in addition, since drug companies want you to take their newest most expensive pill, some offer discount/rebate cards which you present to the pharmacy for a considerable discount. two that i know of are nuvigil and venlafaxine er (original generic for effexor er).

that is a good short-term solution, but a physician cannot take the place of the pharmacy and the drug company be expected to foot the bill for the uninsured...there are separate programs that people can apply for. the purpose of the samples is for someone to try out a medication or get them through a few days (if they are too sick to go to the pharmacy right away)....the supply that the sales rep has is not endless.

in the end i think it comes down with discussing your concerns with your physician because many don't consider cost when prescribing and some are into prescribing the new popular drugs for whatever reason. you may not know what other options are available unless you ask and asking is free.

...which is exactly what i said...take the generic sheet to the physician to see what can be worked out if something can be worked out.

but at the end of the day...and back to the point of the thread...no nurse should participate in this. that is a why the docs live in the big house and i live in the little house..if they want to write it, have at it.

[bjaeram]

It is actually insurance fraud and you can get it big trouble for this by the insurance company. If they happen to have Medicaid/medicare then they are frauding the government and you don't want to do that.

The point of having an inaccurate record at the pharmacy is a big deal too. We often call pharmacy's for current med lists. Or if the patient is unconcious the medics will often grab the pill bottles they find in the house. This would cause us in the ER to think you are either on double the dose or not taking it at all.

Just not a safe practice.