Insulin Pens: Understanding Dosing Increments and Audit Risks

PAAS National® continues to see auditors flag insulin pen prescriptions for containing a dosage that does not align with the product. Most insulin pen products can be dosed in 1-unit increments; however, there are some insulin pens that range from 0.5-unit increments to 5-unit increments.

If prescriptions are written with directions that conflict with the dosing of the medication, pharmacies should clarify the directions with the prescriber and make a clinical note on the prescription. For example…

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a prescription written for Toujeo® Max Solostar® with directions indicating 89 units daily must be clarified because the pen can only be dialed in 2-unit increments (i.e., the directions should either be 88 units daily of 90 units daily).

The following table outlines which insulin pens you should pay close attention to when dispensing:

InsulinDosing Increments
Humalog® Junior KwikPen®0.5 units
Toujeo® Max Solostar®2 units
Tresiba® Flextouch® 200 units/mL2 units
Humulin® R U-500 KwikPen®5 units

PAAS Tips:

  • Prescription directions must be clear and follow product dispensing guidelines like dosing increments
  • Clarify any directions that do not follow the specific dosing intervals available for each insulin pen
  • If directions must be clarified, make a clinical note on the prescription and ensure the patient label instructions are also updated
  • Clinical notes should contain:
    • the date you called the prescriber’s office,
    • the name AND title of who you spoke with,
    • a summary of what was discussed, and
    • your initials
  • Download the PAAS National® Insulin Medication chart which contains information on dosing increments as well as other useful information like priming units and beyond use dates, both of which can vary by product
  • The PAAS Rx Days’ Supply Calculator app also contains information on dosing increments and will warn you about instructions that are not compatible with the product. Download the app for a 7-day free trial (only $5.99/year thereafter)

Jenevra Azzopardi, CPhT
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