Don’t Cut Corners: Notations on Prescriptions

Not only are new medications frequently released to market, but also new strengths and formulations of existing medications. For example, consider Humulin® R U-100 insulin which was developed in the early 1980s. In the mid-1990s, Humulin® R U-500 vials became available in the market. That meant prescribers and pharmacists alike needed to be mindful of indicating which formulation of Humulin® R insulin the patient was to receive.

Not only are there new strengths of existing medications, but also new formulations. In 2016, Humulin® R U-500 insulin became available with a dedicated device used for the delivery of insulin – the KwikPen® – after previously only being available by vial. Yet again, this meant pharmacists needed to be explicit in what the patient was to receive, not only for the sake of the patient but also for accurate billing and dispensing.

For medications that come in one strength or dosage form, PBMs have proven to be more lenient with prescription hard copies that do not contain that information. However, medications that come in different strengths or dosage forms must include that information on the hard copy for it to be accepted by PBMs. Instead of trying to remember whether a medication comes in multiple forms, get all pharmacy staff into the practice of including strength and formulation for prescriptions, especially on telephone and transferred prescriptions. Below are the more common types of medications that could be recouped with missing information:

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  • Missing Strength
    • Topicals
    • Insulin
    • Inhalers
  • Missing Formulations
    • Topicals: cream, ointment, gel or solution
    • Buprenorphine and Naloxone: film or tablet
    • Insulin: vial, pen or refill cartridge
    • Injections: auto-injector/pen, prefilled syringe or vial
    • Vyvanse®: capsules or chew tablets

PAAS Tips:

  • Utilize PAAS’ Self-Audit Mindset to ensure prescription hardcopies include all necessary components
  • If you need to clarify strength or formulation on a hardcopy, include a complete clinical note with the date, name and title of the person you spoke with, what was clarified, and your initials
  • Coach staff members who are able to take telephone prescriptions, transferred prescriptions, or voicemail messages of including all hardcopy components
  • Consider ordering telephone and transfer prescription pads which include all necessary components to meet PBM and state requirements

Meredith Thiede, PharmD