Quantity Written vs Quantity Dispensed – Are You Covered?

when entering the amount prescribed into a pharmacy management system, being careful not to change the amount prescribed to match the quantity being dispensed, unless authorized to do so. Auditors look at the overall quantity authorized by the prescriber, including refills. When the amount dispensed by the pharmacy over the life of the prescription exceeds this, that will result in “unauthorized refills” or “excessive quantity billed”.

Many states allow pharmacists to increase the dispensed quantity on a non-controlled prescription without contacting the prescriber for authorization (e.g., 1 month with 2 refills can be dispensed as 3 months with no refills). Pharmacy management systems also help track the total quantity prescribed to prevent pharmacies from these types of discrepancies, but they’re only as good as the data being inputted.

Pharmacies that dispense insulin pens in the unopened (sealed) carton (which PAAS recommends) can fall into the trap of over dispensing what the prescriber has approved. When a prescription is written for a quantity less than the smallest package size (i.e., 15 mL for insulin pen boxes), any increased amount must be authorized by the prescriber or be taken out of the total refill quantity (in states that allow accelerated/consolidated refills).

 Here is an example: Tresiba^® 100 unit/mL written for 6 mL with 2 refills

1. Pharmacy dispenses a full box (15 mL) to follow FDA guidelines
2. Prescription is refilled 2 additional times
3. Total amount prescribed is 6 mL x 3 = 18 mL
4. Total amount dispensed is 15 mL x 3 = 45 mL
5. Without a complete clinical note authorizing the increase in quantity to 45 mL, the pharmacy over dispensed by 27 mL

Insulin pens are not the only prescriptions to watch, other medications that are dispensed according to package size can also be at risk. See our Dispense in Original Container Chart for medications that may fall into this category.

PAAS Tips:

• Discuss how your pharmacy handles quantity changes with staff, so it is done consistently
• When contacting the prescriber about changing quantities or refills, be sure you document with a complete clinical notation. See our December 2023 Newsline article, Insufficient/Missing Clinical Notes Yield Audit Recoupments
• Be sure your transferred prescription refills are entered appropriately. See our June 2022 Newsline article, Best Practice for Entering Transfers with Partial Refills Remaining
• Self-audit claims by running reports for high-risk products to ensure they have been dispensed appropriately