What Do Bowel Preps, EpiPen®, and Migraine Medications Have in Common?

Prescriptions for medications whose dosing is standardized in the industry often come with directions that simply state, “Use as directed.” These types of products typically have the standard dosing right on the package being dispensed to the patient like bowel preps for colonoscopy, EpiPen®, starter dose kits (e.g., Eliquis® 30-Day Starter Pack), and dose packs (e.g., Medrol® DosepakTM). Similarly, migraine rescue medications, insulin with a sliding scale, and topical medications tend to be generically written with directions that have no mathematical way to calculate the days’ supply.

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directions specific for the individual patient and those directions should be mathematically calculable to bill a proper days’ supply. Directions that come over as “Use as directed” should always be clarified with the prescriber as to whether or not the patient is to “use as directed per package instructions” in addition to updating the patient label directions accordingly. Medications that can be repeated after a certain amount of time (e.g., EpiPen®, migraine medications, Nitrostat®, and Diastat®) will need that information noted in the directions in order to include the additional dose(s) in the days’ supply calculation. Insulin with a sliding scale or topical medications should include maximum daily dose information in the directions and on the patient label.

PAAS Tips:

  • ALWAYS clarify “Use as directed” or “as needed” directions.
  • Clarify starter kits, dose packs, and bowel preps as “Use as directed per package” or with specific directions.
  • Migraine rescue medications should have the maximum number of tablets allowed per day, per week, or per month clarified with the prescriber. Check out the December 2021 Newsline article, Self-Audit Series #11 – Migraine Prescriptions to read more.
  • Topical medications should have mathematically calculable directions. See the November 2021 Newsline article, Calculating the Incalculable – Your Math Teacher Was Right (Show Your Math) for more.
  • Insulin with sliding scale directions should have maximum units per day listed.
  • Any clarification made to the directions needs to be documented with a clinical note AND be on the patient label directions.

Jenevra Azzopardi, CPhT
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