Re: Rx entering Q...can anyone help??

[Guest guest]

For question 1, there is no real set answer. I tend to work as 1 gram

per dose, but if it's a large area (and the techs are from time to

time asking how large of an area is being treated, if there's not a

specific size listed, and it just says #1 tube), then that may be

increased.

But as a basic 'rule', if a Dr writes for " Apply to affected area two

times a day. " and writes for a 15 gram tube, I'll put a week supply on

it. That doesn't mean we don't come up with wrong estimates.

As far as for question 2, if you look at the math as:

Days 1 - 7: 1 po qhs = 7 capsules

Days 8 - 14: 2 po qhs = 14 capsules

Days 15 - 30: 3 po qhs = 48 capsules

7 + 14 + 48 = 69 actually. But still pretty close for the 1st month.

For subsequent months, the patient may take up to 3 po qhs, so might

take up to 90 capsules a month. So to keep the numbers even for

future fills, s/he just had a second prescription put on file for the

#90, and since there were 5 refills on the original, then the 2nd

would be #90 + 4 (to total 5 refills).

I've done things like this with the Chantix Starter (11 tabs of 0.5mg,

42 tabs of 1mg) vs Continuing Packs (56 tabs of 1 mg).

Sometimes for sanity sake (for the future) it's easier to split prescriptions.

As far as why and when, the techs might ask, or I might just add it

when it comes to me at 4point. There's not necessarily a hard and

fast rule.

Della, RPh

On 4/7/07, hazel1z <hazel1z@...> wrote:

> Hi everyone,

>

> Two questions:

>

> 1. What's a good rule of thumb to estimate the days supply of a cream

> or ointment, given the directions and quantity?

>

> 2. Here's something I ran into at work. I'm hoping someone can shed

> light on this.

>

> The Rx is for nortriptyline Quantity 90. Sig: 1 qhs x 7, then can

> increase by 1 q 7 days to max of 3 tablets qhs. Refills: 5.

>

> I was told to enter Quantity 63 for 30 day supply on the first fill

> of this Rx. Then to put this Rx on file with Quantity 90 and 4

> refills.

>

> Does anyone know why the Quantity on the first fill was 63, and 90

> for the next 4 fills? How do you know when to enter the Rx like this

> instead of entering it as you normally would?

>

> Any ideas??

>

[Guest guest]

Dear hazeliz,

Here is my calculationof question #2:

7 the first week, 14 the second week and 21 week 3 and + 21 on week 4

Total 7 + 14 + 21 + 21 = 9 x 7 = 63

Hope this helps. Let me know if you still need help with this.

Lets see what the RETAIL TEXPERTS have to sa abot a cream or ointment.

Respectfully,

Jeanetta Mastron CPhT BS

Pharm Tech Educator

Founder/Owner of this site

>

> Hi everyone,

>

> Two questions:

>

> 1. What's a good rule of thumb to estimate the days supply of a cream

> or ointment, given the directions and quantity?

>

> 2. Here's something I ran into at work. I'm hoping someone can shed

> light on this.

>

> The Rx is for nortriptyline Quantity 90. Sig: 1 qhs x 7, then can

> increase by 1 q 7 days to max of 3 tablets qhs. Refills: 5.

>

> I was told to enter Quantity 63 for 30 day supply on the first fill

> of this Rx. Then to put this Rx on file with Quantity 90 and 4

> refills.

>

> Does anyone know why the Quantity on the first fill was 63, and 90

> for the next 4 fills? How do you know when to enter the Rx like this

> instead of entering it as you normally would?

>

> Any ideas??

>

[Guest guest]

Thanks Della!

Della is the resident site pharmacist.

I have to aggree that there isno hard fast rule on the ointmentor

cream, but I deferred it because it is more retail and perhaps one did

have a rule of thumb. Much depends upon the refills and the area of

the body to be covered etc. Almost impossible to place a rule as this

would vary person to person and indication to indication.

I agree that the 69 caps makes sense with a 30 day supply and

represents REALITY in the pharmacy, meaning in PRACTICE.

Unfortunately from what I see in many study books when they do the

changes from week to week they tend to use 28 days for one month,

instead of 30. This is HOW I got exactly 63 caps in my post previously.

WHY this problem would change from 28 days to 30 days midstream is

consfusing, especially to the new tech.

What can say is this: The rule of thumb: When an insurance company is

paying for something that is by a month supply then 30 is used.

When they are paying for something by a week supply or by weeks, then

multiples of 7 are used: 7,14, 21, 28, 35, 42 etc. EVEN if that is in

a refill being different than the original fill.

Hope this helps a bit more.

Respectfully,

Jeanetta Mastron CPhT BS

Pharm Tech Educator

TEXPERT

Founder/Owner

> > Hi everyone,

> >

> > Two questions:

> >

> > 1. What's a good rule of thumb to estimate the days supply of a cream

> > or ointment, given the directions and quantity?

> >

> > 2. Here's something I ran into at work. I'm hoping someone can shed

> > light on this.

> >

> > The Rx is for nortriptyline Quantity 90. Sig: 1 qhs x 7, then can

> > increase by 1 q 7 days to max of 3 tablets qhs. Refills: 5.

> >

> > I was told to enter Quantity 63 for 30 day supply on the first fill

> > of this Rx. Then to put this Rx on file with Quantity 90 and 4

> > refills.

> >

> > Does anyone know why the Quantity on the first fill was 63, and 90

> > for the next 4 fills? How do you know when to enter the Rx like this

> > instead of entering it as you normally would?

> >

> > Any ideas??

> >

>

[Guest guest]

By the way this is why BCP come in packs of 21 or 28 not just because

a cycle of one month is considered 28 days but because the person is

off of the drug or taking a placebo for 7 days on for 21 days etc.

Even though it may be ordered as 3 months supply

It will be 3 packs of 21's or 3 paks of 28's not 30's

Jeanetta

> > > Hi everyone,

> > >

> > > Two questions:

> > >

> > > 1. What's a good rule of thumb to estimate the days supply of a

cream

> > > or ointment, given the directions and quantity?

> > >

> > > 2. Here's something I ran into at work. I'm hoping someone can shed

> > > light on this.

> > >

> > > The Rx is for nortriptyline Quantity 90. Sig: 1 qhs x 7, then can

> > > increase by 1 q 7 days to max of 3 tablets qhs. Refills: 5.

> > >

> > > I was told to enter Quantity 63 for 30 day supply on the first fill

> > > of this Rx. Then to put this Rx on file with Quantity 90 and 4

> > > refills.

> > >

> > > Does anyone know why the Quantity on the first fill was 63, and 90

> > > for the next 4 fills? How do you know when to enter the Rx like this

> > > instead of entering it as you normally would?

> > >

> > > Any ideas??

> > >

> >

>

[Guest guest]

True.

Della

On 4/7/07, Jeanetta Mastron CPhT BS Chemistry <rxjm2002@...> wrote:

> By the way this is why BCP come in packs of 21 or 28 not just because

> a cycle of one month is considered 28 days but because the person is

> off of the drug or taking a placebo for 7 days on for 21 days etc.

>

> Even though it may be ordered as 3 months supply

> It will be 3 packs of 21's or 3 paks of 28's not 30's

>

> Jeanetta

>

> > > > Hi everyone,

> > > >

> > > > Two questions:

> > > >

> > > > 1. What's a good rule of thumb to estimate the days supply of a

> cream

> > > > or ointment, given the directions and quantity?

> > > >

> > > > 2. Here's something I ran into at work. I'm hoping someone can shed

> > > > light on this.

> > > >

> > > > The Rx is for nortriptyline Quantity 90. Sig: 1 qhs x 7, then can

> > > > increase by 1 q 7 days to max of 3 tablets qhs. Refills: 5.

> > > >

> > > > I was told to enter Quantity 63 for 30 day supply on the first fill

> > > > of this Rx. Then to put this Rx on file with Quantity 90 and 4

> > > > refills.

> > > >

> > > > Does anyone know why the Quantity on the first fill was 63, and 90

> > > > for the next 4 fills? How do you know when to enter the Rx like this

> > > > instead of entering it as you normally would?

> > > >

> > > > Any ideas??

> > > >

> > >

> >

>

>

>

>

>

>

[Guest guest]

Hi Hazel,

If you take the directions the md wrote and fill the rx for a 1 month supply

(which is what most insurance companies cover) you come up with the following:

1 qhs x7 week 1 = 7 (+)

2 qhs x7 week 2 = 14 (+)

3 qhs x7 week 3 = 21 (+)

3 qhs x9 week 4 = (27) based on a 30 day month which is what I think the md

wanted since the quantity of the following refills will be #90 3 qhs. Entering

a quantity of 63 will give you a 28 day supply so that may have been a

difference in semantics as to what constitutes a month supply.

The reasoning behind re-writing the rx and putting the refills on hold comes

down to an insurance/customer service issue. The original rx was written with

the increasing dose directions eventually having the patient take 3 capsules at

bedtime. It was written for #90 with 4 refills so counting the first fill the

patient was given an rx written for a quantity of #450 capsules. If you fill it

the first time with the tapered up directions you gave the patient (for sake of

argument) 63 capsules. Subtract that from the #450 original quantity and you

are left with #387. Now subtract #90 from that for each subsequent fill:

1st refill = 297 left

2nd refill = 207 left

3rd refill = 117 left

4th refill = 27 left

Now the patient comes in for the last refill and they only have 27 capsules left

- enough for only 7 days. And the arguments start, they don't understand why

there isn't a whole month refill left, why am I paying my full copay for only a

weeks worth of pills, etc.

So to save yourself time energy aggravation whatever, you fill the first fill

the way you did and put the rest on hold as a new prescription.

Been there too many times,

--

Life should not be a journey to the grave with the intention of arriving safely

in an attractive and well-preserved body, but rather to skid in sideways,

champagne in one hand, strawberries in the other, body thoroughly used up,

totally worn out and screaming " WOO HOO - what a ride! "

-------------- Original message --------------

From: " hazel1z " <hazel1z@...>

Hi everyone,

Two questions:

1. What's a good rule of thumb to estimate the days supply of a cream

or ointment, given the directions and quantity?

2. Here's something I ran into at work. I'm hoping someone can shed

light on this.

The Rx is for nortriptyline Quantity 90. Sig: 1 qhs x 7, then can

increase by 1 q 7 days to max of 3 tablets qhs. Refills: 5.

I was told to enter Quantity 63 for 30 day supply on the first fill

of this Rx. Then to put this Rx on file with Quantity 90 and 4

refills.

Does anyone know why the Quantity on the first fill was 63, and 90

for the next 4 fills? How do you know when to enter the Rx like this

instead of entering it as you normally would?

Any ideas??

[Guest guest]

Thanks for the responses everyone! That clarified it.

>

> Hi Hazel,

>

> If you take the directions the md wrote and fill the rx for a 1

month supply (which is what most insurance companies cover) you come

up with the following:

>

> 1 qhs x7 week 1 = 7 (+)

> 2 qhs x7 week 2 = 14 (+)

> 3 qhs x7 week 3 = 21 (+)

> 3 qhs x9 week 4 = (27) based on a 30 day month which is what I

think the md wanted since the quantity of the following refills will

be #90 3 qhs. Entering a quantity of 63 will give you a 28 day

supply so that may have been a difference in semantics as to what

constitutes a month supply.

>

> The reasoning behind re-writing the rx and putting the refills on

hold comes down to an insurance/customer service issue. The original

rx was written with the increasing dose directions eventually having

the patient take 3 capsules at bedtime. It was written for #90 with

4 refills so counting the first fill the patient was given an rx

written for a quantity of #450 capsules. If you fill it the first

time with the tapered up directions you gave the patient (for sake of

argument) 63 capsules. Subtract that from the #450 original quantity

and you are left with #387. Now subtract #90 from that for each

subsequent fill:

>

> 1st refill = 297 left

> 2nd refill = 207 left

> 3rd refill = 117 left

> 4th refill = 27 left

>

> Now the patient comes in for the last refill and they only have 27

capsules left - enough for only 7 days. And the arguments start,

they don't understand why there isn't a whole month refill left, why

am I paying my full copay for only a weeks worth of pills, etc.

>

> So to save yourself time energy aggravation whatever, you fill the

first fill the way you did and put the rest on hold as a new

prescription.

>

> Been there too many times,

>

>

>

>

> --

> Life should not be a journey to the grave with the intention of

arriving safely in an attractive and well-preserved body, but rather

to skid in sideways, champagne in one hand, strawberries in the

other, body thoroughly used up, totally worn out and screaming " WOO

HOO - what a ride! "

>

> -------------- Original message --------------

> From: " hazel1z " <hazel1z@...>

> Hi everyone,

>

> Two questions:

>

> 1. What's a good rule of thumb to estimate the days supply of a

cream

> or ointment, given the directions and quantity?

>

> 2. Here's something I ran into at work. I'm hoping someone can shed

> light on this.

>

> The Rx is for nortriptyline Quantity 90. Sig: 1 qhs x 7, then can

> increase by 1 q 7 days to max of 3 tablets qhs. Refills: 5.

>

> I was told to enter Quantity 63 for 30 day supply on the first fill

> of this Rx. Then to put this Rx on file with Quantity 90 and 4

> refills.

>

> Does anyone know why the Quantity on the first fill was 63, and 90

> for the next 4 fills? How do you know when to enter the Rx like

this

> instead of entering it as you normally would?

>

> Any ideas??

>

>

>

>

>

[Guest guest]

THANK YOU Hazel1z, for such a great challenge on such a great question!

We need more on the job real world type questions so please feel free

to print more!

Jeanetta Mastron CPhT BS

F/O

>

> Thanks for the responses everyone! That clarified it.

>

>

>