See, this is where it pays to have a pharmacist who's looking out for your best interests, rather than the chain's. (Or, I should say, rather than just the chains; that's his job, after all.)
I've had patients taking, for example, synthroid, who needed a dose in between what is readily available. Patient had titrated out at 225mcg, which isn't commercially available, so they were getting a 200 and a 25, and paying 2 copays. I suggested to the doctor that they just give him the 112mcg and tell him to take two of them, and thereby get 60 tabs for one copay instead.
(Or, I had to go the other way recently. Patient on Concerta, needed 72mg, so the doctor wrote for 36mg, take 2 tabs daily, dispense #60. Insurance says they're only paying for 30 per fill. This means he's going to run out after only 15 days, and as a C-II you can't give a refill, so he needs to get a new prescription every 15 days now. I suggested he get a 54mg and an 18mg, adds up to the same 72mg, and yes he'll have 2 copays now, but at least he doesn't have to keep getting new Rxs every two weeks.)
I've had patients taking, for example, synthroid, who needed a dose in between what is readily available. Patient had titrated out at 225mcg, which isn't commercially available, so they were getting a 200 and a 25, and paying 2 copays. I suggested to the doctor that they just give him the 112mcg and tell him to take two of them, and thereby get 60 tabs for one copay instead.
(Or, I had to go the other way recently. Patient on Concerta, needed 72mg, so the doctor wrote for 36mg, take 2 tabs daily, dispense #60. Insurance says they're only paying for 30 per fill. This means he's going to run out after only 15 days, and as a C-II you can't give a refill, so he needs to get a new prescription every 15 days now. I suggested he get a 54mg and an 18mg, adds up to the same 72mg, and yes he'll have 2 copays now, but at least he doesn't have to keep getting new Rxs every two weeks.)
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