Pharmacy Filled The Wrong Strength Prescription
The pharmacist discusses what to do if your pharmacy accidentally fills the wrong strength of your prescription.
I transferred my prescription for Cymbalta (duloxetine) 20mg from another pharmacy in September. In December, my MD increased it to 30mg. I received the correct prescription in December but then, on Jan 11, I told the pharmacist I needed a refill on prescription. After 2 days, I realized that the dosage was wrong. When I called the pharmacy, they said they are charging me another co-pay, plus billing my insurance again. The pharmacist said that a new prescription does not supercede an older prescription and they have done nothing wrong. The pharmacist said it is my responsibility to tell them what dosage I want. Is this correct or even ethical?
Situations like this are exactly what pharmacists are for! A pharmacist should notice any change in therapy (such as a change in dose) and discuss, counsel or otherwise alert you to it.
Now, what happened to you is somewhat of a gray area and I don't know the full details of what occurred. Nevertheless, as stated, filling a prescription that is a 'change in dose' from your last certainly should have been noticed by the pharmacist.
In an ideal scenario, the pharmacist (or other pharmacy employee) would have asked you if you wanted to 'de-activate' or 'cancel' the old Cymbalta (duloxetine) prescription from your profile when the new one came in. Prescriptions and their fill history are never truly deleted, but most software programs can at least prevent them from being refilled.
Additionally, when you called and told the pharmacist you needed a refill, they should have noticed two things in your history:
- That you have two different strengths of Cymbalta on your profile.
- That you most recently filled the 30mg strength.
At the very least, when the pharmacist was checking and verifying your prescription, they absolutely should have noticed that this was a change in strength from your prior prescription and made a note to ask you about it or provide counseling regarding it.
Now, there may be an issue with the pharmacy software your pharmacy uses. I unfortunately am not familiar with all of them out there, and I suppose there is a chance that prescription refills are processed through the system immediately, with minimal or no check in regard to your therapy (they will always check to make sure the correct medication is in the appropriately labeled bottle though).
In my experience, even I didn't realize or missed the dose change after looking at your profile, pharmacy software that I am familiar with would have flagged the fact that this most 'recent' prescription was a 'dose change'. I would then have asked/counseled you about said dose change.
In regard to the legal portion of this, pharmacy laws are State specific. Some do have requirements for counseling with any change to a prescription. In New York for example, they require counseling in the case of a 'dose change':
To positively influence patient compliance with medication therapies and to help ensure patient safety, the pharmacy community has strongly supported patient counseling requirements. Leadership within the pharmacy profession worked with the Education Department to develop the counseling requirements that are in place today.
According to rules and regulations affecting the practice of your profession and your professional license, a pharmacist or pharmacy intern must provide counseling:
- Before dispensing a medication to a new patient of the pharmacy
- Before dispensing a new prescription* for an existing patient of the pharmacy
- Every time the dose, strength, route of administration, or directions for use has changed for an existing prescription previously dispensed to an existing patient of the pharmacy.
I don't know if you were offered counseling, or whether or not there are counseling laws in your state, but it would be prudent to look into them.
What To Do From Here
In terms of what to do, I would request to speak with the pharmacy manager or supervising pharmacist to discuss the situation. You should ask:
- Did the pharmacist notice this was a dose change? If not, why?
- Why wasn't I offered counseling regarding a change in dose?
- Why was an older prescription filled instead of my more recently filled one?
There could be more to this situation than I know, which of course could complicate things further. For example, if you told the pharmacist the wrong prescription number by accident, they may have taken that to be what you intended. Nevertheless, they most likely should have confirmed the prescription you were filling based on your history.
If speaking with the supervising or managing pharmacist doesn't get you anywhere, or you are unhappy with the resolution, every State has a Board of Pharmacy that you can contact.
- New York Office of the Professions: Practice Alerts and Guidelines. Accessed 1/14/19