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Dispensing the correct quantity of somatropin can be complicated
Roger Selvage 1459

Dispensing the correct quantity of somatropin can be complicated

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Institute for Safe Medication Practices, Horsham, PA

A young child measuring their own height on a chalk-board chart.

Somatropin human growth hormone is available from multiple manufacturers using various brand names (e.g., Genotropin–Pfizer, Humatrope–Eli Lilly, FlexPro–Norditropin, Omnitrope–Novartis, Saizen–EMD Serono, Inc., Zorbtive–EMD Serono, Inc.) and in multiple dosage forms (e.g., pen devices, cartridges to be used with pen devices, vials). The indications for use vary from product to product. This variety of products, indications, and dosage forms can present challenges to specialty pharmacies.

However, these pharmacies face several other challenges related to dispensing these products. They must have a process to calculate and verify the appropriate dose and dosing frequency as well as ensure the correct quantity and days’ supply are dispensed.

Challenges

Most PBMs limit the quantity of medication that a pharmacy can dispense to a maximum of a 30- or 31-day supply. Depending on the patient’s daily dose, this may require dispensing more than one somatropin pen or cartridge. However, the pharmacist must calculate the correct number of pens or cartridges to provide the patient with enough growth hormone for the month without exceeding the 30- or 31-day supply limits.

Sometimes this requires dispensing medication amounts that will cover fewer than 30 or 31 days (e.g., a 23-day supply) since the pharmacy cannot dispense partial volumes from the medication containers and may not be able to split cartons containing multiple cartridges or pen devices.

Another factor pharmacies must manage is whether the patient is receiving six or seven doses per week. For example, if a patient is prescribed FlexPro 10 mg/1.5 mL pens with a dose of 1 mg per day, three pens will last 30 days. If the patient’s dose is 1 mg per day for six days per week, three pens will last 35 days. If the pharmacy cannot bill for a 35-day supply, they may dispense two pens (a 23-day supply). Or the pharmacy could recommend to the provider that the prescription be changed to FlexPro 5 mg/1.5 mL pens, as five pens will last 29 days.

These situations result in additional workload for pharmacists and pharmacy technicians or liaisons as they must contact the provider to suggest different products to maximize the days supply, and then they have to contact the patient more frequently to coordinate refills. And, given the variable quantity often required for these medications, there is an increased risk that the refill call with the patient or actual refill dates will be set incorrectly, potentially leaving patients without medication for days. There is also the potential for increased costs for the patient if they must pay their regular monthly copay but only receive a 23-day supply. Also, if a patient is enrolled with a copay card that has a limited number of charges per year (e.g., 12 charges for 12 months), they will expend all charges before the end of the year if they need more medicine before 30 days. So, at the end of the year, they may need to pay higher out-of-pocket copays.

Takeaways

Evaluate your pharmacy workflow and the potential for errors when dispensing growth hormone products. Leverage technology to help standardize work and calculations. This may be possible within your pharmacy dispensing and/or clinical patient management software platforms. As drug names may be truncated and carton contents difficult to decipher when selecting products during order entry, work with the pharmacy’s dispensing software vendor to provide a hyperlink to images of the product cartons on data entry and verification screens.

Investigate requiring a pharmacist to double check and document all growth hormone dosing calculations. Finally, educate staff on growth hormone challenges and risks. ■

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