There’s actually a specific set of federal regulations regarding how prescriptions are written and filled.
http://www.medicare.gov/regulations/pharmacy_guidelines_example.pdfArticle 15 provides a breakdown of how this works.
Article 15.a
(1) Unless the doctor specifies otherwise on the prescription, the pharmacy can issue a single
original package of the lowest strength medication available.
(2) If a pharmacy doesn't have the exact medication prescribed, they are required to get it in
for the patient within 3 days at the latest, or ensure the patient can pick it up at another pharmacy.
(3) For refillable prescriptions, the medication is usually dispensed at the same pharmacy, unless it’s an
e-prescription, in which case the patient can go to any participating pharmacy.
(4) As an exception to Article 15, sections 1 and 2, if a pharmacy—during
the first fill or a refill of a recurring prescription—doesn't have the specific
brand in stock due to a shortage in the United States, the pharmacist has the right, without needing to
check with the prescribing doctor first, to provide the patient with a generic version of the same type at an equal or lower price from the approved list,
provided the doctor didn't explicitly write "no substitutions" on the script, and provided that
the patient agrees to the switch.
(5) When such a substitution happens under section 4, the pharmacist is required to note it on the prescription during
the initial fill, or update the electronic record for refills of
recurring prescriptions.
(6) If the patient refuses the generic alternative, the pharmacist will, during the initial fill,
return the prescription and send the patient back to their doctor to get a different one; for an e-prescription,
they'll direct the patient back to the doctor who issued the electronic order. If a patient
refuses the substitute during a refill request for a
recurring prescription, the pharmacist will close out the electronic record and refer the patient back to the
prescribing physician to adjust the prescription accordingly.
(7) If the doctor marks it for "refill..."
Pharmacies have to balance their business operations with keeping customers happy.
Look, it's just not realistic or necessary for a pharmacy to keep every single medication on the list in stock.
They stock what they know they can reliably dispense quickly without having inventory sitting on the shelves for months.
Usually, that means the common stuff doctors prescribe most often, which is easy to have on hand.
Considering how long it takes Medicare to reimburse pharmacies for what they dispense (sometimes up to 300 days!!!!), it’s honestly a miracle pharmacies even stay in business.
Doctors also need to keep an eye on the cost when they're writing these scripts.
Sumamed is definitely one of the pricier macrolides, yet doctors often just write down a generic like Azithromycin (which could be Sandoz or Belupo...) without ever mentioning the price difference to the patient.
When the patient walks into the pharmacy, they feel blindsided, like we're trying to pull a fast one on them.
Luckily, with e-prescriptions, we can show the patient a simplified version.
If they aren't happy with it, we usually just send them back to the doctor so they can work it out.
Patients often end up venting their frustration at the pharmacist while staying perfectly quiet with the doctor.
Then, once they get home and call the doctor, and the doctor says, "Well, that was Sumamed," suddenly everything is fine and they're happy again.
But honestly, it seems to me that the situation mentioned above isn't really about anything shady; it's just standard pharmacy procedure.
Basically, the script says Sumamed, they don't have it, so they offer a generic (per the rules) or tell the patient they'll order it for tomorrow.
That is completely standard practice.
I realize that doesn't make it any less frustrating for the patient, though.
If you suspect anything shady going on with how a pharmacy is running its business, you can file a report with the local Chamber of Commerce, Medicare, or the Department of Health and Human Services...
As for Concor, they’re still manufacturing it, but honestly, shortages happen all the time—and it’s not just with that one drug.
Someone mentioned an alternative AP up above without actually naming which one. Those tend to run out quite often too.
Veli visited the exact same pharmacy three times, so she's moving on now..
It happens to us more often than you'd think: a patient comes in, we don't have what they need, we order it for tomorrow, and then they just never show up. We end up putting the medication back on the shelf because why bother letting it sit there and take up space? Then, three months later, the same person walks in and claims we *never* have it in stock. If they had just come by the next day like they said they would, we'd know they were a regular, and we would've made sure to have it ready for them next month.
