LL is a 16 year old female admitted to our psych emergency ward with suicidal ideation. Her meds prior to admission include:
- Quetiapine 200 mg XR PO QHS (for psychosis)
- Metformin 1000 mg PO BID (for type-2 diabetes)
- Melatonin 15 mg PO QHS (for sleep)
Her metformin was added ~6 months ago due to poor insulin and glucose control likely due to quetiapine, which is known to have metabolic effects. Prior to rounds I discussed the utility of continuing to using quetiapine, despite its metabolic effects, in a patient with type-2 diabetes. The alternatives discussed included aripiprazole. However, in order to have coverage for aripiprazole the patient would either need third party coverage or special authority (citing the metabolic intolerance of quetiapine).
To assess what our next best steps were I called LL’s mom and confirmed that they did have a third party plan. I then called their pharmacy directly and had them confirm if the third party plan would cover the aripiprazole, and to my pleasant surprise it was covered!
During rounds I let the team know, but ensured that they were mindful that if the coverage ever changed she would be a candidate for special authority.
It is during rotations such as this one that I am grateful that I have had some exposure in community pharmacy and am aware of which questions I can ask them directly to help my patient ensure that they receive continuity of care.