Extended Fills

Extended Fills for Hydroxyurea and Antibiotics

What is the maximum days supply that can be dispensed for a single prescription of antibiotics and hydroxyurea?

Due to efforts by our pharmacy workgroup, a 90-day supply of antibiotics and a 102-day supply of hydroxyurea now may be prescribed and dispensed for children with sickle cell anemia.

What should a provider write on the prescription for an extended fill?

Per members of the pharmacy workgroup, a provider may use the following sig:

• “Dispense entire 3-month (or 102-day) supply"

• “Chronic treatment for Sickle Cell Disease” 

• "Do not reconstitute at the pharmacy, please instruct the patient/caregiver on the reconstitution volume and stability so they may reconstitute at home as needed" (For antibiotics only)

How may hematologists or pharmacist support family education regarding reconstitution?

The pharmacy workgroup has suggested the following process for providers and pharmacists:

1. Prescribing hematologist: Write the extended fill prescription based on the sig “dispense entire 3-month/102-day supply" and "do not reconstitute, patient/caregiver has been instructed to reconstitute as needed."

2. Prescribing hematologist: Empower the patient/family to ask for counseling to support the request for an extended fill.

3. Dispensing pharmacist: Counsel family and demonstrate the reconstitution process.

• If the pharmacy declines the extended fill – the pt/family or provider should reach out to the health plan or our team so that we can identify an accommodating pharmacy.

4. Providers/pharmacists may suggest that patients or families may contact their health plan case manager with questions or for additional education and counseling.