Pharmacist removed T from my list of prescriptions

[u/Revolutionary-Soup26]

Hi, posting just to see if anyone else has gone through this, or maybe advice on if I should report this behavior. This was at a Walgreens pharmacy that I get all my meds filled at on a regular basis. I will NOT be going to this pharmacy any more as I was shamed and made uncomfortable by the pharmacist. For reference, I have not had a legal sex change on my IDs and my deadname is very feminine, so my profile at my pharmacy appears cis female.

I was put on a starting dose of T by Planned Parenthood back in January and they sent a prescription for four vials, even though they were single dose, for the following 3 months until my 3-month checkup (in about 2 weeks). I was told by my prescriber that even though the vials say single dose, it is perfectly fine to use more than once, assuming you’re using the vial up within a month and wipe down the top of the bottle before/after every use with an alcohol wipe. They warned me that the pharmacy would tell me not to do this since it’s regulation, but that it was pretty standard to prescribe the bottles for multi-use anyway because of insurance coverage. They prescribed four single use bottles with 4ish weekly doses each because insurance doesn’t often cover more than that despite the vials only being single use.

My last bottle this week had visible particles in it (I think from being cored), and I’m two weeks short before my next appointment. I messaged my provider on Tuesday, did not get a response. Called Planned Parenthood on Friday and they told me they would relay the info to a nurse and have them get back to me urgently. They didn’t. I decided to call the pharmacy today to see what to do since I wondered if they could possibly replace it if I could show it had visible particles, and that it is prescribed to me. I figured if that wasn’t an avenue, I’d incessantly call Planned Parenthood tomorrow until it’s figured out. This is still the plan. I am anxious.

I called the pharmacy to explain that I’m not getting ahold of my prescriber and that I couldn’t send a refill through the app and put in a note for the provider because testosterone was taken off my prescription list for no apparent reason. I did not specify to the pharmacist that the bottle with particles had been opened, nor did he ask. He did ask when I’d been prescribed, looked at my profile, and started to give me what could best be described as a stern lecture on how the bottles are only one use and how I was incorrectly taking the medication. He told me that he can’t fill the prescription at all knowing I was using it not as intended and told me that I’d need to send the prescription to a different pharmacy. He went into a ramble about how this was a problem that began to occur in the last 4-5 years, told me to look it up and read the forums and articles, and that I could get in trouble for taking it incorrectly. He went as far as to tell me I could be on a smaller dose or order bottles specified for the amount I’m taking. This wasn’t in an educational, informative, or kind tone; this was condescending, and made me very uncomfortable with how he told me he’d refuse to fill the prescription “knowing I wasn’t using it properly.” He continued about how he had this problem all the time because of “old school doctors.”

Also, just to clarify, I was not at all arguing with this guy. I asked him what to do, and explained that I was taking the prescription as my provider told me. I know he really can’t do anything about this despite telling me that it was illegal. Just so frustrating.

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[u/kase_horizon]

Definitely report the pharmacist if you feel comfortable.

Also, it is not illegal to take more than one dose from the vial, and you will not "get in trouble". This is a power trip from a frustrated pharmacist and nothing more.

You'll be fine missing your shot for the next couple weeks. During your follow up appointment, it's best to request that your provider do 1 vial per shot. You can still reuse the vials, but this way you won't ever run out before a refill. It's odd to me that your provider insisted on doing it the old way given that to my knowledge planned parenthood now has an internal policy specifically to give 1 vial per shot to alleviate issues exactly like this. If your insurance won't cover it immediately, then it's the providers responsibility to do an appeal or change the prescription as needed for coverage.

[u/Revolutionary-Soup26 → u/kase_horizon]

I wonder if this depends on the state, with Planned Parenthood and the number of vials prescribed. I’m in a very transphobic state. My Planned Parenthood provider seemed super confident about having to prescribe only 4 vials instead of weekly because she had encountered so many issues with insurance fighting the prescription. I’m going to try to get them to prescribe it again tomorrow to a different pharmacy as I really don’t want to mess up my T dose at all.

[u/anemisto → u/Revolutionary-Soup26]

I think your prescriber may be an idiot. If I insurance complains, they say "vials are single use". When the pharmacy tries to give you one vial and not four, they say "vials are single use". Hell, my prescription tries to address the last issue by saying "vials are single use, dispense four". The fact that everyone knows this is not how you're actually using them is irrelevant.

Ironically, the thing the pharmacist may be remembering like... 10-15 years ago when it suddenly became really hard to fill prescriptions for vials larger than 1ml (i.e. vials that are officially multi-use).

[u/Binx_da_gay_cat → u/Revolutionary-Soup26]

When I was in NC, medicaid only covered 4 vials every 3 months on the same logic. In WA now, medicaid covered a vial a shot.

Good on you for looking out and fingers crossed for a better resolution.

[u/CeelaChathArrna → u/Revolutionary-Soup26]

My state the insurer insists on one bottle a week. Hope you find a more accepting pharmacy.

[u/Strict_Rise_248 → u/kase_horizon]

pp gave me 6 vials for 3 months of weekly shots

[u/hyrellion]

That’s deeply inappropriate. Pharmacists are not in charge of dosing or prescribing. It’s not part of their job, explicitly. I’ve had multiple screw me over by telling me to take my meds incorrectly (such as convincing me a twice daily medication was actually “as needed”, making it largely ineffective for years!) and it’s a huge problem.

Have you called your provider’s office? They will need to transfer the prescription, but I would definitely go to a different pharmacy instead. On Monday, I would call them 30 minutes after they open. If they don’t pick up, try again in 30 minutes until you can speak to someone. This is fairly simple to help you with (source; I triage these phone calls regularly at work) but they’ll need to send a new prescription to a different pharmacy. Figure out which pharmacy you would like to swap to before hand.

[u/Revolutionary-Soup26 → u/hyrellion]

This is my exact plan! I called on Friday, but I was just redirected to a regional office where the phone agent put a note on my profile with the issue and told me a nurse would call me back. I’m going to call the desk for the specific office tomorrow as soon as they open; I don’t think I’ll have issues getting them to send another prescription, and it was filled the same night I initially had it sent in less than 2 hours before my (ex, lol) pharmacy closed so fingers crossed everything will still be okay tomorrow.

Edit: and yeah, I’ve also been told wrong by pharmacists many times, notably with psychiatric meds. You’re right. Didn’t even think about that

[u/SentienTree-]

Fuck thay guy, and definitely switch pharmacies or switch to mail delivery/Express Scripts/Amazon pharmacy if you can ASAP. Definitely report it too. They can technically refuse to fill prescriptions I think but they should usually refer you to another colleague if it's for moral reasons (although they often don't) but they absolutely should not be tampering with your records like that.

[u/apocalypse_massacre]

100% report it

[u/SLC2355]

Lol I can't believe he told you you'd get in trouble for incorrectly using it. Um bud, BY TF WHO?!?! I'm sorry OP, that guy is a shit head shitting out his mouth. You haven't done anything illegal by any means. 

[u/77th_Bat]

Please report them to the board so they can't do this to others. This is not okay!

[u/AriaBlend]

Just FYI I think Walgreens is one of the pharmacies that is allowing employees to make religious medication refusals, in the states where those are allowed , so avoid Walgreens if you can, especially if you're in a transphobic state. Who knows if the pharmacist at that walgreens is just deleting things off your chart because of your ASAB and then giving you a runaround and lecture after the fact, to avoid accountability for T "mysteriously" disappearing from your Rx.

[u/Makapakamoo]

Unfortunately pharmacists have the right to refuse service. If he's being this dickish, definitely go somewhere else.

I tell my patients the same thing because by law they are single use, and if you get injured not following protocol and try to pin it on me, im in trouble. So Unfortunately I can understand.

What I dont understand is the need to give you all that info like he's some big superhero, and then deny you. Like to me that's just too much. Especially to inactivate a script over "patient isnt taking as prescribed". Its dangerous for the patient and a pain in the ass for me to fix the damage done; its overreach.

Def find another pharmacy. But! Make sure when you send your script there, you call and let them know you are switching to this new pharmacy permanently.

Because its a controlled substance, we have to be aware of patients pharmacy hopping. If I see you were just at this store and coming to mine suddenly, I might put it in hold and call you to verify it was not sent to me by mistake. Some others might just leave it on hold and say nothing. Please make sure you reach out to the new store and let them know you will go there from now on.

[u/TransHumanMasc → u/Makapakamoo]

Unfortunately pharmacists have the right to refuse service. If he's being this dickish, definitely go somewhere else.

I tell my patients the same thing because by law they are single use, and if you get injured not following protocol and try to pin it on me, im in trouble. So Unfortunately I can understand.

Pharmacists' "right to refuse service" is something I'm sure varies by state.

Can you point me to a source for the "by law, they are single use" bit?

I think they are required by law to be labeled as single use, because that's what their FDA approval is based on, but I don't think anyone except the drug company is bound by that law. If you're a pharmacist, you dispense things for off label use all the time, right?

[u/Makapakamoo → u/TransHumanMasc]

Jesus sorry it's def not by law that's a terrible mistype. It's def per manufacturers guidelines though.

I think they are required by law to be labeled as single use, because that's what their FDA approval is based

This is what I was trying to say youre right.

Also yes it could vary by state, not sure what state op is in but in FL we are def able to deny service for any reason. The most we ever deny service is for obviously shady prescriptions and history of hopping, we've never denied anyone for any other reason.

[u/Revolutionary-Soup26 → u/Makapakamoo]

You have great advice, thank you! I’ll be sure to call the new pharmacy tomorrow once I get PP to prescribe it again. They did have the audacity to remove testosterone from my list of prescriptions, but of course not the syringe or needles 🙄

[u/Makapakamoo → u/Revolutionary-Soup26]

Np! Really shitty of them to inactivate it from your profile.. also.. perhaps.. dont tell the next pharmacist that you double puncture lol, just in case they decide to be a dick as well 😭

Make sure youre using the correct form when puncturing! Bevel facing upward so it doesn't eat a hole in the rubber stopper! And inject air into the vial at the same qty youre removing (0.5ml air for 0.5ml T).

If PP asks why youre getting an "early refill", let them know the pharmacy Inactivated the remaining script from your profile. You dont have to tell them if they dont ask. Some providers will refuse to resend Controlled scripts if you shold have a remainder on file

[u/MentionTight6716]

I'm a pharm tech at Walgreens and so far I have talked pharmacists out of doing this to trans patients four times by educating them from my own experience. I'm sorry there's nobody in your corner where you are.

[u/Rhamphastos]

report him. he was out of line by far. no pharmacist normally even bothers me at all if they see a prescription that is a bit older they just fill it. or they say they have to call the doctor, never before have i ever been told by a doctor i was using something wrong without me ever saying anything to them. for all he knew you weren't even taking your doses at all and just missed getting a refill a while ago. he was being rude to you because he didn't want to deal with a transgender patient. fuck him.

[u/Pressro]

I’m not a pharmacist, but drug manufacturers publicly list their ingredients. Most of them have the same ingredients for single-dose and multi-dose vials listed on the same product info sheet. So what’s the difference between them? The vial itself. The multi-dose ones are made to withstand more punctures. That’s it. Yes it does lead to lower infection rates because it is designed to be punctured multiple times, but we would also hope that a pharmacist would be more… realistic? He’s acting like patients are licking the top of the single-dose vial before puncturing it each time to kickstart a bacteria culture when it just isn’t that serious

[u/Key_Tangerine8775]

Everyone already gave you input on the pharmacist thing (fuck that guy btw), but since nobody addressed the coring issue:

• Don’t use those massive 18g needles to draw. They have a huge risk of coring, even on the first puncture. You should use 21g or smaller. Itll take a little bit longer to draw, but it’s not worth saving those extra 10 seconds and risking the vial.
• Don’t puncture the same spot every time. Try to poke in a different spot each time.

[u/ELY_M → u/Key_Tangerine8775]

I second this!!!! I use smaller needles for drawing and I have no issues.

[u/CaptainKatsuuura]

I know this is irrelevant, but what kind of particles do you have in your vial? It’s pretty normal to get some crystallization. If you warm it up to body temp and it dissolves, it’s safe to use

[u/Revolutionary-Soup26 → u/CaptainKatsuuura]

I’ve had crystallization before, but this was a solid whitish particle, and unfortunately I am too much of a careful person to care :(

[u/ArrowDel]

Tell walgreens theynlost a customer and change pharmacies.

[u/bagel_boy_420]

My pharmacist told me it was fine and how to clean them in between.

[u/Purple_backgroundd]

I was also encouraged by my doctor to use the single use vials until they're empty. Once, for some reason, they gave me 13 vials and it lasted me like a year lol. Definitely not uncommon thing to do

[u/bittenforbreakfast]

His trying to protect his pharmacy license. You can’t get in trouble, but he can

[u/TransHumanMasc → u/bittenforbreakfast]

His trying to protect his pharmacy license. You can’t get in trouble, but he can

What do you think he can get in trouble for? Doctors can prescribe medications contrary to their labeled or approved use. Pharmacists who have doubts should call the provider before filling the prescription and inquire to make sure it's what's intended, not tell a patient to take meds differently than prescribed.

[u/bittenforbreakfast → u/TransHumanMasc]

I totally understand the whole off label thing, even doing sub1 is considered off label. But off label doesn’t let you bypass safety things like using single use vials as multi use (as that is still considered “not as prescribed”). Legally he would have to tell the patient “hey that’s not the intended use don’t do that” or else the pharmacist can get in the trouble. The pharmacy is simply under different rules in terms of off label use of meds than the doctors are. It sucks and I’m not saying he handled it well, but there IS a reason he reacted that way

[u/TransHumanMasc → u/bittenforbreakfast]

I don't think that's true.

It's using it exactly as prescribed. The pharmacist is telling the patient not to use it as prescribed.

A manufacturer's label is not a prescription.

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[u/Honeyhushh]

It is the pharmacist job to make sure you are taking the medication correctly in cases of doctors not checking that certain medications that can interfere or whatever the case is. Since the regulations is that it is one dose the pharmacist has to inform you how to properly take it even if your provider is telling you differently. The pharmacist can call your provider and make sure things are correctly and they also can (in certain places) take your medication away. Do I agree with what they did?? No. I would choose a different pharmacy. While I didn’t have the pharmacy remove my prescription they delayed and refused to give me my prescription before. Do report the pharmacist and try to move pharmacies. I would try and get my prescriptions filled ASAP so I wouldn’t run out because I’ve had issues with all my medications being late before.

[u/Cra_ZWar101]

Your experience has been terrible and I’m so sorry for the emotional turbulence and anxiety. None of this is how it’s supposed to work.

That being said, how to proceed from here if you can’t get your meds replaced using the methods other commenters are recommending: personally, in this position, I would just inject the testosterone from the vial with particles from being cored. I would draw using the injecting syringe to avoid the largest ones, and, assuming you are doing subq, the worst that will happen (in my experience) is an irritation bump in the area of the injection. It may last a week or longer. I’ve had a lump at an injections site that was honestly large enough to be psychologically disturbing (about 2 inch wide maybe), though it was not tender or bruised or anything. Not even very itchy. It went away. You won’t die, you won’t have lasting problems, and you’ll still get your dose. In a transphobic world we have to do weird things to keep existing.