An update on splitting insulin pen boxes

This guest post giving us an update on the back-and-forth with splitting insulin pen boxes is written by Megumi Howard. She is a licensed pharmacist in Japan and is currently in her last year of pharmacy school at Nova Southeastern University. Take it away Megumi!

Splitting insulin boxes has been an extremely confusing topic for community pharmacists. Before all this confusion started, insulin pens were dispensed based on how many pens would last for the corresponding days’ supply allowed by each patient's plan limitation.

When plan limitations were exceeded, pharmacies had to break up insulin boxes to provide the appropriate quantity or adjust the days’ supply to not break boxes. Pharmacies had different policies and procedures in place (or none at all) for how to handle this situation, leading to variation in practice.

After Walgreens was accused of fraud for falsely understating the days’ supply and reached a $269.2 million settlement, retail pharmacies quickly rewrote their policies and started breaking boxes to dispense a more accurate quantity of insulin. By the time we thought the argument was settled, the FDA decided to jump in and stir the situation up even more by requesting not to break insulin boxes for safety purposes.

So where does all this leave us?

First, let’s go through the timeline of events so you can get the full background.