Essential Prescription Elements for Insulin Pump Refills
Your prescription needs to include the total daily dose (TDD) or a specific quantity with days' supply, plus explicit authorization for pump use, to ensure the pharmacy dispenses adequate insulin for continuous subcutaneous infusion.
Critical Missing Information
Your current prescription lacks the following pharmacy-required elements:
1. Quantity and Days' Supply
- Specify the total quantity in mL or units (e.g., "30 mL" or "3,000 units") 1
- Include days' supply (e.g., "30-day supply") to meet insurance and pharmacy dispensing requirements 1
- Most pump users require 1-3 vials (10 mL each) per month depending on total daily insulin dose 1
2. Explicit Pump Authorization
- State "For use in insulin pump (continuous subcutaneous insulin infusion)" 1
- The FDA label specifically approves NovoLog for continuous subcutaneous infusion through insulin pumps, but this must be clearly documented 1
- Without explicit pump indication, pharmacies may question the large quantities typically needed for pump therapy 1
3. Refill Information
- Specify number of refills (e.g., "11 refills" for one year of therapy) 1
- This prevents gaps in therapy that could lead to diabetic ketoacidosis 1
Recommended Prescription Format
NovoLog U-100 (insulin aspart) 100 units/mL subcutaneous solution
- Indication: For continuous subcutaneous insulin infusion via insulin pump
- Dose: Per patient's individualized pump settings (basal rates, carbohydrate ratios, correction factors)
- Quantity: [Insert total mL needed, typically 30 mL for 30 days]
- Days' Supply: 30 days
- Refills: 11
- Instructions: Administer via insulin pump according to programmed basal and bolus settings. Change infusion set every 2-3 days per pump manufacturer guidelines.
Important Pump-Specific Considerations
Storage and Handling for Pumps
- Opened vials used in pumps must be discarded after 19 days (not 28 days like injected insulin) 1
- This shorter timeframe accounts for the insulin being at body temperature in the pump reservoir 1
- Document this on the prescription to ensure adequate supply
Site Rotation Documentation
- While not required for pharmacy dispensing, the FDA label emphasizes rotating insertion sites to prevent lipodystrophy and localized cutaneous amyloidosis 1
- Consider documenting "rotate insertion sites with each infusion set change" for patient safety 1
Common Pitfalls to Avoid
- Don't write "as directed" without specifying pump use—pharmacies need explicit authorization for the quantities required 1
- Don't forget the 19-day expiration rule for pump insulin—this may require more frequent refills than anticipated 1
- Don't omit the concentration (U-100)—this is critical for pump programming and patient safety 1, 2
Insurance Considerations
- Many insurance plans require prior authorization for pump supplies and insulin quantities exceeding typical injection amounts 1
- Including diagnosis code (E10.65 for Type 1 diabetes with hyperglycemia on insulin pump) may facilitate approval 3
The key difference between pump and injection prescriptions is the larger quantity needed (pumps deliver insulin 24/7) and the specific FDA-approved indication for continuous subcutaneous infusion that must be documented 1.