The primary care NP prescribes an inhaled corticosteroid for a patient who has asthma.The third-party payer for this patient denies coverage for the brand that comes in the specific strength the NP prescribes.The NP should:

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The second step of medical decision making takes into account benefits versus costs along with an understanding that it is impossible to do everything because of limited resources.The NP should prescribe what is covered and evaluate its effectiveness; if it does not work,the third-party payer may be approached about the need for the other medication.Providing samples is not always possible,and this practice is being discouraged,so it is not a viable solution.Asking patients to pay out of pocket ultimately may be necessary but carries risks that the patient will not obtain the medication.Writing a letter of medical necessity may be indicated if the available drugs are not effective but is not the initial step.

The Primary Care NP Prescribes an Inhaled Corticosteroid for a Patient