Failure to Provide Physician-Ordered HIV Medication Due to Lack of Coordination and Approval
Penalty
Summary
A deficiency occurred when the facility failed to provide a physician-ordered medication, Biktarvy, to a resident diagnosed with HIV, among other conditions such as COPD, osteoporosis, and multiple fractures. The resident's electronic health record and care plans documented the need for Biktarvy, and the physician's order specified daily administration. Despite this, the medication was not available or administered throughout the resident's stay, as evidenced by repeated nursing notes indicating the medication was 'waiting on delivery' or 'on order' for an extended period. The pharmacy received the order for Biktarvy and attempted to process it, but insurance denied coverage. The pharmacy then contacted the facility for payment approval, as the medication cost exceeded the threshold requiring facility authorization. Multiple emails were sent to the facility requesting approval, but the facility did not respond in a timely manner. Administrative staff acknowledged the lack of response and indicated that the process for obtaining pre-approval or alternative funding was not completed prior to the resident's admission, despite being informed by the discharging hospital that grant funding was available to cover the medication. Interviews with facility staff confirmed awareness of the resident's need for Biktarvy and the existence of grant funding, but no action was taken to secure the medication or utilize the available funding. The facility's own medication administration policy required medications to be administered as ordered and for refusals or issues to be documented and communicated, but these procedures were not followed. As a result, the resident did not receive the prescribed HIV medication during their stay.