F0684

D

Failure to Provide Ordered Antiretroviral Medication Due to Cost and Availability Issues

Sebring, Florida Survey Completed on 01-28-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide ordered antiretroviral medication to an immunocompromised resident in accordance with physician orders and the resident’s needs. The resident was admitted and readmitted with diagnoses including an immunocompromised disease, Type 2 diabetes mellitus with hyperglycemia, and major depressive disorder. The Medication Administration Records (MARs) showed an order for Biktarvy 50-200-25 mg once daily starting in October 2025. In October, the MAR reflected code “9” (other/see progress notes) on two days, but the corresponding progress notes were requested and not provided. In November, the MAR documented that Biktarvy was not administered on six separate days, again marked with code “9,” with associated order administration notes indicating the medication was not available.

Progress notes for November documented multiple days when the antiretroviral medication was not given because it was not available at the facility. Nursing staff documented that the resident reported the medication had been ordered and they were waiting for it to arrive, that they were awaiting the resident to bring it from home, and that the resident had been out of the medication due to insurance changes and needed to call the pharmacy for a refill. Additional entries stated the facility was awaiting the resident to bring the medication from home, that the MD was aware, and that delivery was pending per the resident. During this period, the resident reported having had issues with insurance in the past that caused delays and missed doses of his medication.

In interviews, multiple staff members, including LPNs, an RN, the interim DON, and the NHA, stated that the facility did not provide the resident’s Biktarvy because of its high cost and that the resident was responsible for supplying it. One LPN stated the resident went two days in a row without receiving Biktarvy and that the physician told her to put the medication on hold at that time, while also stating that Biktarvy and cancer medications were not provided by the facility due to cost. Another LPN and the RN confirmed that the medication was not available most of the time and that the facility did not pay for it. The interim DON reported that, upon admission, the resident was told he was responsible for the medication because it was too expensive for the facility, and did not confirm that any assistance was provided to help him obtain it. The NHA described a process in which high-cost medications are reviewed for possible alternatives and stated the prior DON decided not to approve this medication. The resident’s physician stated he had been informed the resident did not receive the medication for a week and a couple of days and that he told the facility they had to ensure the resident received it, emphasizing that it was a medication the resident could not go without and had to take every day. The facility reported having no policy for providing antiretroviral medications.