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Discussion in 'Pharmacy' started by atpsynthase, 07.03.12.

  1. atpsynthase

    atpsynthase Protons and Pumps, Baby!

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    SDN Members don't see this ad. (About Ads)
    Interesting article:

    Pharmacists gain too much power under FDA proposal, doctors say

    http://www.mnn.com/health/fitness-w...too-much-power-under-fda-proposal-doctors-say

    A little excerpt for your pleasure:

    "Pharmacists' training is not even close to the comprehensive systematic training of physicians.." -Dr. Robert Orford, God ... I mean MD

    Thoughts?
  2. BenJammin

    BenJammin No Apologies

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    My doctor had one semester of pharmacology, I had six. Who are they to tell us our training is lacking? We may not be able to diagnose but we can treat if given a diagnosis. The AMA is just trying to bully us around and that's easy to do when APhA is as spineless as a jellyfish.
  3. xiphoid2010

    xiphoid2010

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    Did you really expect doctors not to protect their turf? In the end, it's all about the money.
  4. AlPacino

    AlPacino "We Will!" Moderator

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    Sure they are. They are concerned that the money they would be using to buy that "non-covered" drug cold be spent at their office for that monthly checkup.
  5. StevePerry

    StevePerry

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    Oh I guess next you're going to say something outlandish like dentists are even greedier than doctors or that nurses overstep their educational and capable boundaries for the same reason?
  6. confettiflyer

    confettiflyer Unicorn w/ dirty wings

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    AMA is still relevant outside of the state of IL? That's news to me...
  7. pinipig523

    pinipig523 I like my job!

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    Correction - we have 2.

    That said, I will concede pharmacological expertise to pharmacists like you and my wife, but unless you guys are sure about your diagnosis and mode of treatment AND are willing to be liable for your treatment (malpractice insurance), then I'm all for it. But I don't see this as an overall good thing for patients without continuity of care. Who's going to manage their long term cholesterol levels or blood pressure? Do you know the latest studies regarding ideal levels and have you had experience managing them over the long term?

    Not to mention, if you work for a big corporation like Walgreens... They're just going to add this to your list of things to do without reimbursement on your part in addition to the added liability and headache. Like I'm sure many of you are jumping for joy when someone requests a flu shot or a lipid test.
  8. SpecterGT260

    SpecterGT260 Catdoucheus

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    I think the continuing exposure to prescription drugs including the pharmacological basis, effects, mechanisms, and contraindications that appear throughout years 3 and 4 as well as residency and appear in all 3 board exams should count for something.... that said, # semesters spent is a poor metric for expertise. Chiropractors spend 3 semesters on anatomy where we get only 1. Does that make them the better anatomists?
  9. Rx MPLS

    Rx MPLS

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    Weren't you a pharmacy student at one point? If so, how did you feel about the training in each program? I think both pharmacists and medical doctors so often critique each others' training, but so few have experienced both sides that we really don't know the thing we are criticizing.
  10. SpecterGT260

    SpecterGT260 Catdoucheus

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    No. I have never been in pharmacy school. But I am in agreement with you on the later part (ish...... ;))

    It doesnt exactly sit well with me when people say we only get 1 semester of pharmacology. Diagnostics is only half off our job. Developing treatment plans is the other major component and, at least in terms of the board exams which come at years 2, 3, and PGY-1, we are responsible for knowing, and therefore refreshing on, quite a bit about the mechanisms and interactions as well. It is just really inaccuate to assume that we get 1 semester of pharm in 2nd year and then never touch it again. The 1 semester there sets the groundwork for things to come over the next 3 years.
  11. owlegrad

    owlegrad Uncontrollable Sarcasm Machine Staff Member Administrator SDN Senior Moderator

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    Good insight. Thanks for sharing. :thumbup:

    It is nice when people from other professions visit and share some perspective (and reasonable discourse). :)
  12. pinipig523

    pinipig523 I like my job!

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    It's not the pharmacology that I'm concerned about with pharmacists prescribing. It is the lack of training, lack of continuity of care, and the increased liability without reimbursement to the pockets of pharmacists.

    I have 2 pharmacists in the family, my brother and my wife. While they know that albuterol is a beta agonist, I don't think they know the difference between cardiac asthma and asthma exacerbationnand I'm certain they don't even know which way to place the stethoscope into their ears nor where to place on the patient's chest.
  13. SpecterGT260

    SpecterGT260 Catdoucheus

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    see, even having not lived it I am in agreement with you. Pharmacists are an excellent final line of defense for the patient in terms of catching clerical errors, communication errors between pt and multiple physicians, and just plain "eff-ups" on the part of physicians and residents and are also great for patient information. The exposure to drugs in a "non-restricted by specialty" fashion is also a major benefit (as I have been told by a number of attending that their handle on specific treatments outside their scope of practice gets shaky as they focus their practice.

    That said, aside from things like formulations and practice specific education, there is just nothing that a PharmD is exposed to in terms of pharmacology and clinical use of drugs that an MD/DO is not exposed to. The broader scope of clinical exposure for the PharmD isnt really much of an advantage when we are talking about treatment plans because a broader scope will inevitably mean a lack of familiarity with burgeoning treatments within a specialty.
  14. pinipig523

    pinipig523 I like my job!

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    I would be very wary if I were a pharmacist and a wheezer came asking for a refill of their albuterol. My differential would be asthma vs pneumonia vs CHF vs PE. I mean I'M SCARED of these undifferentiated patients... And I've seen thousands of patients! If you're not afraid it's because of only 1 of 2 things - either you're a pro at this or you are severely undertrained to the point where you don't even know where your knowledge gaps lie.

    If I were a pharmacist and I gave an albuterol script... And the patient dropped dead from a massive PE, I'd crap in my pants. That's easily a $1-$5 million dollar lawsuit right there.

    So let's see. You can now prescribe scripts for certain drugs, you get massively increased liability for something you're not trained for... All while a giant like Walgreens reaps the financial benefits without sharing it with the pharmacist (I mean, do they comp you guys for your flu shots, your zoster shots, your lipid panels???) AND at the same time increasing workload??

    You guys actually want that?

    Be my guest. All I know is that my wife will be complaining every time we have dinner.

    "Honey.. I only had 1 tech today and we filled 250 scripts and the tech went on lunch during the busiest time. And I had 4 flu shots. Someone wanted a lipid panel but ordered the wrong one. And then I had 5 patients who wanted me to write scripts for them and I had to quickly do a history and quick physical on them."

    And I'll tell her, just send your patients to me and my ER and don't take the liability of issuing scripts. You already have your plate full already.
    Last edited: 07.05.12
  15. croquemonsieur

    croquemonsieur

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    pharmacists refer people to the emergency room all the time for potential medical emergencies. wheezing is no exception. that wouldn't change just because they could authorize albuterol refills.
  16. BenJammin

    BenJammin No Apologies

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    You attendings are forgetting that not all pharmacists are stuck in a retail store. Would you be opposed to consultant pharmacists who exist only for OTC+, or whatever you want to call them, products? I was trained in school to differentiate PE, pneumonia, CHF, and asthma so that example is bunk in my opinion.

    That being said, why would you guys think we'd man the ship so to speak and not forward emergencies to hospitals or 911? You guys don't know what we're trained to do so who are you to say we can't differentiate GERD from angina? An alarming migraine from a normal migraine? Give us the tools in the form of lab accessibility and we'll show you what we're made of.

    But deep down, I think you guys just don't want to lose business and dollars to us just like you all went crazy at the idea of pharmacists giving immunizations because "we don't have the proper training". Come on, let's get real here.
  17. SpecterGT260

    SpecterGT260 Catdoucheus

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    The ability to identify the bread and butter cases or follow a cookie cutter flow chart for a differential is not exactly what pinipig was getting at.
    I havent really heard too many docs complain about not being able to get people in the door. Far more likely than fearing "losing the dollars", the chance of further poor reimbursement after having to clean up a mess of misdiagnosis and treatment via OTC+. Far and away the complaints I hear from MDs concerning scope of practice is concerned with having to deal with the aftermath of someone practicing outside of their training.
  18. Sparda29

    Sparda29 En Taro Adun Gold Donor

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    This is the most important thing that people gotta be sure about before they go rushing off to the state legislatures to expand the practice.

    Sure for those of us who work in independent pharmacies or own our own pharmacies, it is great. But if I was gonna guess what CVS/Walgreens and the other chains would do, we would not get any bonuses or make any extra money off of each flu shot, lipid test, that you complete.
  19. pinipig523

    pinipig523 I like my job!

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    Let's get 1 thing straight. I dont need your patients to keep the ER door open, in fact, I welcome it.

    Another thing, you think a large firm like Walgreens will reimburse you for this when they don't for everything else you guys do? If they do, hey I'm all for it. My wife's paycheck will go up.

    And you think you have the experience to clinically be concerned about PE vs simple asthma wheezing? When you say you're trained... Did you attend a 4 year residency and completed board exams? Or are you just telling me that you have the knowledge of a 4th year medical student at best?

    You want a lab? To interpret what? Who's going to draw blood? You? And then what happens when the poop hits the fan? Dial 911 so I can clean up your mess? Wheres your triage nurse? Is Walgreens going to pay you for getting their vitals also? All while the numbers in the wait line lengthen?

    I understand not all are in retail. But the point remains, you guys don't have the training yet you want the liability?

    Go ahead. I really don't care. I'm just going to tell my wife to send everyone over.
  20. rxlea

    rxlea Unicorn in training Moderator Emeritus

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    These threads typically go south quickly.

    I have to say that you're both right, in a way. We are also taught in school and on rotation about the differences between the aforementioned conditions and the pharmacists at my work regularly interpret labs to help guide pharmacotherapy.

    It really depends on the setting and to be honest, it really would help community pharmacists to at least have the diagnosis on the prescription to cover their back and the docs back. If I had a dollar for every time a pharmacist caught something "clinical" ( not just once a day versus twice a day stuff) at my job, I could probably pay some substantial tuition.

    On the other hand, outside of hospital and maybe ambulatory practice, pharmacists aren't given the total clinical picture, which is required much of the time to make a judgment. For example, I can't read X rays or MRIs worth crap, but that's not my role. I can't intubate or know when to intubate nor do I want to. But I will have a physician's back when it comes to choosing the right antibiotic or diabetic regimen incorporating patient factors that physician's just don't have the time to sort through (finances, lifestyle, adherence issues, etc.)

    We may not be able to identify the zebras but we sure as hell can differentiate between at least some of the common horses and know when to send someone to the ER because it's outside of our everyday practice.

    The egos up in this thread are really doing nothing for fostering a collaborative collegial relationship between physician/pharmacist and that's something you will have to have in practice to provide the best care. Come on guys...we need each other. And health care is changing. We need to change with it.
  21. PharmD for Me

    PharmD for Me

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    I'm sure someone's going to jump down my throat about this, but isn't a (IMO, better) option for this MTM? Pharmacists collaborate with prescribers and patients to resolve medication-related complications.

    Let the MDs (or insert other "prescriber") do what they do better than anyone else and diagnose conditions and look at all possible treatment options (drug and non-drug related). Let the pharmacists do what they do best and optimize medication-related therapies.

    MDs and pharmacists can enter into collaborative practice agreements if they so choose. If the patient can benefit from someone who is a specialist on treatment with medications, then the MD can send that patient to the pharmacist. Then the pharmacists can do an in-depth analysis of the patient's entire drug regimen (which pharmacists are arguably best trained to do) and make changes to prescriptions regarding conditions covered under the CPA. If it's not covered under the CPA, then the pharmacist can explain why they think that change should be made to the MD and if the MD is in agreement then they can make the change. Both the pharmacist and the MD have a say in the patient's care, can point out things the other may have missed, and thus they provide better care.

    Everyone wins, unless the MD doesn't like losing that bit of control over the treatment, in which case they wouldn't have entered into the CPA in the first place. It seems like the problem is people getting over their egos and admitting that maybe, just maybe, someone else is better trained to do something than they are (goes both ways for MDs, pharmacists, other health professionals...) and that in the end patients would benefit from a bit of collaboration.

    I think it would be interesting to hear someone who has either done both MD and PharmD or someone who practices MTM.
  22. gotdrugs

    gotdrugs

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    Don't get me wrong, I think you make a lot of good points in this thread, but I would respectfully disagree with what I've bolded. There are a lot of pharmacists and pharmacy practice that do more than "catch clerical errors" or the such. As a medical student, you might also be surprised how often the specialists I work with consult me for recommendations in their specialty.

    Take the above for what it's worth. The practice of pharmacy is beyond the walls of a Walgreens and the "stereotypical" model you have in your head.
  23. gotdrugs

    gotdrugs

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    BTW - great post and is why in the current form I hope this legislation doesn't pass.
  24. SpecterGT260

    SpecterGT260 Catdoucheus

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    The first part you bolded wasnt intended to mean that the extent of the scope of a pharmacists job was to catch errors, it was just meant to imply that it is a benefit and a very good reason for collaboration between the professions.

    I stand by the last part, though. in terms of legitimate training on the clinical applications of drugs (read: excluding standard exposures in practice) there is nothing that a pharmacy student is privy to that is not covered in medical school and tested at the same depth and complexity as any other course we take. It may be 1 formal course in pharmacology, but again, this returns at the same depth in step1, step2 CK has much more in the way of treatment, and step3 is specialty specific but still very much on diagnostics and treatment. To say that medical training is limited to 16 weeks in pharma is really not very accurate. That said, I fully expect a pharmacist to be more up to speed on new drugs in the field and standard drugs of other fields that I will be once I am established in a practice. It is just the way of the world - use it or lose it. So for this reason I would hope to be able to rely on pharmacists to fill that gap for me. Most of my posts, however, have only been to address the notion of the limited pharma training that we receive.
  25. Pharmguy07

    Pharmguy07

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    Just wanted to say as a Walgreens pharmacist I agree 100% with everything you've said in this thread.
  26. Kwiz

    Kwiz

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    Physician's PTs go into their with the highest possible hope of leaving office with a ddx and a script if they're lucky. When a PT goes to their local pharmacist, they trade that in for something tangible that will (more times than not) make them better. If MDs were so knowledgable about drugs, why do they want such mutated crazy drug resistant "bugs"? If they were so smart, why did so many MDs let drug reps influence their prescribing habits? It's getting damn near impossible to find some decent free pens these days thanks to them. Patients use doctors for their prescription pads. So instead of being pricks about how much they help their patients, why don't they start setting up tables in the pharmacy for the MDs, as if they're giving out autographs like famous athletes, that way they can actually help more patients...by making the distance between their office and the pharmacy at an all time minimum. Medical school is rigorous on drugs? Tell that to the resident at my old hospital out of U of R that faxed us a stat order for TPN for a stroke PT a few years back. I had to explain to him that suspected stroke does not mean time for some yum yums. Luckily, he had some COMPETENT nurses already taking care of the tpa for this patient. Who knew proteins were heat labile ? Mind boggling :cool:
  27. Rx MPLS

    Rx MPLS

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    I don't really think it's fair to judge all physicians based on anecdotal mistakes. Not only that, but all of us have done something mindless at one point or another.
  28. ancienbon

    ancienbon

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    Could someone please tell me why a phsycian would prescribe nasonex over flonase, and dexilant over prilosec for someone who is paying cash? I have seen that a lot.
  29. Pharmacy Kid

    Pharmacy Kid LT Smash

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    Yes, I do order labs a few times a week.
  30. cycloketocaine

    cycloketocaine

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    Because that drug rep brought them lunch that week.
  31. ancienbon

    ancienbon

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    thanks,... i thought there might be a reason for that, as i have seen it a lot... I work in a very poor city where most our clientele is immigrant. It hurts when you see a patient paying cash for dexilant, or nexium, or nasonex while they could have easily gotten flonase, or prilosec...
  32. Got Em

    Got Em PharmD, MBA; MD Candidate

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    You order labs at Walgreens? CVS? Pinipig is talking about what happens when a person comes to a retail pharmacy demanding albuterol inhalers. Who is going to do your labs?

    Look, I understand what everyone is saying. Pharmacists are not here to diagnose, just "manage" the diagnoses given by physicians. We're not sure what the law is going to say, but IMO it's fine to have that 3rd class of drugs or refill authority (say if patient has proof of a doctor's visit in the past year). Deciding which drugs would definitely be the hard part.
  33. SpecterGT260

    SpecterGT260 Catdoucheus

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    Except, no....
  34. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

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    OK, what's the reason?
  35. cycloketocaine

    cycloketocaine

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    Yes, pray tell, why is Dexilant better than lansoprazole or Nasonex better than fluticasone all knowing medical student?
  36. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

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    Pristiq
    Nuvigil
    Solodyn
    Moxatog

    Clearly superior products...
  37. SpecterGT260

    SpecterGT260 Catdoucheus

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    Accepting gifts from drug reps is a great way for a doc to lose his job. Once upon a time it worked that way. It is now a major no no. I'm not saying I have some secret as to why one is better.... just saying that bribes is not the answer. More than likely the PCP is as swayed by the advertisements and promo data
  38. SpecterGT260

    SpecterGT260 Catdoucheus

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    :rolleyes: see what happens when you make assumptions? You look like a d bag :D
  39. cycloketocaine

    cycloketocaine

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    Classy. Just keep thinking that....I've seen attitudes like yours stomped on by attendings. And I just sit back and watch.....
  40. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

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    Be nice...
  41. SpecterGT260

    SpecterGT260 Catdoucheus

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    Oh come on now. I contest the notion that docs are paid off by pharm reps and get a "oh mighty med student" retort and cannot stand up for myself? I was matching his level of class and he knows it.
  42. cycloketocaine

    cycloketocaine

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    I'm a chick, thanks for trying out though.
  43. SpecterGT260

    SpecterGT260 Catdoucheus

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    Ok *she :rolleyes:
    This new development obviously changes everything
  44. BidingMyTime

    BidingMyTime Lost Shaker Of Salt

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    Because most physicians have absolutely no idea how much drugs cost. Why would they? (unless they are on a P&T committee somewhere)

    Do you not offer to call & get the drug changed to something cheaper for the pt? I do this routinely...unfortunately, there are some patients who don't want their prescription changed, because they have it in their head that every prescription is magically unique for a particular condition, and that no other prescriptions could treat that condition. But most patients are very grateful when I call the doctor to get it changed to something cheaper, and it's extremely rare that a physician refuses to change a drug due to cost issues (With the exception of antibiotics in which the physician was privy to sensitivity testing, I can only think of about 2 cases in all the years I've worked as a pharmacist 1) a physician who refused to allow generic Coumadin when the pt refused to pay for the brand--the patient actually left the RX and went without, while I understand the physicians concerns about the generic over the brand, I didn't understand how the doctor thought the pt taking nothing was better than taking the generic 2) a very belligerent patient that I suspect the doctor wanted to punish by giving a high cost prescription.
  45. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

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    You're a guest in our sandbox... :)

    Also, there is ample evidence available to suggest that physician prescribing habits ARE influenced by pharmaceutical reps. That's why they are banned from many facilities, including all VA medical centers.
  46. SpecterGT260

    SpecterGT260 Catdoucheus

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    So the rule is to take the condescension with a smile. Noted and moving on :thumbup:
  47. rxlea

    rxlea Unicorn in training Moderator Emeritus

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    Save the "douchebag" insults for the pre med forum. Please don't call my friends names.

    You're not playing nice and you know it.

    If docs weren't swayed by drug reps, then why would companies spend billions of dollars to send hot young men and women to talk to them? Why give the gifts?

    You need only to look at some studies to see some of the shadiness going on with these "new" formulations of products. Those non-inferiority studies sure are enlightening, don't you think :rolleyes:

    And A4D pointed out some pretty significant ones. The evidence is quite compelling but not in the way you may think. ;)
  48. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

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    The rule actually does pertain to home court advantage. Pharmacists who go into the medical forums and insult the physician or med student regulars would be out of line as well. Or optometrists trolling ophthalmology, etc. You are welcome to participate in our forum but be respectful. I don't think it's a difficult or controversial concept at all.
  49. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

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    Whether physicians can receive gifts anymore or not is irrelevant. The new trick is to provide crap like copay cards or coupons to get physicians to write for the expensive new hotness. My little sister was given a copay card for a new cream that her son
    "needed". The doc insisted it was "new and better." The name escapes me, but it was for a diaper dermatitis. That **** was over $100 and guess what was in it? Miconazole, zinc oxide and white petrolatum. Sheesh.

    Another big offender lately has been Edarbi. No one writes for it, since there are so many cheaper options. But the copay cards and coupons come out and suddenly every doc in the area wants to use it, first line. It's all well and good until the cards/coupons are gone and the patient doesn't want to pay the $50 copay. And don't get me started on samples and how they negatively impact prescribing patterns.
  50. rxlea

    rxlea Unicorn in training Moderator Emeritus

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    I've been out of retail a while. I didn't know coupon use had grown so much.

    Oh please do tell our friend about samples! :D

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