Overriding DURs

[Hels2007]

Just this weekend I worked again, and had to call about someone on chronic Cymbalta use being prescribed tramadol by the ER doc... I personally tend to be overly vigilant on serious side effects, besides, if something comes up as a major DUR (btw, does your computer system separate DURs by level - Walgreen's does it by major/medium/minor?) it better not go on my license as my decision... call me a coward. Unless it's about a combination that patient has been taking safely for many months. But I will override meaningless DURs like "late refill" It irritates the heck out of me when other pharmacists do remote verification and then let those stupid DURs sit there and that holds up the prescription...

Just wanted to vent a bit and see how you handle your DURs. Besides, I can't remember if I ever started a thread in this forum, and I have been here for more than a year!

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[psurocks]

wow, tats a cat C interaction, I would never call on that

we only call if its major on wags screen, and if they havent been on the drug before....but if theyve been on it, then we just override it all

 

[meister]

What is remote fill exactly and how is it useful?

 

[Sparda29]

I generally try to do any override possible to get rid of a rejection.

 

[confettiflyer]

I generally try to do any override possible to get rid of a rejection.

P0 1B or even M0 1B usually does the trick with CVS...of course I usually check with the RPh unless i'm 100% sure it's something stupid (ie pt last picked up abx TWO years ago that interacts and indicates they're no longer taking it).

 

[Old Timer]

I generally try to do any override possible to get rid of a rejection.

Absolutely brilliant. Remind, what city and state will you be practicing in?

 

[meister]

Nah it's all about M0 1G

 

[confettiflyer]

Nah it's all about M0 1G

physician consulted.....shat i forgot 1G, prescriber overridden?

 

[meister]

Yeah it's basically just MD override. I don't remember specifics because it's been awhile, but it usually trumped most things.

 

[Sparda29]

When you have to get stuff out in 15 minutes or less, you tend to ignore DURS. If they are interactions, then I'll refer it to the pharmacist but if its something stupid like overuse, I'll override it.

I get this a lot with creams/ointments/topical medications. I'm extremely liberal when it comes to days supply. For example, a 60 gram tube of clindamycin phosphate, I'll give a day supply of 7 days.

 

[meister]

Hell yeah, I'm all about the 1-week supply on any topical stuff. People who put 30 days supply for a 5g tube of triamcinolone were always my sworn enemies. We used to get people coming to our store for a refill after getting an original filled at our local 24 hour CVS. Those ****ers would put 30 days supply in for EVERYTHING. Made me want to shoot someone.

 

[Citsouca1988]

exactly what are DURs? As a technician of cvs, i get very confused when my rejection screen says "DUR reject error." (scratches head)

then I am told to do somthing like R0 then 1b, whatever that means...

 

[117296]

exactly what are DURs? As a technician of cvs, i get very confused when my rejection screen says "DUR reject error." (scratches head)

then I am told to do somthing like R0 then 1b, whatever that means...

DUR= Drug Utilization Review

 

[WVUPharm2007]

I'd just ignore it. Of course I'm a hospital pharmacist...the patient is already in the hospital so if they got seratonin syndrome....eh?

 

[meister]

exactly what are DURs? As a technician of cvs, i get very confused when my rejection screen says "DUR reject error." (scratches head)

then I am told to do somthing like R0 then 1b, whatever that means...

Half the time the RX2000 system kicks back a claim with that reject it's something completely unrelated to what we're talking about. And sometimes it's an internal CVS rejection that is just a headache for everyone put in place by some ****** bean-counter in Woonsocket.

God I hate CVS.

 

[confettiflyer]

****** bean-counter in Woonsocket.

That about sums up the company...haha.

 

[Doctor M]

Half the time the RX2000 system kicks back a claim with that reject it's something completely unrelated to what we're talking about. And sometimes it's an internal CVS rejection that is just a headache for everyone put in place by some ****** bean-counter in Woonsocket.

God I hate CVS.

wow, we agree on something...

 

[Sparda29]

How do you guys fix day supply settings on old prescriptions (basically a reversal)? Like for a 100 gram tube of something that we got a refill for the other day, the tech who initially filled it, set it for 30 days, and the patient came back with an empty tube in 20 days. How do you fix the old days supply, do you contact the insurance company or is there a way to do a reversal from our computer?

 

[psurocks]

How do you guys fix day supply settings on old prescriptions (basically a reversal)? Like for a 100 gram tube of something that we got a refill for the other day, the tech who initially filled it, set it for 30 days, and the patient came back with an empty tube in 20 days. How do you fix the old days supply, do you contact the insurance company or is there a way to do a reversal from our computer?

i think most of the time it requires a call to the company, especially 20 days out

 

[meister]

**** that, edit the original fill and re-submit the claim. I used to do everything possible to avoid making any calls, not only to insurance companies but ESPECIALLY to corporate.

With some third parties you can edit old claims from like 3 months prior. I used to edit the hell out of stuff to avoid pointless calls. I'd also use the dreaded INSERT function too to get things done.

Good times.

 

[Doctor M]

**** that, edit the original fill and re-submit the claim. I used to do everything possible to avoid making any calls, not only to insurance companies but ESPECIALLY to corporate.

With some third parties you can edit old claims from like 3 months prior. I used to edit the hell out of stuff to avoid pointless calls. I'd also use the dreaded INSERT function too to get things done.

Good times.

another agreement!!

 

[afablej]

yeah how accurate is that Major/Moderate level of interactions in Wags .. pretty good i hope?

Would you guys call on a pt that has been on warfarin and they just got a new rx for Amiodarone? I thought I would have called because in school we learn that the interaction is pretty significant when you first add on amiodarone (or maybe i'm just a newbie to DURs), but my pharmacist just overrid it and said the patient's INR levels will be monitored anyway? what do you guys think about that

 

[Requiem]

yeah how accurate is that Major/Moderate level of interactions in Wags .. pretty good i hope?

Would you guys call on a pt that has been on warfarin and they just got a new rx for Amiodarone? I thought I would have called because in school we learn that the interaction is pretty significant when you first add on amiodarone (or maybe i'm just a newbie to DURs), but my pharmacist just overrid it and said the patient's INR levels will be monitored anyway? what do you guys think about that

Hahha, dear god.

 

[Old Timer]

Would you guys call on a pt that has been on warfarin and they just got a new rx for Amiodarone? I thought I would have called because in school we learn that the interaction is pretty significant when you first add on amiodarone (or maybe i'm just a newbie to DURs), but my pharmacist just overrid it and said the patient's INR levels will be monitored anyway? what do you guys think about that

The real answer is, it depends?

• Is it the same physician?
• Is the physician a cardiologist?
• Is the patient still on Warfarin?
• Is this a hospital discharge Rx?
• When is the next scheduled INR?

Answering these questions will lead you to the appropriate course of action. If the patient was just discharged from a hospital and the prescriber is the same as on the warfarin and they are clutching a script for an INR, then I would not call.

 

[meister]

The big thing is to determine if it's the same MD. If it is then it's probably ok, but before dispensing ask the patient if it was discussed at the last office visit or at discharge. If not, then maybe call to double-check.

If it's a different MD then you're probably just about to get a minor headache.