Pill Mills and E-Scripts

[Sparda29]

So e-scripts have gotten rid of the forged script problem. I don't fill any written scripts at all.

I was reading a reddit thread about how there are pill mills that e-prescribe. However, if it's e-script, aren't we supposed to just fill it if the dosing is correct.

I got one doctor who only uses Oxy 30. I do get rejections for the 1 week supply max + PA required for opioids, but then next day the doc has completed the PA and the claim goes through. So what's the deal? Are we still supposed to be the narc police and refuse to fill narcotic e-scripts?

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[wagrxm2000]

So e-scripts have gotten rid of the forged script problem. I don't fill any written scripts at all.

I was reading a reddit thread about how there are pill mills that e-prescribe. However, if it's e-script, aren't we supposed to just fill it if the dosing is correct.

I got one doctor who only uses Oxy 30. I do get rejections for the 1 week supply max + PA required for opioids, but then next day the doc has completed the PA and the claim goes through. So what's the deal? Are we still supposed to be the narc police and refuse to fill narcotic e-scripts?

The answer you aren't wanting to hear is.....yes.

 

[owlegrad]

I don’t think corresponding responsibility went away with paper scripts.

 

[imcallingcorp]

So e-scripts have gotten rid of the forged script problem. I don't fill any written scripts at all.

I was reading a reddit thread about how there are pill mills that e-prescribe. However, if it's e-script, aren't we supposed to just fill it if the dosing is correct.

I got one doctor who only uses Oxy 30. I do get rejections for the 1 week supply max + PA required for opioids, but then next day the doc has completed the PA and the claim goes through. So what's the deal? Are we still supposed to be the narc police and refuse to fill narcotic e-scripts?

lol cmon you know right from wrong. the fact that it is escribed changed nothing if its a pill mill and you have reason to believe so

 

[Sparda29]

lol cmon you know right from wrong. the fact that it is escribed changed nothing if its a pill mill and you have reason to believe so

We have regular prescribers who we know aren't pill mills, however we started getting scripts from a new doctor who sends like 2-3 patients a week. Our pharmacy is in Queens and these patients all live in ghetto areas of the Bronx and are on some form of managed medicaid. And they all seem to be prescribed Oxy 30 #120, Xanax 2 #120, Ambien 10 #30 along with HTN, asthma, COPD, diabetes meds. Something seems off.

 

[CetiAlphaFive]

So e-scripts have gotten rid of the forged script problem. I don't fill any written scripts at all.
I was reading a reddit thread about how there are pill mills that e-prescribe. However, if it's e-script, aren't we supposed to just fill it if the dosing is correct.
I got one doctor who only uses Oxy 30. I do get rejections for the 1 week supply max + PA required for opioids, but then next day the doc has completed the PA and the claim goes through. So what's the deal? Are we still supposed to be the narc police and refuse to fill narcotic e-scripts?

What does your PIC think?

If I encountered a doctor that only dispensed one med or involved themselves in NDC fishing, I'd deny their scripts.

Edit: just read your second post.
I'd deny their scripts and report the doctor.

Put on your Guy Noir hat:

You know people like that don't leave their borough unless they absolutely have to.

Call the pharmacies in a few block radius from the doc and ten bucks says they'll tell you they don't fill their scripts.

Call the doctor and lie that 2mg bars aren't covered. See how mad they get when you try to change it to 1mg tabs.

Tell them you can't get yellow Norco.

Abra Cadabra

 

[CynicalIntern]

I'm sure there are exceptions to this, but in the 5 years since I've been licensed, I have never once had a legitimate patient who was on Xanax 2mg.

Written in combination with Oxy? GTFO

 

[Charcoales]

Dont fill it, if they ask why tell them xanax and oxy is a dangerous drug interaction that could lead to death (which is 100% true)

 

[Old Timer]

I'm sure there are exceptions to this, but in the 5 years since I've been licensed, I have never once had a legitimate patient who was on Xanax 2mg.

Written in combination with Oxy? GTFO

I have 2 right now, though neither one of them takes Oxycodone, Soma, Ambien or other controls. If you met them, you would think the dose is low... There are some really crazy people walking the streets,,,,,, Oxy 30 and Xanax is a no go for me....

 

[Sparda29]

What does your PIC think?

If I encountered a doctor that only dispensed one med or involved themselves in NDC fishing, I'd deny their scripts.

Edit: just read your second post.
I'd deny their scripts and report the doctor.

Put on your Guy Noir hat:

You know people like that don't leave their borough unless they absolutely have to.

Call the pharmacies in a few block radius from the doc and ten bucks says they'll tell you they don't fill their scripts.

Call the doctor and lie that 2mg bars aren't covered. See how mad they get when you try to change it to 1mg tabs.

Tell them you can't get yellow Norco.

Abra Cadabra

What is NDC fishing?

I stopped stocking Endocet a long time ago. The reimbursement is $0.70 below cost per pill.

 

[CetiAlphaFive]

What is NDC fishing?

I stopped stocking Endocet a long time ago. The reimbursement is $0.70 below cost per pill.

"Yellow or spotted norco medically necessary"

"Only dispense blue..." yada yada

 

[Sparda29]

"Yellow or spotted norco medically necessary"

"Only dispense blue..." yada yada

Ah I thought it meant test billing different NDCs of random pain creams to find the best profitable items and then marketing that to docs.

 

[Dred Pirate]

Ah I thought it meant test billing different NDCs of random pain creams to find the best profitable items and then marketing that to docs.

well ya - that could be it to - for your sake I hope you never get a medicaid audit

 

[imcallingcorp]

well ya - that could be it to - for your sake I hope you never get a medicaid audit

Lucky he missed out on the tricare cream compounding days, he definately would’ve been all over that.

 

[VA Hopeful Dr]

"Yellow or spotted norco medically necessary"

"Only dispense blue..." yada yada

Wait, doctors actually do that?

 

[maria1oh]

I once filled in at a pharmacy for a short period of time as floater (a couple months to cover a medical leave). They had a suspiciously large inventory of alprazolam 2mg and I never dispensed it there. Later turns out employee was stealing it.

 

[owlegrad]

Wait, doctors actually do that?

Oh yes, I saw it a noninsignificant amount of times at CVS. "Watson medically necessary" or whatever the manufacturer de jour was. I always wondered if the doctor believed the patient really needed that one or just didn't care enough to fight with the patient or only cared about positive reviews/keeping patients or what.

It's pretty mind-blowing what you see when you work in the trenches.

 

[CetiAlphaFive]

Wait, doctors actually do that?

You would be shocked at the things pharmacists in larger cities see.

I can't imagine what it's like in Houston

 

[Dred Pirate]

Oh yes, I saw it a noninsignificant amount of times at CVS. "Watson medically necessary" or whatever the manufacturer de jour was. I always wondered if the doctor believed the patient really needed that one or just didn't care enough to fight with the patient or only cared about positive reviews/keeping patients or what.

It's pretty mind-blowing what you see when you work in the trenches.

when I moonlighted I saw this, and ignored it, and then caught hell from the patient and the MD - I then quit working at that store, wasn't worth the hassle

 

[CetiAlphaFive]

when I moonlighted I saw this, and ignored it, and then caught hell from the patient and the MD - I then quit working at that store, wasn't worth the hassle

Laughing at doctors who pull stuff like that opn the phone is one of the few pleasures I get in this profession.
I really love when they say "I put medically necessary!"

I always made it clear to everyone at all of the pharmacies I've worked in that we do not take NDC preference into consideration at all for controlled meds.


In Texas, it carries absolutely zero weight if not being used to indicate brand name

 

[BenJammin]

WFAA is the ABC affiliate here in Dallas and they did a report on a pill mill doctor who got homeless people to pose as patients. My retail friends knew about this guy because he would send escripts for the same stuff and the patient address was always the homeless shelter.

 

[VA Hopeful Dr]

Oh yes, I saw it a noninsignificant amount of times at CVS. "Watson medically necessary" or whatever the manufacturer de jour was. I always wondered if the doctor believed the patient really needed that one or just didn't care enough to fight with the patient or only cared about positive reviews/keeping patients or what.

It's pretty mind-blowing what you see when you work in the trenches.

That's just crazy.

 

[BidingMyTime]

Ah I thought it meant test billing different NDCs of random pain creams to find the best profitable items and then marketing that to docs.

Oh, Sparda. Posts like this just warm my heart.

 

[Dred Pirate]

Oh, Sparda. Posts like this just warm my heart.

I just hope some newbies don't see these and go out there and emulate - oh wait, I actually hope they do - when they get fired and lose their license , less competition for jobs