Why can't pharmacists change brand name to generic?

[Socrates25]

Today I sent over an rx for Concerta to the pharmacy. This is in Texas btw.

15 minutes later I get a phone call from the pharmacist at CVS.

Pharmacist: Their insurance won't cover brand name, can you switch to generic?
Me: Why are you calling me? Can't you switch it over on your own?
Pharmacist: Well not really...
Me: Fine then, absolutely, go ahead and change it to generic methylphenidate
Pharmacist: I need your approval to switch it
Me: Why?
Pharmacist: I cant change it without your approval
Me: OK you have my approval
Pharmacist: I need a new prescription sent over
Me: So you went to 4 years of pharmacy school and you don't have approval to switch brand names to generics?
Pharmacist: Ummm

WTF is this? It's not just schedule IIs either, it happens every day. It's not just CVS either, it's every pharmacy.

Is this a Texas deal? I have no idea why a board certified pharmacist doesn't have the authority to switch meds like this. Surely this can't be real in 2018.

I thought the pharmacist was pulling a practical joke on me. 4 years in a PharmD program and they can't switch to generic? How are you guys going to become "health care providers" when you can't even switch brand to generic? Unbelievable....

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[deleted480308]

do your scrips not have the option to select for generic being ok?

 

[genesis09]

The issue is that it is Concerta. There are issues regarding Concerta generics that not all of them are substitutable.

 

[Socrates25]

The issue is that it is Concerta. There are issues regarding Concerta generics that not all of them are substitutable.

It's not just concerta. I had the same issue a couple of weeks ago when I sent omnicef, they wanted an order to switch it to cefdinir. Absolutely ridiculous...

 

[Socrates25]

do your scrips not have the option to select for generic being ok?

EMR system has a checkbox that says "no substitutions" but I never ever check that box and it was not checked on the one I sent to CVS

 

[npage148]

This is either baseless ranting of an imaginary situation to get a rise out of us or they are sending in every thing DAW and deserve the calls they get

 

[txpharmguy]

You're probably picking Brand Medically Necessary. In that case, we do have to call. Is it the same pharmacist from the same CVS?

 

[Bareitashvilli]

Today I sent over an rx for Concerta to the pharmacy. This is in Texas btw.

15 minutes later I get a phone call from the pharmacist at CVS.

Pharmacist: Their insurance won't cover brand name, can you switch to generic?
Me: Why are you calling me? Can't you switch it over on your own?
Pharmacist: Well not really...
Me: Fine then, absolutely, go ahead and change it to generic methylphenidate
Pharmacist: I need your approval to switch it
Me: Why?
Pharmacist: I cant change it without your approval
Me: OK you have my approval
Pharmacist: I need a new prescription sent over
Me: So you went to 4 years of pharmacy school and you don't have approval to switch brand names to generics?
Pharmacist: Ummm

WTF is this? It's not just schedule IIs either, it happens every day. It's not just CVS either, it's every pharmacy.

Is this a Texas deal? I have no idea why a board certified pharmacist doesn't have the authority to switch meds like this. Surely this can't be real in 2018.

I thought the pharmacist was pulling a practical joke on me. 4 years in a PharmD program and they can't switch to generic? How are you guys going to become "health care providers" when you can't even switch brand to generic? Unbelievable....

Probably just their protocol

 

[Charcoales]

If it's daw I call. If not then I'll switch no qualms unless it is a seizure med or something serious like that.

 

[Digsbe]

So long as they are generic drugs they should be able to substitute if it's not DAW 1. Only exception is in some states you need to contact the prescriber to substitute meds for seizure disorders.

Concerta can be funky though, there are several forms of methylphenidate out there that are not interchangeable.

 

[owlegrad]

Perhaps the pharmacists in your area just hate you.

I assure you pharmacists are changing your orders to generic all day every day. Hopefully when they have an issue switching to generic they’re doing a better job explaining it to you then going “uhhhhhhh dur”.

 

[steph7]

1. Not all methylphenidates are substitutable for Concerta. If you ever look inside of our C2 safe, half of all meds in there are different kinds of methylphenidates because there are a million different forms. I hate filling methylpenidates the most because of this.
2. Per Texas law, the pharmacist cannot change 4 things on a CII script. One of which is the name of the medication. Hence why you need to send over a new script.

 

[wagrxm2000]

I've been wanting a good troll thread.

Sorry but pharmacists know the law better then you. You're clearly doing something wrong. I see it often.

 

[Prepharm1214]

Many Concerta generics are not AB rated which explains the call there but not sure why they would call on 'numerous' medications to change to generic. As pharmacists we don't want to spend the time calling the doctor any more than you like taking those calls.

 

[Sine Cura]

These two are AB-rated to Concerta:

DailyMed - METHYLPHENIDATE HYDROCHLORIDE- methylphenidate hydrochloride tablet, film coated, extended release
DailyMed - METHYLPHENIDATE HYDROCHLORIDE- methylphenidate hydrochloride tablet, extended release

The Mallinckrodt and Kremers ones are BX-rated

I've never worked in a chain pharmacy where an authorized generic wasn't the preferred product though

Assuming OP not a troll, I have seen pharmacists "call" to switch Nora-Be to ****ing Lupin norethindrone 0.35 (also AB1) just because the interchange is not automatic in the software. FFS....!!!!!!!!!

 

[wagrxm2000]

Unfortunately some pharmacists refuse to do anything they're technically not allowed to do.

 

[CetiAlphaFive]

This is indeed a Texas specific issue.

It's not just concerta. I had the same issue a couple of weeks ago when I sent omnicef, they wanted an order to switch it to cefdinir. Absolutely ridiculous...

We're telling you what the issue is.

If a generic isn't AB rated, it's not substitutable.
In Texas, it is illegal to change 4 things on a C2:

Name of the drug is one of those things. If you're changing to a non AB rated drug, it could be considered changing the name.
I would've made you send a new Rx.
It's the law.

That's another problem i encounter with MDs like you.
We are not your law professor.
If you don't know something in the law, contact general counsel at your board or the complaince division at the board of Pharmacy.

If they tell you the pharmacist did someone wrong, then report them.

Otherwise, stop making sassy calls because the law inconvenienced you.
It just makes you look like an idiot in the eyes of your patient and the pharmacy.

Perhaps the pharmacists in your area just hate you.

I assure you pharmacists are changing your orders to generic all day every day. Hopefully when they have an issue switching to generic they’re doing a better job explaining it to you then going “uhhhhhhh dur”.

I absolutely do give MDs like this special treatment.

I'll print the law out for the patient, highlight the part that proves their doctor is wrong, explain why the MD is wrong and why I cant help, and i usually include TMB's number if I've heard the arrogant-MD-mantra- "BUT I DO THIS ALL THE TIME"

 

[CetiAlphaFive]

For example, if you were to write " Norco7.5" on a prescription, then you call me to tell me you meant to write a 7.5/300 rx, I'm going to send the patient back to you.

This is Texas specific.

Ten bucks says Socrates25 is hitting DAW1 without realizing what it means or that they're even doing it.

 

[disgonbgud]

Unfortunately some pharmacists refuse to do anything they're technically not allowed to do.

"Unfortunately some pharmacists follow the law"

K.

 

[wagrxm2000]

"Unfortunately some pharmacists follow the law"

K.

What was the point of this?

My post was simple, some pharmacists over call the office to change things that are always going to be told that's fine. Please don't waste your time.

 

[CetiAlphaFive]

What was the point of this?
My post was simple, some pharmacists over call the office to change things that are always going to be told that's fine. Please don't waste your time.

You're trying to present laziness and complacency as efficiency.

You're not necessarily wrong, but let's be honest.

 

[wagrxm2000]

You're trying to present laziness and complacency as efficiency.

You're not necessarily wrong, but let's be honest.

I'm actually presenting unneeded phone calls. You've had to seen the same issue on a script every time they send refills. Say it says Keppra daw and you call for generic. Next time it says it again so you call one more. Are you really going to call a third time? Clearly the office is simply not documenting.

 

[CetiAlphaFive]

I'm actually presenting unneeded phone calls. You've had to seen the same issue on a script every time they send refills. Say it says Keppra daw and you call for generic. Next time it says it again so you call one more. Are you really going to call a third time? Clearly the office is simply not documenting.

You call, get a blanket approval for that specific case, and you file it. Then, you never call again.

You don't simply change without ever calling.

 

[wagrxm2000]

You call, get a blanket approval for that specific case, and you file it. Then, you never call again.

You don't simply change without ever calling.

Essentially what I'm saying.

The main point I'm getting at is simple things where the MD just clicks the first thing he sees, they never care if you change. No md cares which Albuterol you choose.

I'm not telling anyone to do anything they are uncomfortable doing.

 

[npage148]

You call, get a blanket approval for that specific case, and you file it. Then, you never call again.

You mean just remebering down the name of the office manager you always talk to so you just "call" each time? you think "Sarah" is really documenting each time you call to switch to generic in the emr?

 

[wagrxm2000]

You mean just remebering down the name of the office manager you always talk to so you just "call" each time? you think "Sarah" is really documenting each time you call to switch to generic in the emr?

Lol bingo.

But again no one should ever do something they are uncomfortable doing.

 

[Rouelle]

I’m quickly losing track of who’s being sarcastic vs who’s being serious on this thread

 

[wagrxm2000]

I'm being serious I think npage might have been being sarcastic.

We're pharmacists, we shouldn't be calling for pointless things even if we technically can't.

 

[KimChiSlap]

You could write the generic name next time. Makes it alot easier.
UNLESS you want them to have the equivalent to Concerta as some prescribers around my area specify must be Concerta brand or Actavis Methylphenidate as they want the unique osmotic controlled-release oral delivery system is the ONLY generic equivalent available for Concerta.
Not all generics are AB-rated for certain brands.

 

[CetiAlphaFive]

You mean just remebering down the name of the office manager you always talk to so you just "call" each time? you think "Sarah" is really documenting each time you call to switch to generic in the emr?

You mean just remebering down the name of the office manager you always talk to so you just "call" each time? you think "Sarah" is really documenting each time you call to switch to generic in the emr?

I'm not sure what you mean by "remembering down"


It's essentially a standing order that is documented on paper.

I usually keep them all in one folder, but most of my preceptors would literally pin them to the wall.

 

[CetiAlphaFive]

Lol, it's all fun and games and "nothing'll happen" until you're in a deposition with a tile crawler picking apart your life

 

[Son_Goku]

The issue is that it is Concerta. There are issues regarding Concerta generics that not all of them are substitutable.

If they're not AB rated then they simply cannot be substituted.

Pharmacist doesn't need to call.

 

[Rouelle]

This does not apply to BX rated Concerta generics, but:

My state allows a patient to override a DAW1. Simply document that “pt prefers generic” and you’re fine. So when we get a script for Omnicef DAW1, we simply tell the patient something along the following lines: “Your dr wrote for brand name Omnicef. We don’t keep that in stock because it has been available as a generic for so long. I can see if I can order it for you. If so, it will be tomorrow evening, at the earliest, before I can get it and your copay will be $XX.XX. If you want, I can get you the generic today for $X.XX.” Document and done.

 

[owlegrad]

This does not apply to BX rated Concerta generics, but:

My state allows a patient to override a DAW1. Simply document that “pt prefers generic” and you’re fine. So when we get a script for Omnicef DAW1, we simply tell the patient something along the following lines: “Your dr wrote for brand name Omnicef. We don’t keep that in stock because it has been available as a generic for so long. I can see if I can order it for you. If so, it will be tomorrow evening, at the earliest, before I can get it and your copay will be $XX.XX. If you want, I can get you the generic today for $X.XX.” Document and done.

That is really interesting, I wasn't aware that any state allowed a patient to override the doctor for prescriptions written by said doctor. Mind if I ask which state (or states) permit this?

 

[CetiAlphaFive]

I found footage of @Socrates25 attempt to force their way into the pharmacy forum with that condescending attitude:

 

[Apotheker2015]

You could write the generic name next time. Makes it alot easier.
UNLESS you want them to have the equivalent to Concerta as some prescribers around my area specify must be Concerta brand or Actavis Methylphenidate as they want the unique osmotic controlled-release oral delivery system is the ONLY generic equivalent available for Concerta.
Not all generics are AB-rated for certain brands.

I bet you $1 dollar this is the first time OP has heard about the osmotic release mechanism.

Don’t forget they learn drug classes ALL in ONE semester. LOL

 

[CetiAlphaFive]

I bet you $1 dollar this is the first time OP has heard about the osmotic release mechanism.
Don’t forget they learn drug classes ALL in ONE semester. LOL

Inb4 sb247 and stoich drop in to tell us 1 semester of m2 = 3 years of ipt

 

[VA Hopeful Dr]

I bet you $1 dollar this is the first time OP has heard about the osmotic release mechanism.

Don’t forget they learn drug classes ALL in ONE semester. LOL

You'd be correct, I've never heard of that before either.

Now the big question: does is matter for what we do?

No, it doesn't. I know roughly how long the effects of Concerta are supposed to last. Knowing why that is isn't necessary for my role in the world.

 

[CetiAlphaFive]

You'd be correct, I've never heard of that before either.
Now the big question: does is matter for what we do?
No, it doesn't. I know roughly how long the effects of Concerta are supposed to last. Knowing why that is isn't necessary for my role in the world.

That lack of expertise doesn't stop docs like OP from calling and throwing fits.

It also might matter for the 8yo patient that received a prescription for at 4pm on Friday, who now can't get their med, and who now won't be allowed in class/ be able to participate at school until they've had their dose administered by the school nurse.

 

[VA Hopeful Dr]

That lack of expertise doesn't stop docs like OP from calling and throwing fits.

It also might matter for the 8yo patient that received a prescription for at 4pm on Friday, who now can't get their med, and who now won't be allowed in class/ be able to participate at school until they've had their dose administered by the school nurse.

Why can't they get their med?

 

[deleted480308]

Inb4 sb247 and stoich drop in to tell us 1 semester of m2 = 3 years of ipt

Come on, if you’re gonna crap talk me by name tag me so I can be sure to see it....it’s just a waste otherwise

But no, I love a good pharmacist. L. O. V. E. Love. And I think it’s great to have someone around who is far more familiar with the new combos and interactions and logistical packaging options and all that mess. The fact that I don’t want pharmacists prescribing independent of a physician doesn’t mean I don’t think they are fabulous to have available on the team.

 

[Apotheker2015]

You'd be correct, I've never heard of that before either.

Now the big question: does is matter for what we do?

No, it doesn't. I know roughly how long the effects of Concerta are supposed to last. Knowing why that is isn't necessary for my role in the world.

You should know about the osmotic release
Mechanism because it’s beautiful. It’s how Concerta got the patent. Furthermore, if your script does not specify you want us to substitute with a he AB rated methylphenidate, then that’s just sloppy.

Being more familiar with these things would make it less annoying for you when we call you save your sorry physician license. If I had a dollar for every sloppy prescription I’ve gotten, my loans would be paid off.

Seriously...

 

[CetiAlphaFive]

Come on, if you’re gonna crap talk me by name tag me so I can be sure to see it....it’s just a waste otherwise

But no, I love a good pharmacist. L. O. V. E. Love. And I think it’s great to have someone around who is far more familiar with the new combos and interactions and logistical packaging options and all that mess. The fact that I don’t want pharmacists prescribing independent of a physician doesn’t mean I don’t think they are fabulous to have available on the team.

Breh, I could create write some words in the deepest, darkest corner of this website with 100%, court admissible, magic 8 ball says "it's a sure thing", mathematically provable, Maury Povich pulls the answer out of an envelope certainty that you would see it.

 

[VA Hopeful Dr]

You should know about the osmotic release
Mechanism because it’s beautiful. It’s how Concerta got the patent. Furthermore, if your script does not specify you want us to substitute with a he AB rated methylphenidate, then that’s just sloppy.

Being more familiar with these things would make it less annoying for you when we call you save your sorry physician license. If I had a dollar for every sloppy prescription I’ve gotten, my loans would be paid off.

Seriously...

I've never gotten a call back on any of my Concerta prescriptions, so I don't know what to tell you. The prescription always has Concerta by name but I always sign the substitution permitted line. Maybe South Carolina Pharmacy law is more lenient and letting them change it as they need to, I have no idea. I just know that I don't get call backs on this one.

I have no idea what AB rating means.

I think the insult in your post was unnecessary.

 

[Sine Cura]

In California there are two cudgels called California Code of Regulations, section 1716 and California Code of Regulations, section 1762 that board inspectors dual wield to beat pharmacists over the head (issue citations and fines for non-compliance). There are similar regulations for pharmacy acts or equivalent in other states.

You might say the BOP won't know unless they get reported, but it takes only one complaint out of thousands of Rx. In fact I even had a punk prescriber complain to the BOP because he didn't maintain control of his ****ing security prescription forms and a pharmacist happened to fill a fake RX at MY pharmacy, so I get to write an action plan and save this RPH's ass from a citation. So now we get to call for EVERY controlled Rx with any inkling of "uncertainty" of legitimacy

I think prescribers in all states should have some awareness of why they get these seemingly trivial requests for Rx changes and FIX the underlying reason for these requests.

 

[WVUPharm2007]

I don't understand why everyone is so angry. People don't care enough to understand why things are the way they are. They just want to bitch. Years of abuse from the general public has taught me this valuable lesson. Just let them get it out, ignore it, and get on with your shift. Physicians are just another member of the general public. Let them complain. They don't care why we do what we do, it just annoys them and they want to bitch about it. Next time this happens, just do what you do at work. Someone just type "I'm sorry, sir, that's corporate policy. If you'd like to make a complaint, please call 1-800-SHOP-CVS." Then this thread can be avoided.

 

[Sine Cura]

What are internet forums for if not to bitch and moan.

My last post was based on the conceit that op actually wants to understand why when he/she obviously doesn't. Also the conceit that I want to educate when I actually want to bitch

 

[Rouelle]

Interestingly, just a few days separate the threads in which a group of PharmDs are experts on the pharmaceutics of Concerta’s osmotic release mechanism yet cannot figure out how to mix an ointment.

 

[CetiAlphaFive]

Interestingly, just a few days separate the threads in which a group of PharmDs are experts on the pharmaceutics of Concerta’s osmotic release mechanism yet cannot figure out how to mix an ointment.

The more interesting part is the corporate espionage and subterfuge which resulted in millions of "patient" complaints forced the FDA to change their ruling on the AB ratings for Concerta and its generics.

 

[WVUPharm2007]

How do you get into corporate espionage? That sounds more interesting and somehow less stressful than working the bench.