I'm wondering how many other pharmacists actually try to save their clients money? Such as suggesting generics or different types of insurance?
Rex
Rex
Do you try and save consumers money?
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rex_b said:
I have question... If a script is written for #30 with 2 refills, can you dispense #90 through the insurance without oking it with the doctor? (Assuming insurance will pay for it) My pharmacist believes that we can't do that with out checking with the doctor because we can be audited and insurance will then decide to fine us or not pay for it.
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museabuse said:
my understanding is that if the doctor rights for 30, you can give them 30 on their insurance and let them pay cash for the rest (as long as their not controlled).
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rex_b said:
We can not suggest insurance companies. That would be a waste of our time. Generics are automatically substituted if available so there is no "trying to save money" for the patient. We already do our best. If they want Brand, then we fill it for brand. Otherwise it's generic. It saves them money and allows the pharmacist to make more money.
museabuse said:
Your pharmacist is correct. You can not dispense more than what is written at one time. If the patient wants 90, they can either pay cash for 60 or present an rx for 90. Otherwise, you are opening yourself to an audit and you will lose every time.
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I always try to direct patients towards generics. Period.
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I always try to save people money when possible. For example, I'll suggest buying regular ibuprofen 200mg and taking 3 instead of filling an RX for 600mg for cash. I like to give me people OTC meclizine; instead of charging them $10 for #30 they could just buy #100 for the same price. Little things like that.
A little off topic but not really... today a lady brought in an Rx for #90 Xenical 120mg, 1TID. She must pay cash because insurance won't cover it. We had a bottle that had been on the shelf for a looong time and it expires in 05/06. So even though it will technically not expire until the lady should be done with the #90, I feel bad about letting somebody pay over $200 for a medication that most likely will expire before its all used. I don't think she stays on this med regularly or takes 3 every single day.
What do you guys think?
(I showed the pharmacist and he said, "Oh it's good for another 6 months past that date"... is this true?)
A little off topic but not really... today a lady brought in an Rx for #90 Xenical 120mg, 1TID. She must pay cash because insurance won't cover it. We had a bottle that had been on the shelf for a looong time and it expires in 05/06. So even though it will technically not expire until the lady should be done with the #90, I feel bad about letting somebody pay over $200 for a medication that most likely will expire before its all used. I don't think she stays on this med regularly or takes 3 every single day.
What do you guys think?
(I showed the pharmacist and he said, "Oh it's good for another 6 months past that date"... is this true?)
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I saved a guy $50. He was having allergic rash and the doctor gave medrol dose pack, steroid cream, and zyrtec. But the guys copay for Zyrtec was $50 bucks and it was written, for rash. So I asked him if this was a one time rash or if he suffered from allergies. Turns out it was just this once, so, (with the approval of the pharmacist) I recommended he buy OTC benadryl for his rash and skip the zyrtec.
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Just a note, not all Histamine-antagonists are built equal insofar as use in skin reactions due to differing rates of skin perfusion.
http://www.blackwell-synergy.com/links/doi/10.1034/j.1398-9995.1999.00032.x/abs/
http://www.ingentaconnect.com/content/mksg/all/2001/00000056/00000010/art00204
http://www.springerlink.com/(mpspwa...l,33,289;linkingpublicationresults,1:101197,1
http://www.blackwell-synergy.com/links/doi/10.1034/j.1398-9995.1999.00032.x/abs/
http://www.ingentaconnect.com/content/mksg/all/2001/00000056/00000010/art00204
http://www.springerlink.com/(mpspwa...l,33,289;linkingpublicationresults,1:101197,1
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WVUPharm2007 said:
It's nice that you did your research, but oftentimes people can not afford to go with what the research says. They have to go with what they can afford. The pharmacist agreed with me and I saved the guy money. He was thinking about leaving the Zyrtec anyways. If I were that guy, I'd take my chances with the benadryl too. Not to mention that he had two other drugs with more reasonable copays to treat the allergic rash.
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It's something I know from bad experience. The only thing I've researched in the last 10 months is which hotel in Amsterdam I'm going to stay at next Winter break.
This is a situation where the physician should have been consulted, too. The degree to which Zyrtec reaches dermatological tissue really is far greater than loratadine, etc. If the reaction was serious enough, Zyrtec would have been warranted. Sure, it's more expensive, but sometimes it may be needed. Kind of like Zyvox. It should never be used, but every once in a while you get some freak bug that requires it. If it was only a moderate type of thing, then the diphen probably would have ok, too. I don't want to get into a pissing match or anything, I only mention it because the same thing happened to me as I recommended loratadine and the results weren't, how should I say, optimal?
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WVUPharm2007 said:
Saturday nights are not great times to reach physicians, but anyways, thanks for the advice. I should probably have told the guy to come back for the Zyrtec if the benadryl doesn't cut it, its hard to deal I am hoping he has some sort of common sense. Its hard for me to ring people up for expensive copays that may not be necessary, you know? Man, there is so much more to learn.....
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WVUPharm2007 said:
Your research doesn't address the issue of Zyrtec v. Benadryl for dermatological conditions. It only covers zyrtec v. loratadine.
If I read correctly, AlwaysTired recommended diphenhydramine, not loratadine.
I'm a huge fan of Zyrtec, and take it every day for my allergies.
Two summers ago I had a very bad allergic reaction with a rash.
My doctor advised me to d/c the Zyrtec and take Benedryl until the itching subsided.
I'm lucky that I can buy my Zyrtec for about $12/month. For many patients, it is just too costly and they won't pick it up, even if they need it. For those patients, recommending something else is a good option.
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alwaystired said:Saturday nights are not great times to reach physicians, but anyways, thanks for the advice. I should probably have told the guy to come back for the Zyrtec if the benadryl doesn't cut it, its hard to deal I am hoping he has some sort of common sense. Its hard for me to ring people up for expensive copays that may not be necessary, you know? Man, there is so much more to learn.....
You probably did the right thing. I just always have stupid rare annoying things happen to me. Generic is one thing, different agents is another. I'm sure the guy is fine, probably didn't need the Zyrtec, an is happy you helped him. Even if the worst case hapened, you can do worse.
Once when I worked in a hospital, I accidently put adult strength vit K in the neonatal vit k bin in the nursery after a pharmacist checked it and bagged it for me to put in the Pyxis. It resulted in the overdose of 7 newborns. Nothing like thinking you gave a baby a frickin' pulmonary embolism or something. Thankfully the dose was only an OVERDOSE and not a TOXIC dose, so nothing truely bad ever came of it. I probably lost about a weeks' worth of sleep over it because I didn't triple-check it before I put it in the bin. That poor pharmacist probably lost more because it was ultimately his fault.
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WVUPharm2007 said:
Thanks for sharing. I can imagine how you felt. And I do hope I did the right thing. I always check with the pharmacist to see if they agree, but still, you never know. It's going to be scary when you are the pharmacist and there's no one else to check with (well, except the MD).
Those are the types of situations I am afraid of (the Vit. K) It could have been a lot worse. We are all human, and mistakes do happen, but it is going to kill me when I make a big one. Of course I don't want to make ANY, but mistakes happen to the best pharmacists. The only thing we can do is triple check. And then we get accused of being OCD-go figure. 😱
The worst thing I've done so far is fill something from a return to stock bottle that was the wrong dose. We keep the RTS in the same vial, just rip off the names. But to scan it out, we have to pull the stock bottle and use the RTS vial too. Well, the tech pulled the wrong RTS vial with the right stock bottle. I didnt' read the label on the RTS, just ASSUMED it was the same dose as the stock bottle. Scanned the right bottle, put in the wrong dose. Pharmacist caught it, but it still makes me mad that I am so trusting and dumb to overlook it.
This should probably be another thread (what's the worst mistake you have made), although I don't know if I want to know if someone out there has killed anyone. I am saving that kind of news for some of my dumba++ classmates.
rex - back to your original question...depends upon how strict your state is. My state allows us to fill the original quantity on first fill only. Then, it is up to our judgement how to refill it. I consistently do 90 days supply & have had many audits & none balked or refused to pay. If they are significantly concerned, they won't allow 90 day coverage. My prescribers don't care as long as they've written enough refills to cover. The only time I won't is if it for an abusable drug or if I feel the pt might be suicidal or otherwise unstable - but then usually there aren't refills since the psychiatrists thinks this too.
To save patients' money: Generics are an automatic. We also had those coupon/voucher things that we used with a lot of our elderly. Help save them on that first prescription. Before Part D, we had a sort of mini-forms on the Pfizer Share Card, Orange Card, etc... would help some of the people with getting those cards to help save them cash. Also had pretty good relationships with the clinics, so when we had time might call on splitting tabs, etc...
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rex_b said:
As far as I know, unless you are telling an HR person or the company owner(s) to switch insurance, it's useless. Most (with just a few exceptions)employees have no say over which insurance they get (as unfair as that it).
But I've always been appreciative to those pharmacists who notify me of alternatives in meds. 🙂
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Just a lowly MS3 here, but I've found myself in a number of situations where the medication that I know and like is likely pretty expensive and it's no big deal if the guy tries a cheaper drug first. In the situation described I probably would have told the guy to try diphenhydramine first and given him a script for something else in case the diphenhydrame didn't work, produced significant side effects, etc. If I have samples around, that sometimes makes life easier. But frequently I don't know what drug will be cheapest for my patients. In those cases I appreciate the idea of a pharmacist getting involved.
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ndearwater said:
I don't know if this is the case in other states, but it's illegal to do that here in SC. Oops. I didn't know that until my law course this semester. Here you can't instruct people to take more than the recommended dose printed on an OTC product. We were told it had something to do with the "if 3 is good, 5 is even better" idea.
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ndearwater said:
Hmm, I know what you mean with the OTC Ibuprofen but the bioavability and other stuff will be different. You should only do that if the customer is really broke and have no other options. Taking 3 caplets of 200 mg of ibuprofen is different from 1 caplet of 600. In the end, depending on the amount. . . it may be better to take the 600. If the doctor writes for 600, my advice is to fill it out for 600.
About expired meds, its true what the pharmacist said. However there are several factors that come into play. The expiration date on the medication bottle is very conservative. If you store it correctly, the drug may still be potent for up to 10 years???. However there are certain drugs like dilantin and phenobarbital that may lose potency a lot quicker than other drugs.
Opth and Opt solution/drops should be disposed of after approximately 2 weeks once they are opened regardless of expiration dates.
Everything depends on the drug ie tetracycline may be dangerous if u store it for a long time and how you store it. (temperature, fats and stuff, and so on.)
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A single 600 mg tablet (not extended-release) is significantly different from 3*200 mg tablets? Seriously? I'm very curious about this, and any clarification would be much appreciated.
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Adcadet said:
There is no difference, sorry.
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Suppose the MD writes for 30, but the patient is insured in units of 21. Can you just dispense 21?
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Except for swallowing three tablets instead of one. I would balk at this as a patient. And we do want our patients to take their medications, right? Carry on... 🙂
I usually don't suggest insurances. However, atleast 5 times a day I'll call the emergency room or clinic and try to get a script changed from one drug to another because of cost. Today, for example, I called the ER because the patient was given a prescription for Ciprodex which has an outrageous cash price (the patient did not have insurance). I called, got hold of the NP who wrote the script and asked if we could use generic Cortisporin. She ok'd the change without any hesitation.
In my opinion, one of the jobs of a retail pharmacist is to try and save the patient money.
Yes, you can
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I was working the other day and got a script for clindamycin 600 mg. Since it's not available in 600 mg, we dispensed the 300 mg and the price was something outrageous...like $160 (no insurance). When the pharmacist was verifying, he changed it to clindamycin 150 mg and it came out to be $50!
