eRx written by resident using hospital DEA getting rejected by pharmacy

[Comanaprocil]

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So our hospital has transitioned from paper prescriptions to electronic prescriptions in the last few months. Now I'm seeing a few pharmacies reject controlled substance prescriptions written by residents using the hospital DEA number. One pharmacy said the DEA number needs to be specific to the physician, but I don't think this is true, based on the fact that I know other residents who are using the hospital DEA number haven't had this problem. I'm not sure who to call about this - hospital IT, the state, or the DEA?!

Does anyone know if pharmacies are required to fill prescriptions for controlled substances when just the hospital DEA number is used? In our EHR the resident NPI and hospital DEA number appear with the attending's NPI and DEA number when you order an eRx, but if you print a copy of the eRx out, only the resident NPI and hospital DEA number appear. Maybe this is the issue??? I'm not sure what info the pharmacy is seeing on the other end.

 

[PistolPete]

Sounds like a flaw in your system. If it's a controlled substance, either your or your attending's DEA needs to be on the E-Rx, as far as I know.

 

[Shikima]

Have you talked with your hospital's IT, MedEd and Pharmacy?

 

[Bartelby]

I have been using electronic prescribing with a hospital DEA for three and a half years as a resident but recently starting encountering this problem (with CVS). I have been told that I must have an individual DEA and that they can't fill the prescriptions I have sent. I stay on the phone and keep insisting that they can and have for several years, and eventually once they call their own internal help desk they are able to put it through.

Also you have presumably read them the DEA number on the phone and they still reject it because it is a hospital DEA. That isn't an electronic prescribing problem. It's a pharmacy problem.

In short, don't rule out a problem on the pharmacy's end. I think something in their system has changed to create one.

 

[Merovinge]

CVS will no longer fill any controlled substances with our hospital DEA either. It's a sad work around but I just refer my patients to Walgreens or our hospital pharmacy.

 

[birchswing]

I'm not a big fan of CVS. I get my meds from Target pharmacy which is now owned by CVS. They've already switched the staff around (from one store to another). I hope no one gets fired because they have wonderful pharmacists.

I went to Target to get away from CVS. They put Coreg in my Paxil bottle and when I went back to show them, the pharmacist asked me if it was a "street drug" that I had gotten mixed up with my Paxil! Fortunately, I got a nice little settlement from that mistake. But it was just a bad culture--at least at this particular CVS.

Target has been wonderful--some of the pharmacists are just amazing how much they do above and beyond. So far they have the same good service and seem somewhat autonomous from the rest of CVS. I rue the day they switch over to those orange bottles--I really like the red Target prescription bottles.

 

[wolfvgang22]

Yeah, it's CVS policy. When I was in fellowship I'd call customer service and get CVS to fill stimulants for kids with ADHD, but a lot of the time parents would get tired of waiting and just go to Walgreens. Guess CVS doesn't care about the lost business.
I've also had good service from Target pharmacies both as a prescriber and a patient.

 

[PikminOC]

The pharmacies are being extra strict bc they have been in trouble as well when pill mills went down. May wish to post this in the pharmacy forum.

 

[Doctor Bagel]

It sounds like something GME should be helping you out with. Do they know this is an issue? At my program, we had a hospital DEA number, but each resident had a specific number -- all residents had the same initial number, but the last 4 numbers or whatever would be individual to you. Does your hospital have that or do all residents use exactly the same number?

 

[MLT2MT2DO]

I'm confused is this common practice to go 3+ years into residency without an individual DEA number? Our GME requires us to get it early in intern year

 

[hamstergang]

I'm confused is this common practice to go 3+ years into residency without an individual DEA number? Our GME requires us to get it early in intern year

I didn't get my license until 4th year and my DEA until I wanted to moonlight this year (pgy-5, in c/a fellowship). My program never even suggested I get my own DEA.

 

[Doctor Bagel]

I'm confused is this common practice to go 3+ years into residency without an individual DEA number? Our GME requires us to get it early in intern year

Do they pay for this? A DEA number is pretty expensive if you're not going to use it for moonlighting. I didn't get mine until I started moonlighting.

 

[MLT2MT2DO]

They do. I assumed this was common practice.

 

[Doctor Bagel]

They do. I assumed this was common practice.

Nope. My program didn't pay for any of that type of stuff, and GME took away our food benefits. Why we needed a union, man.

 

[MLT2MT2DO]

Nope. My program didn't pay for any of that type of stuff, and GME took away our food benefits. Why we needed a union, man.

Omg, not the food, anything but the food.

Not even kidding. On rough days looking forward to a free lunch can be a saving grace.

 

[thoffen]

There are actually a couple of problems you may be encountering here.

First is that institutional DEAs require an individual identifier attached to them (NOT your NPI). I have gotten burned in the past by pharmacies who reject the paper Rx with only the institutional DEA attached and no identifier. I didn't know I had to until I gave a patient an Rx where the attending didn't countersign and put their own DEA number on it as well. I'm also wondering if some pharmacies went ahead and filled the Rx without the additional identifier anyway, though can't be sure if this is true.

With regards to your situation, I suspect that the electronic Rx either is not putting the individual identifier on it, or putting it in a place that the pharmacies aren't looking for it or are unable to look for it due to their systems. Which leads me to problem #2, and this problem is specific to CVS. Their system automatically rejects controlled substance Rx if the DEA # isn't valid on its own, and it doesn't allow them to look elsewhere for information to replace it with. This is why the Attending's DEA # also being present isn't helping. I know this because it happened to a colleague of mine who moved from state to state and thus got a new DEA number. He kept the same EMR which had his original DEA number on it, and his workaround was to write in the Rx comments his new DEA number. The only pharmacy that gave him hassle was CVS. Apparently, if they call their IT gurus or something they can eventually override it using other information, but it's a big PITA.

Unfortunately also, to cut costs, insurance companies are getting in bed with pharmacies to require their patients get Rx filled only there. So the solution of go to a different pharmacy might not always be viable.

 

[Comanaprocil]

... I suspect that the electronic Rx either is not putting the individual identifier on it, or putting it in a place that the pharmacies aren't looking for it or are unable to look for it due to their systems. Which leads me to problem #2, and this problem is specific to CVS. Their system automatically rejects controlled substance Rx if the DEA # isn't valid on its own, and it doesn't allow them to look elsewhere for information to replace it with. This is why the Attending's DEA # also being present isn't helping...

This makes sense, but I just was told that since I reported it to IT and GME more than 5 days after it happened, I have to wait for it to happen again! Our eRx vendor, Dr First, "can't trace eRxs more than 5 days after they were sent." I thought going electronic was supposed to make things like this easy to fix! Oh well. I'll keep you all posted once I solve The Mystery Of The Rejected Electronic Prescription.

 

[Trismegistus4]

Yes, CVS started doing this to me, too, earlier this year, but I already had 1 foot out the door of residency so I never bothered to try to get the GME office involved or anything. It only happened a few times, so I just sent the patient to a different pharmacy or asked an attending to call it in.

I'm confused is this common practice to go 3+ years into residency without an individual DEA number? Our GME requires us to get it early in intern year

Probably varies by institution and state. As someone upthread said, many residencies don't pay for this stuff, so it only makes sense to get it if you're moonlighting or definitely planning to stay in the state where you do residency. Otherwise you'd shell out big bucks for a license you'd never wind up using.

 

[thoffen]

This makes sense, but I just was told that since I reported it to IT and GME more than 5 days after it happened, I have to wait for it to happen again! Our eRx vendor, Dr First, "can't trace eRxs more than 5 days after they were sent." I thought going electronic was supposed to make things like this easy to fix! Oh well. I'll keep you all posted once I solve The Mystery Of The Rejected Electronic Prescription.

I have a different perspective having been a software engineer before going into medicine. Of course they can keep track of data more than 5 days old. But I think they are telling you truth in that they do not. Data is cheap, but it's not free. And if no one knows better to ask for more than 5 days worth of data at a time, who are they to care enough to provide it anyway.

And even more important is that the 5 day thing here doesn't really matter. If they were truly invested in finding the problem and fixing it, then they could easily replicate the problem themselves.

It's sad, but the people who are actually engineering our software systems in healthcare don't inherently value success in doing so like we do. We understand exactly how important it is that patient X get their medication without any hassle, and we understand that it might mean the difference between life and death. This same problem showed itself with the implementation of the new clozapine registry but at a much bigger scale. Sadly, I think patients really were harmed in that one.

 

[shan564]

I don't know if this is just a state rule, but we can't use e-Rx for controlled substances at all. I have to call in benzos or write paper prescriptions for schedule II drugs (stimulants).

 

[Doctor Bagel]

I don't know if this is just a state rule, but we can't use e-Rx for controlled substances at all. I have to call in benzos or write paper prescriptions for schedule II drugs (stimulants).

Actually here, too. Schedule II drugs need to be on prescription paper, and the rest need to be either phoned in or on paper. I wonder if by eRx, the op means a fax getting sent over ...

 

[thoffen]

Some states at least do have e-Rx systems for schedule II drugs.

 

[jcm189]

I'm a CVS pharmacist. I can tell you that for Illinois and most other states, residents CAN prescribe controlled substances with the hospital DEA. In IL, the attending's DEA is not required to be on the prescription.

Several months ago, CVS's system started rejecting prescriptions saying that we need to validate that the prescriber's DEA is authorized for the class of controlled medication. I don't know exactly why it only happens to certain prescribers. It's a very easy fix. We just need to put in a override saying we validated the DEA and the prescription should go through. Most of the time, if I recognize the prescriber or if it's a hospital DEA, I just put in the override without calling to validate. There was a chain wide message that was sent out instructing all pharmacy personnel on how to override this rejection. I'm surprised there are still CVS's out there that still don't know how to override the rejection since this issue started months ago.