Having good relationships with pharmacists

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npage148 said:
In which case the preferred substitute would be listed on the fax I sent you
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I have NEVER seen this, ever.
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I have been telling patients to go to other pharmacies.
I can't argue or clarify too much anymore.
I'm sick of it.
 
Careful there......strictly speaking directing patients toward or away from specific pharmacies is a very grey area....
 
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From the pharmacy side, we don't give a crap if you authorize it or not. Just tell the patient if you are authorizing it/changing it/denying it so they stop annoying us :)
 
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If you can't tell the doctor an alternative that would be cheaper for the patient, what the hell kind of drug expert are you? I'm not expecting you to know that you should change that Aerospan prescription over to the Pulmicort flexhaler, but you should be able to see a Dymista prescription and say "if it's not covered, maybe you should try just individual flonase and astelin?" Or that Trianex prescription can probably function just fine as generic triamcinolone. There are very few exceptions to this, and most all of them fall under Argus/Humana and their ****show of a PBM.

Every call I have made for the last year to a doctor's office about a PA ends with a "If you don't want to do the PA, you can always switch it to 'x' and the insurance should pay for it. If you can't do that much clinical thinking, then I'm not sure why you're being paid six figures. I agree that calling the insurance company would be more efficient, but raise your hand if you think it's easy to get information from an insurance company. And by information, I don't mean "we are experiencing high call volume, please continue to hold"
 
CynicalIntern said:
If you can't tell the doctor an alternative that would be cheaper for the patient, what the hell kind of drug expert are you? I'm not expecting you to know that you should change that Aerospan prescription over to the Pulmicort flexhaler, but you should be able to see a Dymista prescription and say "if it's not covered, maybe you should try just individual flonase and astelin?" Or that Trianex prescription can probably function just fine as generic triamcinolone. There are very few exceptions to this, and most all of them fall under Argus/Humana and their ****show of a PBM.

Every call I have made for the last year to a doctor's office about a PA ends with a "If you don't want to do the PA, you can always switch it to 'x' and the insurance should pay for it. If you can't do that much clinical thinking, then I'm not sure why you're being paid six figures. I agree that calling the insurance company would be more efficient, but raise your hand if you think it's easy to get information from an insurance company. And by information, I don't mean "we are experiencing high call volume, please continue to hold"
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Because it is nowhere near as simple as you make it out to be. I have one part d plan that requires a PA for Proventil or Ventolin but not Proair. I have another that's the opposite. I have plans that will only cover Colcrys but not colchicine. I have plans that will cover Nexium but not esomeprazole.

Everyone here can say that azelastine and fluticasone is more likely covered than Dymista.

But I am not an expert at insurance formularies and it is not my responsibility. This is between the patient and insurance. I am happy to suggest cheaper alternatives. I am not, however the be all end all expert on why Ms Smiths insurance won't cover her Spiriva and what they prefer. If this is not included in the PA message that I convey to the doctor, than my responsibility is over with. At that point it is between the patient, prescriber, and insurance to work out the formulary. I can suggest the names of other anticholinergic inhalers. I cannot speculate to what is preferred by an individual part D plan out of hundreds.
 
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I sense sarcasm and fakeness from this guy grover since first few posts. His intentions were to rant about pharmacies and pharmacists. Now its starting to really show. Time to change thread title.
 
So as a drug expert we need to memorize everyone's formularies now? I don't recall the insurance company paying me to sort out the issues that their customers run into with their plan. I have no problem with sending the doctor a simple fax/phone call stating the the drug is not covered with possible substitutions or even alternatives that they do cover (providing that the insurance rejection actually states this info)... but if you are doing anything beyond this you are going to fall behind very fast.
 
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GroverPsychMD said:
There is a reason we prescribe what we prescribe. I cannot change a medicine at the whim of the insurance company.
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I completely understand this, but if the patient can't afford the best medicine, an inferior substitute is often better than nothing. The most egregious case I've seen was a doctor who refused to allow generic Coumadin for a patient, and the patient would not/could not pay the $30 co-pay for the brand. I did the best I could to try to get the doctor to OK the generic, and he refused, so the patient left with no Coumadin or warfarin. I totally get why doctors (and often patients) prefer name brand on NTI drugs....but generic warfarin would have been better than the patient getting nothing.
 
BidingMyTime said:
I completely understand this, but if the patient can't afford the best medicine, an inferior substitute is often better than nothing. The most egregious case I've seen was a doctor who refused to allow generic Coumadin for a patient, and the patient would not/could not pay the $30 co-pay for the brand. I did the best I could to try to get the doctor to OK the generic, and he refused, so the patient left with no Coumadin or warfarin. I totally get why doctors (and often patients) prefer name brand on NTI drugs....but generic warfarin would have been better than the patient getting nothing.
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You are in Illinois. The malpractice climate is very high there. You have to do everything right there.
Sometimes the better than nothing is not enough.
 
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GroverPsychMD said:
Thank you, if you hear a pharmacist calling you and start with "Sorry to bother you...that's me. I try to be nice and reasonable, too.
--
I don't need a pharmacist to say that to me.
I can be nice without that.
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hey psych doc. recently my pharmacist coworker called to question an Rx (written on same prescription pad) for Prozac + Zoloft (not tapering or anything...). pharmacist told pt she would not fill Rx until MD called her back d/t being prescribed 2 drugs with same MoA. apparently MD got really upset she "withheld" meds (for not even greater than 24 hrs, by the time he called back) and called her stupid for questioning his authority....really rude. i think a lot of MDs dont know that pharmacists can be held liable for filling an inappropriate Rx, they dont just fill what the doctor ordered if they think there is an issue. secondly, since you're in psych....why in the world would someone get 2 SSRI's lol.
 
GroverPsychMD is a classic example of the unprofessional physician who chooses ego over professionalism. The patient chooses their physician. They have that freedom in this country. The patient chooses their pharmacy. They also have that freedom in this country. Most physicians exhibit what we call "professional courtesy" which is to respect the choices of the patient. If a doctors office frustrates us, we do our best to accommodate the patient but never try and sway the patient from their doctor. If a pharmacy frustrates an MD, they do their best to accommodate the patient but never try and sway the patient from their pharmacy. If the doctor writes an rx that the pharmacy refuses to fill then the patient will receive the prescription back to do with whatever they want. But to steer your patients away from us for an issue like this? Completely unprofessional. Is professional courtesy dead?

I don't believe that Grover is a troll at all. I believe that they want us to satisfy their ego and justify their extremely rude behavior towards another health care professional. Not gonna happen. They get zero respect from me for their behavior in this thread.
 
The best part is that often the drug that requires the PA isn't any better than the covered medication. It's just the doctor likes it when the sales rep come in and flirts with them. Makes them feel important
 
I don't blame Grover for steering patients away from pharmacies if they are being abusive with the fax machine and calls. I've seen people fax doctors office's everyday for a PA or refills. That is excessive and creates a huge workload for the office staff. If you get a PA fax the office once, try to run it again in a day or two, then fax again, then finally call. I don't badger offices over PA's, I let the patient do that.
 
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Gombrich12 said:
I don't blame Grover for steering patients away from pharmacies if they are being abusive with the fax machine and calls. I've seen people fax doctors office's everyday for a PA or refills. That is excessive and creates a huge workload for the office staff. If you get a PA fax the office once, try to run it again in a day or two, then fax again, then finally call. I don't badger offices over PA's, I let the patient do that.
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Exactly right. I need to spend my time in direct patient care. Not in fights with pharmacists.
 
GroverPsychMD said:
You are in Illinois. The malpractice climate is very high there. You have to do everything right there.
Sometimes the better than nothing is not enough.
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the thing is, for many of the PA drugs, they alternative brand name drug prescribed is not better, they just have a better sales rep. That is why I enjoy the hospital world, we just change it to what is on formulary.

You cannot tell me that you can guarantee that nexium is going to work better than protonix, or that brand name steroid nasal inhaler A is better than generic steroid inhaler B - that is one of the reasons that medical costs are spiraling out of control.
 
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"Hey patient this pharmacy is bothering me too much, I want you to drive an extra 15 minutes to the other pharmacy. Thanks" - sincerely Grover 2015 Kappa
 
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lt23 said:
"Hey patient this pharmacy is bothering me too much, I want you to drive an extra 15 minutes to the other pharmacy. Thanks" - sincerely Grover 2015 Kappa
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Especially since the "bothering" sounds like the pharmacy badgering him to do a prior auth. "Hey patient, that pharmacy keeps hounding me because you probably keep hounding them about that prescription. Why don't you go somewhere else who will ignore your repeated requests and not contact me?"
 
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Delusional, unprofessional, the list just keeps growing. Can you imagine the reaction if I told a patient your doctor prescribed you this really expensive drug and the insurance won't pay towards the cost unless your doctor fills out some paperwork. But they told us they aren't going to do it and refuse to switch to a cheaper alternative so you will be forced to pay the full cash price. You should find a new physician who cares about your treatment?

Last year at our outpatient pharmacy we had a patient who told us they were transferring their prescriptions to a different pharmacy connected to their pain management offices. According to the patient they wouldn't write any prescriptions for pain management unless they used this specific pharmacy. I told her to contact the district attorney and state attorney general about this and sure enough, she sent me a copy of the same letter she sent then-attorney general Greg Abbott. Wouldn't you know that the she kept using us and still does to this day....
 
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GroverPsychMD said:
You are in Illinois. The malpractice climate is very high there. You have to do everything right there.
Sometimes the better than nothing is not enough.
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True about the litigious climate in IL, but you think a doctor won't be sued over refusing to change Coumadin to warfarin? What will his defense be when the FDA says there is no practical difference between the two? The physician may be in a lose-lose situation, but I suspect his legal defense will be much better when he has documented that the patient refused treatment A due to cost so he went with treatment B, then when he is sued because the patient received NO treatment because he couldn't afford treatment A.

GroverPsychMD said:
Exactly right. I need to spend my time in direct patient care. Not in fights with pharmacists.
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I wouldn't call repeated faxes from the pharmacy "fighting". Some systems automatically generate these faxes, sometimes overzealous techs generate them. The biggest problem I've seen is when physicians do not communicate back to us. If you are not going to refill the medicine, or if you are not going to refill it until after the patient has an appt, then just let us know--and we will stop bothering you. Same with PA's, if you have already submitted it, or if you are not going to submit it, just let us know--and we will stop bothering you. When we receive NO answer back to a fax, the logical thing is to assume that you did not receive the fax for whatever reason, so you will get faxed again, and again, and again. Myself, and I suspect most pharmacists, really don't care if you do or do not refill a prescription or if you do or do not do a PA, we just need to know what your decision is, so we can communicate that to the patient who is calling us 3 or more times a day for an update on their prescription.

And yes, I'm pretty sure its illegal for a doctor to specifically direct a patient not to use another pharmacy, or to use a specific reason (unless there is a patient specific reason why a pharmacy would not be able to meet that patients specific needs.)
 
See this is really the problem, instead of calling out those who are actually creating the problems (ie insurance companies and law makers) we are too damn busy fighting each other to have anything accomplished. We both need to accept the fact that both sides deal with colossal heaps of bull****. It is really time we get over our damn egos and actually do something to help our patients instead of waving our d**ks around to prove who's is bigger.

If each side could learn to respect the other's education, experience, and time, we really could make positive changes in healthcare. Instead we get doctors who feel the need to constantly phone in scripts because they are only wasting the time of their office secretary (this wastes a huge amount of a pharmacist's time by the way) as they simply do not have the time to sign a sheet of paper, and we have pharmacists who do nothing to help a doctor choose a formulary product for a patient because "that is not our job".

I have to say though, shame on many pharmacists here for insulting and badmouthing a doctor who is simply frustrated with the system, I'm sure other doctors will look really well on us now...way to go.
 
Dr Wario said:
See this is really the problem, instead of calling out those who are actually creating the problems (ie insurance companies and law makers) we are too damn busy fighting each other to have anything accomplished. We both need to accept the fact that both sides deal with colossal heaps of bull****. It is really time we get over our damn egos and actually do something to help our patients instead of waving our d**ks around to prove who's is bigger.

If each side could learn to respect the other's education, experience, and time, we really could make positive changes in healthcare. Instead we get doctors who feel the need to constantly phone in scripts because they are only wasting the time of their office secretary (this wastes a huge amount of a pharmacist's time by the way) as they simply do not have the time to sign a sheet of paper, and we have pharmacists who do nothing to help a doctor choose a formulary product for a patient because "that is not our job".

I have to say though, shame on many pharmacists here for insulting and badmouthing a doctor who is simply frustrated with the system, I'm sure other doctors will look really well on us now...way to go.
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What the hell are you talking about? A physician is being dishonest with us and we're just supposed to sit back and take it like a potted plant? That's the attitude of APhA which explains why they have done NOTHING for this profession. It's not a dong measurement contest, it's about trying to do what's best for the patient. Apparently demanding a low income patient pay hundreds of dollars for a medication is kosher.
 
BenJammin said:
What the hell are you talking about? A physician is being dishonest with us and we're just supposed to sit back and take it like a potted plant? That's the attitude of APhA which explains why they have done NOTHING for this profession. It's not a dong measurement contest, it's about trying to do what's best for the patient. Apparently demanding a low income patient pay hundreds of dollars for a medication is kosher.
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Um no, but you can try to explain where he/she has it wrong without reverting to insults and making us all look stupid.
 
Dr Wario said:
Um no, but you can try to explain where he/she has it wrong without reverting to insults and making us all look stupid.
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Have you read the comments in this thread? That has been done already.
 
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BenJammin said:
Have you read the comments in this thread? That has been done already.
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Anything worth reading in this thread is surrounded by useless garbage. Trust me, I am not calling grover a saint, but that is no reason to portray ourselves as pompous asses just because we are on home turf.
 
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The OP just seems lazy. Doesn't matter if it's the pharmacy faxing your or the patient calling you, one way or another SOMEONE is going to end up bothering you about refill requests/prior auths. Be glad it's the pharmacy to has to explain it all to the patients and deal with them complaining about the 1-3 day wait time rather than your office receiving all of these phone calls when the pharmacy says "call your doctor for refills/call your doctor the med isn't covered".

OP's idea of a good relationship with a pharmacy is that the pharmacy does everything in their power to eliminate their workload. We don't eliminate it but at least all you have to do is some paperwork/call in a script and not deal with your patients that whine and moan and complain as they call us daily (after they waited until they are out of medication and refills to call in their prescription because apparently they can't read a bottle and somehow don't realize they are low on pills in the bottle that they open every damn day and look into).
 
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You're not seeing it from my standpoint at all.
I posted on here so that we could learn from each other.
Of course I could have posted on the all MD/DO forum but I don't think that is useful for this kind of dialogue.
Not lazy, these things add time to my day. My day is to see patients. Think for a minute how many of these faxes we get in a day.
I saw the patient, evaluated, and gave a prescription. Unless it is undreadable or there is an allergy or interaction, my job is done.
My meds are all generics. If they are expensive, I gladly do the prior auth.
I will not do them if the med is generic.
I had a pharmacy yesterday fax me a request for 90 days.
I called them and told them to have the patient take the prescription to a cheaper pharmacy and pay cash for the thirty I wrote for as I will not and did not write for ninety.
My patients only get scripts at appts. They will not get them by going to the pharmacy and asking for fills. They know that, have signed for it, and we discuss at apt time. These auto generated faxes are useless and I tell pharmacies who send me them to stop sending them. They are learning. It clogs my fax machine and costs me more. I need the fax for records on my patients.
I tell patients directly what is going on with the medicine if I will not do the prior auth. I will call the pharmacy as well but Im getting annoyed with the amount of extraneous communication from the pharmacy.
My patients are not requesting the refills or the ninety days.
I cant answer re: Coumadin as I do not prescribe it.
 
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GroverPsychMD said:
My patients are not requesting...the ninety days.
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So, you think they are not requesting 90 days by signing up for an insurance policy that explicitly requires it and then asking a pharmacist to use that policy? Wrong. It may be unintentional, but they are absolutely 100% requesting the 90 days.
 
I would discard the 90 day requests as they come. I work for a major chain and the 90 day requests occur when patients check a box in their profile stating they prefer 90 days. From there on out, scripts that pass data review get stuck in a "90 day will call back" queue and the fax is auto generated. This becomes a major nuisance when processing emergency room or urgent care scripts. In 100% of cases the pharmacy removes the 90 day exception immediately since it's the only way to continue processing the script as written.

We hate the 90 day faxes as much as you do since the exceptions slow down work flow, but it's here to stay since the approval if and when they come add to the company's bottom line. Some of our physicians will approve the 90 day fax weeks or even a month after the original script has been sold. The only way to stop the faxes is to uncheck the "90 days preferred" box in the patients profile, but patients can easily recheck that box themselves.
 
GroverPsychMD said:
You're not seeing it from my standpoint at all.
I posted on here so that we could learn from each other.
Of course I could have posted on the all MD/DO forum but I don't think that is useful for this kind of dialogue.
Not lazy, these things add time to my day. My day is to see patients. Think for a minute how many of these faxes we get in a day.
I saw the patient, evaluated, and gave a prescription. Unless it is undreadable or there is an allergy or interaction, my job is done.
My meds are all generics. If they are expensive, I gladly do the prior auth.
I will not do them if the med is generic.
I had a pharmacy yesterday fax me a request for 90 days.
I called them and told them to have the patient take the prescription to a cheaper pharmacy and pay cash for the thirty I wrote for as I will not and did not write for ninety.
My patients only get scripts at appts. They will not get them by going to the pharmacy and asking for fills. They know that, have signed for it, and we discuss at apt time. These auto generated faxes are useless and I tell pharmacies who send me them to stop sending them. They are learning. It clogs my fax machine and costs me more. I need the fax for records on my patients.
I tell patients directly what is going on with the medicine if I will not do the prior auth. I will call the pharmacy as well but Im getting annoyed with the amount of extraneous communication from the pharmacy.
My patients are not requesting the refills or the ninety days.
I cant answer re: Coumadin as I do not prescribe it.
Click to expand...
Nothing sounds unreasonable here.
 
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zelman said:
So, you think they are not requesting 90 days by signing up for an insurance policy that explicitly requires it and then asking a pharmacist to use that policy? Wrong. It may be unintentional, but they are absolutely 100% requesting the 90 days.
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I have not prescribed 90 days and will not do so unless I have decided to do so. If I decided to do so, it will be on the prescription.
CVS/Caremark is the worst of the offenders with this.
12 of these requests, 5 minutes each is another hour onto my day. Even for me to call the pharmacy, get thru the prompts and say no.
 
GroverPsychMD said:
I had a pharmacy yesterday fax me a request for 90 days.
I called them and told them to have the patient take the prescription to a cheaper pharmacy and pay cash for the thirty I wrote for as I will not and did not write for ninety.
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I agree with the "I wrote for 90" part, especially with psych because of the many titrations and tapers and other adjustments, so 90 days will probably be a waste in many cases. The only problem here is that even for generics, cash price without insurance can be very high, so that's not always an option. Fluoxetine? Yeah, that's going to be under $10, fine, but when you want lamotrigine ER, that's a few hundred bucks.
My patients only get scripts at appts. They will not get them by going to the pharmacy and asking for fills. They know that, have signed for it, and we discuss at apt time.
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This can be an issue because most offices do not have this policy. Many (most, even) outright state "if you want refills, do not call us, call your pharmacy and have them fax the office." That's literally the phone message after "if this is a true emergency call 911" for the majority of practices I've had to call. There may be a learning curve for your patients and the pharmacies getting to know your office, but your office staff should be able to handle this without interrupting you personally. If they have a generic form stating "Dear pharmacy, please do not fax us for refills, the patient must contact us" that would both let us know how your office does things, and let us know to contact the patient, rather than resending the fax in 2 days, 4 days, etc.
Also, it may be that the patient has automatic refills, and it's not the patient who called the pharmacy. It's just that they picked up their 30 days of meds 28 days ago, and our system shows that they are due, yet without a refill, so it generates the message.
 
Ackj said:
I agree with the "I wrote for 90" part, especially with psych because of the many titrations and tapers and other adjustments, so 90 days will probably be a waste in many cases. The only problem here is that even for generics, cash price without insurance can be very high, so that's not always an option. Fluoxetine? Yeah, that's going to be under $10, fine, but when you want lamotrigine ER, that's a few hundred bucks.
This can be an issue because most offices do not have this policy. Many (most, even) outright state "if you want refills, do not call us, call your pharmacy and have them fax the office." That's literally the phone message after "if this is a true emergency call 911" for the majority of practices I've had to call. There may be a learning curve for your patients and the pharmacies getting to know your office, but your office staff should be able to handle this without interrupting you personally. If they have a generic form stating "Dear pharmacy, please do not fax us for refills, the patient must contact us" that would both let us know how your office does things, and let us know to contact the patient, rather than resending the fax in 2 days, 4 days, etc.
Also, it may be that the patient has automatic refills, and it's not the patient who called the pharmacy. It's just that they picked up their 30 days of meds 28 days ago, and our system shows that they are due, yet without a refill, so it generates the message.
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I don't prescribe lamot ER. And I don't need my fax clogged up with garbage.
 
Is it the pharmacy's fault that the insurance won't pay for 30 days supply? Is it the pharmacy's fault for not knowing that your office does things differently than 95% of other offices? How would we know you won't give refills or that you won't let our patient fill their scripts under their insurance's restrictions?

But here is an idea, don't put your fax number on your prescription pad if you plan to ignore all pharmacy faxes anyway. Of course you would need to change your fax number now but still if faxes bother you that much it may be worth it to you to change it.
 
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GroverPsychMD said:
It clogs my fax machine and costs me more. I need the fax for records on my patients.
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If cost of fax is a concern, please consider receiving as Electronic Fax. You can delete the fax before you print, that will save you ink and paper.

Plus, just in case...someday...you upset or cross line with someone, they can send continuous looped black paper and your fax machine will print out pages and pages of black ink and will run out your ink in 1 hour in the middle of the night. Now, that's costly...Just sharing and looking out for you.

Some pharmacies will not suggest covered medication because they don't have time.

If I own my own pharmacy, I will spend time to get the script and suggest covered medication.

Also, please understand that chain pharmacists are under budget cut. Less hours for more services every year. We have to squeeze everything that takes 14 hours of normal speed into 8 hours at high speed. Then, I have to clock out, leaving work behind. California labor law is very strict. (Lunch must be taken, no skipping allowed. Break time, we can skip.)

I feel bad for not finishing work but if I stay after clocking out to volunteer, I will get fired.

I have volunteered by not taking break for the past 8 years, donated 30 minutes of break time daily to the society, that is over 62400 minutes. My teammates are doing the same way, pharmacists and techs.

We are not lazy folks. Just don't have enough hours to do everything.
 
Do you actually have office staff, or are you personally responding to all of these calls and faxes? If they're really eating up that much time in your day, I'm kind of doubting you have (competent) office staff. If you're doing it solo, you might want to consider hiring help. I know pharmacists cannot do their job without techs, and I'm positive the same applies to most docs' support staff.
 
I do everything myself. And I'd rather sdn. It's my choice. I never said yall were lazy. Someone called me that so I was responding. It's the insurances fault. But that's between the patient and insurance. Not me.
I have efax. It's still a waste. I've cut the number of pharmacies that bother me.
 
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GroverPsychMD said:
I had a pharmacy yesterday fax me a request for 90 days.
I called them and told them to have the patient take the prescription to a cheaper pharmacy and pay cash for the thirty I wrote for as I will not and did not write for ninety.
Click to expand...

Instead of being unprofessional all you have to do is fax back or leave a voicemail saying "no". Why is that your behavior is acceptable but if I referred people to cheaper NPs/PAs I'd get my ass chewed out? You just don't get it.
 
BenJammin said:
Instead of being unprofessional all you have to do is fax back or leave a voicemail saying "no". Why is that your behavior is acceptable but if I referred people to cheaper NPs/PAs I'd get my ass chewed out? You just don't get it.
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Not unprofessional. That's what I had told the patient to do too.
please refer patients to np pa. No skin off my back.
fax and phone take time.
 
Not sure what his issue is:

Is it that insurance companies require PAs on generics?
Pharmacies doing their jobs trying to get meds approved?
Not providing enough information because he prescribes abnormal dosing regimens?
What exactly is your issue, you are kinda all over the place.
 
Corpseman said:
Not sure what his issue is:

Is it that insurance companies require PAs on generics?
Pharmacies doing their jobs trying to get meds approved?
Not providing enough information because he prescribes abnormal dosing regimens?
What exactly is your issue, you are kinda all over the place.
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He doesn't have office staff, so he's stressed from doing their job and his own. Pharmacists who are stressed from not having enough tech hours don't get to make the choice; they're stuck with what corporate will give them. He actually has the opportunity to fix the situation, but he won't.
 
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