How do you handle control issues/day to day encounters

[MARX22]

Hey guys! Encountered a bunch of the same issues today working at an independent, and went crazy calling on them all lol. At chains, I’m sure u dont have time. I interned and hated it, so wondering how u guys approach things!


1- first of all why is there levalbuterol nebulization vials that come in packs of 24 and 25 lol. Standard albuterol is 25 x 3 ml=75, this was odd to me lol. That was besides the point. Got rx for xopenex hfa inhaler for a 7 yr old, 2 puffs q4-6. So thats the max dose and also got nebulizer 1 vial (0.63 mg) q4-6. Insurance rejected for too high of a dose for the nebulizer (aside from duplicate therapy, which should be fine since pt shouldnt use both at the same exacr time lol), it said max dose is 9ml per day. Checked lexi, 5-<12 yo is 0.63mg q8h (although for <4 yrs it can be 1.25mg q4-6 or something like that.. basically higher dose and freq than a 7 yr old). In these scenarios, do u call md and push them to switch to q8, or if they insist on q4-6 do u keep that and put in an override for the high dose to make it go thru, or do u change days supply? I.e. lasts 5 days per sig but rejects for high dose so bill for 10 and it goes thru? Ppl do that but idk..


2- got pravastatin, pt been on lovastatin. I would assume its replacing it but this rx is from a diff dr. If dr doesnt answer and pt says theyre supposed to be on prava or they just BS me to get the med lol... the only override that works for therap duplic is M0 consulted dr, 1b filled as is. Do u guys still use that even if u didnt talk to dr, then annotate “as per pt”? The option for patient consulted doesnt work lol. Only reason id try to call is cuz ive had pt on lisinopril from a dr then they suddenly sent losartan from the same md, called and it was an error


3- got rx with weird sig. 1t po qd x 14 days, 1 tablet per 10 days. Qty 14. Lol. Probably meant to be qd, if md doesnt answer and pt is being annoying.. or says dr said qd, do u jus change it or wait to speak to office?


4- got a script for endocet no daw. Pt called saying they need brand. Took hrs to get in touch w md with pt calling every few mins. Dr said no daw finally said ok daw but tell pt i wont give her an rx anymore. I filled and annotated that and DAW. Later got rx with daw and notes said that pt has been complaining of gi upset from generic despite having been on generic for the past few months. I felt upset at myself bc pmp was good but the dr’s right, the pt has been on generic all these months so why is she complaining endocet works better if pmp doesnt even show she was on it. On the other hand, md gave ok for daw. Sure this was a red flag but the dr said to give brand. Lets say i caught this myself, the pattern of being on generic all this time so why is she asking for endocet... how would u even question the patient without them getting confrontational? We get controls with daw on it sometimes, it’s not like we call on those and question why the dr is giving brand, so if the dr says brand it should be okay. Is this really something to lose sleep over? I cant be an investigator over every little detail


5-i kno an rph who refused to fill a control for a dr who kept prescribing for herself. Walgreens transferred him to a crappy store because the md complained to corporate. I thought they should at least have your back with these things esp if they taught us not to say “out of stock” as an excuse. Whats ur take on drs writing for themselves, or generally how do u refuse a pt if too soon or u dnt feel comfortable for whatever reason? If i see pt is getting from diff drs on pmp i contact current dr and was told by fellow rphs that if md says to give then annotate the convo abt md being aware of multiple drs and then dispense. Under what condition do u absolutely refuse besides contraindicated or too soon (Assuming its not a forged blank and its an e rx)? do ya say no cuz of red flags?


Thanks!!!

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[MARX22]

I would let my techs handle those issues.

In all seriousness, it’s best if you just copy what your coworkers are doing. Don’t overthink like this.

Seriously, I’m trying not to overthink. Take away pts comments about the color/it working better (despite her having no history of the brand lol), if it was sent in with daw i wouldnt have questioned it if pmp was clear... guess i gotta just ignore some of the comment, and as long as md is aware it should be fine

 

[wagrxm2000]

1. Tell patient how to take
2. Tell patient which to take
3. Tell patient to take as directed
4. What????
5. Tell patient professional objectivity may be compromised

Now tell yourself to stop overthinking things or you'll never make it.

 

[MARX22]

1. Tell patient how to take
2. Tell patient which to take
3. Tell patient to take as directed
4. What????
5. Tell patient professional objectivity may be compromised

Now tell yourself to stop overthinking things or you'll never make it.

HAHA, ok. 1-tell pt how to take, sure, but q4-6 is considered high dose. If md insists on that, my question was how do u make it go through without changing day supply from 5 days to lets say 10

2-the new one is pravastatin so im assuming thats what they should take and stop the old one. If ins rejects for duplicate therapy, are u still using the override that says u consulted MD even though you didn’t? Also, ive had them send the wrong med by accident so calling helps in that aspect but its too much work... therapy changes all the time lol

3-the qd then one every 10 days, you would just dispense as is and tell pt to take as directed?

4-basically pt got rx for endocet, no daw so i would give generic. She was insisting on brand “the yellow e712” whatever whatever. Supposedly claimed the generic hurts her stomach and brand works, meanwhile has no history of brand on PMP. Called dr, dr said no then finally said ok daw this time and tell her im not prescribing for her anymore. I told pt and annotated and that was that. Dont kno if i was wrong for doing that due to “red flags” or if the only time i should refuse is if theyre early/contraindicated/forged blank rx

5-yes if dr writes control for themselves, i’d refuse bc u need pt and prescriber relationship. U writing for yourself is a gray area

 

[wagrxm2000]

HAHA, ok. 1-tell pt how to take, sure, but q4-6 is considered high dose. If md insists on that, my question was how do u make it go through without changing day supply from 5 days to lets say 10

2-the new one is pravastatin so im assuming thats what they should take and stop the old one. If ins rejects for duplicate therapy, are u still using the override that says u consulted MD even though you didn’t? Also, ive had them send the wrong med by accident so calling helps in that aspect but its too much work... therapy changes all the time lol

3-the qd then one every 10 days, you would just dispense as is and tell pt to take as directed?

4-basically pt got rx for endocet, no daw so i would give generic. She was insisting on brand “the yellow e712” whatever whatever. Supposedly claimed the generic hurts her stomach and brand works, meanwhile has no history of brand on PMP. Called dr, dr said no then finally said ok daw this time and tell her im not prescribing for her anymore. I told pt and annotated and that was that. Dont kno if i was wrong for doing that due to “red flags” or if the only time i should refuse is if theyre early/contraindicated/forged blank rx

5-yes if dr writes control for themselves, i’d refuse bc u need pt and prescriber relationship. U writing for yourself is a gray area

1. Patients will use nebulizers at home and inhalers on the road. The directions while it doesn't say max per day are more so the parent doesn't freak out and think oh no it hasn't been long enough..... Which is why I say tell them how to take it.

2. You will drive yourself crazy if you think every script might be wrong. There's nothing wrong with switching meds.

3. I would dispense the full 14, taking 4 more of I'm going to assume either an antibiotic or prednisone isn't going to hurt the customer.

4. Why do you need daw? Insurance?

5. What I'm saying is when a person prescribes for themself, they may not be objective towards themself.

Anyways you need to save your phone calls to serious issues. Nothing you posted here should involve an MD call.

 

[MARX22]

1. Patients will use nebulizers at home and inhalers on the road. The directions while it doesn't say max per day are more so the parent doesn't freak out and think oh no it hasn't been long enough..... Which is why I say tell them how to take it.

2. You will drive yourself crazy if you think every script might be wrong. There's nothing wrong with switching meds.

3. I would dispense the full 14, taking 4 more of I'm going to assume either an antibiotic or prednisone isn't going to hurt the customer.

4. Why do you need daw? Insurance?

5. What I'm saying is when a person prescribes for themself, they may not be objective towards themself.

Anyways you need to save your phone calls to serious issues. Nothing you posted here should involve an MD call.

Correct me if i misunderstood wrong. You’d dispense the q4-6 and just tell the parent to give it q8? My main concern was also if anyone knows an override if the dr did want that dose or in your case you decide to bill it as is and it keeps rejecting

2-ok so if it rejects for duplicate therapy il use the “md consulted” override even if i didnt speak to them

3-it was for provera, qty 14 and said “1 tab po qd for 14 days, one tab q10 days.” It was just weird lol

4-yep law states u fill with generic unless it says DAW, and insurances also audit. Moreso concerned with whether i should refuse when i see “red flags” or just give myself a break lol

5-yes i def agree with you on mds prescribing controls for themselves. Other meds-whatever

 

[wagrxm2000]

Correct me if i misunderstood wrong. You’d dispense the q4-6 and just tell the parent to give it q8? My main concern was also if anyone knows an override if the dr did want that dose or in your case you decide to bill it as is and it keeps rejecting

2-ok so if it rejects for duplicate therapy il use the “md consulted” override even if i didnt speak to them

3-it was for provera, qty 14 and said “1 tab po qd for 14 days, one tab q10 days.” It was just weird lol

4-yep law states u fill with generic unless it says DAW, and insurances also audit. Moreso concerned with whether i should refuse when i see “red flags” or just give myself a break lol

5-yes i def agree with you on mds prescribing controls for themselves. Other meds-whatever

1. I would tell the patient how much they should be taking per day but explaining that doesn't mean not take it if needed. I would then let them know if they find themself using it chronically way too often they need another maintenance med added.

3. I would assume the MD spoke to the patient how they should use this. If the patient is able to explain an understanding, there's no need to call.

4. In that case I would let the customer handle it if they want brand. No need to waste your time. I see nothing that says don't dispense from what you said.

 

[MARX22]

1. I would tell the patient how much they should be taking per day but explaining that doesn't mean not take it if needed. I would then let them know if they find themself using it chronically way too often they need another maintenance med added.

3. I would assume the MD spoke to the patient how they should use this. If the patient is able to explain an understanding, there's no need to call.

4. In that case I would let the customer handle it if they want brand. No need to waste your time. I see nothing that says don't dispense from what you said.

The fact that she has no history of endocet but claims that controls her pain and generics hurt her stomach meanwhile thats all shes been getting from the dr for months is what raised a red flag. Putting those comments aside its fine, and i did tell her to call the dr but she called me EVERY TEN MINS to ask if i got the script. I got it after a few hours then it had no daw. At that point i just wanted her out of my hair. I guess its easier to have them handle it on their own in a chain, with independents they expect u to flip backwards for them lol.

On what basis do you ever refuse a control, besides too early/contraindicated? If the state registry shows theyve been alternating docs or pharmacies, do you bring that up to the dr and dispense with their approval, or do you refuse? Some people just dispense even if pt sees diff drs/pharmacies. I understand if a pt has to go to the hosp/clinic u cant be seen by the same dr but diff pharmacies idk lol.

Thanks for your help!

 

[wagrxm2000]

The fact that she has no history of endocet but claims that controls her pain and generics hurt her stomach meanwhile thats all shes been getting from the dr for months is what raised a red flag. Putting those comments aside its fine, and i did tell her to call the dr but she called me EVERY TEN MINS to ask if i got the script. I got it after a few hours then it had no daw. At that point i just wanted her out of my hair. I guess its easier to have them handle it on their own in a chain, with independents they expect u to flip backwards for them lol.

On what basis do you ever refuse a control, besides too early/contraindicated? If the state registry shows theyve been alternating docs or pharmacies, do you bring that up to the dr and dispense with their approval, or do you refuse? Some people just dispense even if pt sees diff drs/pharmacies. I understand if a pt has to go to the hosp/clinic u cant be seen by the same dr but diff pharmacies idk lol.

Thanks for your help!

Walgreens has a good faith dispensing form. Pretty much says: cash paying, multiple mds, pharmacy not close to home, MD office unusually far away, early fill, same medication every single month without any change, etc.

I will rarely if ever deny a hospice/cancer patient.

Controls are horrible, it takes awhile to get a system down. If you don't seem to do a ton and your customers stay the same month to month with barely any new ones, I wouldn't worry about it.

I've been at my store for so long now, I can almost list in order when certain customers will be in. I don't worry about elderly Mrs McGillicuddy who comes in every month with Norco.

Ask someone else and they will give you a completely different response.

 

[MARX22]

Walgreens has a good faith dispensing form. Pretty much says: cash paying, multiple mds, pharmacy not close to home, MD office unusually far away, early fill, same medication every single month without any change, etc.

I will rarely if ever deny a hospice/cancer patient.

Controls are horrible, it takes awhile to get a system down. If you don't seem to do a ton and your customers stay the same month to month with barely any new ones, I wouldn't worry about it.

I've been at my store for so long now, I can almost list in order when certain customers will be in. I don't worry about elderly Mrs McGillicuddy who comes in every month with Norco.

Ask someone else and they will give you a completely different response.

So u guys are supposed to refuse those ppl that fall under what’s on that form? I have friends at duane reade who do cash and dont even pay attention to what drs a pt is going to so long as theyre not early. The good faith thing i was told was jus regarding hydromorphone and 2 others I cant recall... that u have to call and get a diagnosis code on it, but not that u refuse

Also my geography sucks lmaooooo

 

[3boooda]

Oh man. I couldn’t finish the whole post

 

[wagrxm2000]

So u guys are supposed to refuse those ppl that fall under what’s on that form? I have friends at duane reade who do cash and dont even pay attention to what drs a pt is going to so long as theyre not early. The good faith thing i was told was jus regarding hydromorphone and 2 others I cant recall... that u have to call and get a diagnosis code on it, but not that u refuse

Also my geography sucks lmaooooo

They are for specific drugs but it's something you can use as your reasoning why you won't fill it.

 

[Sine Cura]

I see about 40 things like this every workday, yes including people who want brand narcs. The following is my instant reaction to each scenario

1) Pay cash if day supply limits or TDD exceeded or go somewhere else. I might fax for regular albuterol nebs if the nebs were levalbuterol. Then they can pay cash for the cheaper option

2) Counsel pt and tell them to stop the older statin. As far as what the prescriber really intended, I'm not a mind reader. If the prescriber doesn't take their job seriously I cannot literally do their job for them unless it may potentially affect my license negatively.

3) Close enough.

4) Pay cash or go somewhere else

5) Tell them to go somewhere else

See a theme here?

 

[CetiAlphaFive]

Hey guys! Encountered a bunch of the same issues today working at an independent, and went crazy calling on them all lol. At chains, I’m sure u dont have time. I interned and hated it, so wondering how u guys approach things!


1- first of all why is there levalbuterol nebulization vials that come in packs of 24 and 25 lol. Standard albuterol is 25 x 3 ml=75, this was odd to me lol. That was besides the point. Got rx for xopenex hfa inhaler for a 7 yr old, 2 puffs q4-6. So thats the max dose and also got nebulizer 1 vial (0.63 mg) q4-6. Insurance rejected for too high of a dose for the nebulizer (aside from duplicate therapy, which should be fine since pt shouldnt use both at the same exacr time lol), it said max dose is 9ml per day. Checked lexi, 5-<12 yo is 0.63mg q8h (although for <4 yrs it can be 1.25mg q4-6 or something like that.. basically higher dose and freq than a 7 yr old). In these scenarios, do u call md and push them to switch to q8, or if they insist on q4-6 do u keep that and put in an override for the high dose to make it go thru, or do u change days supply? I.e. lasts 5 days per sig but rejects for high dose so bill for 10 and it goes thru? Ppl do that but idk..


2- got pravastatin, pt been on lovastatin. I would assume its replacing it but this rx is from a diff dr. If dr doesnt answer and pt says theyre supposed to be on prava or they just BS me to get the med lol... the only override that works for therap duplic is M0 consulted dr, 1b filled as is. Do u guys still use that even if u didnt talk to dr, then annotate “as per pt”? The option for patient consulted doesnt work lol. Only reason id try to call is cuz ive had pt on lisinopril from a dr then they suddenly sent losartan from the same md, called and it was an error


3- got rx with weird sig. 1t po qd x 14 days, 1 tablet per 10 days. Qty 14. Lol. Probably meant to be qd, if md doesnt answer and pt is being annoying.. or says dr said qd, do u jus change it or wait to speak to office?


4- got a script for endocet no daw. Pt called saying they need brand. Took hrs to get in touch w md with pt calling every few mins. Dr said no daw finally said ok daw but tell pt i wont give her an rx anymore. I filled and annotated that and DAW. Later got rx with daw and notes said that pt has been complaining of gi upset from generic despite having been on generic for the past few months. I felt upset at myself bc pmp was good but the dr’s right, the pt has been on generic all these months so why is she complaining endocet works better if pmp doesnt even show she was on it. On the other hand, md gave ok for daw. Sure this was a red flag but the dr said to give brand. Lets say i caught this myself, the pattern of being on generic all this time so why is she asking for endocet... how would u even question the patient without them getting confrontational? We get controls with daw on it sometimes, it’s not like we call on those and question why the dr is giving brand, so if the dr says brand it should be okay. Is this really something to lose sleep over? I cant be an investigator over every little detail


5-i kno an rph who refused to fill a control for a dr who kept prescribing for herself. Walgreens transferred him to a crappy store because the md complained to corporate. I thought they should at least have your back with these things esp if they taught us not to say “out of stock” as an excuse. Whats ur take on drs writing for themselves, or generally how do u refuse a pt if too soon or u dnt feel comfortable for whatever reason? If i see pt is getting from diff drs on pmp i contact current dr and was told by fellow rphs that if md says to give then annotate the convo abt md being aware of multiple drs and then dispense. Under what condition do u absolutely refuse besides contraindicated or too soon (Assuming its not a forged blank and its an e rx)? do ya say no cuz of red flags?


Thanks!!!

1.) Skipping this. Got a headache reading that jumble.

2.) Depends on the patient

3.) Depends on the med. If ABX, dispense exactly as written and clarify later.
Not that big of a deal.

4.) Nope. They can go somewhere else with NDC demands

5.) Absolutely not. No self-prescribing of controls, ever.


Did you not do any internships or what?

 

[MARX22]

1.) Skipping this. Got a headache reading that jumble.

2.) Depends on the patient

3.) Depends on the med. If ABX, dispense exactly as written and clarify later.
Not that big of a deal.

4.) Nope. They can go somewhere else with NDC demands

5.) Absolutely not. No self-prescribing of controls, ever.


Did you not do any internships or what?

I did do internships but the rphs i talk to are so different, like i wouldn’t okay the dr writing for themselves but some ppl say its fine. As for ndc requests, like “i want the yellow alprazolam” i jus tell them sorry i have whatever i have. Requesting brand if the dr said its ok i annotate the daw and give

 

[MARX22]

I see about 40 things like this every workday, yes including people who want brand narcs. The following is my instant reaction to each scenario

1) Pay cash if day supply limits or TDD exceeded or go somewhere else. I might fax for regular albuterol nebs if the nebs were levalbuterol. Then they can pay cash for the cheaper option

2) Counsel pt and tell them to stop the older statin. As far as what the prescriber really intended, I'm not a mind reader. If the prescriber doesn't take their job seriously I cannot literally do their job for them unless it may potentially affect my license negatively.

3) Close enough.

4) Pay cash or go somewhere else

5) Tell them to go somewhere else

See a theme here?

I would tell the dr to go somewhere else. As for the pt wanting brand endocet i called md and they gave the ok so i jus annotated and dispensed.

My question about the statins was if insurance rejects saying theyre on another statin, do u put in the override for md consulted even if ur just assuming this replaced the old one and u didnt contact md?

 

[dblock05]

Yes just put in that override for the insurance, don't make it harder than it needs to be.

 

[Rouelle]

2. If it’s the same prescriber for both the first and the second statin scripts, I would consider that to be enough “prescriber consulting.” Enter the override, verify, and counsel the patient.

4. You don’t have to have DAW1 to dispense brand name. There’s a DAW code for “patient requests brand.” The insurance may or may not pay for it. Offer the price of both brand and generic to the patient and let them decide. Do not call on this.

5. If a prescriber self-prescribes lisinopril, amoxicillin, viagra, etc, you can fill it. NEVER NEVER NEVER fill a self-prescribed controlled substance.

I’m not sure if we all understand what you are asking with #4 and #5. As you have posed the questions, they are very black-and-white. Are we missing some information here?

Edit: I have since read some of the posts and I suppose you clarified some of this. So your state has a law requiring generic sub unless dr writes DAW? So the patient can’t request brand name? Strange...

 

[MARX22]

2. If it’s the same prescriber for both the first and the second statin scripts, I would consider that to be enough “prescriber consulting.” Enter the override, verify, and counsel the patient.

4. You don’t have to have DAW1 to dispense brand name. There’s a DAW code for “patient requests brand.” The insurance may or may not pay for it. Offer the price of both brand and generic to the patient and let them decide. Do not call on this.

5. If a prescriber self-prescribes lisinopril, amoxicillin, viagra, etc, you can fill it. NEVER NEVER NEVER fill a self-prescribed controlled substance.

I’m not sure if we all understand what you are asking with #4 and #5. As you have posed the questions, they are very black-and-white. Are we missing some information here?

Edit: I have since read some of the posts and I suppose you clarified some of this. So your state has a law requiring generic sub unless dr writes DAW? So the patient can’t request brand name? Strange...

Thanks! The issue with the brand was if I shouldn’t have dispensed because she exhibited weird behavior, telling me she needs brand endocet yellow and told me the imprint lol... as well as claiming generic hurt her stomach and endocet controls her pain, meanwhile she has no history of being on endo. I got the drs daw so i guess its okay, gotta learn to ignore the side comments lol.

The statins were from two diff doctors though so I wasnt sure if i should just override w md consulted lol

 

[dblock05]

You override with md consulted and you counsel the patient when they pick it up. If you work at CVS then you do a force counsel to make sure a tech grabs the pharmacist to make sure the patient knows whats going on.

For the person with the brand name Endocet...if they want brand name and you actually do have it in stock then do a daw2 and tell them whats the price of it. Regardless if they have had it or not, you don't need to do anything else extra...you keep it moving. Tell the person the price of generic and the brand and ask what they want or give them back the script if they don't like what they hear.

 

[owlegrad]

Wow. Your posts are very hard to read OP. I am surprised how many good responses you have gotten so far.

To throw in my two cents, it seems to me that what you need is confidence. No one here can tell you if it is "ok" to override using M0, 1b without consulting the prescriber. That is totally up to you to decide for yourself. I will say that your life will be a living hell if you ACTUALLY contact the prescriber every time you need to use that override though. But you have to decide that for yourself and be confident in your decision.

Really everything you posted is a judgement call and no one here can give you the 'right' answers. Except #5 - CVS specifically does not allow this and I would be surprised if Walgreens doesn't have the same policy. No pharmacist in their right mind would fill a self-prescribed control. There is a reason Wilson wrote House's pain scripts.

 

[rx1983]

These are fairly straightforward issues that you will come across on a daily basis. I suggest you learn to make decisions yourself as you are the professional rather than running to a message board and asking what everyone else's decision would be. But since you asked:

#1 This is as needed dosing, discuss with the parent max daily dosing and make sure they understand. Within reason extend days supply to get to go through since it is prn. Use whatever DUR code gets it to go through, don't worry so much about what the DUR codes actually say. Usually prescriber interface/filled with prescriber approval works. Yes put prescriber interface even if you didn't talk to them, what do you think they're going to audit your outgoing phone calls?
#2 If patient says this is my new doctor and this replaces the other statin I take their word for it and annotate. If they are unsure call the MD.
#3 many issues are caused by the weird way Rxs come through on e-prescribing systems. It's probably QD for 14 days, if that's a normal dosing of the medication and the patient verifies that's how the doctor told them to take it I'd go with it.
#4 Patient is being a pain in the ass, give them the prescription back and tell them if this is supposed to be DAW the doctor can write a new Rx. I think you can change to DAW with a phone call but tell pt you need this clearly documented from the prescriber in case of an insurance audit. Making repeated phone calls to a doctor as you say you did here over brand vs. generic is a ridiculous waste of your time. Find any reason to put the burden of making these phone calls on the patient, here the easy reason is its a C-2 it needs to be rewritten.
#5 no controlled substance self prescribing. simple. Sometimes even non controlled substance self prescribing gets a little iffy in my mind but I generally allow.

 

[MARX22]

These are fairly straightforward issues that you will come across on a daily basis. I suggest you learn to make decisions yourself as you are the professional rather than running to a message board and asking what everyone else's decision would be. But since you asked:

#1 This is as needed dosing, discuss with the parent max daily dosing and make sure they understand. Within reason extend days supply to get to go through since it is prn. Use whatever DUR code gets it to go through, don't worry so much about what the DUR codes actually say. Usually prescriber interface/filled with prescriber approval works. Yes put prescriber interface even if you didn't talk to them, what do you think they're going to audit your outgoing phone calls?
#2 If patient says this is my new doctor and this replaces the other statin I take their word for it and annotate. If they are unsure call the MD.
#3 many issues are caused by the weird way Rxs come through on e-prescribing systems. It's probably QD for 14 days, if that's a normal dosing of the medication and the patient verifies that's how the doctor told them to take it I'd go with it.
#4 Patient is being a pain in the ass, give them the prescription back and tell them if this is supposed to be DAW the doctor can write a new Rx. I think you can change to DAW with a phone call but tell pt you need this clearly documented from the prescriber in case of an insurance audit. Making repeated phone calls to a doctor as you say you did here over brand vs. generic is a ridiculous waste of your time. Find any reason to put the burden of making these phone calls on the patient, here the easy reason is its a C-2 it needs to be rewritten.
#5 no controlled substance self prescribing. simple. Sometimes even non controlled substance self prescribing gets a little iffy in my mind but I generally allow.

It was an e-rx, I couldn’t give it back, and she wouldn’t leave us alone lol. Thanks for your advice

For levalbuterol its prly ok to just dispense as is, override, and counsel on max dose. But if it’s any med that can potentially cause harmful side effects, and the patient misuses it (or goes by label despite us counseling on the real max dose), isnt it still kind of on us for not taking initiative to change the dose w md or verify with md?

 

[MARX22]

Wow. Your posts are very hard to read OP. I am surprised how many good responses you have gotten so far.

To throw in my two cents, it seems to me that what you need is confidence. No one here can tell you if it is "ok" to override using M0, 1b without consulting the prescriber. That is totally up to you to decide for yourself. I will say that your life will be a living hell if you ACTUALLY contact the prescriber every time you need to use that override though. But you have to decide that for yourself and be confident in your decision.

Really everything you posted is a judgement call and no one here can give you the 'right' answers. Except #5 - CVS specifically does not allow this and I would be surprised if Walgreens doesn't have the same policy. No pharmacist in their right mind would fill a self-prescribed control. There is a reason Wilson wrote House's pain scripts.

The rph who got transferred to a crappy store for refusing to fill a control for the dr was actually a wags rph lol.

 

[MARX22]

You override with md consulted and you counsel the patient when they pick it up. If you work at CVS then you do a force counsel to make sure a tech grabs the pharmacist to make sure the patient knows whats going on.

For the person with the brand name Endocet...if they want brand name and you actually do have it in stock then do a daw2 and tell them whats the price of it. Regardless if they have had it or not, you don't need to do anything else extra...you keep it moving. Tell the person the price of generic and the brand and ask what they want or give them back the script if they don't like what they hear.

We’re taught to look for “red flags.” Honestly, it’s not our job to be investigators. It complicates things

 

[owlegrad]

The rph who got transferred to a crappy store for refusing to fill a control for the dr was actually a wags rph lol.

That story is highly suspect to me.

 

[MARX22]

That story is highly suspect to me.

I was shocked when I heard as well. Doesn’t make sense why corporate would take a complaint so seriously, esp if it concern’s rph’s license/right to refuse. Doesn’t add up to me either

 

[Thoughtfulsinner]

Very tough read. Pharmacy schools really need to up their standards. That and siphon out the betas who make pharmacists look pathetic.

 

[rx1983]

It was an e-rx, I couldn’t give it back, and she wouldn’t leave us alone lol. Thanks for your advice

For levalbuterol its prly ok to just dispense as is, override, and counsel on max dose. But if it’s any med that can potentially cause harmful side effects, and the patient misuses it (or goes by label despite us counseling on the real max dose), isnt it still kind of on us for not taking initiative to change the dose w md or verify with md?

Just document that you counseled on max dose whatever way possible in your computer system. E-prescribing of C-2s is such a pain and creates so many unintended consequences.

 

[MARX22]

Very tough read. Pharmacy schools really need to up their standards. That and siphon out the betas who make pharmacists look pathetic.

You and cetialphafive seem to rule this board, all hail these two. *bow*

 

[CetiAlphaFive]

You and cetialphafive seem to rule this board, all hail these two. *bow*

No need to indulge in whiny defense-mechanisms.

Grow up. This is a professional forum.

It's not like you're receiving criticism for a physical characteristic or something you can't change.

You're supposed to be a professional.
Your English shouldn't be as bad as it is.
Do you not think your patients deserve better than someone who writes and probably communicates at such a terrible level?

There are plenty of free websites that can help you. Put forth some effort.

 

[MARX22]

No need to indulge in whiny defense-mechanisms.

Grow up. This is a professional forum.

It's not like you're receiving criticism for a physical characteristic or something you can't change.

You're supposed to be a professional.
Your English shouldn't be as bad as it is.
Do you not think your patients deserve better than someone who writes and probably communicates at such a terrible level?

There are plenty of free websites that can help you. Put forth some effort.

Yeah, I agree that I was rambling. However, you and I both know that you like to make wise remarks. If you don’t have something nice to say, don’t say anything at all.

 

[JohnDoeRPH]

In all seriousness, it’s best if you just copy what your coworkers are doing. Don’t overthink like this.

Not all pharmacists have overlap with other pharmacists.

 

[Robbin]

Oh God its too long thread. well! when you are so much tensed about anything you have too copy the work whatever your co-worker are doing . don't take so much tension regarding anything. Also in a weekend you have to met with your doctor if problemoccur is very big or out off control.

 

[CetiAlphaFive]

Oh God its too long thread. well! when you are so much tensed about anything you have too copy the work whatever your co-worker are doing . don't take so much tension regarding anything. Also in a weekend you have to met with your doctor if problemoccur is very big or out off control.

Head In Hands GIF by Australian Survivor - Find & Share on GIPHY

 

[MARX22]

Head In Hands GIF by Australian Survivor - Find & Share on GIPHY

Lmaoooo

 

[BaSsHeAd]

honestly, i'm not even going to answer a single question here. part of being a pharmacist means you need to have critical thinking skills. none of these scenarios are difficult situations.

i’ve noticed saturation is flooding the market with pharmacists that cannot think. this is what happens when schools accept people with 2.5 GPA and no PCAT.

 

[Sparda29]

honestly, i'm not even going to answer a single question here. part of being a pharmacist means you need to have critical thinking skills. none of these scenarios are difficult situations.

i’ve noticed saturation is flooding the market with pharmacists that cannot think. this is what happens when schools accept people with 2.5 GPA and no PCAT.

No man, the people who cannot think are those 4.0 GPA 99 PCAT, they are the robots who will never bend the rules. Eg; pharmacists who will refuse to do therapeutic interchanges without prescriber authorization (you know they are gonna ****ing say YES, don't bother with the call and just document it dammit).

 

[wagrxm2000]

honestly, i'm not even going to answer a single question here. part of being a pharmacist means you need to have critical thinking skills. none of these scenarios are difficult situations.

i’ve noticed saturation is flooding the market with pharmacists that cannot think. this is what happens when schools accept people with 2.5 GPA and no PCAT.

I always say I'd take a hard worker over the smartest.

While I hate to say this, our computer systems do so much for us, I'll gladly take a 2.5 gpa if they do the job efficiently.

 

[CetiAlphaFive]

No man, the people who cannot think are those 4.0 GPA 99 PCAT, they are the robots who will never bend the rules. Eg; pharmacists who will refuse to do therapeutic interchanges without prescriber authorization (you know they are gonna ****ing say YES, don't bother with the call and just document it dammit).

You think that being lazy / complacent is a sign of critical thinking?

 

[Sparda29]

You think that being lazy / complacent is a sign of critical thinking?

Being clever to find shortcuts is critical thinking.

 

[wagrxm2000]

Being clever to find shortcuts is critical thinking.

Lazy=clever.......I guess

Anyways, I wouldn't expect any floaters to make changes without having a relationship with the office. Staff however should know what they can and can't change.

I have not seen a correlation between "book smart" and "2.5 gpa" pharmacists and what they are willing to do. It usually comes down to personality. Some pharmacists are just too concerned on what could happen if they do things on their own. Look at the current thread about a patient having a doctor change their statin and not being sure on if he should fill it or call the MD.

It's just a confidence issue.

 

[CetiAlphaFive]

Being clever to find shortcuts is critical thinking.

If you found out that the cleaning lady was using the same towel to clean the toilet, door handles, and lunch table, would you consider that to be clever critical thinking?

 

[Sparda29]

If you found out that the cleaning lady was using the same towel to clean the toilet, door handles, and lunch table, would you consider that to be clever critical thinking?

Not exactly comparable situations.

 

[CetiAlphaFive]

Not exactly comparable situations.

Please elaborate.

I see two situations where individuals are breaking rules solely for the purpose of making their own experience more comfortable

 

[Sparda29]

Please elaborate.

I see two situations where individuals are breaking rules solely for the purpose of making their own experience more comfortable

One gets the job done, the other one doesn't.

 

[wagrxm2000]

If you found out that the cleaning lady was using the same towel to clean the toilet, door handles, and lunch table, would you consider that to be clever critical thinking?

So what you are saying is by using the same towel, the cleaning lady saves time by not having to switch towels constantly plus saves money by not having to clean as many towels or have to buy new ones from overusing many towels. In the end, both situations get the job done.

Sounds like the same thing.

 

[CetiAlphaFive]

Lol, what a variety of responses.