Little tricks to save patients money

[npage148]

What are all your favorite tricks to help save someone a few bucks. No isurance fraud things either like putting in bad days supplies

My favorite is switching an RX written for zyban to wellbutrin. The generic for zyban ususally is not covered (espceially under the BLUES), so i just make a swtich and use the wellbutrin generic. Its just a little pains since the 2 generics are not AB rated so i usually just give the doctor a call. A 7 dollar copay is alot better than 100dollar cash script espceially when someone is trying to quit smoking to save money

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[WVUPharm2007]

Hiring an assassin to "fix" any practitioner I notice writing for Xopenex. It makes sense in the "Give a man a fish/teach a man how to fish" sort of way.

 

[loo]

Rape the reps for "free seven day supply" coupons and use 'em until the prior authorization goes through. Example, Aciphex.

 

[sdn1977]

Fill the inexpensive, chronic medications the pt is stable on (HCTZ, digoxin, etc..) once for a long days supply (6-12mo) for cash rather than fill & bill the insurance monthly.

 

[ndearwater]

Fill the inexpensive, chronic medications the pt is stable on (HCTZ, digoxin, etc..) once for a long days supply (6-12mo) for cash rather than fill & bill the insurance monthly.

That's a good one.... we do that all the time at my pharmacy.

How about Sarafem? What kind of bull is that?!?! I told this lady to get her doctor to write for Prozac and then we filled fluoxetine. BTW... can a pharmacist switch a patient from Sarafem to fluoxetine without consulting the physician- isn't it exactly the same drug?

 

[Shmy2008]

See next post...

 

[Shmy2008]

Doesn't the whole "use fluoxetine for sarafem" and "use bupropion for zyban" cause problems for the patient insurance-wise? It is my understanding that insurance companies monitor not only drugs, but disease states... so if you submit a claim for bupropion (primarily used as an antidepressant), the patient may be flagged as having a depressive disorder, whereas a claim for zyban would be indicative of a smoking cessation therapy. Not to mention the fact that as frustrated as pharmacists are by doctors who write for off-label uses... in this case, we're actually insisting that they do! And unless you're covering your back by writing out the change as a new prescription instead of crossing out "zyban" and writing in "generic wellbutrin," my guess is that the insurance auditor would get ya good

 

[ultracet]

not to mention the fact that i have had women flip out over the suggestion that they get prozac instead of sarafem....

after all... they don't take prozac
they're not crazy!

 

[npage148]

Doesn't the whole "use fluoxetine for sarafem" and "use bupropion for zyban" cause problems for the patient insurance-wise? It is my understanding that insurance companies monitor not only drugs, but disease states... so if you submit a claim for bupropion (primarily used as an antidepressant), the patient may be flagged as having a depressive disorder, whereas a claim for zyban would be indicative of a smoking cessation therapy. Not to mention the fact that as frustrated as pharmacists are by doctors who write for off-label uses... in this case, we're actually insisting that they do! And unless you're covering your back by writing out the change as a new prescription instead of crossing out "zyban" and writing in "generic wellbutrin," my guess is that the insurance auditor would get ya good

You state on the script that the MD ok'd a non AB rated generic, there is no mention of wellbutrin on it. Thats at least what i do

 

[sdn1977]

I agree with npage...just write on the Rx the change you made & ok'd by...(insert name). When an auditor comes..they just want their records to match up with what is on the Rx - you billed for brand name Prozac & put DAW-1, but it is not there on the Rx. I just went thru this 4 months ago - they reviewed 350 Rx's & that's what they looked for. I think the insurance companies would like to think they reviewed disease states - but...the drug payor is not always the medical insurance payor. The two companies don't communicate like that. So...you might think they would assume the propranolol Rx would be for htn then look for labwork to support that diagnosis & monitoring. But..they don't and no one questions it when it is actually used for migraines or public speaking anxiety. They are not as sophisticated as they'd like you to believe, IMO.

 

[pharma1]

i have a question

dr write prescriptions for carbatuss. i have patients asking me if they could use any otc instead of that ...coz brand is expensive.

what do u all suggest?

 

[pharma1]

i have a question

dr write prescriptions for carbatuss. i have patients asking me if they could use any otc instead of that ...coz brand is expensive.

what do u all suggest?

 

[sdn1977]

I've never dispensed carbatuss but is it carbetapentane, guiafenesin & phenylephrine? So...a similar OTC might be Robitussin Maximum Strength or house brand for $3) - has 15mg Dm & 30mg psuedoephedrine/10ml, add a big slug of water (in place of the guiafenesin) - it might help in place of a $20 cough syrup??.. could be lots of other options though.....

 

[Abilify]

I agree with npage...just write on the Rx the change you made & ok'd by...(insert name). When an auditor comes..they just want their records to match up with what is on the Rx - you billed for brand name Prozac & put DAW-1, but it is not there on the Rx. I just went thru this 4 months ago - they reviewed 350 Rx's & that's what they looked for. I think the insurance companies would like to think they reviewed disease states - but...the drug payor is not always the medical insurance payor. The two companies don't communicate like that. So...you might think they would assume the propranolol Rx would be for htn then look for labwork to support that diagnosis & monitoring. But..they don't and no one questions it when it is actually used for migraines or public speaking anxiety. They are not as sophisticated as they'd like you to believe, IMO.

In other words, you're advocating fraud....great!

 

[bananaface]

In other words, you're advocating fraud....great!

It's fraud if you note something of that sort without involving the prescriber. I don't believe that was what was being advocated. If the prescriber ok's a change from "zyban" to "bupropion 150 SR" you can take it as a new prescription if you aren't comfortable having it appear to be a modification of an existing one.

BTW, we have 2 NDCs of watson bupropion SR 150 in my store. One is generic for Wellbutrin SR, the other for Zyban. I can get you NDCs if you want. I think I may apready have posted them at some point in the past.

 

[bananaface]

http://www.fda.gov/cder/ob/default.htm
If you follow the above link and search "bupropion" as active ingredient, you'll see "AB1" denoting things AB rated to Wellbutrin SR and "AB2" denoting things AB rated to Zyban.

 

[walkamile]

definition of fraud-

A false representation of a matter of fact whether by words or by conduct, by false or misleading allegations, or by concealment of that which should have been disclosed, which deceives and is intended to deceive another so that he shall act upon it to his legal injury.

Patient gets a prescription for zyban intended for smoking cessation.
Insurance will not pay for smoking cessation products.

By having the doctor change the Rx to the generic:
The Rx's intended use is being misrepresented (changing it to generic), by concealment of which should have been disclosed (thus zyban= smoking cessation), which is intended to deceive another (the insurance company), so that he shall act upon it to his legal injury (pay for rx that the insurance company would not otherwise pay for).

Legally and ethically it's fraud.
Did you as the pharmacist commit fraud, maybe, depending on the details.
Will you as the pharmacist get caught, no probably not.
Is the MD commiting fraud, definatly yes.
Will the MD get caught, no probably not.

More from the devil's advocate
Why the american healthcare system has out-of-control inflation costs.
Is the insurance paying for something it never intended to pay for? Yes
Will the insurance increase it's premiums to make up for the loss? yes
Will the increase in premiums make it so less people can afford insurance? yes
Will the uninsured still need healthcare? yes
Who will pay for this healthcare? The government (e.g you will)
So who are you really sticking it to? Yourself

The problem really is a complicated one with no right answer. I'm just trying to say look at the big picture on this one. It really is fraud.

 

[bananaface]

If you are interchanging Zyban with an AB rated generic, there can be no inference of fraud. It's a simple generic substitution. That generic is indicated for smoking cessation specifically. There is no wool being pulled over the insurance company's eyes when they pay that claim.

Tons of products have legitimate off label uses. If insurance doesn't want to have a product required for a specific off label purpose, they will require a PA.

 

[walkamile]

Bannnaface point taken and i agree.

My state laws (not sure about other states) say if a doc writes for a trade name, that the trade name must be on the label. If you dispense for a generic the label must say-- bupropion generic substitute for zyban.

So you you type in zyban, pop up the generic, run it through insurance, and the insurance pays, you did a good job and saved the pt. money.

If you call up the doc and say their insurance won't pay for smoking cessation, why don't we dispense this other stuff that's not AB rated, but really close to the same thing, so their insurance will pay for it. And the doc says ok. (this is what I interpret some of the other post as saying) Thats bending the rules, and in the eyes of the insurance company is fraud, (in the unlikely case that an insurance company would ever know that it happened).

Again this is splitting hairs and dancing around a legal loophole.