Managing drug intxs/insurance issues

[Anxiousone22]

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Hey there pharmacists!
I'm still an intern but I've always worried about intxs. I'm afraid I won't know what drug to recommend to the MD instead of the one that interacts, and what if it isn't covered by the patient's insurance? Do u go with what's covered despite the intx, bc im sure pts won't pay 😡
I know we learn about therapy regimens in therapeutics, but I can't remember all the guidelines! I remember it for the exam and it dumps out bc I don't think my professors actually teach besides reading off of their vague slides. I see pharmacists just writing random drugs on the rx and writing "MD ok" but I want to learn how to do things the proper way. Just curious about how everyone dodges the intxs. Thanks!

 

[trailerpark]

First look to see how long they've been on it. That's a good start.

 

[BidingMyTime]

There are a lot of variables. Few interactions are complete contraindications......an interaction generally means that dosing of one or both medicines may need to be adjusted or that the patient is at a higher risk (not at absolute risk) of side effects. Many insurances are going to require that a patient try their preferred medicine--it the patient has intolerable side effects, then the doctor can document that and at that point petition the insurance to cover an alternative drug (prior auth process.) If the patient has co-existing health conditions that along with the combination of medicines puts them at a great risk for side effects, then instead of trying the insurances preferred drug, the doctor can try to petition the insurance to cover an alternative drug. If the dosing of one or both of the medicines needs to be change, then the doctor needs to change the dosing or follow up with labwork to check the level(s) of the medicine(s) after the combination is started. Insurers want to save money, but they really don't want to worsen a patient's health condition in a way that will cost them even more money. They aren't going to cover a drug just because "the doctor wants it" or because "Company A says their drug is better than Company B" or "patient prefers Drug A because of snazzy commercial on it", but if there is a legitimate, documented reason why the person can't use the formulary drug and needs an alternative drug, then there is a very good change that the insurance will cover it.

Because every patient is different, there are no hard and fast guidelines, but with experience and practice you will get a good feel on applying the knowledge you've learned in pharmacy school, to ask the appropriate questions, which will tell you which course of action to recommend.

 

[Wheresmyaricept]

Hit override all unless it's in red or says major drug interaction.

Prior auth required? Send fax to MD. Step therapy required? Tell him to change drug. Too expensive? Tell patient to not have terrible insurance.

Welcome to community pharmacy.

 

[PharmdA07]

Hi there Anxiouson22: regarding your concern, I'd like to add some of my own thoughts cause I was in your shoes not too long ago when I started out being an RPh
-You spent years in pharmacy school with the most difficult subjects, you'll spend probably a week knowing all the insurance basics, so no worries! Be friendly and ask your senior techs to help! Know the basics on insurance: PA, refill too soon, vacation overide, dual coverage (COB: coordination of benefit); tricare/military type of coverage, billing for compounding etc.
-Regarding interaction: this is where you will do your job to the public as a pharmacist. KNOW YOUR DRUG CLASS!! I can't emphasize this enough. I told this to all the students I have precepted who are going into retail. You've got to know your drug CLASS and their members, and that'll be 90% of the job. If Rx is for simvastatin and amlodipine and for some reason you can't remember the dose cut-off of simvastatin to avoid this interaction, choose some other members in the statin class that doen not have interaction such as Lipitor, Pravachol, etc. and tell the MD to choose from those. If Rx is for Mobic 15 mg QD and insurance does not pay for this, choose some other member in the NSAID class such as Motrin, Naproxen, Lodine, Voltaren etc. then go from there: if patients can't do frequent dosing, chose BID agent; if they have hx of CAD (you see Plavix or Pradaxa or such on their profile), tell MD to move up the ladder in the Pain Meds Class--> opioid, first choose non-controlled med such as Tramadol (in my state, it's still not a controlled).
If Rx is for Boniva and insurance dose not pay, choose a different bisphophanates in that CLASS: Fosamax, Actonel, etc. and tell MD which one it pays and go with that. If Rx is for Topicort and the generic is too expensive and patient ask for something else, choose another topical steroid with similar potency such as Elocon, Cutivate etc. If Rx is for Skelaxin and insrance requires PA, choose a different muscle relaxant (preferably not soma LOL) like Flexeril, Baclofen, Robaxin etc. As you can see from all these examples, if you know your drug CLASS and its members, you can come up really quick with a recommendation
-As time goes on, you will become familiar with all the questions frequently asked / interactions. You will also become familiar with other things such as Pregnancy, Lactation, Allergy-specific etc. But usually the basic will come down to knowing your DRUG CLASS and asking yourself what thing similar to this drug that does the same stuffs but does not interact or contraindicates. Remember all the drug cards in school we used to group together?
-Of course I assume you will continue to strive to be a knowledgeable pharmacist and pursue further C.E.; therefore, you'll be more fluent as time goes by. Knowing the guidelines helps but not a must, it will make you stand out in a retail setting: you will know what is prefered first to treat GERD in pregnancy, to treat constipation in geri, etc. If you work in an institutional setting like mine (LTC, Hospice/ Palliative/ Geri), you must know your guideline on your population inside-out; but in the general retail world, knowing nothing about guidelines is still so-so OK (but I believe there's still some vague ideas in your fresh-out of school neurons, so you're good LOL)
-And don't be too hard on yourself, things take times. if you're willing to put in the effort, you'll be OK 🙂

 

[sakigt]

What do you guys do with warfarin and ATBs on the outside? QT prolongation?

Here in the hospital, its easy.

 

[zelman]

What do you guys do with warfarin and ATBs on the outside? QT prolongation?

Here in the hospital, its easy.

"This medicine might alter your warfarin level. Tell them you're taking it when you get your bloodwork done."