Oregon Pharmacists can now prescribe birth control w/o doc visit

[Lexington2012]

http://rhrealitycheck.org/article/2...h-control-prescription-without-doctors-visit/

From what I understand, pharmacists will now be expected to assume increased liability as a prescriber... and without having the ability to bill for the service of prescribing.

Without having provider status, this is BAD for the profession.

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[gwarm01]

I like the idea, but I agree with you. No point in taking on more responsibility and liability without any personal benefit.

 

[Digsbe]

Good for advancing the profession, but not so good that you can't get paid for it (at least not yet). It makes a stronger argument for provider status though, and if anything if they pay $30 or so for the evaluation to get birth control the state will still save tons of money considering the average office visit to get it probably runs $200-$300.

 

[WVUPharm2007]

In some countries its just OTC.

 

[Digsbe]

In some countries its just OTC.

I've heard basically everything in Mexico is OTC. When I was in San Diego they said some brave souls would cross over to Mexico to buy drugs over getting scripts for them.

 

[SClENCE]

How do you know which one to prescribe? Just wondering because some are twice the strength of others and there's quite a lot of them to choose from.

 

[GoldfishPharmD]

Yeah, I don't know how I feel about this. I wouldn't be writing a script for birth control. Just wait until someone gets a DVT and looks to sue. Nope. Tons of other stuff I'd be more interested in writing scripts for and birth control is probably at the bottom of the list.

 

[Pharmgrlnxdor]

What about the ruling in Ohio where pharmacists can now prescribe life saving meds once per patient.

 

[SClENCE]

Even if the pharmacist can charge for it the money goes into your employers pocket. Maybe the "trickle down effect" would cause a larger demand for pharmacists/increase in pay but not likely to happen because of just birth control alone.

 

[Digsbe]

They taught us prescribing considerations in school regarding birth control, I believe if there is clot risk you use a progesterone formulation (with counselling about bone health). I'd have to revisit that though, just going off the top of my head. In many cases we'd be held liable for dispensing the med and overlooking clot risk and then the patient having a DVT/PE from it as well anyway.

 

[SClENCE]

What about the ruling in Ohio where pharmacists can now prescribe life saving meds once per patient.

I'v never actually seen this occur and didn't even know it existed lol

 

[BidingMyTime]

I don't get this.....so for the past 60+ years, birth control has been so dangerous that a woman must have a yearly pap smear and visit with her doctor/NP/PA in order to get a prescription......and now its suddenly deemed so safe that pharmacists can prescribe it on the basis of a questionnaire the patient fills out?

SO.....have doctors/providers been milking the system all along to get money from healthy women, or are pharmacists being set up for major malpractice lawsuits?

 

[Pharmgrlnxdor]

I can't cut and paste a link on the device I am on but if you Google the following Ohio pharmacists can prescribe insulin the first story to come up is State Senate passes legislation allowing pharmacists to provide life saving meds. If someone can post the link that would be nice since I am using this crappy tablet.

 

[deleted480308]

Good for advancing the profession, but not so good that you can't get paid for it (at least not yet). It makes a stronger argument for provider status though, and if anything if they pay $30 or so for the evaluation to get birth control the state will still save tons of money considering the average office visit to get it probably runs $200-$300.

closer to $85 for medicare, although insurance pays slightly more... http://truecostblog.com/2010/03/10/do-doctors-really-lose-money-on-medicare/

 

[trailerpark]

I honestly think birth control should be in vending machines in every school, college, walmart, etc... tax payers can't afford these Medicaid babies.

 

[gwarm01]

I don't get this.....so for the past 60+ years, birth control has been so dangerous that a woman must have a yearly pap smear and visit with her doctor/NP/PA in order to get a prescription......and now its suddenly deemed so safe that pharmacists can prescribe it on the basis of a questionnaire the patient fills out?

SO.....have doctors/providers been milking the system all along to get money from healthy women, or are pharmacists being set up for major malpractice lawsuits?

A little from column A, a little from column B..

I wonder if there will be CE requirements? Or maybe some sort of certificate class you'll have to take beforehand? As a pharmacist, I am cautious by nature when it comes to medication. I don't know that I'd be comfortable prescribing medicine, especially being a few years out of school and not as familiar with the knowledge that I don't use in my current practice.

 

[Pharmgrlnxdor]

Insulin, asthma inhalers/meds, any meds where lack of the med could result in death. I guess it was spearheaded by the family of a man who ran out of insulin before a holiday long weekend and his doctor was unavailable to write a new script. Of course there is always the ER and proper planning, but I digress.

 

[SClENCE]

Insulin, asthma inhalers/meds, any meds where lack of the med could result in death. I guess it was spearheaded by the family of a man who ran out of insulin before a holiday long weekend and his doctor was unavailable to write a new script. Of course there is always the ER and proper planning, but I digress.

Proper planning? Personal responsibility? HAHAHA this is 2015... those in the medical profession are the babysitters of the adult population.

 

[zelman]

I don't get this.....so for the past 60+ years, birth control has been so dangerous that a woman must have a yearly pap smear and visit with her doctor/NP/PA in order to get a prescription......and now its suddenly deemed so safe that pharmacists can prescribe it on the basis of a questionnaire the patient fills out?...

Well, part of the reason may be those 60+ years. Claritin was safe enough to be OTC when it came out, but we didn't know it at the time. Nobody expected PPA to be 1000x more dangerous for allergy sufferers at the time, but that's how it worked out after years of observation.

 

[Digsbe]

closer to $85 for medicare, although insurance pays slightly more... http://truecostblog.com/2010/03/10/do-doctors-really-lose-money-on-medicare/

Dang, I hadn't realized it was that low.

 

[rph3664]

I don't get this.....so for the past 60+ years, birth control has been so dangerous that a woman must have a yearly pap smear and visit with her doctor/NP/PA in order to get a prescription......and now its suddenly deemed so safe that pharmacists can prescribe it on the basis of a questionnaire the patient fills out?

SO.....have doctors/providers been milking the system all along to get money from healthy women, or are pharmacists being set up for major malpractice lawsuits?

THIS.

 

[rph3664]

Insulin, asthma inhalers/meds, any meds where lack of the med could result in death. I guess it was spearheaded by the family of a man who ran out of insulin before a holiday long weekend and his doctor was unavailable to write a new script. Of course there is always the ER and proper planning, but I digress.

Not to mention Humulin.

I once worked with a pharmacist who, while working the weekend, gave some NitroStat to a patient who said he needed it, then called 911 and got an RX on Monday.

 

[BenJammin]

The law states that a pharmacist can only prescribe if there is an existing prescription.

 

[group_theory]

Dang, I hadn't realized it was that low.

For Oregon Medicaid, it's much lower. If you bill this as a 99213 established outpatient visit (where you're prescribing the birth control), you'll get $35.
Make sure you have all elements documented to justify your level 3 visit, otherwise if audited and you are missing key elements, you will be accused of illegally upcoding (and arrested for insurance fraud). If the billing is for a non-physician, non-PA/NP visit, it might be a 99211 Level 1 visit ... which pays $7.

http://www.oregon.gov/oha/healthplan/DataReportsDocs/May 2015 Fee Schedule - PDF.pdf

Just because you could bill doesn't mean commercial insurance will pay. As an example, there is a CPT code for telephone consultation which I get all the time from patients (my practice doesn't charge for this, it's a courtesy). The code is 99441. However, even though there is a code, and I could bill for it, I (and my partners) do not. That's because Medicare, Medicaid, and almost all commercial insurance have decided not to pay for this.

Imagine if a retail pharmacist have to deal with prior authorization (and peer-to-peer review for denial of coverage) during a regular shift? Chaos!!!

 

[Lexington2012]

Another concern I would have is that the person prescribing the drug is also the one profiting from its sale.

I feel that it is unethical to be both a prescriber and a dispensing pharmacist for the same drug.

 

[deleted480308]

Another concern I would have is that the person prescribing the drug is also the one profiting from its sale.

I feel that it is unethical to be both a prescriber and a dispensing pharmacist for the same drug.

it's no different from the surgeon about to benefit from your surgery saying "you need a surgery".....there is only an ethical issue if you make the wrong call for purpose of profit

 

[BenJammin]

Another concern I would have is that the person prescribing the drug is also the one profiting from its sale.

I feel that it is unethical to be both a prescriber and a dispensing pharmacist for the same drug.

Semantics.

 

[SClENCE]

Another concern I would have is that the person prescribing the drug is also the one profiting from its sale.

I feel that it is unethical to be both a prescriber and a dispensing pharmacist for the same drug.

How is it unethical to prescribe and dispense a drug? Veterinarians have been doing it forever with no issue. What would be unethical is prescribing and dispensing the highest cost/unnecessary drugs just for the profit. Even if this happened I would strongly hesitate in implementing such restrictive laws. The forces of the market would steer patients elsewhere and I'm pretty sure most insurance companies are going to require prior auths on expensive birth controls to begin which would eliminate this problem before it even occurred.

 

[eagles22]

Just wait for the metrics. You think hitting the flu shot numbers was a difficult task? Watch what happens when everyone is required to hit numbers on birth control.

 

[BidingMyTime]

Just wait for the metrics. You think hitting the flu shot numbers was a difficult task? Watch what happens when everyone is required to hit numbers on birth control.

Eh, for the under 65 set, BC is more likely to be covered by ins than flu shots, therefore BC will be easier to push.

 

[WVUPharm2007]

I honestly think birth control should be in vending machines in every school, college, walmart, etc... tax payers can't afford these Medicaid babies.

Some people say the choices are pro-life and pro-choice.

I'm anti-choice and anti-life.

I think people shouldn't be allowed to create a new life unless they are proven to be mentally and financially viable. We are entering into a period of time where we won't need that many humans. Robots and AI will do everything labor intensive. We sure as **** don't need billions of us. Let's make parenthood a privilege, not something any idiot can do.

Sterilize everyone until they prove they are worthy.

Yeah, yeah, I know, I'm literally Hitler...

 

[trailerpark]

I's be nice if people had to take a pill in order to get pregnant, not the other way around... And they would have to fill out an application to get a hold of these pills. Basically they would have to prove they could support a child without tax payer's help.

 

[SClENCE]

I's be nice if people had to take a pill in order to get pregnant, not the other way around... And they would have to fill out an application to get a hold of these pills. Basically they would have to prove they could support a child without tax payer's help.

I think we should just get rid of taxpayer help altogether. Medicaid breeds ignorance and entitlement. Maybe a more viable option would be a 6 month time limit on medicaid. I know somebody will post some novel about how someone in their family lost their job and medicaid helped them get back on their feet blah blah blah but the reality is most people on medicaid are damn idiots.

 

[owlegrad]

Well, you are the one paying for the medicaid (or will be once you are a pharmacist), so who it the real damn idiot?

 

[Digsbe]

How about Medicaid/welfare becomes like a high interest loan program to get people back on their feet. If it's good enough for students who are broke and want to better themselves why not others?

 

[GoldfishPharmD]

It has been posted on FB now. The argument given was that men have uncontrolled access to contraception, why can't females? Um, I'm guessing we're talking about condoms. Last time I checked, both women and men could buy as many condoms as they want. How did this turn into a sexism issue?? I'm scrolling through all the comments and trying hard not to comment.

 

[SClENCE]

It has been posted on FB now. The argument given was that men have uncontrolled access to contraception, why can't females? Um, I'm guessing we're talking about condoms. Last time I checked, both women and men could buy as many condoms as they want. How did this turn into a sexism issue?? I'm scrolling through all the comments and trying hard not to comment.

Id delete anyone who spews that kind of stupidity

 

[rph3664]

It has been posted on FB now. The argument given was that men have uncontrolled access to contraception, why can't females? Um, I'm guessing we're talking about condoms. Last time I checked, both women and men could buy as many condoms as they want. How did this turn into a sexism issue?? I'm scrolling through all the comments and trying hard not to comment.

There's also foam, suppositories, and other methods. I wouldn't recommend a female condom because, well, because.

As for parenthood tests, two of the most unsuitable candidates for parenthood who unfortunately also had children that I have ever known are a husband and wife who are both pharmacists.