Pharmacies doing PA.. Legal?

[Chrish]

So I have heard that some independent pharmacies do PA for physicians. The way it works is, doctor office would give pharmacy their long in info for cover-my-‘meds and pharmacy would submit the paperwork on behalf of doctor office and get it approved. Physicians love it because they don’t have to deal with this. In return, they would refer their patients to that pharmacy.

My question is about legality of this. Someone I know had to close down their pharmacy after a year because they didn’t feel comfortable doing this and hence they didn’t get any patient referrals. Whenever they went to doctors’ office for marketing, first thing they were asked was if they provide this “service”. Apparently this is a common practice among independents.

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[owlegrad]

Isn't this the basis of "specialty" pharmacy? I think doing PAs are a big part of what they do.

 

[Pronounce Doxazosin]

So I have heard that some independent pharmacies do PA for physicians. The way it works is, doctor office would give pharmacy their long in info for cover-my-‘meds and pharmacy would submit the paperwork on behalf of doctor office and get it approved. Physicians love it because they don’t have to deal with this. In return, they would refer their patients to that pharmacy.

My question is about legality of this. Someone I know had to close down their pharmacy after a year because they didn’t feel comfortable doing this and hence they didn’t get any patient referrals. Whenever they went to doctors’ office for marketing, first thing they were asked was if they provide this “service”. Apparently this is a common practice among independents.

I don’t see why it would illegal assuming
1. They have the permission from the prescriber
2. They are not falsifying any information on the form

 

[confettiflyer]

Isn't this the basis of "specialty" pharmacy? I think doing PAs are a big part of what they do.

Pretty much. Physicians can pretty much delegate anything, at most, it needs their signature at the end, but 99% of the work has been done. Our docs have MA’s and scribes that pretty much do everything except examine the patient.

Sharing credentials/log-in might be a strict T&C violation for a particular site/payer, but in principle a pharmacy should be able to start the PA paperwork and coordinate with someone who has chart access.

One of our specialty sites, the medical assistant attaches the H&P/recent progress notes to the script.

 

[Chrish]

I don’t see why it would be illegal. Is it ethical?

Pharmacy logging into physician account and getting PA done. Does sound bit shady to me.

Owl raises valid point about specialty pharmacy. Not sure how they do it on a daily basis. If someone works here can shade some light.

 

[Chrish]

Is it financially worth it?

Read first post..

 

[Aznfarmerboi]

So I have heard that some independent pharmacies do PA for physicians. The way it works is, doctor office would give pharmacy their long in info for cover-my-‘meds and pharmacy would submit the paperwork on behalf of doctor office and get it approved. Physicians love it because they don’t have to deal with this. In return, they would refer their patients to that pharmacy.

My question is about legality of this. Someone I know had to close down their pharmacy after a year because they didn’t feel comfortable doing this and hence they didn’t get any patient referrals. Whenever they went to doctors’ office for marketing, first thing they were asked was if they provide this “service”. Apparently this is a common practice among independents.

Why would it be illegal?

A lot of hospital networks have speciality pharmacies with in house teams consisting of pharmacists and techs that support providers with these services. Their ambulatory clinics like Oncology, Infectious Disease, Liver, Rheum, Pulm, and Derm prescribe tons of specialities drugs which requires a lot of paperwork and nonsense that would not be efficient for the office to do. Those pharmacists and team besides doing PA are also authorized agents of the doctor that okay refills; prescribe based off protocols.

The speciality drugs require knowledge and monitoring where your CVS and mom and pop stores would not be capable of, so should be filled by specialty pharmacies who provide these teams.

Im assuming the independent pharmacies you are speaking of are these specialty pharmacies as I don’t see why doctors would be giving out access to their EMRs for non specialty PA and majority of drugs that need PA are specialty drugs now.

 

[Aznfarmerboi]

Is it financially worth it?

Yes. A lot of these specialty drugs reimburse very well.

In addition, there is a good chance they are 340B drugs which means $$$. For example, Daraprim if 340B eligible costs 50 cents but gets reimbursed by insurance 50k.

It’s ethical and good for the patient because if the PA holds up patient care, that can translate to therapy failure if it’s HIV, oncology, or Hep C.

 

[Sine Cura]

See how this degeneracy is normalized.

PAs, 340B, patient steering

 

[BidingMyTime]

It's not illegal to do PA's. Of course, it *could* be done illegal, like has previously been mentioned, if someone is making up info or falsifying doctors signature or anything like that.

For people who think it's illegal, do you think its illegal for the office medical assistant to fill out PA's? Do you think any doctor anywhere actually fills out all the PA's on his/her own?

Certainly in some cases, it is going to be hard for the pharmacist to fill out a PA, if they don't have access to the patient's medical records. But assuming a patient only uses 1 pharmacy, the pharmacist is going to have the history of what drugs they have tried for the condition in the past, and for how long they used them. They could also get a history of current symptoms directly from the patient.

 

[wolingfeng]

Yeah if everything is filled our truthfully with the office/doctor consent, it should be good. The problem is that if fraud is involved, such as information filled is made up... or PA is submitted without doctor consent, then you shooting yourself in the foot. It helps a lot to smooth out the PA process for doctors, but it’s not the solution to get all meds covered...

 

[FoodstampPharmacist]

Pharmacy logging into physician account and getting PA done. Does sound bit shady to me.

Owl raises valid point about specialty pharmacy. Not sure how they do it on a daily basis. If someone works here can shade some light.

I worked in a pharmacy (independent) where this was commonly done. It was a favor for the physician to do a PA as they were alway a pain in the butt to fill out and get approved. It was our pharmaceutical rep that filled out the PA for the physician and submitted it. The rep would also give detailed medical advice to the patients on what drugs work the best for what condition (again at best a gray area as only a pharmacist can consult) The rep was a biology major that failed to get into medical school so maybe she wanted to use some of her education.

I'm pretty sure its a gray area at best because she got in big trouble in one state with the BOP over PAs. I think she may have been being very liberal with saying a patient has already tried X when they haven't or patient has x condition with no objective labs to back it up. Our rep. really wanted to sell X Brand Name medication so she did whatever she could to make sure the patient was able to get that expensive med paid for by their insurance.

I no longer work there because too many controlled substances were going missing and the cameras we had seemed to never record who took them. It was a shady operation and I wanted to get out before someone tried to blame me for taking the missing drugs (ruining my potential career in pharmacy). The rep would also take bimatoprost off the shelf and take it to try to make her eye lashes look better. I doubt she had a prescription for that.

 

[confettiflyer]

We have drug reps that work with individual patients (mostly high cost/orphan drug status infusions) on the financial and logistics side of things (like helping a pt find an infusion center if they’re taking a long vacation and need a dose), but full on doing a PA just reeks of conflict of interest.

They usually know very granular details regarding a payor’s criteria for approving/denying something, which isn’t necessarily bad (it’s helpful for us).

I empathize with smaller/resource poor practices, though...so I kind of understand.

 

[spacecowgirl]

We have drug reps that work with individual patients (mostly high cost/orphan drug status infusions) on the financial and logistics side of things (like helping a pt find an infusion center if they’re taking a long vacation and need a dose), but full on doing a PA just reeks of conflict of interest.

They usually know very granular details regarding a payor’s criteria for approving/denying something, which isn’t necessarily bad (it’s helpful for us).

I empathize with smaller/resource poor practices, though...so I kind of understand.

Drug reps should never do a PA. I'm looking at you Amgen.