Question for CVS/Walgreens/Duane Reade Pharmacists!

[psychnp1]

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I am a new psychiatric nurse practitioner. I've had my DEA license for almost 2 months. Can anyone tell me why I am having issues with my patients filling their controls?

The pharmacists keep saying that when they enter my DEA to confirm it says it doesn't exist.

Do they need to update their databases?

I called DEA and everything was confirmed and they said its all good on my end. They told me the pharmacies must need to update their system.

This is extremely frustrating. Every day for every patient I need to have the same convo and argue with the pharmacists. Nobody can lead me to the company that makes the program or anything. They all think I'm nuts and need to speak to DEA to resolve - which I have. I assume the mom and pop pharmacies are overriding this but its been a nightmare elsewhere.

Any advice? Thanks!

 

[trailerpark]

My pharmacy checks DEA registration from the DEA's website and if our system rejects it we can override it if the DEA WEBSITE confirms you. This is Walmart. You haven't had any Walmart pharmacist call you, have you?


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[psychnp1]

Honestly trailerpark, I can't recall since I have only a few patients using walmart. I dont recall it though so prob not. The main culprits are CVS, Walgreens, Duane reade and rite aid. It is really boiling my blood. They say that the electronic script that shows on the screen shows the correct DEA and NPI so its not the e-prescribing program either. It's funny because I would think they could check that and override - very simple. They all refuse - the worst part is a lot of these pharmacists or techs are telling MY PATIENTS that i have a dea that doesnt exist. Completely unprofessional and im sure you know how bad that makes me look to patient.

 

[Lnsean]

Honestly trailerpark, I can't recall since I have only a few patients using walmart. I dont recall it though so prob not. The main culprits are CVS, Walgreens, Duane reade and rite aid. It is really boiling my blood. They say that the electronic script that shows on the screen shows the correct DEA and NPI so its not the e-prescribing program either. It's funny because I would think they could check that and override - very simple. They all refuse - the worst part is a lot of these pharmacists or techs are telling MY PATIENTS that i have a dea that doesnt exist. Completely unprofessional and im sure you know how bad that makes me look to patient.

For Walgreens the DEA rejection is from the 3rd party insurance plans, there is a code in the 3rd party authorization to override for missing/invalid/inactive DEA if the rph confirms that the DEA is still in fact legit. Why are they not doing this and just letting the system tell them it's not legit? They are probably too busy and understaffed to check and assumed the computers are right. There's no way to fix this easily except to wait for your DEA to get updated with all the insurance plans. The more scripts you write and the more your scripts are filled...you will eventually be updated in all the plan's database.

Walgreen's system rarely rejects for invalid DEA and any of the staff can add new prescriber info to prescriber profiles with DEA/NPI/address and such. In your situation, I highly doubt it's Walgreens system. These rejections are coming from your patient's insurance plans.

 

[psychnp1]

For Walgreens the DEA rejection is from the 3rd party insurance plans, there is a code in the 3rd party authorization to override for missing/invalid/inactive DEA if the rph confirms that the DEA is still in fact legit. Why are they not doing this and just letting the system tell them it's not legit? They are probably too busy and understaffed to check and assumed the computers are right. There's no way to fix this easily except to wait for your DEA to get updated with all the insurance plans. The more scripts you write and the more your scripts are filled...you will eventually be updated in all the plan's database.

Walgreen's system rarely rejects for invalid DEA and any of the staff can add new prescriber info to prescriber profiles with DEA/NPI/address and such. In your situation, I highly doubt it's Walgreens system. These rejections are coming from your patient's insurance plans.

Wow great info. So do I need to call the insurance companies? Do I need to call for every patient separately or can it be once for each company and it'll cover all pts under that insurance?

Also, how come my coworker is a np and it's her practice so when I write a script the insurance needs a pa. Why do we need a pa for a med that the patient gets from my boss? You need to do it again simply because a new provider is writing it? Insane!

 

[BidingMyTime]

Walgreen's system rarely rejects for invalid DEA and any of the staff can add new prescriber info to prescriber profiles with DEA/NPI/address and such. In your situation, I highly doubt it's Walgreens system. These rejections are coming from your patient's insurance plans.

This makes sense, when its more than one chain rejecting, its unlikely to be an issue with the pharmacy.

Wow great info. So do I need to call the insurance companies? Do I need to call for every patient separately or can it be once for each company and it'll cover all pts under that insurance?

I would think you would just have to call each insurance company that you are contracted with (you are contracted with insurance companies aren't you? If not, that's the problem.) IE, call AETNA, and once AETNA puts in their system, then you will be in the system for all AETNA patients (or not depending on their group and if you are only contracted with certain groups of the insurance.)

Also, how come my coworker is a np and it's her practice so when I write a script the insurance needs a pa. Why do we need a pa for a med that the patient gets from my boss? You need to do it again simply because a new provider is writing it? Insane!

PA means you are writing for a non-formulary medication, with many insurance companies the PA is specific to 1 prescriber, so if another prescriber writes for it, then another PA will be needed (possibly if you call the insurance and let them know you are in the same practice, that they will quickly do an override.) Sometimes a PA is specific to 1 pharmacy, so if your patient changes pharmacies, you will have to redo the PA.

 

[ldiot]

Probably the insurance doesn't recognize your DEA... same deal with PA; unique to each prescriber. You can thank the insurance for this and stop arguing with the pharmacists lol.

 

[maria1oh]

At cvs this was a rejection from the insurance company. When I did not know how to override this I would tell patients to pay cash for it. This was usually doctors from emergency rooms and I would say something like the particular doctor is out of network for your insurance. There is a way to over ride it but cvs turnover and training is so bad a lot of techs and rphs don't know how to.
It is fairly easy to override once someone shows you how to do it.
It usually is for medicaid plans and sometimes medicare. I do not recall a commercial insurance plan giving me trouble.

 

[psychnp1]

Quick update: spoke to dr first they are looking into a better response than "it will be updated at some point". Dea says I'm fine. If it's in fact insurances then what is the quickest way to solve? Why can pharmacy see my dea and not insurance.

Btw I have a cash practice so we don't accept any insurances. Pt use insurance for Rx only.

 

[doublehh03]

There's an override at CVS for this when the insurance rejects it saying DEA is invalid. it's either 45 or 46 in additional information.

 

[lcow2004]

There's an override at CVS for this when the insurance rejects it saying DEA is invalid. it's either 45 or 46 in additional information.

At CVS, when we input DEA, it does a search in the system and pulls up the providers with DEAs that are the closest match and we usually just pick one of those that are already in there in order to get around this. This pretty much always works.

 

[ldiot]

At CVS, when we input DEA, it does a search in the system and pulls up the providers with DEAs that are the closest match and we usually just pick one of those that are already in there in order to get around this. This pretty much always works.

In other words just put in some random doctor because nobody has time to deal with this crap haha

 

[BidingMyTime]

Btw I have a cash practice so we don't accept any insurances. Pt use insurance for Rx only.

Then this is the likely problem. It's not that insurances can't see your DEA, it's that your DEA isn't listed as being contracted with them. Because you aren't contracted for them, not only aren't they going to pay for office visits of your patients, they also aren't going to pay for prescriptions written by you, because you aren't contracted with them.

 

[owlegrad]

Then this is the likely problem. It's not that insurances can't see your DEA, it's that your DEA isn't listed as being contracted with them. Because you aren't contracted for them, not only aren't they going to pay for office visits of your patients, they also aren't going to pay for prescriptions written by you, because you aren't contracted with them.

This isn't correct. Do you really think all prescribers are contracted with all plans?

 

[Lnsean]

Quick update: spoke to dr first they are looking into a better response than "it will be updated at some point". Dea says I'm fine. If it's in fact insurances then what is the quickest way to solve? Why can pharmacy see my dea and not insurance.

Btw I have a cash practice so we don't accept any insurances. Pt use insurance for Rx only.

The problem will eventually fix itself as more and more patients get your prescriptions filled, but you can do the following:

1. ASK the pharmacists there to over-ride the rejection using 3rd party clarification codes: usually a 42/43 in the submission clarification field. Again, I hate to say this...but this is not the pharmacist's job to keep your DEA updated with these insurance plans. I don't know how these pharmacists are communicating this to you. They maybe unprofessional in the way they say it, but professionally speaking, it is your responsibility to make sure your DEA is working with your patient's plans...just like when prescribers are enrolling themselves in certain networks,eg. The fact that your practice is all cash only makes it harder for these plans to have any record of you as prescriber in their computers. I would request to talk to a pharmacist or pharmacist-in-charge (at the pharmacy where most of these rejections are coming from) and explain to them the situation: your DEA is active and that they should be able to verify it and over ride the rejection. Again, they are taking time out of their day to log into another computer system to verify that your DEA is active and testify to these plans that it is such..and then they have to input these codes for each and everyone of your prescription. They don't have to do that. All of this should've been taken care of by your office staff.

2. Call the insurance yourself and make sure your DEA is in their system. You can find out specifically from those patients who are getting these rejections and calling their plans specifically to kinda address the majority of your patient base in the least amount of time.

 

[BidingMyTime]

This isn't correct. Do you really think all prescribers are contracted with all plans?

No, but some plans are picky that way, and maybe one of the major plans in her area is picky this way. It doesn't sound like this is happening with all the patients, just a few. But you are right, I am speculating. I just don't think its a pharmacy issue when its happening a different chain pharmacies.

 

[Lnsean]

No, but some plans are picky that way, and maybe one of the major plans in her area is picky this way. It doesn't sound like this is happening with all the patients, just a few. But you are right, I am speculating. I just don't think its a pharmacy issue when its happening a different chain pharmacies.

It's definitely not pharmacy related...her practice is all cash so these plans probably do not even have any record of her being a prescriber.

 

[owlegrad]

I do recall 'prescriber outside network' rejections so it is possible if it is a closed network, but that is a completely separate issue from the DEA number validation. 🙂

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[Deja]

At CVS, when we input DEA, it does a search in the system and pulls up the providers with DEAs that are the closest match and we usually just pick one of those that are already in there in order to get around this. This pretty much always works.

wtf

 

[maria1oh]

Be careful about filling controls under someone else's DEA number. The board has fined certain CVS stores before for this.

 

[wagrxm2000]

At first I thought this was just pharmacists being lazy but after reading some of the responses it shows a lack of training. Like most have stated, this is likely an insurance block to clarify a dea. However even if its something different, I don't care how busy you are someone should be calling the insurance to find out what can be done to fix the issue.

Even if this takes up too much of your time it will then save you time in the future when it occurs again.

 

[Sine Cura]

Why would you knowingly allow the wrong DEA number to be entered? Good way to get fired for misconduct if your sup was fishing for a reason.

 

[lcow2004]

Why would you knowingly allow the wrong DEA number to be entered? Good way to get fired for misconduct if your sup was fishing for a reason.

I don't think anyone really cares about this. My sup was certainly aware of this but would always just turn the other way since there are no metrics for this. Corporate philosophy was as long as metrics were being met and everything looked fine on paper, you could do whatever you wanted/needed to do to make sure things stayed that way. Nobody has time to deal with these things anyway.

 

[Lnsean]

I don't think anyone really cares about this. My sup was certainly aware of this but would always just turn the other way since there are no metrics for this. Corporate philosophy was as long as metrics were being met and everything looked fine on paper, you could do whatever you wanted/needed to do to make sure things stayed that way. Nobody has time to deal with these things anyway.

It's a violation to knowingly bill a script through a different prescriber. It's not about the timing...it's the training like the other poster said. All it takes is a few minutes to input the correct codes...to call and verify if you need to. I don't think it's a matter of convenience or choice in this matter but legality and standard procedure which could be cause for termination in any setting. Sure, those minutes add up but when matters of legality are at hand...convenience should take a back seat.

 

[ldiot]

Quick update: spoke to dr first they are looking into a better response than "it will be updated at some point". Dea says I'm fine. If it's in fact insurances then what is the quickest way to solve? Why can pharmacy see my dea and not insurance.

Btw I have a cash practice so we don't accept any insurances. Pt use insurance for Rx only.

Wait what? You aren't contracted with any insurance company and wonder why they don't cover it? Good God

 

[Deja]

wrong person

 

[Deja]

I don't think anyone really cares about this. My sup was certainly aware of this but would always just turn the other way since there are no metrics for this. Corporate philosophy was as long as metrics were being met and everything looked fine on paper, you could do whatever you wanted/needed to do to make sure things stayed that way. Nobody has time to deal with these things anyway.

everything aside, these types of rejections takes 2 seconds to solve... I hope you are new and just lacks training

 

[Dr Wario]

Wow this thread is 100% speculation, not one person here is sure where the problem is coming from but like to say it is laziness/unprofessionalism/lack of training on the part of the pharmacists. We really are a pathetic profession when we immediately blame ourselves for something that we have absolutely no control over, this issue is between the prescriber, DEA and insurance companies. How dare the OP come on here and insinuate that we are unprofessional for reading the reject on our screens to customers so that they know what is happening, and how dare us to start pointing fingers at eachother.

If you are the prescriber, call the pharmacy to figure out the exact wording they are getting for rejections, and fix the damn problem yourself. Wow

 

[Carol is Alpha]

At CVS, when we input DEA, it does a search in the system and pulls up the providers with DEAs that are the closest match and we usually just pick one of those that are already in there in order to get around this. This pretty much always works.

This is what happens when all the veteran pharmacists have been quitired and chased away. There has been nobody to mentor this new generation. Whatever happened to that kid who made this statement: "Above all else be practical! Make some non AB substitutions without calling DR .. it will impress staff and also veteran (ie important) Rph." Oh, dear God. Does he still have a license?

 

[wagrxm2000]

Wow this thread is 100% speculation, not one person here is sure where the problem is coming from but like to say it is laziness/unprofessionalism/lack of training on the part of the pharmacists. We really are a pathetic profession when we immediately blame ourselves for something that we have absolutely no control over, this issue is between the prescriber, DEA and insurance companies. How dare the OP come on here and insinuate that we are unprofessional for reading the reject on our screens to customers so that they know what is happening, and how dare us to start pointing fingers at eachother.

If you are the prescriber, call the pharmacy to figure out the exact wording they are getting for rejections, and fix the damn problem yourself. Wow

Lol a prescriber calling the pharmacy to see whats wrong, now that's a good one.

I think laziness is the correct word because at least at Walgreens, you see the same rejections over and over again. While I may not like the word, after you find out what it means its a quick solve in the future. If its not the insurance recognizing the dea, the pharmacy should WRITE DOWN not simply tell the patient the problem so they can tell the office what needs done. I personally hate faxing because you always get told we didn't receive it. So fax and write it down.

I think after reading that, laziness is correct.

 

[297point1]

I don't think anyone really cares about this. My sup was certainly aware of this but would always just turn the other way since there are no metrics for this. Corporate philosophy was as long as metrics were being met and everything looked fine on paper, you could do whatever you wanted/needed to do to make sure things stayed that way.

That's great.
Supervisors turn over frequently, and seemingly getting faster every year.
How does your next supervisor feel about this? Don't know? Of course you don't know.

I wouldn't worry too much, with the pharmacist shortage and all- I'm sure you are both valued and irreplaceable. 🙄