Rodney-frickin'-Dangerfield

hell-freakin-yeah! stupid medicaid and stupid er and stupid pa's. unfortunetly that is real life pharmacy. i would have personally seriously debated throwing the augmentin at them at that point and why is it that if the patient is public aid and you make a large switch for them and then tell them about it they always want the other med not covered and don't understand why it's not covered.

 

what's wrong with regular amoxicillin? Most ear infections clear w/o AB anyways so way waste some expensive amox/clav? I've heard that ceftin oral susp tastes horrible

 

You can't expect everyone to know what drugs are on the Medicaid formulary. You yourself had to check and see if Augmentin XR was covered. Also, npage is correct. There isn't really a good a reason to go with higher cost and higher side effect amox/clav over amox unless amox has failed.

You also can't expect people to be grateful when you fix a problem that is beyond their understanding. You have to educate them as to what your job entails, without being judgemental at them for them not understanding without your intervention. If you explain in a kind manner that there was a coverage problem and that you did alot of background work to resolve it, but still need the kid's weight to determine a safe and effective dose, 99% of patients, including those on Medicaid are going to be agreeable. And, next time they come back, they are more likely to be understanding if there is a delay in the filling process, because they know a bit more about what your job entails.

 

For resistant otitis media, we were taught Augmentin for 3 to 5 days is good enough. Increases chances for compliance for shorter course antibiotics, which is usually low in lower socioeconomic populations. There haven't been much if any data saying whether 7 to 10 days is really worth it.

We occasionally get that person who complains about the wait after all the work you do for them, but usually that's because they have other problems. Our pharmacy sees a lot of Medicaid patients, and 99% of them are really appreciative after you explain how you actually called the doctor so they could get the medicine or else it wouldn't have been covered and they would have had to pay the true out of pocket price.

 

Well, the nice bit about failing amox was important info to leave out. Alot of times, pa/md/np's dont follow guidelines, they just write for wahtever they think is cool/what pen they have in their hand. I guess the medicaid people in NY have it lucky, baiscally the only thing medicaid doesnt over is tigan, combo cough syrups (they only cover robitussin DM), second generation antihistamines and PPI's (besides prilosec OTC) needs PA. I guess thats why NY spends the most in the nation on medicaid

 

So it's ok if the person writing the prescription just picks whatever antibiotic they feel like? Leave it to the pharmacist to sort out? They always do anyways....

 

Prescribers have as little responsibility for carrying around insurance formulary booklets as we do. The should (obviously) pick the drug of choice unless they know it's not covered or there are contraindications. They didn't create the insurance formulary and don't typically have access to it, so I don't see why they should be blamed for the lack of coverage. If you accept insurance, it's a given that this sort of scenario is going to happen. In a way, we have brought the problem on ourselves. I personally choose to suck it up and accept that resolving formulary issues is part of providing good patient care. Getting upset at the prescriber is just ridiculous.

 

That would totaly work!

Imagine
dx:major depressive disorder
rx:ssri

dx:schizophrenia
rx:atypical


dx:insomnia
rx:benzo

 

That would irritate me too, it's an often thankless job. Of course prescribers don't know the formulary of every third party plan, but I don't think having a Medicaid formulary reference on hand is such a wacky demand.


I have to wonder why people here have to be so goddamn disagreeable all of the time? It's frustrating to be unappreciated even with no reasonable expectation of being recognized.

 

[
I have to wonder why people here have to be so goddamn disagreeable all of the time? It's frustrating to be unappreciated even with no reasonable expectation of being recognized.[/QUOTE]


I am wondering the same thing. SDN is not the same as it used to be a year or so ago. People are not very respectful or considerate anymore. Very combative.

 

We have a therepeutic interchange program in WA that lets us do that for certain prescribers and certain patients (ie: state sponsored plans and prescribers who sign up). It's nice for some things, like PPIs. But, for most of the other drugs, it's a huge PITA. Basically, instead of tossing it back to the prescriber if there is a problem, we are supposed to pick and dose a therepeutic equivalent. I hate being asked to do this without access to the patient's pertinent medical history. And, I worry that proper followup by prescribers will be lacking.

 

A formulary might be useful in a community clinic. But, usually prescribers don't know who is or is not on Medicaid during their visit.

I don't think our Medicaid system issues formulary booklets here. If they did, they'd be useless by the time they were shipped out. The formulary is subject to sudden capricious change. And, they pull crap like stating that Toprol XL is a preferred drug while simultaneously insisting that it requires a PA.

 

Thank you. I could not agree more. I used to enjoy reading here but lately the content is far less informative and a lot more silly arguing from the few people left not afraid to post.

 

so do something about it

 

I honestly dont think that SDN has changed all that much.
Perhaps because when I first started posting I was in pharmacy school, it has never really been all that informative to me... More... entertainment than anything else really

I thought that the pharmacy forum would actually be informative but again... its not.. its mainly a forum for discussing current issues and opinions on those issues.

I actually stopped using the forums for a while (6 months- year range) because it was such a hassle a few months after i first joined..

I have found that typically people dont like for you to disagree with them and get their panties all in a wad when you do and become combative.

like i said...

entertainment value nothing else...


oh and so my post is relevant....

its too bad we cant be like hospitals with medicaid patients.... automatic substitution baby!

 

Thats how i became i freakin alcoholic!!.......yes those retail days sound the same. all i got to say to you younglings STAY THE FREAKING HECK AWAY FROM ANYTHING THAT RESEMBLES RETAIL.

 

Thats how i became i freakin alcoholic!!.......yes those retail days sound the same. all i got to say to you younglings STAY THE FREAKING HECK AWAY FROM ANYTHING THAT RESEMBLES RETAIL.

 

There are plenty of people who can and do survive retail. There are even some who enjoy it.