maria1oh

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If a doctor self prescribes for themselves is it ok to bill their insurance or should this be run without insurance? I have heard doctors tell me two different things.

Also when a doctor self prescribes with the directions "for office use" is it ok to bill their prescription insurance or does this have to be a cash claim? State law allows for office use prescribing for non-controls but does not mention about insurance billing.

It's mostly always commercial insurances but I suppose this could happen with other insurances like medicare or workers comp.
 

zelman

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If a doctor self prescribes for themselves is it ok to bill their insurance or should this be run without insurance? I have heard doctors tell me two different things.

Also when a doctor self prescribes with the directions "for office use" is it ok to bill their prescription insurance or does this have to be a cash claim? State law allows for office use prescribing for non-controls but does not mention about insurance billing.

It's mostly always commercial insurances but I suppose this could happen with other insurances like medicare or workers comp.
Medical insurance policies pay for drugs to be used by/on the insured party*. Not for them to administer to others in their practice.

Regarding self-prescribing, I would think that it should be billable to insurance. Has anyone else heard otherwise?



*the only exception is newborns' drugs are often covered by their mother's policy
 

ldiot

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There's no way that it's acceptable to bill their personal insurance for drugs to be used in the office on patients. And if you are selling a narc you have to have the DEA 222, not a "for office use" script.

If they write themselves a script for personal use and not office use then I'd say insurance is okay.

For non-controls fill the script for cash. My question is do you fill it under the doctor's patient profile or do you make some kind of "office profile"? That I don't know
 
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It is really funny, in my fifteen years of pharmacy I have had exactly one script written for office use. It was a local addiction specialist getting the nasal naloxone kit for demonstration purposes and she was very aware that I could not bill insurance and had no problem with it.

As for newborns, how have you guys handled this? Apparently my state's medicaid program has been saying that you can bill the mother's insurance, however, when I call the processor for the claims they say you can't do that. Our store used to bill by putting the mother's date of birth and ID number on the newborn's profile, but this would create many annoyances and really does not seem to be legal (you are falsifying information), so I'm not really sure how this is supposed to be done.
 

doublehh03

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It is really funny, in my fifteen years of pharmacy I have had exactly one script written for office use. It was a local addiction specialist getting the nasal naloxone kit for demonstration purposes and she was very aware that I could not bill insurance and had no problem with it.

As for newborns, how have you guys handled this? Apparently my state's medicaid program has been saying that you can bill the mother's insurance, however, when I call the processor for the claims they say you can't do that. Our store used to bill by putting the mother's date of birth and ID number on the newborn's profile, but this would create many annoyances and really does not seem to be legal (you are falsifying information), so I'm not really sure how this is supposed to be done.
Doctors bill the mom's insurance so what they would do is write the script under the mother's name, but would note this is for her child on the script.
 

samuricool

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It is really funny, in my fifteen years of pharmacy I have had exactly one script written for office use. It was a local addiction specialist getting the nasal naloxone kit for demonstration purposes and she was very aware that I could not bill insurance and had no problem with it.

As for newborns, how have you guys handled this? Apparently my state's medicaid program has been saying that you can bill the mother's insurance, however, when I call the processor for the claims they say you can't do that. Our store used to bill by putting the mother's date of birth and ID number on the newborn's profile, but this would create many annoyances and really does not seem to be legal (you are falsifying information), so I'm not really sure how this is supposed to be done.

I've seen private insurance do this all the time. I just change the dob on the profile to match moms and then put a note on the profile saying what is going on. Never had an audit or anything.


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zelman

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It is really funny, in my fifteen years of pharmacy I have had exactly one script written for office use. It was a local addiction specialist getting the nasal naloxone kit for demonstration purposes and she was very aware that I could not bill insurance and had no problem with it.

As for newborns, how have you guys handled this? Apparently my state's medicaid program has been saying that you can bill the mother's insurance, however, when I call the processor for the claims they say you can't do that. Our store used to bill by putting the mother's date of birth and ID number on the newborn's profile, but this would create many annoyances and really does not seem to be legal (you are falsifying information), so I'm not really sure how this is supposed to be done.
I encourage the patient to manually submit the claim. When that doesn't work, I change the DOB to mom's, submit the claim, then change it back.
 

Apotheker2015

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If a doctor self prescribes for themselves is it ok to bill their insurance or should this be run without insurance? I have heard doctors tell me two different things.

Also when a doctor self prescribes with the directions "for office use" is it ok to bill their prescription insurance or does this have to be a cash claim? State law allows for office use prescribing for non-controls but does not mention about insurance billing.

It's mostly always commercial insurances but I suppose this could happen with other insurances like medicare or workers comp.
Maria1oh,

I would definitely check on your state's stance on self-prescribing. Most states have an issue with self-prescribing of controlled substances. Some do not even address self-prescribing of non-controlled substances or prescribing to family members. A prescription written for"office use" or "medical bag" is not valid. Typically, the prescriber and pharmacist, are both subject to discipline by the board. Anything deemed for "office use" is really a "stock transfer of medications". If it's a schedule II, then you would generate a DEA form 222 and act as a supplier. If it's either in schedule III, IV or V or non-controlled, then you would use an invoice and both parties would maintain the record for however long is required by your state.

Prescribers know this. This is not new. I don't get it why some act surprised when a pharmacist tells them a prescription for office use is not valid because it is not a prescription. If you already supplied the drugs and finalized the transaction, I would suggest covering your back by generating an invoice and having the prescriber sign it. Hand him/her a copy and your pharmacy keeps one. I personally don't like dealing with that. If you need something for office use, then get it from a distributor. Just tell them that you tend to keep on the shelves just about what you need for your patients.

Best,

Apotheker2015
 

ldiot

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I encourage the patient to manually submit the claim. When that doesn't work, I change the DOB to mom's, submit the claim, then change it back.
Better damn well hope it's covered when they manually submit it or you're going to have one pissed off medicaid lady in your pharmacy:laugh:
 

zelman

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Better damn well hope it's covered when they manually submit it or you're going to have one pissed off medicaid lady in your pharmacy:laugh:
This applies to all patients, but we'd give them a heads up for any questionable products. And anyway, people are surprisingly very willing to shell out a few bucks for their 2 day old child.
 

ldiot

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This applies to all patients, but we'd give them a heads up for any questionable products. And anyway, people are surprisingly very willing to shell out a few bucks for their 2 day old child.
In some communities this is sadly the exception and not the norm. Maybe that's an exaggeration but I'm always amazed by decisions that some people make. And it does apply to all patients. I've literally, I kid you not, had a guy pick up his Viagra for a couple hundred dollars but refuse an infant's eye drops because they were 80 dollars. This was all the same visit to the pharmacy. I would have given him the benefit of the doubt and assumed it was no longer needed but after watching him get real comfortable at the register and have a debate with himself for 5 minutes I know this not to be the case.
 

lord999

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Maria1oh,

I would definitely check on your state's stance on self-prescribing. Most states have an issue with self-prescribing of controlled substances. Some do not even address self-prescribing of non-controlled substances or prescribing to family members. A prescription written for"office use" or "medical bag" is not valid. Typically, the prescriber and pharmacist, are both subject to discipline by the board. Anything deemed for "office use" is really a "stock transfer of medications". If it's a schedule II, then you would generate a DEA form 222 and act as a supplier. If it's either in schedule III, IV or V or non-controlled, then you would use an invoice and both parties would maintain the record for however long is required by your state.

Prescribers know this. This is not new. I don't get it why some act surprised when a pharmacist tells them a prescription for office use is not valid because it is not a prescription. If you already supplied the drugs and finalized the transaction, I would suggest covering your back by generating an invoice and having the prescriber sign it. Hand him/her a copy and your pharmacy keeps one. I personally don't like dealing with that. If you need something for office use, then get it from a distributor. Just tell them that you tend to keep on the shelves just about what you need for your patients.

Best,

Apotheker2015
Office use is not a valid prescription and I agree, this is an old and dead issue. However, if you want to actually sell the med to the office as an invoice matter, there is no objection. This is a normal transaction between two licensed parties, but if for office use, that's different than personal use. For controls, there's a little more paperwork involved, but if they are DEA registered, there's nothing against just selling (not through a prescription, but just selling as a pharmacy to a medical office) the meds to them. However, on their part, they have to track that.

If you have prescriptions where you did fill for office use and the prescribers insurance was charged, Utilization Review could end up refunding them as well as penalizing your pharmacy financially for filling something that's clearly not supposed to be a prescription.

There's a rider though that if you do more than 5% of your controls business that way, you have to register as a wholesaler. Chains under normal circumstances are opposed to that and usually would direct that traffic to their in-house wholesaler.
 

Apotheker2015

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Office use is not a valid prescription and I agree, this is an old and dead issue. However, if you want to actually sell the med to the office as an invoice matter, there is no objection. This is a normal transaction between two licensed parties, but if for office use, that's different than personal use. For controls, there's a little more paperwork involved, but if they are DEA registered, there's nothing against just selling (not through a prescription, but just selling as a pharmacy to a medical office) the meds to them. However, on their part, they have to track that.

If you have prescriptions where you did fill for office use and the prescribers insurance was charged, Utilization Review could end up refunding them as well as penalizing your pharmacy financially for filling something that's clearly not supposed to be a prescription.

There's a rider though that if you do more than 5% of your controls business that way, you have to register as a wholesaler. Chains under normal circumstances are opposed to that and usually would direct that traffic to their in-house wholesaler.
Right. I agree. I was just saying that I'd rather not deal with that and having to make sure you don't exceed that 5%.
 
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maria1oh

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I have seen about a dozen scripts for amoxicillin for office use over the years. Dentists like to keep these on hand in case patients forget to fill their pre-appt amoxicillin scripts. They charge like 20-30 bucks for the 4 capsules according to a mutual patient. I never paid attention to insurance billing with amoxicillin because it is so cheap. Recently had a doctor prescribe epipen for office use so I had to decide about not billing insurance.
 

Apotheker2015

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I have seen about a dozen scripts for amoxicillin for office use over the years. Dentists like to keep these on hand in case patients forget to fill their pre-appt amoxicillin scripts. They charge like 20-30 bucks for the 4 capsules according to a mutual patient. I never paid attention to insurance billing with amoxicillin because it is so cheap. Recently had a doctor prescribe epipen for office use so I had to decide about not billing insurance.
I have only run into one prescription for office-use. I was an intern at the time and my preceptor had me research it. It's a no go. Now Epi pens... don't know about Epipens for "office use". I do know that some states allow Epipens to be prescribed to a school or the nurse who would administer it during an emergency.
 

Ackj

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I recall once filling an Epipen and Nitrostat for a dentist for office use/crash cart. It was just sold to them without any insurance, but I couldn't find any practical way for the pharmacy to generate an invoice and record the sale. We just put it on his Rx file and rang it out as cash, even though it wasn't really a prescription per se.
 

sosoo

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reading comments above, i wonder do pharmacists not study pharmacy laws? "office use" is not valid.
 

owlegrad

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reading comments above, i wonder do pharmacists not study pharmacy laws? "office use" is not valid.
How is it any worse then the prescribers who write that garbage? They should know what they can and can't write.

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Dred Pirate

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I know in the state I previously worked you could not write for office use on a rx - you had to invoice the order. I was pathetic that I as a new grad at the time had to explain this to my manager (who had been out of school probably 7-10 years at the time) - but had much mgmt experience. In my current state? I don't know and I don't even care and glad i don't have to mess with that stuff....

But ya - know your state laws as many it is illegal to write a rx for office use
 
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