The AMA wants to stick it to us!

[BenJammin]

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Those sneaky dogs are going to vote on these two resolutions tomorrow.

http://www.hpm.com/pdf/blog/AMA RES 218 061313.PDF
http://www.hpm.com/pdf/blog/AMA Resolution 12 061313.PDF

Delegations from New England have put forth an almost identical resolution to the AMA House of Delegates that also, while noting the regulations “only” require pharmacists to ensure the prescription is legitimate, pharmacists are “under no circumstances should be required to confirm the appropriateness of a prescription; the decision is purely a medical one, completely in the purview of the treating physician.” AMA House of Delegates Resolution 218 (A-13), AMA Response to Drug Store Chain Intrusion into Medical Practice, received May 17, 2013. Furthermore, calls from pharmacists to doctors’ offices to verify prescriptions will be deemed an “inappropriate interference with the practice of medicine and unwarranted ....” Id. If pharmacists continue to conduct routine prescription verification, the AMA plans to take its fight to the implicated companies (i.e., drug store chains), DEA, and other involved state and federal regulators to stop what the AMA believes is interference in the physicians’ practice of medicine and their medical treatment decision-making. If those efforts fail, the AMA will turn to Congress for legislation to eliminate any form of pharmacist prescription verification requirement, or to otherwise clarify physician and pharmacist roles in dispensing controlled substances.

Time to take up arms, fellow pharmacists. If the DEA is going to fine us for not calling about the legitimacy of these scripts then who the hell does the AMA think they are to tell us we shouldn't be "doing our jobs"?

 

[WVUPharm2007]

It's just the AMA, they have no true power. They are a lobbying group and that's it.

And I'll call to verify a script for whatever reason I damned please if I have some sort of question about it or doubt its legitimacy. The AMA can suck my balls.

 

[joetrisman]

It's just the AMA, they have no true power. They are a lobbying group and that's it.

And I'll call to verify a script for whatever reason I damned please if I have some sort of question about it or doubt its legitimacy. The AMA can suck my balls.

"You will fill my script and like it you mid level practitioner!"

 

[chuckle beast]

This seems to be more of an issue with the DEA

 

[BMBiology]

Don't worry about it. The APhA is much more powerful than the AMA. They will learn not to mess with pharmacists. Let me tell you what the APhA has done......uhhh, anyone know? come on! someone must know!

 

[Pharmgrlnxdor]

Awwww man, you know what they do. They collect dues MAN! Isn't that enough?

 

[Ackj]

So verify that it's a legitimate rx, not if its accurate? "Doctor, did you prescribe metoprolol for John Smith today?" "Yes" Does that mean we are free from liability when we dispense the prescribed 250mg bid rather than 25mg?

Like the other thread about errors, most of them are clerical mistakes. But now we won't call to get them changed, despite knowing it is wrong. 🙄

 

[spacecowgirl]

Sweet! No OBRA, no duty to warn? Just lick and stick, baby!

 

[jrlbc06]

From actually clicking the links and reading it sounds more like they're talking about questioning appropriateness of narcotic / controlled prescriptions. I kind of got the impression they were more talking about questioning painkiller dosing or something along those lines vs questioning clerical errors / obvious dosing mistakes.

 

[DAW2]

well i guess i won't be on the phone that much anymore, so i'll get rid of the phone shoulder rest thingy. oh wait, still gotta call insurances...

 

[WVUPharm2007]

From actually clicking the links and reading it sounds more like they're talking about questioning appropriateness of narcotic / controlled prescriptions. I kind of got the impression they were more talking about questioning painkiller dosing or something along those lines vs questioning clerical errors / obvious dosing mistakes.

It is. And the AMA needs to realize that I turn on the news and see a physician arrested for running a pill mill like once a week. The bad eggs ruined it for all of them. Yes, you're prescriptions will be scrutinized. Yes, they will be verified.

What's their gripe? That they are being annoyed? Boo freakin hoo. I'm annoyed by them being too damned lazy to consult easily obtainable formulary documents and forcing me to deal with it when the patient arrives at the pharmacy with a prescription their insurance won't pay for. But, hey, that's the job. I'm not going to go whine to the APhA about it.

 

[confettiflyer]

People still take the AMA seriously?

And in other news, California is close to expanding scope of practice for pharmacists, optometrists, and NP's.

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB493

 

[Old Timer]

This is not the AMA run a muck. This is the AMA's response to Walgreens run a muck. If you have been a pharmacist for more than 15 minutes you know which doctors are on the level, which are on the bubble and which are just crooks selling prescriptions under some guise or another. Group A is pissed they have to waste time speaking to Walgreens to justify an obviously legitimate prescription written in the normal course of the practice
of Medicine.

There is a difference between little Miss Jones who has been a patient of Dr. X and the same pharmacy for 10 years getting 100 Percocet and the strapping 25 year old looking to score 180 Oxycodone 30 mg from a "Pain Clinic". Since Walgreens is too stupid to know the difference doesn't mean GP's need to waste their limited resources keeping Walgreens from getting another 80 million dollar fine.

 

[npage148]

Maybe if the good docs didn't want to be bothered they should clean up their profession. Nothing makes you look credible when a colleague is selling narc scripts for yard work

 

[smercer]

You see where the AMA voted to begin considering Obesity to be a disease.
http://www.nytimes.com/2013/06/19/business/ama-recognizes-obesity-as-a-disease.html?_r=0

Because you know getting more drugs and surgery covered for by insurance is how you fight it.


Guess it is a bonus for my hospital though, as we just started a new Bariatric Surgery program.

 

[VA Hopeful Dr]

It is. And the AMA needs to realize that I turn on the news and see a physician arrested for running a pill mill like once a week. The bad eggs ruined it for all of them. Yes, you're prescriptions will be scrutinized. Yes, they will be verified.

What's their gripe? That they are being annoyed? Boo freakin hoo. I'm annoyed by them being too damned lazy to consult easily obtainable formulary documents and forcing me to deal with it when the patient arrives at the pharmacy with a prescription their insurance won't pay for. But, hey, that's the job. I'm not going to go whine to the APhA about it.

Easily obtainable? Maybe for you guys, but the only ones I can get are either a) my various medicaid HMOs or b) ones who build the formulary into my EMR. The rest, almost all of the Part D ones, I don't have and I don't know how to obtain them.

 

[WVUPharm2007]

Easily obtainable? Maybe for you guys, but the only ones I can get are either a) my various medicaid HMOs or b) ones who build the formulary into my EMR. The rest, almost all of the Part D ones, I don't have and I don't know how to obtain them.

Call the PBM, tell them what class of medication, they will tell you what's covered and what criteria are needed to get what you wanted prescribed in the first place. It takes like 3 minutes. I do it a few times a week.

And if it is easy to get or hard to get, it would still be pawned off on me. Pharmacists have become prescribing practitioners' personal insurance liaisons. But, again, I understand that its the job. I don't go around whining about it.

 

[Ackj]

Easily obtainable? Maybe for you guys, but the only ones I can get are either a) my various medicaid HMOs or b) ones who build the formulary into my EMR. The rest, almost all of the Part D ones, I don't have and I don't know how to obtain them.

Has it been on the market less than a year? It needs a PA.

Is it a brand name drug in a class of medications that have generics? It needs a PA.

That clears up the majority of them. Now, knowing whether Benicar or Edarbi is the preferred tier 3 ARB after failing losartan, or whether Omnaris or Nasonex is the preferred nasal spray after fluticasone, that's a different story. Nobody would remember all of those for each plan. But if the patient has never had an ARB or nasal spray ever, don't think that Edarbi or Omnaris will be covered.

 

[owlegrad]

Call the PBM, tell them what class of medication, they will tell you what's covered and what criteria are needed to get what you wanted prescribed in the first place. It takes like 3 minutes. I do it a few times a week.

And if it is easy to get or hard to get, it would still be pawned off on me. Pharmacists have become prescribing practitioners' personal insurance liaisons. But, again, I understand that its the job. I don't go around whining about it.

I have an app for that.

 

[Digsbe]

This actually makes me a little mad.

"Whereas, Pharmacists are valuable members of the health care team, and often call physicians for clarification of prescriptions, for patient safety issues, but these verification telephone calls will be an added burden to them, delaying work flow and delivery of medications to all patients;"

Far over the line in my opinion. Is not the definition of pharmacy practice to ensure the safe and effective use of medication? So we shouldn't call on a safety issue when a patient allergic to penicillin is prescribed it because the nurse/physician didn't check their history? What about a drug-drug interactions or dangerously high doses? What if something is contraindicated for a disease state that the pharmacist knows about?

Seems like they want to redefine pharmacy practice to essentially mean "count, print, and stick." Are they not aware that pharmacists get sued for missing safety mistakes and errors in prescribing? The AMA only looks out for physicians, that's their job. I understand them howling and raving over any kind of expanded scope for anyone other than a physician and protecting turf (no matter how idiotic their reasons are), but this is them stepping into a pharmacists scope of practice and essentially redefining it because they don't like to be confronted on something or bothered with pharmacy calls. Either that or it's to feed the ego of some as if their decision is always 100% error free and correct and there is no need for someone with a doctorate degree in pharmacy to use any kind of clinical judgement at all when it comes to their area of expertise...

Thank goodness they are just a lobby organization. But then again if we no longer have to care about patient safety and medication appropriateness (like that mistakenly written Vagifem applicator for a man, which I've seen personally happen) then maybe we won't have to worry about law suits or actually caring anymore beyond "is the pill right? Yes. Are the instructions right? Yes. Did you count to 30/90/120 right? Sure."

 

[vistaril]

Those sneaky dogs are going to vote on these two resolutions tomorrow.

http://www.hpm.com/pdf/blog/AMA RES 218 061313.PDF
http://www.hpm.com/pdf/blog/AMA Resolution 12 061313.PDF



Time to take up arms, fellow pharmacists. If the DEA is going to fine us for not calling about the legitimacy of these scripts then who the hell does the AMA think they are to tell us we shouldn't be "doing our jobs"?

Most of the retail pharmacists I encounter would love if something like this were implemented....

 

[Momus]

Why Men are boycotting marriage

 

[VA Hopeful Dr]

Has it been on the market less than a year? It needs a PA.

Is it a brand name drug in a class of medications that have generics? It needs a PA.

That clears up the majority of them. Now, knowing whether Benicar or Edarbi is the preferred tier 3 ARB after failing losartan, or whether Omnaris or Nasonex is the preferred nasal spray after fluticasone, that's a different story. Nobody would remember all of those for each plan. But if the patient has never had an ARB or nasal spray ever, don't think that Edarbi or Omnaris will be covered.

The bold part is what I'm talking about that drives me insane. If each insurance that I accept would even send me an e-mail/hard copy of their formulary, I promise I'd read it. I hate PAs/pharmacy changes as much as you guys do.

 

[WVUPharm2007]

Why Men are boycotting marriage

I think I predicted men checking out of marriage in 2009 or so on this forum. I've noticed that many of the rants I go off on here instantly labeled as "oh, crazy Mikey and his crazy thoughts" eventually becomes a more mainstream, accepted thought. Like how the word nocebo has gotten popular in journals lately after I spent the last decade complaining about idiot patients that claim their Greenstone branded sertraline doesn't work as well as their Pfizer branded Zoloft. Perhaps I am a futurist. Catch up to me, people.

I'ma get a copy of that book though. That quote about modern feminism not being about equality, but being about special privileges for women is undeniably true. I can't believe a person, let alone a woman, is actually getting away with throwing out the cold, hard truth like that.

That said...we are derailing the thread...

 

[Digsbe]

Most of the retail pharmacists I encounter would love if something like this were implemented....

I can't think of any pharmacist I've ever worked with that would want to be restricted in calling an office when they find an error or alert the office that the prescription is unsafe or for significant problems. Yeah it takes up time, but personally I do care about the patients I would be dispensing for (if I go into retail) and honestly I would take the time to call an office if it means keeping patients safe when I find a significant problem or error. And trust me, problems and errors do happen.

 

[spacecowgirl]

The bold part is what I'm talking about that drives me insane. If each insurance that I accept would even send me an e-mail/hard copy of their formulary, I promise I'd read it. I hate PAs/pharmacy changes as much as you guys do.

http://www.fingertipformulary.com/

 

[BenJammin]

I think I predicted men checking out of marriage in 2009 or so on this forum. I've noticed that many of the rants I go off on here instantly labeled as "oh, crazy Mikey and his crazy thoughts" eventually becomes a more mainstream, accepted thought. Like how the word nocebo has gotten popular in journals lately after I spent the last decade complaining about idiot patients that claim their Greenstone branded sertraline doesn't work as well as their Pfizer branded Zoloft. Perhaps I am a futurist. Catch up to me, people.

I'ma get a copy of that book though. That quote about modern feminism not being about equality, but being about special privileges for women is undeniably true. I can't believe a person, let alone a woman, is actually getting away with throwing out the cold, hard truth like that.

That said...we are derailing the thread...

You're not crazy at all when it comes to the topic of marriage. There is no benefit for a man to get married in today's age. The only ones who benefit are women and children. Men are treated like dogs by divorce courts and it's really sad.


By the way, the AMA didn't pass those resolutions today so it's not official policy.

 

[Momus]

You're not crazy at all when it comes to the topic of marriage. There is no benefit for a man to get married in today's age. The only ones who benefit are women and children. Men are treated like dogs by divorce courts and it's really sad.

By the way, the AMA didn't pass those resolutions today so it's not official policy.

I said it here multiple times. The only way I consider marriage is if I set up a revocable living trust before commingling assets, or a prenup. These can be waived if the woman has similar assets, or is making equal/more than me LOL

 

[radio frequency]

When was the last time you heard a physician say they thought the AMA was relevant?

This is all just a ****-waving contest, trying to show off to the base and prove quien es mas macho.

 

[Old Timer]

I said it here multiple times. The only way I consider marriage is if I set up a revocable living trust before commingling assets, or a prenup. These can be waived if the woman has similar assets, or is making equal/more than me LOL

I'll bet the women are lining up to spend their lives with you....

 

[ChicagoPharmD]

You're not crazy at all when it comes to the topic of marriage. There is no benefit for a man to get married in today's age. The only ones who benefit are women and children. Men are treated like dogs by divorce courts and it's really sad.


By the way, the AMA didn't pass those resolutions today so it's not official policy.

Just verifying - they did not pass either resolution? Been looking around online but can't find the resolutions from today....Thanks!!!

 

[BenJammin]

Just verifying - they did not pass either resolution? Been looking around online but can't find the resolutions from today....Thanks!!!

Verified. Check the AMA website where they talk about policy approved at today's house of delegates. Nothing mentioned about either resolution and today was the final day of voting.

 

[Momus]

I'll bet the women are lining up to spend their lives with you....

80% of divorce is initiated by women. You have a... what 10 years with no prenup? I hope you never have a divorce and your woman never gets tired of you. I am not going to gamble on 50% chance my hard earn money splits into 2 whenever she likes.

If I had a wife, I'd kill my wife before I ever get a divorce LOL.

 

[VA Hopeful Dr]

http://www.fingertipformulary.com/

That's just fantastic, thanks 🙂

 

[npage148]

If I had a wife, I'd kill my wife before I ever get a divorce LOL.

Quoting for evidence for your future trial

 

[WVUPharm2007]

I'd kill my wife before I ever get a divorce LOL.

 

[Old Timer]

80% of divorce is initiated by women. You have a... what 10 years with no prenup? I hope you never have a divorce and your woman never gets tired of you. I am not going to gamble on 50% chance my hard earn money splits into 2 whenever she likes.

If I had a wife, I'd kill my wife before I ever get a divorce LOL.

Unless you know when you are going to kick and plan on spending every last cent, you can't take it with you when you go. Money is just not that important....

 

[rxlea]

80% of divorce is initiated by women. You have a... what 10 years with no prenup? I hope you never have a divorce and your woman never gets tired of you. I am not going to gamble on 50% chance my hard earn money splits into 2 whenever she likes.

If I had a wife, I'd kill my wife before I ever get a divorce LOL.

Wow. I hope you're joking. I'd hope that anyone who marries someone does it with the intention of making it last. It's fantastic finding that one person you can be yourself with- someone to go home to. But I know that's not for everyone just like kids are not got everyone.

If you're thinking about pre-nup and all that and you're not a big movie star or something, then it's like you're expecting the marriage to fall apart at some point and you want to be ready for that. It's all about the sanctity of marriage, eh? 🙄

I mean, what's the point? Just be single at that point.

 

[WVUPharm2007]

If you're thinking about pre-nup and all that and you're not a big movie star or something, then it's like you're expecting the marriage to fall apart at some point and you want to be ready for that. It's all about the sanctity of marriage, eh? 🙄

I mean, what's the point? Just be single at that point.

UNLESS she is your financial equal, you really should get a pre-nup. 50% chance of failure. Use logic, not emotion. Everyone marries with the right intentions, but ignoring statistics is foolish. Especially considering the fact that 70% of divorces are initiated by women. The most common excuse is "boredom."

So there ya go...

 

[xiphoid2010]

UNLESS she is your financial equal, you really should get a pre-nup. 50% chance of failure. Use logic, not emotion. Everyone marries with the right intentions, but ignoring statistics is foolish. Especially considering the fact that 70% of divorces are initiated by women. The most common excuse is "boredom."

So there ya go...

Well, as someone who tries to be objective and rational, that was one of the major consideration in choosing who I married. Liberal arts girl might be crazy sex cats in the bed, but in the end, you need someone who can take on half of the world with you, not someone who is going to be a net liability. By marrying someone with similar income you (1) improve the standards of living (2) decrease the number 1 cause of divorce -- money, and (3) even if in a divorce, it decrease the downside.

Not sexy, and I certainly wouldn't say it out loud to my wife. But I have complimented her in an indirect ways hinting these are something of the things I love about her. Now you know why the my buddy the HIM director calls me the 4-eyed computer.

P.S, I agree, men gain very little if anything from marriage. In fact, my wife demanded that I propose, and so I did. Well what can I say, I admire a girl who know what she wants, and I saw that she was indeed one who had what it takes. 🙂

 

[joetrisman]

Well, as someone who tries to be objective and rational, that was one of the major consideration in choosing who I married. Liberal arts girl might be crazy sex cats in the bed, but in the end, you need someone who can take on half of the world with you, not someone who is going to be a net liability. By marrying someone with similar income you (1) improve the standards of living (2) decrease the number 1 cause of divorce -- money, and (3) even if in a divorce, it decrease the downside.

Not sexy, and I certainly wouldn't say it out loud to my wife. But I have complimented her in an indirect ways hinting these are something of the things I love about her. Now you know why the my buddy the HIM director calls me the 4-eyed computer.

P.S, I agree, men gain very little if anything from marriage. In fact, it was my wife who demanded that I propose. Yeah, she's romantic like that. 🙂

I've mentioned a list about the same to my wife before, but she gets it as we are a lot alike. A good marriage is run like a good business imo.

 

[xiphoid2010]

I've mentioned a list about the same to my wife before, but she gets it as we are a lot alike. A good marriage is run like a good business imo.

I'm with you. That's why divorce rate is higher for younger couples -- too much heart and not enough brain.

Love is not just emotional attraction. It falls into stages. Initially, it's lust, that's love at first sight -- primitive hormonal response. Then comes infatuation, when serotonin and dopamine drives a semi-euphoria (it felt great, I remember when smiling for no reason when thinking I'm the man for this perfect girl who could do no wrong). But such an altered brain chemistry can not last, until it evolves into: attachment -- when life are co-dependent, kind of like China and US, where you evolve and develop a life that is more painful without someone than with them. This is when reverse psychology plays a part -- I put up with them therefore I must love them.

 

[BenJammin]

If you're thinking about pre-nup and all that and you're not a big movie star or something, then it's like you're expecting the marriage to fall apart at some point and you want to be ready for that. It's all about the sanctity of marriage, eh? 🙄

I mean, what's the point? Just be single at that point.

This mentality needs to die a slow, painful death. Prenups protect current AND future assets. Say you start a corporation and grow it into a million dollar company. Guess what? Your wife now owns 50% of it. B-b-b-b-but I thought I was going to be a poor loser forever hahahaha get real.

Marriage is a business contract and not protecting your assets is like giving a loan to someone with a credit score of 0.

 

[xiphoid2010]

This mentality needs to die a slow, painful death. Prenups protect current AND future assets. Say you start a corporation and grow it into a million dollar company. Guess what? Your wife now owns 50% of it. B-b-b-b-but I thought I was going to be a poor loser forever hahahaha get real.

Marriage is a business contract and not protecting your assets is like giving a loan to someone with a credit score of 0.

moderation my friend, moderation.

If a girl who can spot your potential 10 years before you make it big, I say she earned her 50%. It's like investment. If you were about to invest in google in the 90s, would you want google make you sign a prenup?

I say stop the gold-diggers, have a prenup that stop someone from taking 50% of assets (and growth from that assets) in place before the marriage, but for additional assets invested and earned after marriage, I would consider 50% of that to her as a reward for a game well played. I would tip my hat off to a girl who foreseen the value before I saw that in myseff.

 

[radio frequency]

This all presupposes only men make big-time money. Maybe women should be demanding pre-nups of their men...

 

[Ackj]

Talked to a patient today for about 10-15 minutes. He's now in pretty sad shape, around 400lbs, disabled, unemployed, lives with his mom, etc. In the 80s he had a very successful marketing business, all going well until his wife decided to take every last cent of his $400k in the bank and leave him. At that point he became depressed and went into a tailspin.

Moral of the story: don't get married, and if you do, at least don't have a joint bank accounts/financial access.

 

[npage148]

You guys all have a pretty depressing outlook on life, love, and marriage

 

[xiphoid2010]

You guys all have a pretty depressing outlook on life, love, and marriage

More people should take a rational and realistic view before they tie the knot. People would like to think love and passion makes marriage, but it is mostly a whole lot of chores and responsibilities minus the sex (especially after having kids), kinda like a second job. But at at least for me as a moderate, there should be a moral and pragmatic center. Marriage is more like trying to build a small joint venture, the reward comes from the satisfaction when you succeed, but there is also the risk of heavy losses and frustration if it fails. It's not a low risk, fun, sex filled game like dating was.

 

[Old Timer]

You guys who think that they are giving 1/2 their stuff to somebody else are not only greedy little turds who know the price of everything and the value of nothing, you also never like to let the facts get in the way of a good story.

First women are almost always worse off financially after a divorce. Google is your friend here. They are more likely to be poor, in poverty, on welfare and generally less financially stable after a divorce even if they have 1/2 of your hard earned stuff.

Second your view of marriage is like a business contract at best and prostitution at worst. You give the woman money and she performs certain deeds for you.

Finally, you undervalue the services she provides. It is wrong to say your wife does not work. The correct statement is she does not work outside the home. They cook, clean, do laundry, shop and are the primary care givers for your offspring. Try to factor in the cost of providing these services on a 24/7 basis and you will see you are getting off cheap. Now add in the value of having another human being to share your life with and have an emotional connection to and you are really getting off cheap. Now factor in the fact that most women are not stay at home moms but also work and many of those work full time. In those situations, they provide more of the housework than the men even though they also work outside the home.

If you try to take the scared (skipping the religious part for a second) out of marriage, it's just a business arrangement and most people will want some kind of golden parachute, so if you treat it that way, you can't be surprised if you have have to buy her out of the contract with 1/2 of your stuff.....

This is from a guy who has been happily married for more than 30 years and my wife does not contribute financially what I contribute to the family. I would not be able to have achieved the success in life and the happiness in life without her. I could not measure what we have in dollars and cents. any attempt to do so devalues what we have in every sense of the word.....

 

[Old Timer]

Talked to a patient today for about 10-15 minutes. He's now in pretty sad shape, around 400lbs, disabled, unemployed, lives with his mom, etc. In the 80s he had a very successful marketing business, all going well until his wife decided to take every last cent of his $400k in the bank and leave him. At that point he became depressed and went into a tailspin.

Moral of the story: don't get married, and if you do, at least don't have a joint bank accounts/financial access.

Moral of the story DON'T MARRY A CROOK. Also, for every story you can tell like this I can tell you one of the other side where the man in rolling in money and hides it in cash or other people's names to avoid taking care of his children and wife.

You are a pharmacist and you are using ANECDOTAL EVIDENCE.

Why don't you spend some time with Google and see how women fare after divorce.