The Holy Trinity

[aznkukuboi]

My corporation has told us not to fill the holy trinity of oxycodone, xanax, and soma.

I was told by my district manager that the there is no medical reasoning to prescribe all three at once by the FDA. Some of my local stores have faxed the MD's offices saying they will not fill this combination. Just last week an office asked for this proof. I went digging on both FDA and DEA website and have found nothing.

Just asking for some help from you guys. Is my company just trying to be safe?
Some pharmacists have gone to refuse a "soft" trinity. Meaning instead of oxycodone, it'll be vicodin or norco or any hydrocodone combination.

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[WVUPharm2007]

I was told by my district manager that the there is no medical reasoning to prescribe all three at once by the FDA.

Your district manager is an idiot. If a patient has chronic or severe acute pain, muscle pain, and anxiety it is certainly indicated and would be prescribed legally. This doesn't mean those three aren't abused and shouldn't be dispensed with caution, however. You have to use your own judgement as to whether or not it is prescribed for a legitimate medical purpose and within the usual course of the prescriber's practice. But such blanket statements are pretty irresponsible.

 

[BenJammin]

DEA: The biggest barrier to patient treatment since 1973.

 

[mursepharmd]

i think he's gonna quickly change his mind when the script numbers for his district decreases which would severely affect his bonus

 

[Aznfarmerboi]

i think he's gonna quickly change his mind when the script numbers for his district decreases which would severely affect his bonus

For CVS, C2S and controls do not count toward script budget... I do not know where he works for though.

While scripts is a significant percentage of a bonus, it is not that much. Script budget probably accounts for about 15 percent of a pharmacy supervisor's and 7 percent of DM's bonus. This translates to about 3.5k cash. After tax, 2k. Not something for them to go crazy about.... On the other hand, if their store gets killed with a heavy fine, they might lose their job. Something to go crazy about.

 

[Dr Wario]

For CVS, C2S and controls do not count toward script budget... I do not know where he works for though.

While scripts is a significant percentage of a bonus, it is not that much. Script budget probably accounts for about 15 percent of a pharmacy supervisor's and 7 percent of DM's bonus. This translates to about 3.5k cash. After tax, 2k. Not something for them to go crazy about.... On the other hand, if their store gets killed with a heavy fine, they might lose their job. Something to go crazy about.

Um...how does your district calculate bonuses...? In mine, even for store level rphs scripts to budget account for about 60% of the bonus. For the past two years, I have received approx 7k bonus because we were greater than 10% over budget, for sups and DM's that portion of their bonus can have a much greater financial impact.

 

[wucool33]

It's not just his district... Mine too. I know Costco and rite aid in my region won't fill that script anymore... Not sure about cvs or Walgreens. The docs just cancel one of the med around here.

 

[Ackj]

For CVS, C2S and controls do not count toward script budget

So what if you're in a control-heavy store? You're busting your ass with no numbers to show for it?

 

[owlegrad]

So what if you're in a control-heavy store? You're busting your ass with no numbers to show for it?

Correct. CVS gives you NO incentive to fill controls. Which is good, IMO. Sure it means a lot of work for "nothing" but at least you are not pressured to fill stretchy drugs to make a bonus or "numbers". I thought that would be standard but maybe not?

 

[Aznfarmerboi]

Um...how does your district calculate bonuses...? In mine, even for store level rphs scripts to budget account for about 60% of the bonus. For the past two years, I have received approx 7k bonus because we were greater than 10% over budget, for sups and DM's that portion of their bonus can have a much greater financial impact.

Not my bonus... I am talking to poster about DM and Pharmacy supervisors. Their bonus is equal to 20-30 percent of their salary.

Like us, their bonus takes into account for many things besides sales , including customer service, key performance metrics, payroll budgets, new store approvals, etc. I was trying to inform poster that controls/narcotic prescriptions does not impact bonus, and if it does..., less so than he thinks. For DM, it matters even less since he is responsible for overall front and pharmacy sales.



Also, did you see next year's bonus structure? It is a lot higher..., and it focuses less on script count. It is based on SOS... and scripts is 20 percent of SOS. if you get 5s on all of the other metrics, you can still get a good bonus

If that bonus structure was in place right now, I would be getting 14 percent of my salary or 20k!

 

[Aznfarmerboi]

So what if you're in a control-heavy store? You're busting your ass with no numbers to show for it?

I was in a couple of control heavy stores. I filled according to my professional judgment. Corporate never gave me any problems about it.

Recently, a kid said he was short 17 pills from a controlled prescription, raised a fuss, and threatened me. I didn't take any of it. He called corporate. The customer service guy told him to take it up with me and there was nothing that he or they can do.

Another complaint a few months ago was from a customer who was filling her percs early constantly. I refused it so she called corporate. My supervisor told her to take her business somewhere else.

 

[zelman]

Dr. C.M. Schade, a former president of the Texas Pain Society, said he knows of no legitimate medical reason for a doctor to prescribe all three together.
"It's a red flag that can be seen across the country," he told the newspaper.
The three drugs include: hydrocodone, a narcotic known by brand names such as Vicodin; alprazolam, an anti-anxiety drug known as Xanax; and carisoprodol, a muscle relaxant known as Soma.

I think this was what your supervisor was misquoting

http://www.dallasnews.com/news/state/headlines/20100601-Houston-area-tops-Texas-in-prescriptions-1341.ece

 

[farmadiazepine]

Not my bonus... I am talking to poster about DM and Pharmacy supervisors. Their bonus is equal to 20-30 percent of their salary.

Like us, their bonus takes into account for many things besides sales , including customer service, key performance metrics, payroll budgets, new store approvals, etc. I was trying to inform poster that controls/narcotic prescriptions does not impact bonus, and if it does..., less so than he thinks. For DM, it matters even less since he is responsible for overall front and pharmacy sales.



Also, did you see next year's bonus structure? It is a lot higher..., and it focuses less on script count. It is based on SOS... and scripts is 20 percent of SOS. if you get 5s on all of the other metrics, you can still get a good bonus

If that bonus structure was in place right now, I would be getting 14 percent of my salary or 20k!

The MAX that I can get in my yearly bonus is $2,500 as an RPh for CVS. This, after taxes, becomes about an extra $1,250 in my pocket.

There is absolutely no reason I work hard at all for CVS. There is zero reason for me to bust my butt or even barely move my butt to make the metrics good. For a shi*** bonus like that, I don't care. I don't understand why so many RPh's working for CVS go head over heels crazy to meet these metrics. For what reason? To make an extra $1,000 in cash?

Just picking up an extra day a month at CVS or an independent, you can have an additional $10,000 on top of your salary. That's a lot easier than writing SOS plans, KPM, SSS, or whatever it is CVS tracks anymore (sorry I honestly don't know as an employee).

 

[zelman]

The MAX that I can get in my yearly bonus is $2,500 as an RPh for CVS. This, after taxes, becomes about an extra $1,250 in my pocket.

There is absolutely no reason I work hard at all for CVS. There is zero reason for me to bust my butt or even barely move my butt to make the metrics good. For a shi*** bonus like that, I don't care. I don't understand why so many RPh's working for CVS go head over heels crazy to meet these metrics. For what reason? To make an extra $1,000 in cash?

Just picking up an extra day a month at CVS or an independent, you can have an additional $10,000 on top of your salary. That's a lot easier than writing SOS plans, KPM, SSS, or whatever it is CVS tracks anymore (sorry I honestly don't know as an employee).

It's not the bonus. It's avoiding harassment from above.

 

[farmadiazepine]

It's not the bonus. It's avoiding harassment from above.

You can take the harassment as much as you want. You pretend like you heard it, then management stops bothering you, then you shrug it off.

I know a PIC who is in charge of a shi*** store. he or she has been there for years and years and years. They keep telling their rx sup they want out, but the sup says, no i have no one else but you. no matter how shi*** his metrics become, they are not going to get rid of this person. True story. It must've been like 5 years or more now. That's what cvs does.

 

[Aznfarmerboi]

Just picking up an extra day a month at CVS or an independent, you can have an additional $10,000 on top of your salary. That's a lot easier than writing SOS plans, KPM, SSS, or whatever it is CVS tracks anymore (sorry I honestly don't know as an employee).

LOL! Lets just make it simple... CVS tracks everything.

I do it because I like things done my way. If it is reasonable..., I will do it. If they give me something ******ed like wanting me to do a million flu shots, I will shrug it off.

 

[boriqua]

Your district manager is an idiot. QUOTE]

lol

 

[knight on horse]

oxy and soma together are flagged at my chain

 

[sosoo]

we finally have an official legal reason not to dispense the Holy Trinity. from the Washington Post... The question is why was the pharmacist not charged for the crime, or license revoked?

A doctor prescribed so many painkillers, she’s been charged with murdering her patients, authorities say
....

 

[Lnsean]

My corporation has told us not to fill the holy trinity of oxycodone, xanax, and soma.

I was told by my district manager that the there is no medical reasoning to prescribe all three at once by the FDA. Some of my local stores have faxed the MD's offices saying they will not fill this combination. Just last week an office asked for this proof. I went digging on both FDA and DEA website and have found nothing.

Just asking for some help from you guys. Is my company just trying to be safe?
Some pharmacists have gone to refuse a "soft" trinity. Meaning instead of oxycodone, it'll be vicodin or norco or any hydrocodone combination.

I haven't dispensed soma in like a year. I probably got like 1-2 scripts the last 6 months.