This is why we need provider status

[Lexington2012]

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Pharmacist saves man's life, but insurance won't pay.

 

[croquemonsieur]

lol

 

[owlegrad]

Shocking.

 

[deleted480308]

THe patient owes the money, it should be their fight with the insurance company

 

[owlegrad]

THe patient owes the money, it should be their fight with the insurance company

Interesting thought. Does the patient owe the money? Legally I mean, not morally or ethically. Did the patient agree to a price before getting the life saving Epipen shot? The article says this:

“He came in, he had trouble breathing, his lips were swelled, he was screaming,” Fornataro said. “I grabbed an EpiPen off the shelf, opened it up to get it out of its little container, pulled the plunger off the end to load it. I handed it to Dan. He pulled his shirt up and gave himself a shot in the abdomen.”

So I don't know if the patient is obligated to pay. He didn't agree to pay before service was rendered.

 

[deleted480308]

Interesting thought. Does the patient owe the money? Legally I mean, not morally or ethically. Did the patient agree to a price before getting the life saving Epipen shot? The article says this:

“He came in, he had trouble breathing, his lips were swelled, he was screaming,” Fornataro said. “I grabbed an EpiPen off the shelf, opened it up to get it out of its little container, pulled the plunger off the end to load it. I handed it to Dan. He pulled his shirt up and gave himself a shot in the abdomen.”

So I don't know if the patient is obligated to pay. He didn't agree to pay before service was rendered.

Presenting yourself in a place of business in search of a service/product, then willingly taking the product and using it? Yeah, if I was on that jury he would owe the money

 

[CetiAlphaFive]

Ok, I'm calling horse **** on this story.

"Hurrrr it didn't work because it was expired"

I bet this ******* ***** injected himself in the gut and then went about his day thinking the Epi-Pen cured his a aphylaxis forever.
The timeline just doesn't make sense.

THe patient owes the money, it should be their fight with the insurance company

Why?
It's two consenting adults that are attempting to complete a transaction.


Sarcasm aside, here is what is going through an independent pharmacist's mind in this situation:

"I can give this dude a pen that cost the pharmacy $500, or i can watch this dude die and deal with a lawsuit from his idiot family."

Last week, I pretty much threw a ProAir at some idiot screeching at me because their doctor hadn't approved refills.

**** getting sued over $40

 

[josh6718]

Or this is why Epi-Pens should be available without a prescription like they do in Canada already.

 

[owlegrad]

Or this is why Epi-Pens should be available without a prescription like they do in Canada already.

How would that have helped this situation?

 

[RxPreceptor]

I would personally like a new category of meds that could be obtained with RPh consult (albuterol, epinephrine, possibly corticosteroids, etc. with limitations of course. Similar to birth control in some states). Pharm Professors have spoken about this as a possibility in the future

 

[owlegrad]

I would personally like a new category of meds that could be obtained with RPh consult (albuterol, epinephrine, possibly corticosteroids, etc. with limitations of course. Similar to birth control in some states). Pharm Professors have spoken about this as a possibility in the future

We actually have that in FL. The list is so old that nearly everything on it has gone OTC in the meantime and no one ever took advantage of it when they were RX only.

 

[Dr. Pill]

We actually have that in FL. The list is so old that nearly everything on it has gone OTC in the meantime and no one ever took advantage of it when they were RX only.

When was this available? Always? Do you have any info or links about this, I worked in Florida as a tech for a while before going to school and never was aware of this.

 

[owlegrad]

When was this available? Always? Do you have any info or links about this, I worked in Florida as a tech for a while before going to school and never was aware of this.

I am not surprised; no one knows about it. I will give you the benefit of the doubt and assume you haven't had your FL law class yet. 🙂

It is Statue 465.186 and can be found here: resources

It is very dry and lengthy so I will not repost it here. The list will make very little sense to you because practically everything on it is over-the-counter; when this law was passed that was not the case.

EDIT: Ok in it's current form it mostly just says "any over the counter product" so obviously they have updated it. It used to give specific drug classes like PPI and such. You can ask your law professor for the history of it if you are curious.

 

[josh6718]

I am not surprised; no one knows about it.

What caught me off guard when I started working in FL was all the Amerigroup items. I remember my first weekend at CVS someone coming up to the counter with Cough Drops, Ear Swabs, and Naproxen saying "I want these three but I'll be back tomorrow to pick them up" and having no idea what they were meaning.

 

[Lexington2012]

For those of us in other states, what exactly does this mean?

 

[PharFromNormal]

What caught me off guard when I started working in FL was all the Amerigroup items. I remember my first weekend at CVS someone coming up to the counter with Cough Drops, Ear Swabs, and Naproxen saying "I want these three but I'll be back tomorrow to pick them up" and having no idea what they were meaning.

Wait will provider status let us bill Medicare for putting things on layaway? If so I’m all in and calling my representative now to support the bill!

 

[wagrxm2000]

.

 

[txpharmguy]

For those of us in other states, what exactly does this mean?

64B16-27.220 Medicinal Drugs Which May Be Ordered by Pharmacists.

A Pharmacist may order and dispense from the following formulary, within their professional judgment, subject to the stated conditions.

(1) Oral analgesics for mild to moderate pain. The pharmacist may order these drugs for minor pain and menstrual cramps for patients with no history of peptic ulcer disease. The prescription shall be limited to a six (6) day supply for one treatment. If appropriate, the prescription shall be labeled to be taken with food or milk.

(a) Magnesium salicylate/phenyltoloxamine citrate.

(b) Acetylsalicylic acid (Zero order release, long acting tablets).

(c) Choline salicylate and magnesium salicylate.

(d) Naproxen sodium.

(e) Naproxen.

(f) Ibuprofen.

(2) Urinary analgesics. Phenazopyridine, not exceeding a two (2) day supply. The prescriptions shall be labeled about the tendency to discolor urine. If appropriate, the prescription shall be labeled to be taken after meals.

(3) Otic analgesics. Antipyrine 5.4%, benzocaine 1.4%, glycerin, if clinical signs or symptions of tympanic membrane perforation do not exist. The product shall be labeled for use in the ear only.

(4) Anti-nausea preparations.

(a) Meclizine up to 25 mg., except for a patient currently using a central nervous system (CNS) depressant. The prescription shall be labeled to advise the patient of drowsiness and to caution against concomitant use with alcohol or other depressants.

(b) Scopolamine not exceeding 1.5 mg. per dermal patch. Patient shall be warned to seek appropriate medical attention if eye pain, redness or decreased vision develops.

(5) Antihistamines and decongestants. The following, including their salts, either as a single ingredient product or in combination, including nasal decongestants, may be ordered for a patient above 6 years of age.

(a) Antihistamines. The pharmacist shall warn the patient that an antihistamine should not be used by patients with bronchial asthma or other lower respiratory symptoms, glaucoma, cardiovascular disorders, hypertension, prostate conditions and urinary retention. An antihistamine shall be labeled to advise the patient of drowsiness and caution against the concomitant use with alcohol or other depressants.

1. Diphenhydramine.

2. Carbinoxamine.

3. Pyrilamine.

4. Dexchlorpheniramine.

5. Brompheniramine.

(b) Decongestants. The pharmacist shall not order an oral decongestant for use by a patient with coronary artery disease, angina, hyperthyroidism, diabetes, glaucoma, prostate conditions, hypertension, or a patient currently using a monoamine oxidase inhibitor.

1. Phenylephrine.

2. Azatadine.

(6) Topical antifungal/antibacterials. The pharmacist shall warn the patient that any of the products should not be used near deep or puncture wounds and contact with eyes or mucous membranes should be avoided. Iodochlorhydroxyquin preparations shall be labeled with staining potential.

(a) Iodochlorhydroxyquin with 0.5% Hydrocortisone (not exceeding 20 grams).

(b) Haloprogin 1%.

(c) Clotrimazole topical cream and lotion.

(d) Erythromycin topical.

(7) Topical anti-inflammatory. The pharmacist shall warn the patient that hydrocortisone should not be used on bacterial infections, viral infections, fungal infections, or by patients with impaired circulation. The prescription shall be labeled to advise the patient to avoid contact with eyes, mucous membranes or broken skin. Preparations containing hydrocortisone not exceeding 2.5%.

(8) Otic antifungal/antibacterial. Acetic acid 2% in aluminum acetate solution which shall be labeled for use in ears only.

(9) Keratolytics. Salicylic acid 16.7% and lactic acid 16.7% in flexible collodion, to be applied to warts, except for patients under two (2) years of age, and those with diabetes or impaired circulation. Prescriptions shall be labeled to avoid contact with normal skin, eyes and mucous membranes.

(10) Vitamins with fluoride. (This does not include vitamins with folic acid in excess of 0.9 mg.)

(11) Medicinal drug shampoos containing Lindane. The pharmacist shall:

(a) Limit the order to the treatment of head lice only;

(b) Order no more than four (4) ounces per person; and

(c) Provide the patient with the appropriate instructions and precautions for use.

(12) Ophthalmics. Naphazoline 0.1% ophthalmic solution.

(13) Histamine H2 antagonists. The pharrmacist shall advise the patient to seek medical attention if symptom persist longer than 14 days while using the medication or if stools darken or contain blood.

(a) Cimetidine.

(b) Famotidine.

(c) Ranitidine HC1.

(14) Acne products. Benzoyl Peroxide. The prescription shall be labeled to advise the patient to avoid use on the eye, eyelid, or mucous membranes.

(15) Topical Antiviral.

(a) Acyclovir ointment may be ordered for the treatment of herpes simplex infections of the lips.

(b) Penciclovir.

Specific Authority 465.186(2) FS. Law Implemented 465.186 FS. History–New 5-1-86, Amended 10-7-90, Formerly 21S-18.003, Amended 7-30-91, Formerly 21S-27.220, 61F10-27.220, Amended 3-12-97, Formerly 59X-27.220, Amended 6-15-98, 11-30-99, 11-18-07

 

[owlegrad]

64B16-27.220 Medicinal Drugs Which May Be Ordered by Pharmacists.

That's what I was looking for! Thanks.

 

[txpharmguy]

64B16-27.220 Medicinal Drugs Which May Be Ordered by Pharmacists.

A Pharmacist may order and dispense from the following formulary, within their professional judgment, subject to the stated conditions.

(1) Oral analgesics for mild to moderate pain. The pharmacist may order these drugs for minor pain and menstrual cramps for patients with no history of peptic ulcer disease. The prescription shall be limited to a six (6) day supply for one treatment. If appropriate, the prescription shall be labeled to be taken with food or milk.

(a) Magnesium salicylate/phenyltoloxamine citrate.

(b) Acetylsalicylic acid (Zero order release, long acting tablets).

(c) Choline salicylate and magnesium salicylate.

(d) Naproxen sodium.

(e) Naproxen.

(f) Ibuprofen.

(2) Urinary analgesics. Phenazopyridine, not exceeding a two (2) day supply. The prescriptions shall be labeled about the tendency to discolor urine. If appropriate, the prescription shall be labeled to be taken after meals.

(3) Otic analgesics. Antipyrine 5.4%, benzocaine 1.4%, glycerin, if clinical signs or symptions of tympanic membrane perforation do not exist. The product shall be labeled for use in the ear only.

(4) Anti-nausea preparations.

(a) Meclizine up to 25 mg., except for a patient currently using a central nervous system (CNS) depressant. The prescription shall be labeled to advise the patient of drowsiness and to caution against concomitant use with alcohol or other depressants.

(b) Scopolamine not exceeding 1.5 mg. per dermal patch. Patient shall be warned to seek appropriate medical attention if eye pain, redness or decreased vision develops.

(5) Antihistamines and decongestants. The following, including their salts, either as a single ingredient product or in combination, including nasal decongestants, may be ordered for a patient above 6 years of age.

(a) Antihistamines. The pharmacist shall warn the patient that an antihistamine should not be used by patients with bronchial asthma or other lower respiratory symptoms, glaucoma, cardiovascular disorders, hypertension, prostate conditions and urinary retention. An antihistamine shall be labeled to advise the patient of drowsiness and caution against the concomitant use with alcohol or other depressants.

1. Diphenhydramine.

2. Carbinoxamine.

3. Pyrilamine.

4. Dexchlorpheniramine.

5. Brompheniramine.

(b) Decongestants. The pharmacist shall not order an oral decongestant for use by a patient with coronary artery disease, angina, hyperthyroidism, diabetes, glaucoma, prostate conditions, hypertension, or a patient currently using a monoamine oxidase inhibitor.

1. Phenylephrine.

2. Azatadine.

(6) Topical antifungal/antibacterials. The pharmacist shall warn the patient that any of the products should not be used near deep or puncture wounds and contact with eyes or mucous membranes should be avoided. Iodochlorhydroxyquin preparations shall be labeled with staining potential.

(a) Iodochlorhydroxyquin with 0.5% Hydrocortisone (not exceeding 20 grams).

(b) Haloprogin 1%.

(c) Clotrimazole topical cream and lotion.

(d) Erythromycin topical.

(7) Topical anti-inflammatory. The pharmacist shall warn the patient that hydrocortisone should not be used on bacterial infections, viral infections, fungal infections, or by patients with impaired circulation. The prescription shall be labeled to advise the patient to avoid contact with eyes, mucous membranes or broken skin. Preparations containing hydrocortisone not exceeding 2.5%.

(8) Otic antifungal/antibacterial. Acetic acid 2% in aluminum acetate solution which shall be labeled for use in ears only.

(9) Keratolytics. Salicylic acid 16.7% and lactic acid 16.7% in flexible collodion, to be applied to warts, except for patients under two (2) years of age, and those with diabetes or impaired circulation. Prescriptions shall be labeled to avoid contact with normal skin, eyes and mucous membranes.

(10) Vitamins with fluoride. (This does not include vitamins with folic acid in excess of 0.9 mg.)

(11) Medicinal drug shampoos containing Lindane. The pharmacist shall:

(a) Limit the order to the treatment of head lice only;

(b) Order no more than four (4) ounces per person; and

(c) Provide the patient with the appropriate instructions and precautions for use.

(12) Ophthalmics. Naphazoline 0.1% ophthalmic solution.

(13) Histamine H2 antagonists. The pharrmacist shall advise the patient to seek medical attention if symptom persist longer than 14 days while using the medication or if stools darken or contain blood.

(a) Cimetidine.

(b) Famotidine.

(c) Ranitidine HC1.

(14) Acne products. Benzoyl Peroxide. The prescription shall be labeled to advise the patient to avoid use on the eye, eyelid, or mucous membranes.

(15) Topical Antiviral.

(a) Acyclovir ointment may be ordered for the treatment of herpes simplex infections of the lips.

(b) Penciclovir.

Specific Authority 465.186(2) FS. Law Implemented 465.186 FS. History–New 5-1-86, Amended 10-7-90, Formerly 21S-18.003, Amended 7-30-91, Formerly 21S-27.220, 61F10-27.220, Amended 3-12-97, Formerly 59X-27.220, Amended 6-15-98, 11-30-99, 11-18-07

That's what I was looking for! Thanks.

Other than perhaps, scopolamine, topical acyclovir, and 2.5% hydrocortisone, it seems pointless. Wonder if pharmacists there charge for this service. (I only interned one summer in Florida many moons ago, so that's why I was aware of it.)

 

[owlegrad]

Other than perhaps, scopolamine, topical acyclovir, and 2.5% hydrocortisone, it seems pointless. Wonder if pharmacists there charge for this service. (I only interned one summer in Florida many moons ago, so that's why I was aware of it.)

I am sure that was the idea when this was developed but you will find swampland in Arizona before you will find a pharmacist who has ever prescribed something off that list.

Also at the risk of being repetitive, it is pointless, but the items were not OTC when the regulation was passed. That's how old and out of date it is. At this point it is just something you learn for the school/MPJE (although I don't think they test on it, or at least I wasn't).

 

[SterlingMaloryArcher]

Can I ask what Dr Sandra Lee (Dr Pimple Popper) was talking about in one of her videos telling a patient of hers that they can just go to the pharmacist to get (I'm pretty sure) tretinoin over the counter? This is in California.

 

[beautifulrobot]

Can I ask what Dr Sandra Lee (Dr Pimple Popper) was talking about in one of her videos telling a patient of hers that they can just go to the pharmacist to get (I'm pretty sure) tretinoin over the counter? This is in California.

Maybe she was referring to adapalene? That went OTC in recent years, but there's no need to talk to the pharmacist to get access to it, AFAIK. Medscape: Medscape Access

 

[josh6718]

For those of us in other states, what exactly does this mean?

Certain patients in Florida that have the Amerigroup insurance plan are able to have various OTC processed by the pharmacy as a prescription (somewhat similar to how flu-shots are processed) to be paid for. CVS stores did this on a regular basis.

The above is NOT the same as the medicinal drugs that pharmacists can order- which I have not seen any CVS pharmacies perform.

 

[steveysmith54]

Things that come to mind.

1. WHAAAAAT expired epipen don't work? Who would have thunk it...
2. Idiot customer aware of his allergy, doesn't bother to get a NON expired epipen handy with him, comes running into the pharmacy hoping epipen is in stock, pharmacist isn't busy, pharmacist will refill(?) the rx in a VERY timely manner. Sorry, but customer isn't that bright or responsible. Maybe quit playing golf and get a job and pay the pharmacist back.

 

[steveysmith54]

Just hope that patients don't read this article and think that they can come into a pharmacy, especially CVS/Walgreens and get crap for free and for emergencies. We ain't NO ER.

I remember i'd get pts come in wanting Nitroglycerin, BP meds that they filled at independents that close at 5pm, or emergency fills for BP meds that were filled 3 yrs ago. Man, i'd despise every single one of these people.

 

[CetiAlphaFive]

Things that come to mind.

1. WHAAAAAT expired epipen don't work? Who would have thunk it...
2. Idiot customer aware of his allergy, doesn't bother to get a NON expired epipen handy with him, comes running into the pharmacy hoping epipen is in stock, pharmacist isn't busy, pharmacist will refill(?) the rx in a VERY timely manner. Sorry, but customer isn't that bright or responsible. Maybe quit playing golf and get a job and pay the pharmacist back.

Epinephrine Concentrations in EpiPens After the Expiration Date | Annals of Internal Medicine | American College of Physicians

 

[DrVader]

Pharmacist saves man's life, but insurance won't pay.

I don't think pharmacist will ever get provider status. Everyone else would fight against it. The general public, Government included has no idea what we do. Pharmacist organization do not lobby aggressively.

 

[josh6718]

How would that have helped this situation?

Instead of being out $600 and fighting with an insurance company for reimbursement, a $80 price-tag is something most (or at least more) individuals would actually be able to afford.

 

[owlegrad]

Instead of being out $600 and fighting with an insurance company for reimbursement, a $80 price-tag is something most (or at least more) individuals would actually be able to afford.

I bet the guy in the article spent more on his golf clubs than he would on an Epipen.

Anyway I don’t think the point of this story is that Epipens are too expensive.

 

[catalyzt]

Epinephrine Concentrations in EpiPens After the Expiration Date | Annals of Internal Medicine | American College of Physicians

Here's some detail from the study that CetiAlphaFive posted (for those that don't have full-text access:

The study found that:

• All EpiPens that had expired up to 29 months prior to analysis (n=19) retained 89% or more of the listed epinephrine (range 89% to 100%)
• EpiPens expiring 35 to 49 months before analysis (n=10) retained 84% to 90% of their potency
• Two EpiPens that had expired 50 months prior to analysis retained 88% and 84% of their epinephrine, respectively
• EpiPen Jrs expiring one to two months before testing retained 92% to 99% of their potency
• Two EpiPen Jrs examined seven months after their expiration date had 88% and 91% of their epinephrine remaining
• Three EpiPen Jrs expiring 30 months prior to testing retained 81%, 82%, and 86% of their epinephrine

 

[W19]

pharmacist with provider status would definitely be better than NP... You guys should fight for that.