Weird Interaction with Pharmacist

[Anonymous6547]

Hello, everyone! I'm a medical student and a long-time SDN user, but I wanted to make sure these questions were anonymous.

I've used Prozac for several years (10 mg usually), and it's mailed to me every few months. Recently, the medication was reportedly delivered, but I never received it. No problem, I had an upcoming appointment with my physician, and she was happy to write another prescription so that I could pick it up instead of having it mailed. The dose was also changed to 20 mg.

However, when I went to pick it up, the pharmacist refused to fill the prescription, because "you already received this medication," and "we have to figure out what happened to the mailed medication first." I left and went back the next day when a different pharmacist was working, and he had no issues with it and filled the new prescription.

I, admittedly, don't have a good understanding of what things look like from the pharmacist's perspective, and I can see myself running into this issue when I'm a provider. So, here are my questions:

1. What was the thought process of the first pharmacist? Was she concerned that I was abusing the medication? I've not yet heard of someone abusing Prozac (especially at such a low dose), but that's not to say that it never happens.

2. When I'm a provider, how can I protect my patients from these sorts of interactions? Do I call the pharmacy and speak with the pharmacist directly? Do I keep track of which pharmacies do this sort of thing and try to send prescriptions elsewhere?

Thank you for any responses!

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[APN-59 rph]

You ran into some nit-noid..possible perfectionist.....likely newbee..who may enjoy a little power trip action...Actually..over the last few years the pharmacist trade tried to change so that you got your meds from the same person...like having your favorite doctor....It never worked out...Sooo you could try and stick with the guy who helped out..

 

[owlegrad]

I don't even know how the pharmacist knew you had a different prescription mailed to you.

 

[rxkrafted]

Yeah im guessing its a new pharmacist and ran into an insurance claim problem or probably too cautious about everything to protect brand new license. The one that was able to help you out was probably familiar with things like this and was able to override as it was a dose increase.

 

[Sine Cura]

OP,

Did you actually ask the pharmacist "what the F is your Fing problem" in a nicer manner of course.

 

[quickpic007]

Hello, everyone! I'm a medical student and a long-time SDN user, but I wanted to make sure these questions were anonymous.

I've used Prozac for several years (10 mg usually), and it's mailed to me every few months. Recently, the medication was reportedly delivered, but I never received it. No problem, I had an upcoming appointment with my physician, and she was happy to write another prescription so that I could pick it up instead of having it mailed. The dose was also changed to 20 mg.

However, when I went to pick it up, the pharmacist refused to fill the prescription, because "you already received this medication," and "we have to figure out what happened to the mailed medication first." I left and went back the next day when a different pharmacist was working, and he had no issues with it and filled the new prescription.

I, admittedly, don't have a good understanding of what things look like from the pharmacist's perspective, and I can see myself running into this issue when I'm a provider. So, here are my questions:

1. What was the thought process of the first pharmacist? Was she concerned that I was abusing the medication? I've not yet heard of someone abusing Prozac (especially at such a low dose), but that's not to say that it never happens.

2. When I'm a provider, how can I protect my patients from these sorts of interactions? Do I call the pharmacy and speak with the pharmacist directly? Do I keep track of which pharmacies do this sort of thing and try to send prescriptions elsewhere?

Thank you for any responses!

1. Liability exists for the rph filling ANY RX. Early refilling of any rx poses liability, even greater for psychotropics. The insurance probably kicked back with refill too soon on this medicine and would require dose change override. The rph should have filled it for you though due to dose change and your claim that the mail order rx was lost. Abuse of anxiety RX is rampant, but not really 10 mg prozac.

2. I wouldn't bother if I was a doc. The patient can figure out where to get better service. Just avoid busy CVS, Walgreens in general

 

[ranger99rx]

The pharmacist probably got a duplication therapy from insurance stating when it was last fill. After speaking to the patient about mail order problem, I would document it and override for new dose change though. I had a patient that came to us a few months back that tried to OD all his psychiatric meds that he got from another pharmacy so MD just sent in 2 weeks at a time now. Best if MD includes note “new dose” to avoid delay in patient care.

 

[WorthlessOxygen]

I don't even know how the pharmacist knew you had a different prescription mailed to you.

It's prretty common to get insurance rejections saying something to the effect of "rx filled (date) via mail next fill (date)"

 

[Dr Wario]

You ran into some nit-noid..possible perfectionist.....likely newbee..who may enjoy a little power trip action...Actually..over the last few years the pharmacist trade tried to change so that you got your meds from the same person...like having your favorite doctor....It never worked out...Sooo you could try and stick with the guy who helped out..

Where is Pac-man when you need him?

 

[owlegrad]

It's prretty common to get insurance rejections saying something to the effect of "rx filled (date) via mail next fill (date)"

I’m probably rusty from being out of the game but I don’t remember seeing that for different strengths of the same medication.

 

[Sine Cura]

This one you'd get a ID DUR reject most likely

 

[RxPreceptor]

Somewhat strange...maybe NOOBIE/rushed for time...I'd usually ask follow up questions...too soon until XX/YY, did you do a mail order? Do you have enough on hand currently? Did you check your mail/double check @ home? Use override codes if needed

 

[zelman]

Everyone else has covered this pretty well. Just wanted to chime in to ask if it was Caremark mail order and a local CVS as the two filling pharmacies. They can actually see each other’s fill histories.

 

[Anonymous6547]

Thanks for the replies everyone! It sounds like this was just a very rare/unlikely scenario.

Everyone else has covered this pretty well. Just wanted to chime in to ask if it was Caremark mail order and a local CVS as the two filling pharmacies. They can actually see each other’s fill histories.

The two pharmacies were postal prescription services and Walgreens.

I’m probably rusty from being out of the game but I don’t remember seeing that for different strengths of the same medication.

I also made the mistake of telling her about the situation while she was giving me a flu shot! She said, skeptical to an almost comical extent, "medication doesn't just disappear."

OP,

Did you actually ask the pharmacist "what the F is your Fing problem" in a nicer manner of course.

Get depressed ==> Need Prozac ==> Interact with pharmacist ==> Get more depressed ==> Need more Prozac ==> Interact with pharmacist......

 

[radio frequency]

Thanks for the replies everyone! It sounds like this was just a very rare/unlikely scenario.



The two pharmacies were postal prescription services and Walgreens.



I also made the mistake of telling her about the situation while she was giving me a flu shot! She said, skeptical to an almost comical extent, "medication doesn't just disappear."



Get depressed ==> Need Prozac ==> Interact with pharmacist ==> Get more depressed ==> Need more Prozac ==> Interact with pharmacist......

It’s entirely possible you just got a weird pharmacist.

I have met and had doctors before that were comically bad. These people exist in every profession; pharmacy isn’t unique here.

 

[dmd20000]

Like someone mentioned above the first pharmacist tried to fill it and the insurance said refill too soon so it couldn't be filled but the 2nd pharmacist put an override knowing that you needed it and it got filled. We are allowed to override refill too soon prescription due to loss or due to vacation supply and the override doesn't always work.

 

[allantois]

the first guy/gal was a *****. Patients running out of psychotropics is a big concern. I’ve run into an issue with my patients not receiving full 30 day supply for their sleep medication, without pharmacy making any effort to notify the prescriber of the fact

 

[mentos]

That pharmacist is an idiot. Being new is not an excuse. Probably went to a diploma mill. A result of 150 or whatever pharmacy schools lowering their standards to fill as many seats as possible.

Even if insurance rejected for duplicate therapy, he/she should have just put in an override for dose change. Or lost med if the dose was the same, this happens all the time.

I'm annoyed at this pharmacist and I'm not even the one that had to deal with him/her. OP should inform the other pharmacist so they don't keep doing this to other customers.

 

[johnpharm01]

Hello, everyone! I'm a medical student and a long-time SDN user, but I wanted to make sure these questions were anonymous.

I've used Prozac for several years (10 mg usually), and it's mailed to me every few months. Recently, the medication was reportedly delivered, but I never received it. No problem, I had an upcoming appointment with my physician, and she was happy to write another prescription so that I could pick it up instead of having it mailed. The dose was also changed to 20 mg.

However, when I went to pick it up, the pharmacist refused to fill the prescription, because "you already received this medication," and "we have to figure out what happened to the mailed medication first." I left and went back the next day when a different pharmacist was working, and he had no issues with it and filled the new prescription.

I, admittedly, don't have a good understanding of what things look like from the pharmacist's perspective, and I can see myself running into this issue when I'm a provider. So, here are my questions:

1. What was the thought process of the first pharmacist? Was she concerned that I was abusing the medication? I've not yet heard of someone abusing Prozac (especially at such a low dose), but that's not to say that it never happens.

2. When I'm a provider, how can I protect my patients from these sorts of interactions? Do I call the pharmacy and speak with the pharmacist directly? Do I keep track of which pharmacies do this sort of thing and try to send prescriptions elsewhere?

Thank you for any responses!

Why didn't you ask the first pharmacist,have a conversation?

 

[mentos]

Why didn't you ask the first pharmacist,have a conversation?

The pharmacist was being a bitch and already said he/she would not fill it.

 

[BidingMyTime]

The pharmacist was being a bitch and already said he/she would not fill it.

If you had extenuating information (such as this was a dose increase), and you shared it with the pharmacist, the pharmacist would have been likely to change their mind and fill their prescription. Maybe the pharmacist really hated you and wasn't going to fill the prescription under any circumstances, but more likely, the pharmacist wasn't going to fill the prescription with the limited information they had, and if you had offered new, pertinent information, they would have reconsidered their stance.

 

[mentos]

If you had extenuating information (such as this was a dose increase), and you shared it with the pharmacist, the pharmacist would have been likely to change their mind and fill their prescription. Maybe the pharmacist really hated you and wasn't going to fill the prescription under any circumstances, but more likely, the pharmacist wasn't going to fill the prescription with the limited information they had, and if you had offered new, pertinent information, they would have reconsidered their stance.

I'm not the OP guy.

 

[BidingMyTime]

I'm not the OP guy.

I see that now, you confused me when you answered a question posed to the op. Also, how did you know the pharmacist was a bitch if you weren't there?

 

[mentos]

I see that now, you confused me when you answered a question posed to the op. Also, how did you know the pharmacist was a bitch if you weren't there?

Because OP said, "the pharmacist refused to fill the prescription, because "you already received this medication," and "we have to figure out what happened to the mailed medication first."

Pharmacist made OP go home without his meds for no valid reason. First, it was a dose increase so obviously it's not a duplicate fill. Second, even if it's not a dose increase and a duplicate fill then pharmacist should have put in override for missing med. Most insurance pays for 1-2 missing meds per year, it's routine.