What would you do?

[PharmProfit]

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If you are a floater and get a script for norco, xanax, and soma, you see it’s been filled before. Would you fill it? You don’t want to lose a customer but you also don’t want to hurt the patient or get in trouble

 

[CetiAlphaFive]

Would you fill it? You don’t want to lose a customer but

I would surrender my license for even asking such a stupid question

 

[PharmProfit]

Well I’m a new grad Floating so it’s not my store and I’m not familiar with the customers. The patient had multiple other non controlled prescriptions and it looks like the pharmacy filled that several times before for him. So there’s no chance whatsoever you’d fill that?

 

[PharmProfit]

I would surrender my license for even asking such a stupid question

The reason I am asking is to double check and cover my bases as a new grad. Is it wrong to ask these days

 

[CetiAlphaFive]

The reason I am asking is to double check and cover my bases as a new grad. Is it wrong to ask these days

Here's what you should do:

Fax MD.

Write,

"This combination is never appropriate.
Soma metabolizes into meprobamate, which kills people when given with a benzo and opioid.
Again, please note that we are notifying you that we won't fill it, not asking permission.
Yes, we're sure you've done it before. Yes, we know we're the only Pharmacy that gives you trouble."

 

[PharmProfit]

Here's what you should do:

Fax MD.

Write,

"This combination is never appropriate.
Soma metabolizes into meprobamate, which kills people when given with a benzo and opioid.
Again, please note that we are notifying you that we won't fill it, not asking permission.
Yes, we're sure you've done it before. Yes, we know we're the only Pharmacy that gives you trouble."

Thank you

 

[CetiAlphaFive]

Thank you

It takes practice learning to deal with the MDs who call to throw a fit, but you'll learn to do it after a while.

 

[PharmProfit]

It takes practice learning to deal with the MDs who call to throw a fit, but you'll learn to do it after a while.

Why do you think doctors write such scripts? Could it be because they’re old school and just not up to date- ofcourse thinking of a pill mill also comes to mind

 

[CetiAlphaFive]

Thank you

I also usually tell them "you know, meprobamate is what killed Bruce Lee, and carisoprodol was pulled off of the market in Europe already" if they get mouthy

 

[CetiAlphaFive]

Why do you think doctors write such scripts? Could it be because they’re old school and just not up to date- ofcourse thinking of a pill mill also comes to mind

For the most part, the doctors we encounter in the community setting are ****ing *****s.

 

[zelman]

If you are a floater and get a script for norco, xanax, and soma, you see it’s been filled before. Would you fill it? You don’t want to lose a customer but you also don’t want to hurt the patient or get in trouble

Not unless I see excessive documentation or speak to the doctor myself.

 

[BigBoss]

"We're out of stock."

 

[SELDANE]

Honestly, there's no reason to even call the provider. Just simply tell the patient that you won't fill that combination of medications.

 

[npage148]

It's a lot like drunk driving. They've been told not to to it and it's dangerous yet they do it because they've always gotten away with it. More than likely no one will get hurt but when they do heads roll

 

[Sine Cura]

I try to root out every holy trinity especially those that are split up among pharmacies (and why is the pt doing this?) For example this can occur with psych doctors and pain management not knowing what the other is doing... but all three from the same practice.... **** that ****. Yeah these patients get pissed but so what. This is for the most part an easy call

No reputable pain management practice issues holy trinities with a plethora of other non-BZD muscle relaxants commercially available so why would you accept it from some dumb-**** NP. I swear some of these *****s will spend more time doing a PA for prometh w/ codeine (and the PA actually got approved) when the patient is already on Norco than taking care of patients with real problems.

I'll tell you this. In my brief career not a single patient on a holy trinity has been anything but trouble. Histrionics, crying etc... oh you will take your business somewhere else? kthxbye

Now back to the question of being a floater. Well at the end of the day it's your license so your call. No PIC should be bending over backwards for these kinds of pt unless there's a REALLY good reason (99.9% of the time no)

 

[CetiAlphaFive]

It's a lot like drunk driving. They've been told not to to it and it's dangerous yet they do it because they've always gotten away with it. More than likely no one will get hurt but when they do heads roll

This is a perfect example of abberant MD behavior in the community setting.

Whenever I hear, "I've always done that/I've never had a problem before/ I've been a doctor for X years!" I usually ask if they think that's enough evidence to save our licenses before the board or in front of a lawsuit

I try to root out every holy trinity especially those that are split up among pharmacies (and why is the pt doing this?) For example this can occur with psych doctors and pain management not knowing what the other is doing... but all three from the same practice.... **** that ****. Yeah these patients get pissed but so what. This is for the most part an easy call

No reputable pain management practice issues holy trinities with a plethora of other non-BZD muscle relaxants commercially available so why would you accept it from some dumb-**** NP. I swear some of these *****s will spend more time doing a PA for prometh w/ codeine (and the PA actually got approved) when the patient is already on Norco than taking care of patients with real problems.

I'll tell you this. In my brief career not a single patient on a holy trinity has been anything but trouble. Histrionics, crying etc... oh you will take your business somewhere else? kthxbye

Now back to the question of being a floater. Well at the end of the day it's your license so your call. No PIC should be bending over backwards for these kinds of pt unless there's a REALLY good reason (99.9% of the time no)

Sweet Jesus.

Some days my jaw gets tired after explaining to MD after MD that the codeine in promethazine with codeine doesn't do anything special that the 10mg of hydrocodone doesn't do.
"No, but I wrote the Norco for pain. The phenergan with codeine is for cough.
What do you mean the hydrocodone is also a cough suppressant? It's a pain medicine."
The sheer lack of critical thinking makes my head spin.

 

[CetiAlphaFive]

Wrong thread, lol

 

[6GodPharm]

This isn’t a ABC show. Fill it or move the f*ck on.

 

[CetiAlphaFive]

This isn’t a ABC show. Fill it or move the f*ck on.

Translation:

"I graduated with a 2.0 so I don't know what meprobamate is, so I'm gonna make it seem like I'm pragmatic instead of incompetent"

 

[Apotheker2015]

The reason I am asking is to double check and cover my bases as a new grad. Is it wrong to ask these days

If you do not think a regimen is appropriate, that's where it ends. It's your license. Document why you are not filling. You will not get in trouble for exercising your judgment unless you're mean and berate the patient, etc. Keep it short, cool and done.
If I am not going to fill a script, there is no point in wasting time calling the prescriber. I do fax the prescriber letting them know the combo is not appropriate.. Do they call back to tell me to PROCEED AS ORDERED? Sure, but I have not once budged. Proceed as ordered? What's that? Is the prescriber writing the check for my monthly student loan payment? Nope.
You're the last checkpoint for a reason. Enforce it. Be comfortable with that fact. If you are wrong, then the patient can just go somewhere else. This is 2017. We're in the information era. That patient could get whatever is medically necessary from anywhere.
If you fill that script, that patient will pull out his/her phone and tweet the rest of the beehive letting them know there is a newbie at X location.
Look up what your company wants you to say when declining to fill scripts and say just that. Read it to them if you have to. Saying you're out of stock sends the wrong message. Grow a spine and say no.

 

[PharmD.girl]

Unfortunately, this combo is extremely common. I worked in retail for 9 years up until about 4 years ago. An older (family medicine) physician down the street prescribed all of his Medicaid patients the same 3 meds: Norco 10/325mg #150, Soma #120 and Xanax 1mg #90. (Just so you know, I am not singling out Medicaid in any way at all. He happened to contract with many Medicaid plans that other doctors in the area were not. That population is younger and most are not on meds for HTN, DM, etc.) It makes no sense that he happens to find a need to prescribe (yes, he is still in practice) the exact same 3 meds, of the same strength with the same sig to all of his patients. I hope he has changed his prescribing habits. We also had another doctor on the same street that had a cash-only pill mill where every patient was prescribed high doses of oxy (luckily he lost his license after many complaints to the board, mostly from family members of his patients).
I do have a recommendation for new pharmacists. It is very difficult for someone like me who is very empathetic to refuse someone in distress. It took me a couple of years to gain a backbone and firmly deny certain RX's despite their sob stories. I worked in a local grocery store pharmacy that had a more independent feel. Make decisions as soon as possible on how you are going to handle certain situations. For example, I decided that I would only fill controlled substances 3 days early on a 30 day supply. I felt so much better and more confident once I decided how to approach situations. You know what? The patients didn't stop filling at my pharmacy and most of them did not scream and yell. For some reason I was afraid of putting my foot down earlier, but I wish I would have.
I am so glad that we are moving in such a positive direction i.e. opioid crisis awareness, insurers limiting what and how much is prescribed, more pharmacists refusing to fill high doses and combinations of meds, state controlled substance reports (I loved this one because I had hard evidence to refuse to fill an Rx), new recommendations for maximum daily morphine equivalent doses and regulatory agencies cracking down on over-prescribers and pill mills.

 

[Apotheker2015]

Unfortunately, this combo is extremely common. I worked in retail for 9 years up until about 4 years ago. An older (family medicine) physician down the street prescribed all of his Medicaid patients the same 3 meds: Norco 10/325mg #150, Soma #120 and Xanax 1mg #90. (Just so you know, I am not singling out Medicaid in any way at all. He happened to contract with many Medicaid plans that other doctors in the area were not. That population is younger and most are not on meds for HTN, DM, etc.) It makes no sense that he happens to find a need to prescribe (yes, he is still in practice) the exact same 3 meds, of the same strength with the same sig to all of his patients. I hope he has changed his prescribing habits. We also had another doctor on the same street that had a cash-only pill mill where every patient was prescribed high doses of oxy (luckily he lost his license after many complaints to the board, mostly from family members of his patients).
I do have a recommendation for new pharmacists. It is very difficult for someone like me who is very empathetic to refuse someone in distress. It took me a couple of years to gain a backbone and firmly deny certain RX's despite their sob stories. I worked in a local grocery store pharmacy that had a more independent feel. Make decisions as soon as possible on how you are going to handle certain situations. For example, I decided that I would only fill controlled substances 3 days early on a 30 day supply. I felt so much better and more confident once I decided how to approach situations. You know what? The patients didn't stop filling at my pharmacy and most of them did not scream and yell. For some reason I was afraid of putting my foot down earlier, but I wish I would have.
I am so glad that we are moving in such a positive direction i.e. opioid crisis awareness, insurers limiting what and how much is prescribed, more pharmacists refusing to fill high doses and combinations of meds, state controlled substance reports (I loved this one because I had hard evidence to refuse to fill an Rx), new recommendations for maximum daily morphine equivalent doses and regulatory agencies cracking down on over-prescribers and pill mills.

I do 3 days early, too and up to 5 fills. I figure you must have an extra 15 day supply. Some don’t like it but the ones who are taking their medication as prescribed have no issue with it.