What's up with new pharmacy rules on non-narcotic scripts?

[Socrates25]

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Multiple pharmacies have come out stating that they can't accept scripts that include designators like "drops" or "spray" and instead have to be converted to "milligrams"

Also they can't accept scripts for designations like "bottle" or "tube" and have to have an exact milligram or gram designation.

So when I write for a prescription steroid cream for eczema, I can't just write "tube" I have to look up how many grams are in each tube. Apparently 4 years of a pharmacy education isn't enough to decide what tube size to use and pharmacists have to be spoon fed the exact gram/mg dose.

BS like this is exactly why the healthcare field is going to hell -- these rules have ZERO improvement on patient care and instead put up stupid roadblocks that don't need to be there.

 

[Sine Cura]

Qty "1 spray" instead of 1 inhaler
Qty "1 drop" instead of 1 bottle
Sig "1 drop" po daily for vitamin drops

Qty "1 tube" when there are varying sizes e.g. 15g, 30g, 60g

Qty "1 bottle" when there are varying sizes like 5 ml, 10ml, 15 ml

You gonna get mad when a pharmacist decides to use the smallest size available "bUt It Is FoR tHe WhOlE bOdy"

A lot of these rules are driven by pbms and fears of clawbacks and false claim act allegations, especially for high-cost medications. If cvs caremark will audit ds on freakin lancets imagine what else they look at

Or you can learn how to write a script and use your software correctly

 

[owlegrad]

Needing the package size is an insurance requirement sadly. It is dumb but it is what it is.

I doubt any pharmacy wants a dose of MLs for drops or sprays. On topicals some insurances do require an amount to apply though. Again annoying but if pharmacies want to be paid we have to play by the payer rules.

 

[Socrates25]

I don't know what tube sizes you have in stock, that's why it's better for me to write "tube" and you can give whatever you have in stock. Otherwise I have to guess what you have, and then when you don't have the tube size I specified, it requires a completely unnecessary delay in processing and playing phone tag for a script that turns into a 30 minute ordeal instead of a simple 10 second judgment call by the pharmacist.

I find it hard to believe that pharmacists and give shots, counsel people on medications, run coumadin clinics and medication management, yet you can't use your judgment to decide what tube size to use.

The number of times that I have called the pharmacist and told them they gave the wrong tube size is ZERO.

 

[projektreverb]

I agree, I think it’s stupid as well. For me “1 tube” or “1 bottle” translates into “give the patient the biggest bottle/tube you have”. You know patient is gonna overuse/apply.

 

[RxPreceptor]

Pretty standard to use the smallest size if given a generic "1 tube" as a quantity...unless MD notes clarify give largest tube, duration of treatment/area of body, etc.

 

[projektreverb]

Pretty standard to use the smallest size if given a generic "1 tube" as a quantity...unless MD notes clarify give largest tube, duration of treatment/area of body, etc.

I’ve seen an argument for both smallest and largest Tube available

 

[RxPreceptor]

I’ve seen an argument for both smallest and largest Tube available

Ok, smallest size being company policy/in training section of triage/accepting prescriptions

 

[PharFromNormal]

The number of times that I have called the pharmacist and told them they gave the wrong tube size is ZERO.

This might hurt.. hope it’s not too harsh but you know what doc... sometimes it’s not always about you.

Us pharmacists don’t like when we get our small amount of reimbursement ripped away when we aren’t playing by the rules that are set by the ones with the gold (insurer).

Could you see how a bad actor might try to exploit reimbursement if they gave a gigantic tube when the patient really only needed 5gm? Generally it’s smallest package available but not all pharmacies stock or may even know off hand that it might come in an even smaller package size so would get constantly lit up on audits.

Also I’m sorry that your prescribing system isn’t smart enough to provide you the package sizes that each of those products come in when you go to prescribe them. That sounds like it would probably be pretty easy.

Also... dailymed is pretty easy to use. If you know there’s going to be a back and forth could you just look it up or even just google it? If you don’t care what size you give the patient... we won’t mind you just picking any size YOU want to prescribe.

 

[Wickett]

Multiple pharmacies have come out stating that they can't accept scripts that include designators like "drops" or "spray" and instead have to be converted to "milligrams"

Also they can't accept scripts for designations like "bottle" or "tube" and have to have an exact milligram or gram designation.

So when I write for a prescription steroid cream for eczema, I can't just write "tube" I have to look up how many grams are in each tube. Apparently 4 years of a pharmacy education isn't enough to decide what tube size to use and pharmacists have to be spoon fed the exact gram/mg dose.

BS like this is exactly why the healthcare field is going to hell -- these rules have ZERO improvement on patient care and instead put up stupid roadblocks that don't need to be there.

My advice is write where on the body it is being applied and duration of treatment for topicals....then it's reasonable to assume we know whether you want a 15g tube or a big tub. For drops and sprays, indicate duration of treatment if they come in multiple sizes.

We get audited constantly by insurance companies, and if a specific amount applied isn't designated on the script, they expect pharmacies to dispense the smallest possible amount or it is considered waste and our money paid out on the claim is all taken back.

Even if it only comes in one size, expensive topicals like eucrisa will get audited and denied payment if specific body area isn't noted in order to have an accurate days supply.

This is just the reality of our insurance based healthcare system. Trust me, we also dont like stopping what we are doing to play phone tag with an annoyed prescriber's staff. Adapt or continue getting calls all the time.

 

[zelman]

Triamcinolone comes in a half ounce tube and a 1 pound jar. When a taxi driver hands me an Rx they’re playing courier for, you think I’m the person best able to decide the appropriate size for the patient to use on an unspecified amount of their body for an unspecified duration? We can always give less than you order. Just put down 1 oz, 100g or 500g and we’ll give them something.

 

[mentos]

If a pharmacist has time to play phone tag over the tube size then their store isn't busy and they should worry about their job security. Ain't nobody got time for that. Pick the smallest tube and they can refill if they need more.

 

[Wickett]

I agree, I think it’s stupid as well. For me “1 tube” or “1 bottle” translates into “give the patient the biggest bottle/tube you have”. You know patient is gonna overuse/apply.

Good luck on an audit.

 

[Rockinacoustic]

I must've missed the lecture on what tube size treats eczema.

 

[projektreverb]

Good luck on an audit.

Just read your post above. You learn something every day.

 

[PharmtoCS]

Welcome to the world of our profession. We're getting steamrolled by the PBMs, corporate bean counters, and regulatory boards that literally don't let us use our four-year doctorate education to figure out the right package size, switch tablets and capsules, substitute Proair with generic albuterol, etc. without getting written up or having reimbursements clawed back.

Most pharmacists don't (and shouldn't) care about these technicalities we have no choice but to CYA.

 

[DASicari]

For e-Prescribing, NCPDP is sunsetting a lot of “generic” dispense units at the end of this year, so they won’t be available to be sent electronically. Tube is one of them.

 

[Sine Cura]

I don't know what tube sizes you have in stock, that's why it's better for me to write "tube" and you can give whatever you have in stock.

Even if you wrote 50 g of TAC for some reason, the vast majority would dispense 45g or less

"high-risk" topicals like Eucrisa might need a little more info to protect against audits like area to apply and estimated grams application per day.

 

[Old Timer]

Multiple pharmacies have come out stating that they can't accept scripts that include designators like "drops" or "spray" and instead have to be converted to "milligrams"

This is *****ic and there is no reason for this. You should order the drug as you see fit in this regard. If the drug is dosed in drops, use drops. If dosed in sprays, use sprays. There is no legal, regulatory or financial reason to order in mg. If however, you are ordering Diclofenac gel. you must have 2 gm or 4 gm.

Also they can't accept scripts for designations like "bottle" or "tube" and have to have an exact milligram or gram designation.

So when I write for a prescription steroid cream for eczema, I can't just write "tube" I have to look up how many grams are in each tube. Apparently 4 years of a pharmacy education isn't enough to decide what tube size to use and pharmacists have to be spoon fed the exact gram/mg dose..

First, legally we don't have the authority. Secondly, from a practical standpoint, we don't know what size they need. Is it a 2 cm leasion on the arm or is the entire torso involved? Finally and most importantly, these claims will not survive on audit. The PBM will either say we used the smaller size to increase dispensing fees or say we gave more than the provider ordered and take back the entire cost of the claim. Which some steroid creams now going for upwards of $200.00, we cannot and should not absorb the risk.

BS like this is exactly why the healthcare field is going to hell -- these rules have ZERO improvement on patient care and instead put up stupid roadblocks that don't need to be there.

I have been a pharmacist for almost 40 years and when I started out doctors knew what package size things came in. They didn't mindlessly let the system spit out nonsensical orders Like Amoxicllin 400 mg/5 ml 193 ml sig 9.653 ml po bid for 10 days. Really? There is some lay person that can accurately measure out 9.653 ml with any precision? They would also know the bottle size is 100ml. They would either make it 9.5 or 10ml based on their professional judgement. So if you are concerned with patient care be knowledgeable about the products you are ordering and order them appropriately.

 

[RxPreceptor]

I envision myself becoming just as angry and bitter as @Old Timer ...give me another 10-20 years, I promise, LMFAO

 

[Old Timer]

I envision myself becoming just as angry and bitter as @Old Timer ...give me another 10-20 years, I promise, LMFAO

What makes you think I'm angry and bitter. Just pointed out the facts

 

[Socrates25]

I never use quantities larger than 50 grams for tubes.

So if I start putting down 50g on all the tubes, what happens when all you have is 30g, or 60g?

Are you going to use your judgment to change it (which you should) or are you going to call me and tell me you dont have 50g in stock and that I have to send over a new script?

 

[RxPreceptor]

What makes you think I'm angry and bitter. Just pointed out the facts

Just joking with you, lighten up a bit...I know, work with plenty of RPhs with similar personalities (always fun hearing the rants)

 

[Old Timer]

I never use quantities larger than 50 grams for tubes.

So if I start putting down 50g on all the tubes, what happens when all you have is 30g, or 60g?

Are you going to use your judgment to change it (which you should) or are you going to call me and tell me you dont have 50g in stock and that I have to send over a new script?

If you order 50 gm, I'm going to give the largest size I can w/o going over 50 gm. But stop being lazy jerk and look at the package insert, get a drug app or look it up in the P.D.R. under How supplied and educate yourself.

If you order 50 gm with no refills and it only comes in 30 gm. they are getting 50 gm and they lose the other 20 gm.

If you order a size that is nonsensical, I"ll call for a clarification and take a verbal. But all of this would go away if you took the time to educate yourself and not put other professionals at finnancial risk or delay your patient's therapy becuase you are lazy.

 

[Socrates25]

This is *****ic and there is no reason for this. You should order the drug as you see fit in this regard. If the drug is dosed in drops, use drops. If dosed in sprays, use sprays. There is no legal, regulatory or financial reason to order in mg. If however, you are ordering Diclofenac gel. you must have 2 gm or 4 gm.

As I suspected it sounds like these pharmacies are full of BS.

 

[Old Timer]

As I suspected it sounds like these pharmacies are full of BS.

In this case, you would be correct. You would have to tell me what drugs they are referencing. Some might be needed to order in mg. Most do not.

 

[Socrates25]

If you order 50 gm, I'm going to give the largest size I can w/o going over 50 gm. But stop being lazy jerk and look at the package insert, get a drug app or look it up in the P.D.R. under How supplied and educate yourself.

If you order 50 gm with no refills and it only comes in 30 gm. they are getting 50 gm and they lose the other 20 gm.

If you order a size that is nonsensical, I"ll call for a clarification and take a verbal. But all of this would go away if you took the time to educate yourself and not put other professionals at finnancial risk or delay your patient's therapy becuase you are lazy.

Doesn't matter if I know how it's supplied it only matters what is in stock.

Here's a typical conversation I have after sending in elidel 1% cream 30g tube:

Pharmacist: We dont have the 30g tube
Me: What do you have?
Pharmacist: 60g
Me: Ok then use that one
Pharmacist: I can't do that without a new script
Me: Seriously, you can't change to a size you have in stock?
Pharmacist: Nope, I don't have the authority to do that.
Me: You are an EXPERT on medications, with a doctoral degree in pharmacy, and you don't have the authority to change the tube size?
Pharmacist: Nope, I need a new script
Me: LOL

 

[WVUPharm2007]

Doesn't matter if I know how it's supplied it only matters what is in stock.

Here's a typical conversation I have after sending in elidel 1% cream 30g tube:

Pharmacist: We dont have the 30g tube
Me: What do you have?
Pharmacist: 60g
Me: Ok then use that one
Pharmacist: I can't do that without a new script
Me: Seriously, you can't change to a size you have in stock?
Pharmacist: Nope, I don't have the authority to do that.
Me: You are an EXPERT on medications, with a doctoral degree in pharmacy, and you don't have the authority to change the tube size?
Pharmacist: Nope, I need a new script
Me: LOL

The insurance company doesn't care. If the rx reads dispense 30g and we only have 60g tubes , technically we need the rx changed. Otherwise, we lose money on audits.

 

[Old Timer]

Doesn't matter if I know how it's supplied it only matters what is in stock.

Here's a typical conversation I have after sending in elidel 1% cream 30g tube:

Pharmacist: We dont have the 30g tube
Me: What do you have?
Pharmacist: 60g
Me: Ok then use that one
Pharmacist: I can't do that without a new script
Me: Seriously, you can't change to a size you have in stock?
Pharmacist: Nope, I don't have the authority to do that.
Me: You are an EXPERT on medications, with a doctoral degree in pharmacy, and you don't have the authority to change the tube size?
Pharmacist: Nope, I need a new script
Me: LOL

First, Elidel is never an emergency. They can order the 30 gm or find another store that has the 30 gm Second, if it has refills, they can give the 60 gm as long as they note it on the rx, thirdly, they can take a verbal order from you for the 60 gm. Absent any of that, they are Jerk offs who should hand in their spatulas and try another profession. making you send a new rx because they have bad inventory control is ludicrous. I have no time for people who don't do their job either doctors or pharmacists.

Remember what I posted earlier. If you write 30gm and no refills, I can't dispense 60 gm. An rx is a legal order. I can as a courtesy to you and our patient take a verbal order and any pharmacist should do that.

 

[Socrates25]

First, Elidel is never an emergency. They can order the 30 gm or find another store that has the 30 gm Second, if it has refills, they can give the 60 gm as long as they note it on the rx, thirdly, they can take a verbal order from you for the 60 gm. Absent any of that, they are Jerk offs who should hand in their spatulas and try another profession. making you send a new rx because they have bad inventory control is ludicrous. I have no time for people who don't do their job either doctors or pharmacists.

Remember what I posted earlier. If you write 30gm and no refills, I can't dispense 60 gm. An rx is a legal order. I can as a courtesy to you and our patient take a verbal order and any pharmacist should do that.

Fair enough. As an aside, I freaking LOVE small town pharmacies. They provide true customer service and don't jerk me off like the big chains do. I will always steer my patients to the mom/pop stores.

I really don't understand how stores like the local CVS down the street stay in business. They have a 1.5 star rating on Google reviews, I know of at least 10 dispensing errors commited there over the last 3-4 years, yet people keep flocking there for ****ty service.

 

[Old Timer]

Fair enough. As an aside, I freaking LOVE small town pharmacies. They provide true customer service and don't jerk me off like the big chains do. I will always steer my patients to the mom/pop stores.

I really don't understand how stores like the local CVS down the street stay in business. They have a 1.5 star rating on Google reviews, I know of at least 10 dispensing errors commited there over the last 3-4 years, yet people keep flocking there for ****ty service.

Well, mom and pop stores have their own issues. I have seen more unethical things happen at independents than chains. But they do as a general rule provide better service. As for why people go to the CVS there are a number of reasons. It's too complicated an issue to gave the discussion here. Goggle ratings and especially involving healthcare are to be taken with a grain of salt. I send a lot of people away mad when i refuse to give them cold medicine for a 2 y/o. They can rate me anyway they want. It's not appropriate and I won't do it. People don't always want to hear the truth. I'm not bashful when a diabetic is buying cheetos with their Metformin. They can't possibly have the knowledge to rate me or you on anything except personality.

 

[RxPreceptor]

Uh huh, so small town/independents cater to half-@$$'ing prescriptions. Probably a reason why there are so few left
Public loves to hate on corporate/chain pharmacies, nothing can ever be good enough (nothing to do with the actual service or employees). Many insurances dictate where a person must fill his/her prescriptions unfortunately

 

[mentos]

This is *****ic and there is no reason for this. You should order the drug as you see fit in this regard. If the drug is dosed in drops, use drops. If dosed in sprays, use sprays. There is no legal, regulatory or financial reason to order in mg. If however, you are ordering Diclofenac gel. you must have 2 gm or 4 gm.



First, legally we don't have the authority. Secondly, from a practical standpoint, we don't know what size they need. Is it a 2 cm leasion on the arm or is the entire torso involved? Finally and most importantly, these claims will not survive on audit. The PBM will either say we used the smaller size to increase dispensing fees or say we gave more than the provider ordered and take back the entire cost of the claim. Which some steroid creams now going for upwards of $200.00, we cannot and should not absorb the risk.


I have been a pharmacist for almost 40 years and when I started out doctors knew what package size things came in. They didn't mindlessly let the system spit out nonsensical orders Like Amoxicllin 400 mg/5 ml 193 ml sig 9.653 ml po bid for 10 days. Really? There is some lay person that can accurately measure out 9.653 ml with any precision? They would also know the bottle size is 100ml. They would either make it 9.5 or 10ml based on their professional judgement. So if you are concerned with patient care be knowledgeable about the products you are ordering and order them appropriately.

To be fair, there were much less drugs available 40 years ago. Way less.

 

[Old Timer]

To be fair, there were much less drugs available 40 years ago. Way less.

There were plenty of drugs 40 years ago. It wasn't the stone age. As many drugs have been d/c'd as have been created. New classes of drugs for sure. But for the most part drugs where you need to know the package size have not changed that much. You don't need to know what size Pavabid comes in nor do you need to know what size Lisinopril comes in. Mostly topicals, Otic's and ophthalmic products

 

[JustFillIt]

If a pharmacist has time to play phone tag over the tube size then their store isn't busy and they should worry about their job security. Ain't nobody got time for that. Pick the smallest tube and they can refill if they need more.

Yea... I never gave it any thought at all. 90% of the time a triamcinolone Rx would say # 1 “aaa”.. there is not indication whatsoever as to how much they would need. I just didn’t care and would give anything that I had...

I was never audited by insurance. I guess if I was concerned with this I would do it for expensive topicals like tacrolimus cream..

To the op - you need to understand that we are dealing with a world of regulations/rules.. on top of this there is the insurance company that prays off of frivolous claims against the pharmacy in order to increase their revenue - they don’t care that it effects us and our livelihood.

 

[JustFillIt]

Fair enough. As an aside, I freaking LOVE small town pharmacies. They provide true customer service and don't jerk me off like the big chains do. I will always steer my patients to the mom/pop stores.

I really don't understand how stores like the local CVS down the street stay in business. They have a 1.5 star rating on Google reviews, I know of at least 10 dispensing errors commited there over the last 3-4 years, yet people keep flocking there for ****ty service.

You completely lack insight on how a pharmacy functions. This is like me believing the countless number of patients that end up standing in front of me saying something along the lines of, “My doctor doesn’t know his A$$ from a home in the ground.” Fortunately for me I know better and never assume that the physician in question providing “****ty service”. I guess the difference here is you do not give the other end the benefit of the doubt...

By the way it is against the law to encourage your patients to go to a specific pharmacy, unless that pharmacy provides a unique service that would effect outcomes (specialty compounding).

 

[PharmacistFl12]

Multiple pharmacies have come out stating that they can't accept scripts that include designators like "drops" or "spray" and instead have to be converted to "milligrams"

Also they can't accept scripts for designations like "bottle" or "tube" and have to have an exact milligram or gram designation.

So when I write for a prescription steroid cream for eczema, I can't just write "tube" I have to look up how many grams are in each tube. Apparently 4 years of a pharmacy education isn't enough to decide what tube size to use and pharmacists have to be spoon fed the exact gram/mg dose.

BS like this is exactly why the healthcare field is going to hell -- these rules have ZERO improvement on patient care and instead put up stupid roadblocks that don't need to be there.

 

[PharmacistFl12]

My pharmacy was audited 6 times this year by Express Script and Caremark for processing a prescription without exact grams and ml on the prescriptions. All because prescriber wrote 1 tube or 1 box. It is due to insurance reason, you as a doctor should try to understand our perspective.

 

[CynicalIntern]

The number of times that I have called the pharmacist and told them they gave the wrong tube size is ZERO.

You may not, but the point of contention certainly exists.


I get at least a dozen prescriptions a day that says "dispense largest tube size paid for by insurance"

The largest tube size paid for by insurance without further documentation is always the smallest available tube size. They will pay for a larger tube size with more documentation.

 

[mentos]

There were plenty of drugs 40 years ago. It wasn't the stone age. As many drugs have been d/c'd as have been created. New classes of drugs for sure. But for the most part drugs where you need to know the package size have not changed that much. You don't need to know what size Pavabid comes in nor do you need to know what size Lisinopril comes in. Mostly topicals, Otic's and ophthalmic products

Nah. My old preceptor became a pharmacist in the 90s and said it was much easier back then. Much easier to remember all of the drugs and what size they came in. There were even less in the 70s.

Do you all call for every script without a tube size? You guys must make 30 calls per day then.

 

[Wickett]

Yea... I never gave it any thought at all. 90% of the time a triamcinolone Rx would say # 1 “aaa”.. there is not indication whatsoever as to how much they would need. I just didn’t care and would give anything that I had...

I was never audited by insurance. I guess if I was concerned with this I would do it for expensive topicals like tacrolimus cream..

To the op - you need to understand that we are dealing with a world of regulations/rules.. on top of this there is the insurance company that prays off of frivolous claims against the pharmacy in order to increase their revenue - they don’t care that it effects us and our livelihood.

Honestly, you probably wont get audited on cheap topicals, because it isn't worth the insurance's time to audit it. I personally dont waste my time getting BSA and exact grams for common, cheap topicals. A general rule I tell the techs is if something is over $75, we should be sure to have everything properly documented to survive a potential audit on it.

Doing it that way, we have gotten by pretty unscathed in the 3 audits we've had the past year. Insurances mainly audit blood thinners, insulins, and anything else brand name that's really expensive. And they will look for ANYTHING to deny a claim....a sister store lost a 6k claim on a med because it was a transfer and they didn't have the address of the transferring pharmacy written down on the transfer pad.

I lost a claim on levemir once because the prescriber put 5 as the quantity without signifying if it was pens or ml (they had days supply typed out for 30 days, where the math added up to clearly wanting 5 pens). Insurance said we should've processed it as quantity 5ml and just dispense one 3ml pen, so we got clawed back on the other 4. It's all a game.

 

[Old Timer]

Nah. My old preceptor became a pharmacist in the 90s and said it was much easier back then. Much easier to remember all of the drugs and what size they came in. There were even less in the 70s.

Do you all call for every script without a tube size? You guys must make 30 calls per day then.

The number of drugs has sky rocketed, The number of drugs this applies to has not. Even if the number of topical drugs doubled, iy would still not be a great deal of information. It was still bad then. Insurance companies were much more intrusive. Now they are data driven. Once got an rx for Cipri 500 mg. When it first came out. Th MD had given the patient samples of the 250 and then followed up with an rx fro 500 mg. They called the MD office, somebody at the office said they gave 250 mg samples and they accused us of fabrication the 500 mg rx.......

I don't call unless I have to. At the chains you are insulated from the prices. Do you know how much Clobetasol is going for these days. It also, does your patient no good to give them a 15 gm tube when they have a large area to cover. Passing the buck to the MD is the same as them passing the buck to us when they write 1 tube.

I'll bet every single solitary pharmacist would call on an rx for Prometh w/codeine disp 1 bottle eventhough the DEA will NEVER check for this and you will never be audited for it. But you would mess with a steroid cream that could cost $300.00

 

[mentos]

The number of drugs has sky rocketed, The number of drugs this applies to has not. Even if the number of topical drugs doubled, iy would still not be a great deal of information. It was still bad then. Insurance companies were much more intrusive. Now they are data driven. Once got an rx for Cipri 500 mg. When it first came out. Th MD had given the patient samples of the 250 and then followed up with an rx fro 500 mg. They called the MD office, somebody at the office said they gave 250 mg samples and they accused us of fabrication the 500 mg rx.......

I don't call unless I have to. At the chains you are insulated from the prices. Do you know how much Clobetasol is going for these days. It also, does your patient no good to give them a 15 gm tube when they have a large area to cover. Passing the buck to the MD is the same as them passing the buck to us when they write 1 tube.

I'll bet every single solitary pharmacist would call on an rx for Prometh w/codeine disp 1 bottle eventhough the DEA will NEVER check for this and you will never be audited for it. But you would mess with a steroid cream that could cost $300.00

You guys are making a big deal about nothing. Just dispense the smallest tube, that solves the cost issue. If it's for large area they will most likely write refills or sometimes specify two tubes. Or if they run out and need more, they can call in a refill. Like you said, not an emergency.

 

[JustFillIt]

The number of drugs has sky rocketed, The number of drugs this applies to has not. Even if the number of topical drugs doubled, iy would still not be a great deal of information. It was still bad then. Insurance companies were much more intrusive. Now they are data driven. Once got an rx for Cipri 500 mg. When it first came out. Th MD had given the patient samples of the 250 and then followed up with an rx fro 500 mg. They called the MD office, somebody at the office said they gave 250 mg samples and they accused us of fabrication the 500 mg rx.......

I don't call unless I have to. At the chains you are insulated from the prices. Do you know how much Clobetasol is going for these days. It also, does your patient no good to give them a 15 gm tube when they have a large area to cover. Passing the buck to the MD is the same as them passing the buck to us when they write 1 tube.

I'll bet every single solitary pharmacist would call on an rx for Prometh w/codeine disp 1 bottle eventhough the DEA will NEVER check for this and you will never be audited for it. But you would mess with a steroid cream that could cost $300.00

Huh... I have dispensed countless codeine bottles with a qty of 1 bottle.. I don’t work retail anymore.... if I remember right the bottle was 434 ml?

 

[Sine Cura]

Strict insurance limits would be an obstacle as monthly quantity limits might require PA overrides (or had the prescriber specified enough information to make an informed judgment there wouldn't be a need for an override).

Huh... I have dispensed countless codeine bottles with a qty of 1 bottle.. I don’t work retail anymore.... if I remember right the bottle was 434 ml?

1 bottle could be a 30 mL amber bottle.

Who said it had to be a stock bottle size?

 

[JustFillIt]

Strict insurance limits would be an obstacle as monthly quantity limits might require PA overrides (or had the prescriber specified enough information to make an informed judgment there wouldn't be a need for an override).




1 bottle could be a 30 mL amber bottle.

Who said it had to be a stock bottle size?

Fair enough...

 

[Bubba98]

Multiple pharmacies have come out stating that they can't accept scripts that include designators like "drops" or "spray" and instead have to be converted to "milligrams"

Also they can't accept scripts for designations like "bottle" or "tube" and have to have an exact milligram or gram designation.

So when I write for a prescription steroid cream for eczema, I can't just write "tube" I have to look up how many grams are in each tube. Apparently 4 years of a pharmacy education isn't enough to decide what tube size to use and pharmacists have to be spoon fed the exact gram/mg dose.

BS like this is exactly why the healthcare field is going to hell -- these rules have ZERO improvement on patient care and instead put up stupid roadblocks that don't need to be there.

I think there might be a real push happening to take the e-scribed med from the prescriber check formulary issues and then go directly on the bottle without the need for a rph checking it. I am all for it just let me grab a huge bowl of popcorn.

 

[Socrates25]

BTW, when are pharmacists going to get the authority to write scripts for tamiflu?

I'm sick and tired of entire families asking me for it -- would much rather turf that to you, at least you can make some money off it whereas I can't

 

[Socrates25]

By the way it is against the law to encourage your patients to go to a specific pharmacy, unless that pharmacy provides a unique service that would effect outcomes (specialty compounding).

Nonsense, I'm going to call BS on this. I'm not getting any kickbacks from these stores.

 

[panicatthepharmacy]

I don't know what tube sizes you have in stock, that's why it's better for me to write "tube" and you can give whatever you have in stock

Sounds good. Let me know your billing address so I can bill you after it gets charged back during an audit.