Why do they do it???

[All4MyDaughter]

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Why do ER doctors/NP's/PA's insist on writing prescriptions for expensive medications for patients with no insurance?

Don't they realize that the patients won't PAY $100+ for antibiotics (hellooooo, Levaquin)?

Plus, it is soooo hard to call the ER to try to get the medicine changed to something less expensive. You can almost never get the prescriber on the phone. The PA's are the easiest to reach.

I am also not fond of scripts for Paxil CR and Wellbutrin XL. Most of the insurance plans in our area will not pay for these formulations. What's wrong with the old formula - with the nice generic available?

😛

 

[ultracet]

they probably #1 have no idea how much they cost and #2 have no idea the pt has no insurance

 

[All4MyDaughter]

they probably #1 have no idea how much they cost and #2 have no idea the pt has no insurance

Not sure about #1, but the vast majority of the scripts I'm referring to come from the ER at our local charity hospital. So I do think the providers know about (or at least suspect) the patients' financial/insurance status.

 

[pharmacology]

It is because Pharmaceutical sales personel bombard physicians with the newest, most expensive drugs. Plus the pharmaceutical industry bombards physicians with real nice CE seminars with plenty of freebies. People tend to respond when that happens. Plus the have a major lobby force to help promote their industry and the drug pipeline.

Wait til you are a pharmacist at an independent and you find out that you are paying $20 for a drug on your shelf while some local hospital is getting the same drug for 29 cents!!! Well the costs alignments are getting better but it is still out of wack.

I was talking with one pharmacist who mentioned that one day he recieved a script for a drug which was not even in the distribution pipeline yet. It seems the sale people were out in force doing their job early on the docs.

Why do ER doctors/NP's/PA's insist on writing prescriptions for expensive medications for patients with no insurance?

Don't they realize that the patients won't PAY $100+ for antibiotics (hellooooo, Levaquin)?

Plus, it is soooo hard to call the ER to try to get the medicine changed to something less expensive. You can almost never get the prescriber on the phone. The PA's are the easiest to reach.

I am also not fond of scripts for Paxil CR and Wellbutrin XL. Most of the insurance plans in our area will not pay for these formulations. What's wrong with the old formula - with the nice generic available?

😛

 

[All4MyDaughter]

I think you are so right about the sales pitches having an impact on the prescribers.

I also think that sometimes the docs hear so much junk from sales reps that they get mixed up. I recently had two doctors very upset with me because they just KNEW that Avelox and Norvasc were available as generics. In both cases we had called to get alternative Rx because those medications were too expensive for the patients. On both occasions the doctors were upset because "the rep had told them that it was available as a generic." I think they were confused...

It is because Pharmaceutical sales personel bombard physicians with the newest, most expensive drugs. Plus the pharmaceutical industry bombards physicians with real nice CE seminars with plenty of freebies. People tend to respond when that happens. Plus the have a major lobby force to help promote their industry and the drug pipeline.

Wait til you are a pharmacist at an independent and you find out that you are paying $20 for a drug on your shelf while some local hospital is getting the same drug for 29 cents!!! Well the costs alignments are getting better but it is still out of wack.

I was talking with one pharmacist who mentioned that one day he recieved a script for a drug which was not even in the distribution pipeline yet. It seems the sale people were out in force doing their job early on the docs.

 

[calrx]

I think you are so right about the sales pitches having an impact on the prescribers.

I also think that sometimes the docs hear so much junk from sales reps that they get mixed up. I recently had two doctors very upset with me because they just KNEW that Avelox and Norvasc were available as generics. In both cases we had called to get alternative Rx because those medications were too expensive for the patients. On both occasions the doctors were upset because "the rep had told them that it was available as a generic." I think they were confused...

A similar thing has been happening here with Allegra. Today alone 3 people came in asking why they couldn't find Allegra out in the isles. Apparently their doctor(s) were telling them that they no longer need a prescription for Allegra because it is now available OTC. I thought one lady was going to strangle the poor pharmacist. She couldn't fathom the fact that her doctor was clearly wrong.

 

[sdn1977]

they probably #1 have no idea how much they cost and #2 have no idea the pt has no insurance

That's it right here! In their mind, perhaps they feel the drug (in this case, the fluoroquinolone - Levaquin) is the cheapest since that is on the one on their formulary. Hospital formularies are skewed because they are tied to all sorts of budget incentives. They just may not be aware that a less expensive therapeutic substitution may be available - ciprofloxacin (yeah...it may not always be substitutable, I know!)

View this as an opportunity for practice management!!!! This is a pt who requires antibiotics for whatever reason....be persistent & call the prescriber & talk about alternatives. I sat on the phone for 20min with a prescriber so I could find something the pt could afford & something the prescriber was comfortable with. It got to the point I was recommending choices, but thats my job & one I'm willing to do.

Hang in there - these are opportunities!

 

[All4MyDaughter]

A similar thing has been happening here with Allegra. Today alone 3 people came in asking why they couldn't find Allegra out in the isles. Apparently their doctor(s) were telling them that they no longer need a prescription for Allegra because it is now available OTC. I thought one lady was going to strangle the poor pharmacist. She couldn't fathom the fact that her doctor was clearly wrong.

WHAT are YOU talking about??? The doctor is ALWAYS RIGHT. 😀

 

[insipid1979]

WHAT are YOU talking about??? The doctor is ALWAYS RIGHT. 😀

"Doctor.....Pharmacist? Doctorrrrrr....Pharmacist? Doctor...Pharmacist? I'm going with the pharmacist"

Does anyone know what that is from? 😀

 

[WVUPharm2007]

I told a Xopenex drug rep I saw at school once that she had no soul.

 

[All4MyDaughter]

I told a Xopenex drug rep I saw at school once that she had no soul.

I let the Aciphex rep buy me dinner at Outback Steakhouse.
It was yummy.

 

[npage148]

I told a Xopenex drug rep I saw at school once that she had no soul.

I cant figure out why any insurance company or person would pay for xopenex and today we filled a clarinex for $30 copay. I told the person the truth about it and they still wanted it.

 

[Moxxie]

"Doctor.....Pharmacist? Doctorrrrrr....Pharmacist? Doctor...Pharmacist? I'm going with the pharmacist"

Does anyone know what that is from? 😀

Hehe, too bad that show isn't on the air anymore. That was one of the few episodes that I actually watched (Curb Your Enthusiasm).

I cant figure out why any insurance company or person would pay for xopenex and today we filled a clarinex for $30 copay. I told the person the truth about it and they still wanted it.

We've had a few people come in for loratidine and I wanted to say something... but then medicare picked up the entire thing and their copay was $0.

There was a lady this weekend, though, with no insurance that could only afford to buy 10 Effexor XR at a time - I wish that she could have just gone with the normal Effexor, but I don't think the pharmacist even thought about calling the doc (and the pt didn't know any better). In this case, though, I think that the MD must have thought that she was on Medicare/Medicaid. Probably ~50% of the people that come into our store pay $0-$3 for drugs that would cost me $30 on my insurance plan. I wouldn't mind so much if they didn't pick them up in the drive-through in cars much nicer than mine...

 

[goodb29]

I LOVE it when patients come through the drive thru and complain that they have to pay $1 !!!!! for their Rx, but are driving a 2006 Mercedes SL convertible, lol, we should start a new thread on great patient stories, LOL

 

[SwePharm]

Wait til you are a pharmacist at an independent and you find out that you are paying $20 for a drug on your shelf while some local hospital is getting the same drug for 29 cents!!! Well the costs alignments are getting better but it is still out of wack.

It’s the same here in Europe. It’s a standard marketing procedure used by the drug companies. They practically give the hospitals the drugs for free or at least at a heavily discounted price. The drug companies know that when patients get bored they will examine the drugs closely. So when the patients get out of the hospital they want the same tablet with the same color and shape that helped them so much when they where hospitalized.

It also has the effect that doctors sometimes believe they are prescribing the cheapest drug because that’s the one that the hospital pays less for.

 

[dgroulx]

I LOVE it when patients come through the drive thru and complain that they have to pay $1 !!!!! for their Rx, but are driving a 2006 Mercedes SL convertible, lol, we should start a new thread on great patient stories, LOL

I believe that thread is called "Things I Learned From My Patients". You may have to dig for it.

 

[Sosumi]

Hehe, too bad that show isn't on the air anymore. That was one of the few episodes that I actually watched (Curb Your Enthusiasm).

We've had a few people come in for loratidine and I wanted to say something... but then medicare picked up the entire thing and their copay was $0.

There was a lady this weekend, though, with no insurance that could only afford to buy 10 Effexor XR at a time - I wish that she could have just gone with the normal Effexor, but I don't think the pharmacist even thought about calling the doc (and the pt didn't know any better). In this case, though, I think that the MD must have thought that she was on Medicare/Medicaid. Probably ~50% of the people that come into our store pay $0-$3 for drugs that would cost me $30 on my insurance plan. I wouldn't mind so much if they didn't pick them up in the drive-through in cars much nicer than mine...

Effexor XR has been proven to cause less nausea than regular release Effexor and thus better tolerability. The generic effexor is still expensive too.

I once had a phone conversation at one of my community rotation sites with a woman who couldn't understand why her co-pay was $100 for 3 months worth of Clarinex. I asked her if she's tried loratadine or Claritin and explained the cost-benefit, but she called back and decided to buy a month's worth of Clarinex for $50 anyway.

Now Xopenex, I do have no clue why that's being used so often at my hospital. The respiratory techs seem to use it like water. It's also annoying with their lousy packaging, difficult to read labelling on the nebulizer solution vials (0.63mg vs 1.25mg: medication errors!), and the 14 day avoid from light expiration once opened from the original packaging.

 

[Moxxie]

Effexor XR has been proven to cause less nausea than regular release Effexor and thus better tolerability. The generic effexor is still expensive too.

Good to know! Is it generally only recommended when SSRI's aren't effective, or do a lot of docs prescribe it before trying other meds?

 

[Sosumi]

Good to know! Is it generally only recommended when SSRI's aren't effective, or do a lot of docs prescribe it before trying other meds?

Hehe, we just had our two therapeutics exams for neurology and psychology drugs last week and today.

Anyway, Effexor's been shown to have good efficacy for generalized anxiety disorder and is a good choice in major depressive disorder. It's usually first line monotherapy alongside SSRI's for anxiety and depression. The main disadvantages are that it's activating (insomnia) and can cause increased diastolic blood pressure so usually avoided in patients with uncontrolled hypertension. It's also the culprit for why we have to put that suicide and medication guide with all antidepressants now -- it has the highest rate of suicide among the antidepressants even though Prozac is the one that's getting blamed.

 

[Jennay41]

I LOVE it when patients come through the drive thru and complain that they have to pay $1 !!!!! for their Rx, but are driving a 2006 Mercedes SL convertible, lol, we should start a new thread on great patient stories, LOL

There was a guy on medicaid that came to get prescriptions, and he actually came in the store instead of driving his escalade through the drive through. He made a big stink about making sure all his prescriptions were $0 copay on his medical card, bought about $7 worth of other stuff and pulled out his wallet to pay. It was FULL of hundreds and he ended up going with a fifty since it was the smallest bill he had. How in the hell does this guy qualify for state assistance but on a pharmacy tech's pay if I wasn't living with my parents to save up for school next year I'd probably be homeless. 😡

 

[npage148]

There was a guy on medicaid that came to get prescriptions, and he actually came in the store instead of driving his escalade through the drive through. He made a big stink about making sure all his prescriptions were $0 copay on his medical card, bought about $7 worth of other stuff and pulled out his wallet to pay. It was FULL of hundreds and he ended up going with a fifty since it was the smallest bill he had. How in the hell does this guy qualify for state assistance but on a pharmacy tech's pay if I wasn't living with my parents to save up for school next year I'd probably be homeless. 😡

Selling drugs doesnt show up on your taxable income 🙄

 

[insipid1979]

How in the hell does this guy qualify for state assistance but on a pharmacy tech's pay if I wasn't living with my parents to save up for school next year I'd probably be homeless. 😡

I would like to know how a kid in my high school got reduced cost lunches yet drove a brand new Mustang. These are the type of people that hurt the ones who legitimately need support...because when people see that they start thinking people using the system are abusing it and don't deserve to be on it...and just leeching off of everyone else.

 

[calrx]

I would like to know how a kid in my high school got reduced cost lunches yet drove a brand new Mustang. These are the type of people that hurt the ones who legitimately need support...because when people see that they start thinking people using the system are abusing it and don't deserve to be on it...and just leeching off of everyone else.

This is why there really should be some sort of time limit on how long a person gets assistance (maybe 5 years.) People start getting free money and suddenly lose all ambitions to better themselves and their families; then, before you know it they've been living off of everyone else for 30 years. People annoy me...

Cheers to all of us who actually have our **** together.

 

[DownonthePharm]

I thought they did limit assistance to two years, unless you qualified for aid based on your mental or physical inability to work?

OK this could be touchy, but how do you feel about students taking assistance because "technically" they arent making any money? Such as med students getting food stamps and whatnot?

 

[ForgetMeNot]

These people are the reason there are fraud and abuse hotlines for the state programs.

 

[Jennay41]

Selling drugs doesnt show up on your taxable income 🙄

lol and I'm guessing he didn't have to go school to do it legally like the rest of us do