Why don't pharmacies fill my tylenol prescription?

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Contach

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Hello All,

I'm an Oral and Maxillofacial Surgeon practicing in NY. My post-operative pain regimen usually entails stacking ibuprofen 400 Q4H or 600 Q4H and tylenol 500 Q4H, and a few oxycodones (4-12) for breakthrough pain. HMy oxycodone prescription tells patients to take the ibuprofen and tylenol first, wait 30 minutes, then take the oxycodone, to drive home the idea of breakthrough pain. The only other medication I'll prescribe is an antibiotic, in probably half the patients.

What I've noticed, is that pharmacies are pretty regularly not giving my patients the tylenol prescription. And the patients dont even know they should have gotten tylenol. I'm trying to streamline my discharge / post-op instructions for patient ease (half of what I say I'm sure they don't hear, b/c they are so nervous, and there's so much going on, and after the procedure, they are generally groggy b/c most of my procedures are under sedation).

Most of my prescriptions go to CVS, Walgreens or Hannaford Pharmacy, and then the odd independent pharmacy.

Any tips or ways to make sure the pharmacies dispense the tylenol? Thanks!
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You need to include on the prescription “The patient is aware that the Tylenol is not covered by their insurance. If they argue with you about it, I will bill them $100 as per the written agreement they signed at my office and pay it to the person they fought with. Also, just give them the closest package size to what I ordered so you don’t have an open bottle of #4 tablets left on the shelf.”
 
Tylenol is not covered by insurance. Your patients would probably get mad at pharmacies and want to get refund later because we fill their tylenol.... you can send them the list of medication before surgery.... Or they can purchase tylenol otc after having the consultation with you (before surgery )
 
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Yeah patients are going to argue with the pharmacy about it being covered and most pharmacists don’t dispense OTCs that aren’t covered by insurance since the patients can just buy it OTC without the headache/argument.

You are better off providing written post-op instructions to your patients that include buying or using their own IBU and APAP.
 
What you hear from your patient: "Pharmacy is not filling my Tylenol"

What the patient hears from the Pharmacy: "We only filled the Ibuprofen and Oxycodone"

What the Pharmacy really told the patient: "Your insurance covered everything except Tylenol, here is the OTC version and it will cost you $X"
 
Rockinacoustic said:
What you hear from your patient: "Pharmacy is not filling my Tylenol"

What the patient hears from the Pharmacy: "We only filled the Ibuprofen and Oxycodone"

What the Pharmacy really told the patient: "Your insurance covered everything except Tylenol, here is the OTC version and it will cost you $X"
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You are leaving the part out where they have their phone in hand, are on Facebook, and ignoring everything you say.
 
I always found it odd how some retail stores don't automatically fill the OTC item even though we have the #500 ct of acetaminophen 500 mg. At the independent, we pay $12 for a 500 ct bottle. That comes out to about 3 cents a pill. We could just fill it and come up with a decent price right?
 
have to be more specific, what strength of tylenol are you writing not sure about ny but 500mg is covered more often than 325
 
Sparda29 said:
I always found it odd how some retail stores don't automatically fill the OTC item even though we have the #500 ct of acetaminophen 500 mg. At the independent, we pay $12 for a 500 ct bottle. That comes out to about 3 cents a pill. We could just fill it and come up with a decent price right?
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Walgreens can do this too but most stores don’t. Probably because it’s not covered and most patients say they don’t want it filled. But it’s so inexpensive-
 
Sparda29 said:
I always found it odd how some retail stores don't automatically fill the OTC item even though we have the #500 ct of acetaminophen 500 mg. At the independent, we pay $12 for a 500 ct bottle. That comes out to about 3 cents a pill. We could just fill it and come up with a decent price right?
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Probably because you can't just 'make up' a price at chain pharmacies. They would end up paying something like $5 for 12 tablets via the pharmacy filling them since it's not covered. They can get a 100 ct bottle for 1.99 or something like that, so why waste the time?
 
some patients don't understand the concept of 1+1>2, they'll think they took Tylenol for headache in the past and it didn't help much, so it won't work this time either.
 
Thank you for helping me understand what the problem is.
Tylenol must be pretty cheap though, no? 20 tabs can't be more than a couple dollars?

It is not easy for me to just give the instructions to a patient. We are telling the patients so much already, a post-op prescription is only one thing we have to review. Not to mention, my patients are sedated, so may or may not remember what we tell them. Escorts are notoriously unreliable. If I tell them before the procedure... well most my patients are so nervous about the upcoming procedure that they likely won't hear much I tell them prior to the procedure, and we also have to go over consent for procedure, consent for anesthesia, and entertain their questions. Hence, it is best to be written down or handed to them at the pharmacy. But then not EVERY patient is healthy enough to take tylenol. So imagine if I print this off on my regular instructions then accidentally give these instructions to a patient with liver disease. The pharmacy visit is so important, but once again, the f****** system works against us in providing good care to our patients.

Do pharmacists understand the synergistic analgesic effects of tylenol and ibuprofen together?
 
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Contach said:
Thank you for helping me understand what the problem is.
Tylenol must be pretty cheap though, no? 20 tabs can't be more than a couple dollars?

It is not easy for me to just give the instructions to a patient. We are telling the patients so much already, a post-op prescription is only one thing we have to review. Not to mention, my patients are sedated, so may or may not remember what we tell them. Escorts are notoriously unreliable. If I tell them before the procedure... well most my patients are so nervous about the upcoming procedure that they likely won't hear much I tell them prior to the procedure, and we also have to go over consent for procedure, consent for anesthesia, and entertain their questions. Hence, it is best to be written down or handed to them at the pharmacy. But then not EVERY patient is healthy enough to take tylenol. So imagine if I print this off on my regular instructions then accidentally give these instructions to a patient with liver disease. The pharmacy visit is so important, but once again, the f****** system works against us in providing good care to our patients.

Do pharmacists understand the synergistic analgesic effects of tylenol and ibuprofen together?
Click to expand...
I suggest you prescribe ibuprofen with directions that include, "take with Tylenol". That way it is printed on the patient's ibuprofen label whether or not Tylenol is dispensed. The ibuprofen 400, 600, or 800 will definitely get dispensed since it is rx only.

Working at a corporate pharmacy with no access to pricing, sometimes an APAP prescription is dispensed with a minimum $9.99 cost. It's not likely to be purchased so sometimes I'll just delete the prescription and attach a note on the bag for the patient.
 
Contach said:
Thank you for helping me understand what the problem is.
Tylenol must be pretty cheap though, no? 20 tabs can't be more than a couple dollars?

It is not easy for me to just give the instructions to a patient. We are telling the patients so much already, a post-op prescription is only one thing we have to review. Not to mention, my patients are sedated, so may or may not remember what we tell them. Escorts are notoriously unreliable. If I tell them before the procedure... well most my patients are so nervous about the upcoming procedure that they likely won't hear much I tell them prior to the procedure, and we also have to go over consent for procedure, consent for anesthesia, and entertain their questions. Hence, it is best to be written down or handed to them at the pharmacy. But then not EVERY patient is healthy enough to take tylenol. So imagine if I print this off on my regular instructions then accidentally give these instructions to a patient with liver disease. The pharmacy visit is so important, but once again, the f****** system works against us in providing good care to our patients.

Do pharmacists understand the synergistic analgesic effects of tylenol and ibuprofen together?
Click to expand...

99% of the time, OTC strength anything is not covered. A pharmacy will tack on a dispensing fee along with some silly minimum pricing if they DO fill it behind the counter. I've seen stuff like acetaminophen being 7-8 dollars for 12. Therefore we just tell them its not covered, don't fill it and direct them to the OTC section where they can get a big bottle for much cheaper. Sometimes people want to use their HSA, in which some OTC products aren't covered. In that case if the patient tells me that, I'd fill it. Hell, even when they had $4 30 day supply of generic meds, one tablet would cost you $4, just like 30 tablets would cost you $4. Typically meds get cheaper the more you buy, just like any large quantity product sold.
 
Contach said:
Thank you for helping me understand what the problem is.
Tylenol must be pretty cheap though, no? 20 tabs can't be more than a couple dollars?

It is not easy for me to just give the instructions to a patient. We are telling the patients so much already, a post-op prescription is only one thing we have to review. Not to mention, my patients are sedated, so may or may not remember what we tell them. Escorts are notoriously unreliable. If I tell them before the procedure... well most my patients are so nervous about the upcoming procedure that they likely won't hear much I tell them prior to the procedure, and we also have to go over consent for procedure, consent for anesthesia, and entertain their questions. Hence, it is best to be written down or handed to them at the pharmacy. But then not EVERY patient is healthy enough to take tylenol. So imagine if I print this off on my regular instructions then accidentally give these instructions to a patient with liver disease. The pharmacy visit is so important, but once again, the f****** system works against us in providing good care to our patients.

Do pharmacists understand the synergistic analgesic effects of tylenol and ibuprofen together?
Click to expand...
Some good recommendations below your post. A lot of places will give the patient a handout with the dosing in advance of the procedure on a printed sheet of paper and have an RN review prior to the appointment (or at least I've seen this done).

Also, pharmacists definitely understand the synergistic analgesic effects of tylenol + ibuprofen. 🙂
 
firework said:
some patients don't understand the concept of 1+1>2, they'll think they took Tylenol for headache in the past and it didn't help much, so it won't work this time either.
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That really cracked me up.

Contach said:
Do pharmacists understand the synergistic analgesic effects of tylenol and ibuprofen together?
Click to expand...
No, please explain it to us.
 
We get people fishing for OTC products to put together a OTC-only bowel prep regimen from a sheet of paper provided by the GI office.

Even Kaiser pharmacy sends their "members" on a wild goose chase to find some rando OTCs because "CVS/Walgreens/Rite Aid/Walmart would have it"

What makes OP special?
 
ValeRx said:
Probably because you can't just 'make up' a price at chain pharmacies. They would end up paying something like $5 for 12 tablets via the pharmacy filling them since it's not covered. They can get a 100 ct bottle for 1.99 or something like that, so why waste the time?
Click to expand...

That sucks. I vaguely remember things like price modify functions when I used to work at CVS 11 years ago. At the independent, if it was a quantity of like #30-40, I would just charge them like $3-5 and call it a day.

I know Medicaid/Managed Medicaid patients can definitely fill things like APAP or other OTCs.
 
APAP tabs can be an excluded benefit of Medicaid managed care plans.
 
Contach said:
Thank you for helping me understand what the problem is.
Tylenol must be pretty cheap though, no? 20 tabs can't be more than a couple dollars?

It is not easy for me to just give the instructions to a patient. We are telling the patients so much already, a post-op prescription is only one thing we have to review. Not to mention, my patients are sedated, so may or may not remember what we tell them. Escorts are notoriously unreliable. If I tell them before the procedure... well most my patients are so nervous about the upcoming procedure that they likely won't hear much I tell them prior to the procedure, and we also have to go over consent for procedure, consent for anesthesia, and entertain their questions. Hence, it is best to be written down or handed to them at the pharmacy. But then not EVERY patient is healthy enough to take tylenol. So imagine if I print this off on my regular instructions then accidentally give these instructions to a patient with liver disease. The pharmacy visit is so important, but once again, the f****** system works against us in providing good care to our patients.

Do pharmacists understand the synergistic analgesic effects of tylenol and ibuprofen together?
Click to expand...
Huh, how is it "not easy to give instructions to the patient" as their atending physician? Do you not use an electronic health record that does this for you? How hard is it for you or your staff to create a handout with medication directions if this is your usual regimen? Make one for your rare liver patients, and one for your rare bariatric patients.
 
Sparda29 said:
I know Medicaid/Managed Medicaid patients can definitely fill things like APAP or other OTCs
Click to expand...
If you happen to be able to get the NDC that they actually cover. APAP is one of the easier ones but I come across a bunch of OTCs that medicaid will only pay for ones that I'm not able to order.
Sine Cura said:
APAP tabs can be an excluded benefit of Medicaid managed care plans.
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I don't think this is true in New York. All managed care plans changed over to follow NY Medicaid formulary earlier this year.
 
Coverage of APAP and OTC cold/cough preps was "temporarily reinstated" for fee-for-service Medi-Cal and managed care plans were supposed to follow that guidance but at least 2 plans don't give 2 ****s (like commercial plans don't give 2 ****s about covering a year's worth of contraceptives)
 
Contach said:
Do pharmacists understand the synergistic analgesic effects of tylenol and ibuprofen together?
Click to expand...

Do not believe the cliche “there is no such thing as a stupid question”. However, I will say that we can certainly agree that there are stupid people.

Are you really this dense? We literally just told you what the problem is. It has nothing to do with you, with us, your patients, or your prescribing practices.

The issue is the patients insurance and the general ignorance of everyone involved in the process. You seem to understand this with your post then turn around and ask a question like that?

Look - let me give you a hint as I worry that you may not be quite up to snuff. First off - don’t freaking prescribe oxy for an acute dental patient.... Let’s start there... Instead - prescribe some Norco (which has your precious Tylenol in it in case you didn’t know) and some Rx strength ibuprofen. I will leave it up to you to find out what a Rx strength nsaid is. That will be a neat little project for you. Maybe you can make a poster with all the different nsaids and their doses etc. Then you can hang it up in your office or something.

Viola! You have your “synergy” which you are so impressed with and you have fillable rx. Not so hard to understand...

Unreal...... This is a great case study on the crap that we deal with. How many conversations do you think this guy has had behind closed doors trashing the pharmacy/pharmacist because he thinks he is so incredibly synergistic and the pharmacist is so beneath him...

Geeze - woke up pissed today after checking crypto markets.. guess it will be one of those days. Wish me luck!
 
Last edited:
JustFillIt said:
Do not believe the cliche “there is no such thing as a stupid question”. However, I will say that we can certainly agree that there are stupid people.

Are you really this dense? We literally just told you what the problem is. It has nothing to do with you, with us, your patients, or your prescribing practices.

The issue is the patients insurance and the general ignorance of everyone involved in the process. You seem to understand this with your post then turn around and ask a question like that?

Look - let me give you a hint as I worry that you may bot be quite up to snuff. First off - don’t freaking prescribe oxy for an acute dental patient.... Let’s start there... Instead - prescribe some Norco (which had your precious Tylenol in it in case you didn’t know) and some Rx strength ibuprofen. I will leave it up to you to find out what a Rx strength nsaid is. That will be a neat little project for you. Maybe you can make a poster with all the different nsaids and their doses etc.

Viola! You have your “synergy” which you are so impressed with and you have fillable rx. Not so hard to understand...

Unreal...... This is a great case study on the crap that we deal with. How many conversations do you think this guy had had behind closed doors trashing the pharmacy/pharmacist because he thinks he is so incredibly synergistic and the pharmacist is so beneath him...

Geeze - woke up pissed today after checking crypto markets.. guess it will be one of those days. Wish me luck!
Click to expand...
Why don’t you…. just fill it LOL. But seriously great response.
 
projektreverb said:
Why don’t you…. just fill it LOL. But seriously great response.
Click to expand...

Well, back in the day when I dealt with the daily nightmare and dr. synergy - I would have just filled the oxy/Rx strength nsaid and walk out to the floor and grab a bottle of store brand Tylenol and just throw the bottle in the tray and offer that to the patient when they came in. I rarely ran into issues with this and if I did I certainly would not loose time or sleep over it when Dr. synergy called and asked if I knew how acetaminophen/nsaid work together and why the hell i won’t fill his acetaminophen rx
 
It’s not easy for you to give post op instructions to a patient? Isn’t that literally part of your job? For which you are paid far more for than any pharmacist...
I had major surgery two weeks ago. I realize I take post op instructions far better than much of the general population, but I was provided very specific written instructions that nurses went over with me, line by line. The surgeons gave me some instructions verbally.
I’d be pretty annoyed to pay a minimum pharmacy fee for acetaminophen which I a) already have at home or b) can buy a big bottle of for much less.
 
Why not dispense Tylenol and ibuprofen in the office and send them to pharmacy just for the narcotics.
 
It’s also kind of funny to me that OP is concerned about accidentally giving the wrong set of instructions to his patients with liver problems but apparently not concerned about accidentally giving a prescription for APAP to the same patient.
 
owlegrad said:
It’s also kind of funny to me that OP is concerned about accidentally giving the wrong set of instructions to his patients with liver problems but apparently not concerned about accidentally giving a prescription for APAP to the same patient.
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his mind is too pre occupied with the synergistic effect of tylenol and ibuprofen
 
JustFillIt said:
And - why the heck are we not talking about the fact that about 95% of households in this country already have Tylenol at home.

Paging Dr. Synergy - are you aware that just about everyone already has Tylenol at home?
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A big part of wanting it to be filled at the pharmacy is that every time the patient takes it, they have those instructions right there. Discharge instructions get lost with great frequency and then you either end up with patients taking how many ever Tylenol they feel like (which is often wildly dangerous amounts) or calling your office repeatedly for clarifications on the instructions. A great number of patients in my area have a reading comprehension in the 6th to 8th grade range and low levels of health literacy, so making sure they have clear instructions that they can understand is critical to safe and effective care
 
Mad Jack said:
A big part of wanting it to be filled at the pharmacy is that every time the patient takes it, they have those instructions right there. Discharge instructions get lost with great frequency and then you either end up with patients taking how many ever Tylenol they feel like (which is often wildly dangerous amounts) or calling your office repeatedly for clarifications on the instructions. A great number of patients in my area have a reading comprehension in the 6th to 8th grade range and low levels of health literacy, so making sure they have clear instructions that they can understand is critical to safe and effective care
Click to expand...

Okay - well set up a campaign to push the insurance companies to pay for otc. This has nothing to do with us. And for the most part we do not satisfy state laws unless we get a complete label for an Rx - which won’t happen unless we get a paid claim. We do not control what the insurance will and will not pay for. We simply need to adapt. Maybe you should buy a case of cheap acetaminophen and print a bunch of store bought labels and stick them to the bottle and give them out.

As long as you are not making this a “pharmacy issue”, pulling rank, and asking a dumb question like “do you know the synergistic relationship between IBU/apap” it’s fine by me.

What is wrong with saying - “take the Tylenol according to the directions on the OTC bottle”?
 
JustFillIt said:
Okay - well set up a campaign to push the insurance companies to pay for otc. This has nothing to do with us. And for the most part we do not satisfy state laws unless we get a complete label for an Rx - which won’t happen unless we get a paid claim. We do not control what the insurance will and will not pay for. We simply need to adapt. Maybe you should buy a case of cheap acetaminophen and print a bunch of store bought labels and stick them to the bottle and give them out.

As long as you are not making this a “pharmacy issue”, pulling rank, and asking a dumb question like “do you know the synergistic relationship between IBU/apap” it’s fine by me.

What is wrong with saying - “take the Tylenol according to the directions on the OTC bottle”?
Click to expand...
Uh, dude, I was just explaining why we do it, no need to get so defensive. Never assigned any blame to anyone, was just explaining why it happens on our end since everyone was like, "tell them to pick up some OTC"
 
Mad Jack said:
Uh, dude, I was just explaining why we do it, no need to get so defensive. Never assigned any blame to anyone, was just explaining why it happens on our end since everyone was like, "tell them to pick up some OTC"
Click to expand...

Gotcha - well now you understand that you can simply say to a patient “go to the store and buy a bottle of Tylenol. Take it according to the directions attached to the bottle”.

And if you ever hear anyone complaining about the pharmacy running into issues filling easily available OTC products - you can say to the group “hey we can just tell them to buy a bottle of Tylenol and take it according to package directions”.
 
JustFillIt said:
Gotcha - well now you understand that you can simply say to a patient “go to the store and buy a bottle of Tylenol. Take it according to the directions attached to the bottle”.

And if you ever hear anyone complaining about the pharmacy running into issues filling easily available OTC products - you can say to the group “hey we can just tell them to buy a bottle of Tylenol and take it according to package directions”.
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Patients can often struggle with unclear directions. When you've got a bottle that says take 1-2 tablets every 4-6 hours they'll come calling, "do I take one or two? Do I take it every four or six? Paperwork... Oh, I lost that." I realize there is no changing it with chain pharmacies (our local pharmacies will fill anything and for cheap), but it's an inevitable call every single time
 
any Friends fans? when ross tries to flirt by telling the pizza delivery girl they add the smell/odor to gas? and phoebe is thoroughly fascinated and asks ross later "ross, what else do they add smell to?"

OP, what other drugs have synergy?
 
Mad Jack said:
Patients can often struggle with unclear directions. When you've got a bottle that says take 1-2 tablets every 4-6 hours they'll come calling, "do I take one or two? Do I take it every four or six? Paperwork... Oh, I lost that." I realize there is no changing it with chain pharmacies (our local pharmacies will fill anything and for cheap), but it's an inevitable call every single time
Click to expand...

ummmm 99% of those scripts say take 1-2 q4-6h anyways lol
 
ValeRx said:
Just think about poor gastroenterologists that have to give colonoscopy prep instructions out. If he doesn't trust a patient to remember to pick up APAP OTC... forget about bowel preps! Geez.
Click to expand...
That’s funny that you think the gastroenterologist themselves are the ones giving the bowel prep instructions 🤣🤣
 
Contach said:
Hello All,

I'm an Oral and Maxillofacial Surgeon practicing in NY. My post-operative pain regimen usually entails stacking ibuprofen 400 Q4H or 600 Q4H and tylenol 500 Q4H, and a few oxycodones (4-12) for breakthrough pain. HMy oxycodone prescription tells patients to take the ibuprofen and tylenol first, wait 30 minutes, then take the oxycodone, to drive home the idea of breakthrough pain. The only other medication I'll prescribe is an antibiotic, in probably half the patients.

What I've noticed, is that pharmacies are pretty regularly not giving my patients the tylenol prescription. And the patients dont even know they should have gotten tylenol. I'm trying to streamline my discharge / post-op instructions for patient ease (half of what I say I'm sure they don't hear, b/c they are so nervous, and there's so much going on, and after the procedure, they are generally groggy b/c most of my procedures are under sedation).

Most of my prescriptions go to CVS, Walgreens or Hannaford Pharmacy, and then the odd independent pharmacy.

Any tips or ways to make sure the pharmacies dispense the tylenol? Thanks!
Click to expand...


Pharmacist do give out Acetemenphen (for a loss ) all the time but if you want to make sure your patient gets this vital common and inexpensive OTC drug that nearly everyone in America has stocked in their medicine cabinet, I suggest you stock it in your office and just give it out to all your patients since it is OTC. Pay for it out of your pocket since it is essential.
 
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