Why is Caremark restricting doses on Alprazolam?

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Have a couple of customers who have been on Alprazolam 2 mg TID PRN for quite a while with a quantity of 90. I've been getting rejections since the beginning of the year that these patients can now only receive a quantity of 60 per 25 days.

Any particular reason?

Maybe you should write a doctor's note and fax it to the insurance?

EDIT:

LOL, I haven't really been seeing those with any Caremark. I wonder if it's those specific patients.
 
its ok for caremark to reject it without concerns to patient health like that. but when i reject opioid/benzo combination, another pharmacist will have a fit. they would even dispense high dose opioid/benzo combo.. the state of maryland has declared a state of emergency on drug abuse and 1 of them doesn't have a clue, wasn't aware, and the others don't care..
 
It would be truly radical in the U.S. if a payer doesn't cover alprazolam, period.
 
It's rejecting becaue 95% (I made this # up) of the time benzos and z-drugs are used inappropriately. Either duration, indication, dose. Like opioids they are used becaue they are the easy way out and the paths of least resistance. Patients like them and doctors won't lose patients by saying no. I spend a good chunk of my days dealing with benzo issues. They should be made schedule II
 
I wish they'd just make early filling illegal or set a legal limit like 3 days or so on a non-regular basis. Our professional judgement isn't enough sometimes to satisfy drug seeking patients and we wind up in trouble when they complain of "poor customer service" because we won't hand out scripts a week early without a valid reason. Making Benzo's a CII would intensify the workload profoundly, can you imagine processing a new RX for every Xanax refill? Just make it illegal to fill them early and give us a hard law to cite to patients.

Honestly, I wish they'd set limits on pharmacists filling early and also mandate that on all controlled substances the prescriber place a DNF date on there. I feel like most don't even check the PDMP, I've saved many a practitioner who wrote an opioid for a drug seeking patient on zubsolv/suboxone in addiction recovery. In half the cases it's sad because they don't even know what those drugs are and I have to explicitly explain the situation too them... I told a dentist his zubsolv patient can't receive opioids and he said "well give them Tramadol then" and I'm like.... bruh I can do ibuprofen.
 
They are C-II in NY and it it's fine. New script every month, only 5 day emergency on phone in. There was way less benzo use than I see in Maine where's it's a free for all. The only PITA thing if it went fed c2 would be maintaining the perpetual inventory but eh we'd live.

As for filling early, just buck up and hold strong. When push comes to shove no manager will go after you for refusing to fill controls early. Luckily we have a company policy of 48 hours early max so at least we have support.
 
Why would "professional judgment" ever satisfy a drug abuser?

The rampant abuse of benzos and opioids in the U.S. is sad. MAGA. At least I don't work in the South or WV. What a joke.
 
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Why would "professional judgment" ever satisfy a drug abuser?for a lawsuit.

The rampant abuse of benzos and opioids in the U.S. is sad. MAGA. At least I don't work in the South or WV. What a joke.

It's everywhere. I work in a very blue state now and it's just as bad here as it was in TN, if not worse. To the drug seeker we aren't a professional with liability or a license to practice, we are the mean old pharmacist overstepping our authority by not following "the doctor's orders." I've had several tell me "you're not a doctor you have no right to refuse my medicine."
 
It's rejecting becaue 95% (I made this # up) of the time benzos and z-drugs are used inappropriately. Either duration, indication, dose. Like opioids they are used becaue they are the easy way out and the paths of least resistance. Patients like them and doctors won't lose patients by saying no. I spend a good chunk of my days dealing with benzo issues. They should be made schedule II

Honestly I think so.

It's ridiculous that the ADHD meds are but benzos
I wish they'd just make early filling illegal or set a legal limit like 3 days or so on a non-regular basis. Our professional judgement isn't enough sometimes to satisfy drug seeking patients and we wind up in trouble when they complain of "poor customer service" because we won't hand out scripts a week early without a valid reason. Making Benzo's a CII would intensify the workload profoundly, can you imagine processing a new RX for every Xanax refill? Just make it illegal to fill them early and give us a hard law to cite to patients.

Honestly, I wish they'd set limits on pharmacists filling early and also mandate that on all controlled substances the prescriber place a DNF date on there. I feel like most don't even check the PDMP, I've saved many a practitioner who wrote an opioid for a drug seeking patient on zubsolv/suboxone in addiction recovery. In half the cases it's sad because they don't even know what those drugs are and I have to explicitly explain the situation too them... I told a dentist his zubsolv patient can't receive opioids and he said "well give them Tramadol then" and I'm like.... bruh I can do ibuprofen.

Pfffft.

People said the same thing about norco.
"Wahhh it's gonna be too much work"

The fact that virtually every female patient I've ever seen over the age of 65 is on at least one benzo or hypnotic is sad

It's everywhere. I work in a very blue state now and it's just as bad here as it was in TN, if not worse. To the drug seeker we aren't a professional with liability or a license to practice, we are the mean old pharmacist overstepping our authority by not following "the doctor's orders." I've had several tell me "you're not a doctor you have no right to refuse my medicine."

That one always threw me for a loop.
I told them once, "OK, get your doctor to come here and give it to you then"
 
They are like skittles here.
 
You know you're dealing with an abuser when the claim March XX is 30 days after February XX and they "ran out"
 
They are C-II in NY and it it's fine. New script every month, only 5 day emergency on phone in. There was way less benzo use than I see in Maine where's it's a free for all. The only PITA thing if it went fed c2 would be maintaining the perpetual inventory but eh we'd live.

As for filling early, just buck up and hold strong. When push comes to shove no manager will go after you for refusing to fill controls early. Luckily we have a company policy of 48 hours early max so at least we have support.

You'd be surprised. I've actually seen this happen to another pharmacist. I was shocked. I don't know why we continue to fill scripts for some of our patients. Ie how is the whole family on the same medications every month? Patient shop lifts regularly but sure let us get that xanax ready for you. Shm
 
An employer cannot force anyone to do anything that is against the law.

By extension, a district manager cannot, under any circumstances, force a pharmacist to fill a prescription that is not for a legitimate medical purpose.

Whether or not you think that applies here is the golden question.
 
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