Yet another customer wants the limelight, this time due to cvs

[wagrxm2000]

---

Members don't see this ad.

Very interesting point.

In this era of emperors with no clothes, would a pharmacy get dinged in an audit if the patient's gender had been changed willy nilly?

A lot of insurances already won't bill the wrong gender so I'm curious why this store does it.

 

[beautifulrobot]

Very interesting point.

In this era of emperors with no clothes, would a pharmacy get dinged in an audit if the patient's gender had been changed willy nilly?

Does the insurance claims system even reference what sex the pharmacy has listed? I have actually never had to deal with a pharmacy claim that was rejected because of the patient's sex, so I don't know if changing the patient's sex on the pharmacy side would make the claim go through. I assume the system just references whatever sex the patient is registered on the insurance system's side (which is usually information submitted by HR if it's employer-based insurance). If the insurance rejects a claim because the drug is only covered for a specific sex that doesn't match what the patient has listed with their insurance, that is 1) not entirely legal anymore per ACA non-discrimination rules 2) something that the patient will have to take up with their insurance/HR department and/or something that the pharmacist may be able to get an override for by calling the insurance company and explaining that he patient is transgender.

 

[CetiAlphaFive]

Does the insurance claims system even reference what sex the pharmacy has listed? I have actually never had to deal with a pharmacy claim that was rejected because of the patient's sex, so I don't know if changing the patient's sex on the pharmacy side would make the claim go through. I assume the system just references whatever sex the patient is registered on the insurance system's side (which is usually information submitted by HR if it's employer-based insurance). If the insurance rejects a claim because the drug is only covered for a specific sex that doesn't match what the patient has listed with their insurance, that is 1) not entirely legal anymore per ACA non-discrimination rules 2) something that the patient will have to take up with their insurance/HR department and/or something that the pharmacist may be able to get an override for by calling the insurance company and explaining that he patient is transgender.

Yup

 

[BidingMyTime]

There are enough transgendered/transgendering people now, that I think computer systems need to be updated to have places to show their gender at birth(or biological sex, whatever they want to call it), and their preferred gender. Especially, since as I understand, people are still at risk for sex-related cancers from their biological sex, regardless of surgery/hormones.

 

[Saisri_PharmStdnt]

Speaking for one specific insurance, when the member changes their gender, their profile is updated to reflect the change. Previous items will still list their "previous" gender for record keeping, but all new claims and adjudication will process under the "new" gender. If the patient went from Male to Female, only claims marked Female would pay (for us).

I hope that helps.

 

[PharmDBro2017]

There are enough transgendered/transgendering people now, that I think computer systems need to be updated to have places to show their gender at birth(or biological sex, whatever they want to call it), and their preferred gender. Especially, since as I understand, people are still at risk for sex-related cancers from their biological sex, regardless of surgery/hormones.

0.3% of the population is enough to change all of the computer systems in healthcare? (stats per Dr. Google)

 

[owlegrad]

0.3% of the population is enough to change all of the computer systems in healthcare? (stats per Dr. Google)

It's only going to increase as time goes by. At what percentage should we make the leap?

If Facebook can have 21 different categories for gender I think health care applications that could actually use that information can accommodate a few extra as well. 😉

 

[owlegrad]

FWIW my doctor's office asks for "Gender at birth" and then "Gender identity" (or something very close to that, I might have the exact verbiage wrong). It's not difficult to accommodate transgender people if you inclined to do so.

 

[PharmDBro2017]

It's only going to increase as time goes by. At what percentage should we make the leap?

If Facebook can have 21 different categories for gender I think health care applications that could actually use that information can accommodate a few extra as well. 😉

Idk, I'm just playing devil's advocate (as always). My hospital system sent out a new policy to calculate CrCl based on their birth gender, but that's all I've seen. I can always just look at H&P and it wouldn't take long to find something in the notes that would alert me to make a proper decision.

Would it actually help in the retail setting? I mean... how much common sense does it take to look at the person, see a HRT rx or look over their previous records, clarify with the patient (in a private area obviously) and/or physician if you still can't put two and two together, and dispense said HRT.

 

[CetiAlphaFive]

FWIW my doctor's office asks for "Gender at birth" and then "Gender identity" (or something very close to that, I might have the exact verbiage wrong). It's not difficult to accommodate transgender people if you inclined to do so.

Agreed.

It would be incredibly simple for a programmer to add a list of the most common alternative genders to the diagnosis options

 

[beautifulrobot]

Idk, I'm just playing devil's advocate (as always). My hospital system sent out a new policy to calculate CrCl based on their birth gender, but that's all I've seen. I can always just look at H&P and it wouldn't take long to find something in the notes that would alert me to make a proper decision.

I wonder at what point after starting cross-sex hormone therapy is the patient's assigned sex at birth no longer the most accurate for CrCl calculations. E.g., A transgender male assigned female at birth who has taken T consistently for 10+ years likely has a muscle mass profile that is more typical of a cisgender male adult than a cisgender female adult. You could always calculate both for male and female and just use clinical judgment, but it's just something I've been curious about.

 

[PharmDBro2017]

Agreed.

It would be incredibly simple for a programmer to add a list of the most common alternative genders to the diagnosis options

Well...most common...is that technically a list when there's two options on it?

 

[beautifulrobot]

Agreed.

It would be incredibly simple for a programmer to add a list of the most common alternative genders to the diagnosis options

Well...most common...is that technically a list when there's two options on it?

The first thing to consider is what are we actually asking. It seems there are three different variables in our current discussion - assigned sex at birth, one's current sexual characteristics, and current gender/gender identity

Assigned sex at birth - female and male usually the only two options, as even intersex folks / folks born with ambiguous external genitalia are almost always still assigned one or the other at birth and have either male or female listed on their birth certificate.

Current sexual characteristics - basically, what genitalia and gonads does the person currently have or not have, which sex hormones are they exposed to and at what levels, and what secondary sexual characteristics are predominant for this person - these are things that could be captured in ICD codes / past medical and surgical history / current med list / asking the patient if needed.

Current gender identity - this is the variable that can get kind of tricky, as people may self-identify in many different ways. Common options include Male, Female, Trans Male, Trans Female, Genderqueer/Gender Non-Conforming or "Different" with an option to specify.

@owlegrad's doctor's office employ's the popular "two-step method" for collecting gender identity data - i.e., what sex were you assigned at birth, and what is your current gender identity? If you answer male for one and female for the other, that clues in your doctor that you may be transgender. Some folks who are transgender (in the sense that their current gender is not aligned with the sex they were assigned at birth) don't identify as transgender, so just asking on the form if someone is transgender is not an effective way to get the information you're trying to get. More on the two-step method and it's purpose is available here for your reading pleasure: https://williamsinstitute.law.ucla.edu/wp-content/uploads/geniuss-report-sep-2014.pdf

 

[PharmDBro2017]

The first thing to consider is what are we actually asking. It seems there are three different variables in our current discussion - assigned sex at birth, one's current sexual characteristics, and current gender/gender identity

Assigned sex at birth - female and male usually the only two options, as even intersex folks / folks born with ambiguous external genitalia are almost always still assigned one or the other at birth and have either male or female listed on their birth certificate.

Current sexual characteristics - basically, what genitalia and gonads does the person currently have or not have, which sex hormones are they exposed to and at what levels, and what secondary sexual characteristics are predominant for this person - these are things that could be captured in ICD codes / past medical and surgical history / current med list / asking the patient if needed.

Current gender identity - this is the variable that can get kind of tricky, as people may self-identify in many different ways. Common options include Male, Female, Trans Male, Trans Female, Genderqueer/Gender Non-Conforming or "Different" with an option to specify.

@owlegrad's doctor's office employ's the popular "two-step method" for collecting gender identity data - i.e., what sex were you assigned at birth, and what is your current gender identity? If you answer male for one and female for the other, that clues in your doctor that you may be transgender. Some folks who are transgender (in the sense that their current gender is not aligned with the sex they were assigned at birth) don't identify as transgender, so just asking on the form if someone is transgender is not an effective way to get the information you're trying to get. More on the two-step method and it's purpose is available here for your reading pleasure: https://williamsinstitute.law.ucla.edu/wp-content/uploads/geniuss-report-sep-2014.pdf

Word. I was being a bit facetious up there. Thank you though.

 

[BidingMyTime]

0.3% of the population is enough to change all of the computer systems in healthcare? (stats per Dr. Google)

Ankylosing Spondylitis is just as rare, but I bet most computer systems have that as a diagnosis selection.

 

[CetiAlphaFive]

Ankylosing Spondylitis is just as rare, but I bet most computer systems have that as a diagnosis selection.

Actually, it could be as high as 1.35% of the population, or 1/3 of the gay population.