PharmCountry

Ok, Cigna, you really need to get your act together. The other day, I had a patient (one of our regulars) come in with an Augmentin Rx for her son. Her employer had just switched their carrier to Cigna, but she hadn’t received the new card yet.

So, I think, no big deal. Call Cigna, give them name, DOB, address if neccesary. Wrong!

Once I finally got through to somebody, I was asked for my name, pharmacy name, NPI#, Rx#, and the patient’s name. (after I had given all of this to Cigna’s lovely IVR system.)

I explained the situation to the representative. She told me that I needed the primary cardholder’s social security number due to the “new HIPAA law.” (What, you mean the one that was passed in 1996 and its “final rule on Security standards” went into effect in 2003?)

I calmly explained to her that HIPAA doesn’t apply to me because I am a health provider using the information for provision of health services. As long as I can verify basic information (such as name, DOB, address, and phone number), I am entitled to the account number. Her response: “Sorry, I’m just following the law.” My response: “Well, then every other insurance company is violating it.” Click.

I called back, to get a second opinion, as it were. This time I was told the same thing, except that it was due to Cigna policy, not HIPAA. So, I called the mom back and asked her for the account holder’s SSN. She was understandably reticent to give it to me, until, of course, I told her how much it would be without insurance. I had her write it on the back of the Rx, but she made me promise that the pharmacist would cover it, so other nobody else could see it when we were done.

So, I called back (again), this time with the SSN in hand, and got the ID#. I asked this representative, “By the way, is it Cigna policy that I have to have the social security number to get an ID number?” She told me no, so I asked, “Well, then why did not one, but two other reps tell me that it was?”

“I apologize for that. It’s easier to look it up by SSN than by using name and dob, and some of the other representatives are just lazy.” They must have felt my jaw dropping to the ground in China when I her that. I told her that I wanted a complaint filed that Cigna needs to get their reps off their butts and stop lying to pharmacies.

This is particularly annoying when Medco (don’t get me started on Medco) will give you the ID without even having to speak to a live person (which is no fun with Medco).

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So, did you work today?

If the answer is yes, and you work in a pharmacy, you know what Pharmacy New Year is. For those of you who don’t know, let me explain:

January 2nd is the first day doctor’s offices are open again, many of them since before Christmas, or at least since last Friday. That means, a ton of faxes (though for some reason I got even more on New Years’ Eve than today), and a lot of “patients” realizing they are “sick” because they don’t want to go back to school/work.

Plus, it’s a new insurance plan year, so lots of people have new cards or deductibles (that they never seem to know about until their script turns out to cost $300) or formulary changes.

On top of that, Zyrtec just went generic, and is going OTC later this month, so all of the insurance companies’ computers are confused.

So please don’t complain that your prescription isn’t ready when you didn’t tell me you had a new insurance card, didn’t respond to my repeated pages to return to the pharmacy, and then hand me a card written in igPay atinLay that doesn’t have the essential information (like the bin number or, god forbid, the ID number.)

I offered to switch three people to generic Zyrtec today. All three of them (all of them Argus/Carefirst), were rejected for “non-match NDC number.” Well, ok, it’s new, not in their system yet. Let’s try the brand name Zyrtec: Reject “NDC not covered; OTC available.”

Umm, you mean it’s January 27th already? Because as far as I’ve been told, that’s when it’s going OTC. Thankfully, all three patients were willing to wait until tomorrow, when Argus says they’ll have it straightened out.

Today was also the day for people to call in all their refills (as in 8 or 9) at the same time. Some because they were waiting to be out of the dreaded Medicare donut hole, some because they’re trying to get everything on the same schedule.

We had one patient who used to be on Avalide, and was warned ahead of time (a shock, I know) that is was no longer going to be covered. He was prepared last month with a script for Benicar HCT, another ARB+diuretic that was on the list the insurance had mailed him. When he called in the Avalide, it was rejected (as expected; hey that rhymes). So, I tried the Benicar HCT and it was rejected, too. It turns out the insurance had a change of heart, and now prefers Diovan HCT. I faxed the MD for a change, and thankfully got it fairly quickly.

An 18-year-old girl (I can’t call her a woman) brought in 3 scripts: Doryx 100mg, Tazorac cream, and Duac. We filled the scripts; the two creams came to about $120, and the Doryx was about $300; she had a $1500 deductible, then everything is $7. Of course, she didn’t understand that. “Last month at the other pharmacy they were $7! Why are you charging me almost $600!?” Because, girl, you have a dumb-as-dung insurance plan. So, she put me on her cell phone with her mom, who argued with me, but ultimately seemed to understand that I couldn’t do anything about it. I handed the girl back the phone (did I forget to mention I had a cold?) and she demanded the scripts back.

So, Happy Pharmacy New Year. Are you ready for a vacation yet?

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So, unless you’ve been under a rock (or working 12-hour shifts in a pharmacy), you’ve probably heard that the FDA is considering a third class of drugs called “Behind the counter,” where certain drugs will be made available without a prescription as long as a pharmacist counsels the patient.

The prime example of this is already in effect: Plan B. I was just reading an article on the subject of BTC, when I came across this doozy:

Citing Plan B as an example, [Kristin Moore, an opponent of BTC] said placing it behind the counter has unnecessarily delayed access to this time-sensitive treatment, potentially increasing the risk of unintended pregnancy.

Wait a second; making Plan B available without a prescription has delayed access to it? Let me get this straight; being able to show ID at any local pharmacy takes longer than scheduling an emergency appointment at your doctor’s office, waiting for hours to be seen by a doctor, then driving to the pharmacy and having to wait for the pharmacist to fill the prescription?

As John Stossel would say, give me a break.

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Yesterday, a concerned father came into the pharmacy with a pill his wife found in their 13 year old son’s bedroom. We took a look at the pill, knowing full well that it was most likely a narcotic, but we gave the kid the benefit of the doubt.

It was a round, white pill, with the number 30 on one side, and some other numbers on the other side. When we looked it up, it turned out to be Morphine Sulfate ER 30mg.

The pharmacist told this to the father, who just about lost it. “What!” he said in disbelief. He asked for a printout about it, and of course all we could do was print the patient info sheet that goes in every prescription bag. (He wanted something with a picture, but none of our sources had one.)

Personally, I feel no sympathy for the kid, only for the parent.  If you’re smart enough to hide it from your parents and stupid enough to get caught, you deserve whatever your parents dish out. (If this had happened when I was 13, my parents would have smacked me so hard, I’d still be feeling it.)

Besides, there are enough illegal drugs out there with fewer side effects.

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So this lawyer-type came up to the pharmacy counter the other day with a script for Keflex. Of course, he had never been to our store before, so I had him fill out a patient profile. When he was done, I looked over it to check for missing information (which is common in my store; I mean, who really forgets to write their name down?)

Well, he had forgotten to write his birthday down–or so I thought. When I told him I needed his birthday, he told me he didn’t want to give it to me, since I didn’t need it to fill the prescription. (WTF?)

When I told him that, yes, indeed, I did need his DOB, he started arguing with me: “Tell me where it says that I’m required to give you my date of birth to get a prescription filled!”

Me: “Well, for one thing, I can’t process your insurance without it, and I’m pretty sure it’s the law.

Lawyer Guy: Which law? oops, I should have known better.

Me: I don’t know off the top of my head, probably OBRA ‘90 or something.

LG: They haven’t passed a law like that in more than 15 years. Oh, really. They haven’t passed one since, I don’t know, 1990.

Well, we finally got his date of birth out of him, so I started entering everything into the computer. (It’s funny how he didn’t want to give me something simple like his DOB, but had no problem giving me his address, medical history, and even email address.)

That’s when I noticed that he had put a question mark over the box for penicillin allergy. Since he was getting a cephalosporin (which, for all my non-pharmacy readers, all 2 of you, can have a cross-sensitivity with penicillin), the pharmacist asked him about it when he came back for the script.

RPh: Sir, are you allergic to penicillin?

LG: I’m not sure, but my mom is, so I might me. Wrong.

RPh: So you’ve never had a penicillin product before?

LG: Well, last year in Germany, I was given a penicillin injection, but I had a nasty infection, so it probably “metastasized” (his word) out of my system before I could react to it.

RPh: No, sir, if you were allergic to it, the reaction would have been immediate.

So, finally we rang him out for the script, and he left–for a minute. He came back, saying, “This isn’t what my doctor said I would be getting. This says cephalexin.”

RPh: “Well, we dispensed the generic for Keflex, which is what the doctor wrote.”

LG: The doctor said I would be getting Biaxin, not Keflex.

RPh: (bringing the script out to the counter to show him) Well, he wrote for Keflex. He probably changed his mind. This should work just as well and is much cheaper.

LG: Oh. Ok. Bye.

The really funny part is, I was looking through our tech-in-training’s study book, and came across the law section. I was right about OBRA ‘90; it requires full name, date of birth, and address.

Score. CPhT: 1, , RPh: 1, Lawyer Guy: 0

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Ah, druggies, don’t ya just love ‘em? The other day a lady called up and said she was out of her Vicodin, and wanted a refill. But when I looked her up, I saw that she had just gotten the prescription filled 8 days before for what was technically an 11 day supply (90 tabs and 1-2 every 6 hours as needed; 90tabs/8 tabs per day = 11.25 days)

It was only a few days early, so I tried to run it through anyway. Surprise, surprise, it was rejected by the insurance; they wouldn’t fill it until Sunday. (This was actually because the insurance had required us to bill for 20 days instead of 11.)

She, of course, was mad that she couldn’t get it even though she was “out,” so I asked her how often she takes it. She told me that, yes, she was only taking the maximum (8 tabs daily).

By this time, I was getting really fed up with her, so I just flat out told her, “Look, 90 tabs divided by 8 per day comes out to more than 11 days, so either you have some left in the bottle, or you’re taking more than you’re telling me. If you want more pills before the insurance will allow it, you’ll have to have your doctor increase the dose (which wouldn’t happen, since she was already at the max), or call in a different medication.”

“Well, can I just pay for it?”

“I would still have to call the doctor and get approval to fill it early.”

So, she hung up, and I was proud of myself for handling a druggie so well. Of course, the doctor called the next day, and I told her the same thing I told the patient. Her reply? “Oh, I see. Never mind then, I’ll call the patient back.”

Score CPhT: 1, Druggie: 0.

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Ok, so, yeah, I’ve been neglecting you guys lately. My pharmacy’s been really busy lately due to an excess in coupons and the cold/flu season starting. I’ll try to be a better CPhT for you.

Since I last posted, we’ve had the insurance system go down twice (company wide), I’ve gotten some overtime filling in at another store (yay), and gathered so many “I gotta blog this” stories, I’ve forgotten half of them.

Today, we spent 20 minutes working on a prescription that was already done. How, you may ask? A patient, Ms. Waffler, called and asked to have her Wellbutrin transferred from our store to another of our stores down the highway. I told her she should just call the other pharmacy and ask them to transfer it, since our stores are all connected.

Of course, 5 minutes later, the pharmacist from the other store called and asked me to back it out so they could transfer it (we had just auto-filled it the other day). So, I backed it out, and put it back on the shelf.

30 seconds (literally, 30 seconds) after I hung up with the other store’s pharmacist, Ms. Waffler called back and said, “I changed my mind. I’m going to be by your store tonight afterall.” Of course, the other pharmacy had already transferred it.

Another phone call: “Hi, guess what? Ms. Waffler changed her mind. Can you put your rx on hold, so I can transfer it back?”

I joked with the other store’s pharmacist, “I guess we’re just all too efficient.” That’s certainly nothing I’ve ever been accused of before.

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<begin shameless plug>

Well, there have been hints about it (read through the comments on some posts from a month or two ago and it’s pretty obvious), but I’m finally ready to announce….(drum roll please):

BlogPharm, the blogging community for pharmacy people, and…stuff.

Seriously, if you’re a pharmacist/tech/student/pbm employee/drug rep/etc, and you’d like to blog but don’t know how, BlogPharm is for you.

It’s based on the world-renowned WordPress (the same software this blog runs on), and it has so many features, you can do almost anything with it

So if you’re interested, head on over to BlogPharm and sign up today!

</shameless plug>

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If you work in a pharmacy, the words “Prior Authorization” can run chills down your spine. Normally, when a medication requires a PA, we just fax a form that we print out to the doctor’s office that has all the pertinent information:

• Patient’s name and DOB
• name of the medication and why it’s rejecting (if we know)
• Insurance ID# and phone#

In the rare case when a doctor doesn’t have a fax number, I get to call and leave all of this information on their voicemail (god forbid they should actually answer the phone, yet they still complain when I pick up the phone and they have to wait 30 seconds to speak to the pharmacist.)

An hour or so after I called in one particular PA today (well, yesterday now; man I hate it when I can’t sleep all night) the doctor himself called back.

MD: “Hi The is Dr. Highandmighty. I need to speak to the person who called in this Prior Authorization for my patient Mrs. Outofluck.” (Don’t you just love my nicknames for patient?)

RPh: “Hold on one second that was my Tech.”

Me: “This is Andrew; How can I help you?”

MD: “Hi, Andrew. I just wanted to let you know that you did a better job than most when you called in the Prior Authorization; you gave me the ID# and insurance phone#” (at this point I’m expecting that he got it through quickly and was just letting us know) “but you forgot one thing.”

Me: “Oh, what was that?” (puzzled, since I was sure I had left all of the information)

MD: (in a very condescending tone) “Well, don’t you think I could’ve used the patient’s date of birth?”

Me: (doh!) “Oh, sorry about that, it’s 1/5/62.”

MD: “Well, next time just make sure you don’t forget it so I don’t have to waste my time calling you back.”

Here’s the response I gave:

Me: “I’ll be sure to do that. Thanks, uh huh, bye.”

Here’s the response I wanted to give:

Me: “First of all, how many times have you called in a script without a DOB, and we had to look it up” (he does this a lot, actually) “or forgotten to write the date or your signature or a strength (etc.) and we had to call your staff to verify it. Plus, if we had had a valid fax number or if your voicemail had listed it, I could have just faxed you over this nice clean form we have with all of the information you need laid out very nicely, instead of having to leave it on your voicemail while trying to count out a script and tell someone where the toothpaste is (something you don’t have to deal with because you at least get to hide in your office and actually schedule when patients are allowed to come in).

“Second of all, you’re going to have to pull the chart anyway (unless, of course, you have it memorized, which I seriously doubt) to be able to document for the insurance company what other medication’s the patient has tried and the medical reasons the patient has to be on this medication, so unless your charts are organized by DOB or date seen by the doctor (which again, I seriously doubt) you could’ve kept from wasting both our time and just gotten her DOB from her file. Thanks, bye.”

So instead of wasting 5 minutes calling us, he could have just looked at the file he was going to have to pull (or have his staff pull, since most MD’s farm PA’s out to their nursing staff anyway). I wish I could make that much money for being such a moron.

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Hi, everybody. Sorry for the long hiatus, but I was trying to keep the “desperate plea” post at the top of the site for obvious reasons. The good news is we’ve hired a new technician (well, technician in training) and we’re interviewing another new tech on Saturday that has 6 years of experience, so posts should become more frequent around here.

–

If you’ve ever been in the military, known someone in the military, or read a newspaper some time in the past year, you know how bad military medicine can be.

Now, imagine trying to deal with all that, and a kid that has been off of their ADHD medicine for a week and a half, and having to find your way around in a new town at your latest posting.

A while back, a mother brought in a script for her son for Focalin XR 15mg, and no other pharmacy in the area had it. (Now, normally, this line would get an automatic “we don’t have it either” from me, but since the kid was bouncing up and down like a chimpanzee, I was more apt to believe her).

The doctor in Ohio had written a script, but nobody (including us) would fill it because he had forgotten to write the “XR”. They had run out when they first moved to out area from Ohio, and the base clinic couldn’t (or wouldn’t) schedule an appointment until that morning.

Problem One: The script was written on a god-forsaken DOD script that are never legible and look like they were printed in the 1960’s.

Problem Two: The doctor didn’t put her DEA number on the script, which of course, is required form all Schedule II medications (and indeed, all schedule III-V medications.)

Thankfully, the mom had a phone number for the clinic, a rarity in military medicine. So, we called and asked for the Doctor’s DEA number.

Problem Three: This particular doctor didn’t have a DEA number (WTF?), so we legally couldn’t fill the script.

Problem Four: Since Focalin XR is a schedule II medication, we’re not allowed to change much on the prescription, including the doctor’s name (same reason the “Focalin”, sans “XR” above couldn’t be filled).

Problem Five: It was almost 5pm and there was no way for the mom to make it back to the clinic before they closed.

However, the doctor offered to have someone stay until the mom could make it back to the clinic, which is 30+ minutes away. A new script, written by a doctor with a DEA number, would be waiting there for her to pick up.

Problem Six: She had to deal with a screaming kid in the car for yet another hour.

When the mom brought the new script back to the pharmacy, I typed it in and gave it to the pharmacist so she could pull the medication from the safe and count it. When she was checking it, she came across:

Problem Seven: The new doctor had neglected to write the strength (15mg); I had come to know the script so well, I hadn’t even noticed the lack of a strength when I was typing it in.

Thankfully, the mom still had the other (technically non-valid) script, so we just took both and called the clinic the next day to verify (the strength is one of the few things on a Schedule II that we can change.)

So after about 4 hours work (granted most of the work was the mom’s, not ours) TriCare paid us a whopping $5.69 over our cost. Thanks.

At least the mom was nice throughout the whole ordeal, especially considering the problem child she was having to deal with the whole time. Thank goodness for small miracles.

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