I received a fax back from a prescriber's office last week with this note:
"Stop sending prior auth requests for meds patients can buy OTC."
To which I promptly replied:
"Stop sending Rxs for items patients can buy OTC."
The question often arises on pharmacy phorums about OTC products being prescribed and filled as prescriptions and a lengthy, often heated debate ensues. I often wonder why. Here is a discussion I recently had with myself playing Devil's Advocate with. . . well, myself.
CP: We get paid to fill prescriptions.
Me: But they're a pain in the ass.
CP: How, exactly?
Me: They're not in the computer.
CP: When was the last time we dispensed something that wasn't in the computer?
Me: I don't know. That's the typical counter argument.
CP: I can find an NDC made by Major or Rugby for almost every medication prescribed in our area.
Me: But they're not covered.
CP: Sure they are. Most Medicaid plans cover those NDCs in particular. Most commercial insurances do not, but I have had a few Medicare D plans pay as well.
Me: They're more expensive than the patient buying it OTC.
CP: Match the price.
Me: Too much work.
Me: They. Can. Buy. It. O. T. C. and not bother me.
CP: They can. Maybe they don't need the whole box which will go to waste. Also, if we fill it as a prescription, it will have a label on it. The label will clearly instruct the patient how the prescriber wanted them to take it which may differ from the OTC package directions. In a week or a month when the patient has to take it again, where will the directions be? Which will they follow?
Me: They will have kept the instructions in the package, right?
CP: Sure. And I'm Batman.
Me: But we don't make money off them.
CP: Really? That's your argument? We are the better profession. We are the last line in making sure our patients take their medications correctly. When was the last time you had to do an MTM and the patient remembered every OTC item they were taking? If we fill them as Rxs, we have them on file. We can run drug interactions against the other medications we are filling. Why would we not fill these as prescriptions?
Me: The patients won't pay for them.
CP: The patients who have FSA accounts will be happy to pay for them. Many plans will only allow their funds to go towards Rx items. If they walk up with a box of Pepcid, their card will not allow the purchase. They may be able to submit the receipt, but this is easier for them. Also, they can bypass the Pseudoephedrine limits and get a whole month of Claritin-D or Allegra-D if we fill it as a prescription.
Me: What about supplies?
CP: What about them? We already bill Glucose meters, test strips, lancets, alcohol pads, syringes, and pen needles on prescriptions. How would a nebulizer be any different? We do those too. Once you find an NDC that works, order it. Bill it. Fill it.
CP: I have.
Me: So there are a lot of items we could bill?
CP: Yes. The vast majority of OTC prescriptions we fill are for former or current Rx items (Ibuprofen, APAP, ASA, Pepcid, Zantac, Prilosec, Flonase) and Mucinex, Delsym, Benadryl, eye drops, ear drops, etc. All you have to do is find one once and keep it on the shelf. Our job is to provide healthcare. I fail to see how telling people to buy something OTC when we received it as a prescription is doing our job.
Some insurances pay for OTC items. If not, override the price.
The patients will have the correct instructions.
The patient doesn't have to purchase a whole box if they only need a week supply.
FSAs will pay for OTCs as Rx items.
We will have a more complete medication history for interactions.
Patients will be happy.
It's no more work than any Rx item you're already filling.
We get paid to fill prescriptions. (ps these count as prescriptions too.)
As for my note at the top, I knew the patient's insurance would cover the medication with a PA which is why I faxed it initially. We filled it on a discount card for less than OTC and the patient was happy.
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