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Wednesday, February 16, 2022

This Is The Reason. . .

 . . . You Can't Just Write What You Want And The Pharmacist Won't Just Fill It

CP: How often have we said "If you're a prescriber and you don't know how to prescribe a medication, perhaps you shouldn't be prescribing it"?
CPP: in aeternum. I don't mind if they call for some help, but I also don't want to prescribe the medication for them.
CP: Yeah, we should get a consulting fee on some of these. I do appreciate them leveraging us but choosing the medication and telling them how to write it is a bit much. 
CPP: Especially when they send it to another pharmacy. Or completely ignore our advice.
CP: Exactly. 
CPP: What spurred this topic today?
CP: A recent conversation with a prescriber and his nurse.

CP: Hello, Nurse!
Nurse Obviously Clueless Like U Expect: Hey, CP. Did you receive the e-script we sent?
CP: I did. Except there's a problem; the Oxycontin isn't available as 50mg. 
NO CLUE: It's not? Doctor wasn't sure. He stepped the patient up from 20mg to 40mg and wanted to go to 50mg now. 
CP: The next increase is 60mg. 
NO CLUE: Well he wants 50mg.
CP: The only way to achieve that would be to prescribe 40mg plus 10mg (or 20mg plus 30mg) but I'd advise against it. It will be quite difficult to get both strengths approved. Especially with how quickly he moved the patient from 20mg to 40mg, I'd go with 60mg. I have 10, 20, 30, 40, 60 in stock. 
NO CLUE:  How about 25mg? 
CP: No. The only ones they make I am missing are 15mg and 80mg.
NO CLUE: So there's no other way to get 50mg?
CP: I'm still recommending against it based on the patient's history but no, there is not.  
NO CLUE: Okay. I'll check with him. 
<1 hour later>
CP: So I see we received Rx's for 10mg and 40mg Oxycontin.
NO CLUE: That's what he wanted.
CP: Ok. Did you start the prior auth?
NO CLUE: Yes. 
<3 days later>
CP: So I see we received a new prescription for 60mg Oxycontin. 
NO CLUE:  Yeah. The 50mg just wasn't enough and it was confusing for the patient to remember to take one of each twice a day. 
CP: You don't say. Did you start the prior auth yet?
NO CLUE: This needs one too? I thought you said it wouldn't?
CP: If you had prescribed that first, it wouldn't have. Now that the patient has all kinds of tablets hanging around, the insurance needs an explanation. 
CPP: I like being asked how to make my job easier, then being ignored, then being provided the exact opposite then being forced to explain how to fix the problem I tried talking them out of making which makes more work for me because I have time to fix mistakes I preemptively fixed in the first place. 
CP: You can give a man an education but you can't make him take it. 

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