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Medical Forum / General / Cardiology / April 2005Sharing RX medication to save $
I am a reporter at a national newspaper researching a story about pepole who share prescription drug medications to deal with rising drug costs. Doctors and researchers say the elderly and chronically ill are doing this most. Is there anyone who is doing this? Thanks. Dan. danieljcostello@gmail.com. danieljcoste...@gmail.com wrote: > I am a reporter at a national newspaper researching a story about > pepole who share prescription drug medications to deal with rising drug > costs. Doctors and researchers say the elderly and chronically ill are > doing this most. Is there anyone who is doing this? Thanks. Dan. > danieljcostello@gmail.com. How does this purportedly save money? Maybe I should try it. If two are using the drug, they will use twice as much. If one is using the drug and both need it, then one or both will suffer. If they are doing this to save on medical costs, then one or the other will not be visiting a doctor and they will have only one Rx to share between the two. It is a lose-lose situation. Maybe you are researching an urban myth. > How does this purportedly save money? Co-pay. For instance, one script for 60 pills twice per day vs two scripts of 30 pills one per day. One co-pay vs two. > Maybe you are researching an urban myth. Not at all. > > How does this purportedly save money? > [quoted text clipped - 6 lines] > > Not at all. Without a crooked doctor to write the script incorrectly, it would never get past the Drug Utilization Review (DUR) alerts. When the pharmacy receives a script, they verify the prescription with the prescribing doc, they enter the patient's insurance information, the Rx, dose and prescribing provider's ID: the payer's claim payment system would immediately detect the error, and the pharmacist would not fill the Rx. Either you have a crooked doctor, or a crooked pharmacist. Why would they risk their licenses, their practices, their livlihoods and families for someone to save a $2 to $20 copay? I admit, you could be right. I just don't get it. > > > How does this purportedly save money? > > [quoted text clipped - 20 lines] > > I admit, you could be right. I just don't get it. Even with a crooked doctor, you would hit max dosage limitation audits on many drugs. Once the pharmacist sees the DUR alert, they are not likely to dispense the perscription. The payer, insurance or Medicaid, won't pay for it. > Without a crooked doctor to write the script incorrectly, it would > never get past the Drug Utilization Review (DUR) alerts. Many medications have a sufficiently wide range of dosages to not trigger an alert. For instance, I take a BP med, avalide, (FYI, I'm not sharing it) and get 60 pills monthly. Going from 30 to 60 is within normal dosage. > When the > pharmacy receives a script, they verify the prescription with the > prescribing doc, I'm sure mine doesn't. It just gets keyed into their computer. They get it wrong often enough. > they enter the patient's insurance information, the > Rx, dose and prescribing provider's ID: the payer's claim payment > system would immediately detect the error, and the pharmacist would not > fill the Rx. > Either you have a crooked doctor, or a crooked pharmacist. You jump to an erroneous and dangerous conclusion. I did not say I do this. I don't share my meds. > Why would > they risk their licenses, their practices, their livlihoods and > families for someone to save a $2 to $20 copay? For some people, a second $20 co-pay is the difference between getting the presciption filled or going without. > I admit, you could be right. I just don't get it. tonywes...@gmail.com wrote: > > Without a crooked doctor to write the script incorrectly, it would > > never get past the Drug Utilization Review (DUR) alerts. [quoted text clipped - 3 lines] > not sharing it) and get 60 pills monthly. Going from 30 to 60 is > within normal dosage. True. But, in this case the person sharing half of their prescription would be doing so only at the risk of their own health (i.e. they receive only half of the prescription). This behavior might be more common where the patient is conning the doctor for pain killers, or some other drug that is being abused. > > When the > > pharmacy receives a script, they verify the prescription with the > > prescribing doc, > > I'm sure mine doesn't. It just gets keyed into their computer. They > get it wrong often enough. It gets keyed into their computer and processed by the payer. The pharmacist is supposed to validate the original prescription with the doctor's office (it may be done electronically). Refills don't need to be checked unless there is a change in dosage. > > they enter the patient's insurance information, the > > Rx, dose and prescribing provider's ID: the payer's claim payment [quoted text clipped - 6 lines] > You jump to an erroneous and dangerous conclusion. I did not say I do > this. I don't share my meds. Neither. The familiar "you" was not intended to refer to you personally. I apologize for my lack of clarity. > > Why would > > they risk their licenses, their practices, their livlihoods and > > families for someone to save a $2 to $20 copay? > > For some people, a second $20 co-pay is the difference between getting > the presciption filled or going without. Possibly correct. The copay system is designed to introduce an element of patient responsibility without introducing undue financial burden. A person who is not in need of cash assistance might have a $20 copay, another person who is on cash assistance might have only a $2 copay. > > I admit, you could be right. I just don't get it. You're probably right. It probably does happen. Especially when one of the patients is conning the doctor for purposes of drug abuse - in which case, I don't have much sympathy. I appreciate your response in this matter. You have helped me to see that it may in fact be happening. People do stupid things sometimes. ">> >. > >> > When the >> > pharmacy receives a script, they verify the prescription with the >> > prescribing doc, no...properly written scripts are NEVER verified in any manner...to do so would entail a LOT of unnecessary work... scheduled meds...sometimes...but routine meds,,never but as to the "crooked doctor" example...this is a valid statement... a prescriber will write on the script AND document in the chart EXACTLY what the patient is taking..ie...1 tab twice a day or 60/month.....scripts and charts have to match..in case of audits..another provider filling in...etc...not many prescribers are willing to risk being "caught" in insurance fraud... which is what it is...EVEN if the stated number and dosage on the script is within the range... I once asked hubby's doc to write for TWICE the dose of an expensive med,,,then I would split the pills..he would get two months for one co pay.... doc's answer " I always promised my wife I would not go to jail...for insurance fraud"... this is NOT to say that some providers will not do this...but it is insurance fraud in a "small" context >> I'm sure mine doesn't. It just gets keyed into their computer. They >> get it wrong often enough. [quoted text clipped - 40 lines] > I appreciate your response in this matter. You have helped me to see > that it may in fact be happening. People do stupid things sometimes. > I once asked hubby's doc to write for TWICE the dose of an expensive > med,,,then I would split the pills..he would get two months for one co > pay.... Hmmm. My family has a plan in which we can either fill the prescrip locally or submit it to our insurance drug program. Locally we're limited in the quantity (or something or other) but if we submit the scrip to the program we can get up to 3 months worth - with only one copay.  Signature__________ "As democracy is perfected, the office of president represents, more and more closely, the inner soul of the people. On some great and glorious day the plain folks of the land will reach their heart's desire at last and the White House will be adorned by a downright moron." H.L. Mencken (1880 - 1956) >> I once asked hubby's doc to write for TWICE the dose of an expensive >> med,,,then I would split the pills..he would get two months for one co [quoted text clipped - 5 lines] > scrip to the program we can get up to 3 months worth - with only one > copay. no....I meant TWICE the dose of the med!!! so if he was on 20 mg...write for 40....then we could split the pills.. mail order or not...40 instead of 20mg...split in half give you TWICE the dose...ie twice as much time for the script to last...all for the same co pay...works whether filling per month at local pharmacy..or mail order... ironically..our insurance co which uses mail order now charges TWO copays for THREE months worth..... <Hawk...@sbcglobal.net> wrote: > ">> > >. [quoted text clipped - 5 lines] > no...properly written scripts are NEVER verified in any manner...to do so > would entail a LOT of unnecessary work... Depends on the state and the drug. > scheduled meds...sometimes...but routine meds,,never > [quoted text clipped - 4 lines] > charts have to match..in case of audits..another provider filling > in...etc...not many prescribers are willing to risk being "caught" in > insurance fraud... > [quoted text clipped - 6 lines] > > doc's answer " I always promised my wife I would not go to jail...for > insurance fraud"... > > this is NOT to say that some providers will not do this...but it is > insurance fraud in a "small" context I believe any fraud is significant and should be prosecuted; but, I understand your sentiment. I cannot imagine a provider cooperating in this type of mini-fraud to save copay any more easily than I can imagine chickens eating coconuts. > >> I'm sure mine doesn't. It just gets keyed into their computer. They > >> get it wrong often enough. [quoted text clipped - 40 lines] > > I appreciate your response in this matter. You have helped me to see > > that it may in fact be happening. People do stupid things sometimes. > <Hawk...@sbcglobal.net> wrote: >> ">> [quoted text clipped - 10 lines] > > Depends on the state and the drug. hmmm...would be interested in data here...I know our pharmacy has a sign saying all controlled scripts will be verified...however I have watched them fill my scripts on a WEEKEND....so know they never called to verify..must have an honest face!! not to mention the type of meds I get but verifying ALL scripts?? yikes that would be cumbersome!! >> scheduled meds...sometimes...but routine meds,,never >> [quoted text clipped - 30 lines] > I cannot imagine a provider cooperating in this type of mini-fraud to > save copay any more easily than I can imagine chickens eating coconuts. you are correct....obviously my doc agrees ....ANY fraud is fraud.... oh well...now the old guy is on Medicare..so no drug coverage anyway!!! >> >> I'm sure mine doesn't. It just gets keyed into their computer. > They [quoted text clipped - 53 lines] >> > that it may in fact be happening. People do stupid things > sometimes. <Hawk...@sbcglobal.net> wrote: > > <Hawk...@sbcglobal.net> wrote: > >> ">> [quoted text clipped - 17 lines] > > but verifying ALL scripts?? yikes that would be cumbersome!! Unfortunately, I don't have all the answers, but in some cases, depending on the payer, the prescribing doctor may have already submitted the prescription authorization to the payer and the verification is done automatically when the pharmacist enters the script online into their system. And, yeah despite some automation, the process is cumbersome. > >> scheduled meds...sometimes...but routine meds,,never > >> [quoted text clipped - 34 lines] > > oh well...now the old guy is on Medicare..so no drug coverage anyway!!! You have been notified, of course, about the new Medicare Part D drug program? http://www.cms.hhs.gov/media/press/release.asp?Counter=1117 http://www.cms.hhs.gov/medicarereform/drugcard/ It may not be perfect, but some help is on the way. > >> >> I'm sure mine doesn't. It just gets keyed into their computer. > > They [quoted text clipped - 53 lines] > >> > that it may in fact be happening. People do stupid things > > sometimes. > <Hawk...@sbcglobal.net> wrote: >> > [quoted text clipped - 30 lines] > script online into their system. And, yeah despite some automation, the > process is cumbersome. "authorization" is NOT required on scripts that are included in the payer's formulary do you REALLY think "we..the prescribers" have to obtain authorization on EVERY script we write?? yikes...thank God we don't ..or we would have NO time left to see patients thus...if the drug prescribed on the payer's formulary...no authorization is required...thus NO verification is done(believe me...I write scripts!!) >> >> scheduled meds...sometimes...but routine meds,,never >> >> [quoted text clipped - 47 lines] > You have been notified, of course, about the new Medicare Part D drug > program? at this point ANY Medicare drug plan is a complete joke!! Firstly...one has to PAY for most plans...except maybe those cards that are good ONLY for one manufacturer(which don't do much good!!) the monthly cost I read was $50...times 12 that is $600 per year...read the fine print...at this rate...the MAXIMUM yearly drug benefit is $1500....so you pay $600 to get $1500 a year of coverage...not a good investment!! yes...there is a $600 subsidy that can be added to the above..however the yearly income level for a couple is $16, 363 to qualify....luckily we have more than that...so again..it is worthless.... email me is you want some tips on how I am getting his meds...and yes..it is legal!!!! ps...Statins ALONE can cost $300 a month > http://www.cms.hhs.gov/media/press/release.asp?Counter=1117 > http://www.cms.hhs.gov/medicarereform/drugcard/ [quoted text clipped - 65 lines] >> >> > that it may in fact be happening. People do stupid things >> > sometimes. <Hawk...@sbcglobal.net> wrote: > > <Hawk...@sbcglobal.net> wrote: > >> > [quoted text clipped - 36 lines] > do you REALLY think "we..the prescribers" have to obtain authorization on > EVERY script we write?? No. I said, it depends on the state and the drug. > yikes...thank God we don't ..or we would have NO time left to see patients > > thus...if the drug prescribed on the payer's formulary...no authorization is > required...thus NO verification is done(believe me...I write scripts!!) It's not that I don't believe, it's that your experience is not transferrable to every state. Each of the 50 states, largely through Medicaid, implement their own versions of the laws and regulations governing public medical assistance programs. Those state laws also protect the public health (or, they are supposed to) and govern private insurance payers as well (in some cases). In fact, there is a quiet controversy rumbling as the governors of the states are trying to work together to establish greater conformance from state to state in order to leverage their Medicaid dollars more efficiently and effectively. They plan to present their proposals to Centers for Medicare & Medicaid Services (CMS). > >> >> scheduled meds...sometimes...but routine meds,,never > >> >> [quoted text clipped - 49 lines] > > at this point ANY Medicare drug plan is a complete joke!! Not a very funny joke. > Firstly...one has to PAY for most plans...except maybe those cards that are > good ONLY for one manufacturer(which don't do much good!!) > > the monthly cost I read was $50...times 12 that is $600 per year...read the > fine print...at this rate...the MAXIMUM yearly drug benefit is $1500....so > you pay $600 to get $1500 a year of coverage...not a good investment!! Hmmm. Actually, a $1500 return on a $600 investment would be a very good investment indeed. However, I think your point is that it is not a very good insurance. The annual benefit is capped way too low. > yes...there is a $600 subsidy that can be added to the above..however the > yearly income level for a couple is $16, 363 to qualify....luckily we have > more than that...so again..it is worthless.... Yes, indeed. Needs based programs do seem unfair. It is as if those who don't prepare are rewarded. Meanwhile, those who did everything right, pay until they too have nothing. > email me is you want some tips on how I am getting his meds...and yes..it is > legal!!!! Never fear, I am not on any meds. > ps...Statins ALONE can cost $300 a month That is expensive. And, I certainly do not judge anyone, but in part that is why I am making lifestyle changes now. By modifying my diet and lifestyle I can avoid the need for medication for the time being, perhaps long enough so as not to have to spend so much on drugs in my retirement. I don't know for how long I will be successful, but I am going to try. > > http://www.cms.hhs.gov/media/press/release.asp?Counter=1117 > > http://www.cms.hhs.gov/medicarereform/drugcard/ [quoted text clipped - 65 lines] > >> >> > that it may in fact be happening. People do stupid things > >> > sometimes. > <Hawk...@sbcglobal.net> wrote: >> > [quoted text clipped - 45 lines] > > No. I said, it depends on the state and the drug. ahhh...didn't know you are on Medicaid...yes...their formulary is VERYYYY limited....so auths are required for many many meds those of us who have the "privilege" of paying nearly $20,000 a year for private coverage (no slur on your situation!!) have far more friendly formularies...better be for what we pay...cannot recall when ANY med we take needn't a pre auth...but I understand your point >> yikes...thank God we don't ..or we would have NO time left to see > patients [quoted text clipped - 3 lines] >> required...thus NO verification is done(believe me...I write > scripts!!) again...my experience has been in private med..so different than yours...no offense intended > It's not that I don't believe, it's that your experience is not > transferrable to every state. Each of the 50 states, largely through [quoted text clipped - 72 lines] > > Not a very funny joke. for sure for sure...which is why I found another way'... >> Firstly...one has to PAY for most plans...except maybe those cards > that are [quoted text clipped - 10 lines] > good investment indeed. However, I think your point is that it is not a > very good insurance. The annual benefit is capped way too low. not only that...the way I read it...it is not the FIRST $1500 they cover...but a portion of each script..again..depending upon the price of the drug...one STILL ends up paying at least 50% > > yes...there is a $600 subsidy that can be added to the above..however > the [quoted text clipped - 5 lines] > don't prepare are rewarded. Meanwhile, those who did everything right, > pay until they too have nothing. agreed...it sucks >> email me is you want some tips on how I am getting his meds...and > yes..it is [quoted text clipped - 10 lines] > retirement. I don't know for how long I will be successful, but I am > going to try. good for you... however...after a heart attack..angioplasty..3 stents (that occluded)...and CABG....we tend to follow doc's orders... at this stage of the research...I "have" to believe that the numbers count...tho I may be wrong.. THO...as a 60 year old female...I DID take myself off statins...read all the lit...am losing weight...eating better etc...and had a pristine stress test in Oct prior to my knee surgery unfortunately I cannot change my family history...36 year old brother who died of sudden cardiac death..and Dad with first MI at 57...and dead at 63..... hoping I break the spell!! good luck to you tho!!! >> > http://www.cms.hhs.gov/media/press/release.asp?Counter=1117 >> > http://www.cms.hhs.gov/medicarereform/drugcard/ [quoted text clipped - 75 lines] >> >> >> > that it may in fact be happening. People do stupid things >> >> > sometimes. <Hawk...@sbcglobal.net> wrote: > > <Hawk...@sbcglobal.net> wrote: > >> > [quoted text clipped - 48 lines] > ahhh...didn't know you are on Medicaid...yes...their formulary is VERYYYY > limited....so auths are required for many many meds Umm, no. I am not on Medicaid. I am a moderately successful businessman who happens to be a public speaker in addition to working closely with government and the health care industry. > those of us who have the "privilege" of paying nearly $20,000 a year for > private coverage (no slur on your situation!!) have far more friendly > formularies...better be for what we pay...cannot recall when ANY med we take > needn't a pre auth...but I understand your point State law affects how carriers do business perhaps more than you may realize. > >> yikes...thank God we don't ..or we would have NO time left to see > > patients [quoted text clipped - 142 lines] > lit...am losing weight...eating better etc...and had a pristine stress test > in Oct prior to my knee surgery You took yourself off of statins? Now, that is interesting. What was your approach? > unfortunately I cannot change my family history...36 year old brother who > died of sudden cardiac death..and Dad with first MI at 57...and dead at [quoted text clipped - 82 lines] > >> >> >> > that it may in fact be happening. People do stupid things > >> >> > sometimes. > > You jump to an erroneous and dangerous conclusion. I did not say I do > > this. I don't share my meds. > > Neither. The familiar "you" was not intended to refer to you > personally. I apologize for my lack of clarity. Apology accepted. And I offer an apology for taking it the wrong way. > [...] The copay system is designed to introduce an element > of patient responsibility without introducing undue financial burden. A > person who is not in need of cash assistance might have a $20 copay, > another person who is on cash assistance might have only a $2 copay. With private insurance, the co-pay (normally?) has nothing to do with your financial need. In fact, it's probably inversely related. This year, I selected my co-pay. To get a lower co-pay, I had to pay higher premiums. > You're probably right. It probably does happen. Especially when one of > the patients is conning the doctor for purposes of drug abuse - in > which case, I don't have much sympathy. In that case, neither do I. But how about a father with four sick children and a big co-pay? If it meant the difference between getting antibiotics for some of the child vs all of the children, would your sympathies be different? > I appreciate your response in this matter. You have helped me to see > that it may in fact be happening. People do stupid things sometimes. For children, how much insurance they have is not their choice or their responsibility. And if the children are unlucky enough to have parents who are working but low income, without good insurance, they're the loser. tonywes...@gmail.com wrote: > > > You jump to an erroneous and dangerous conclusion. I did not say I > do [quoted text clipped - 4 lines] > > Apology accepted. And I offer an apology for taking it the wrong way. That was really unnecessary, but it speaks well of you. > > [...] The copay system is designed to introduce an element > > of patient responsibility without introducing undue financial burden. [quoted text clipped - 4 lines] > With private insurance, the co-pay (normally?) has nothing to do with > your financial need. In fact, it's probably inversely related. Financial need only comes into play with public assistance programs. > This year, I selected my co-pay. To get a lower co-pay, I had to pay > higher premiums. True. But, in your case it is probably not a decision of whether or not to eat, but whether or not to save for your children's college fund. There are many who fall through the safety net, but public assistance is supposed to fill in the gaps. > > You're probably right. It probably does happen. Especially when one > of [quoted text clipped - 5 lines] > antibiotics for some of the child vs all of the children, would your > sympathies be different? If you would introduce me to him, then I would help him. I support organized charities, but I am not a great believer in their distribution systems. I believe in the person-to-person type of charity. Anonymity tends to cheat the receiver of the right to feel gratitude and the ability to express appreciation to a real person. Meanwhile, giving money is impersonal and the giver is isolated from the reality of the need as well as the very personal experience of fulfilling a need. Nothing substitutes for personal involvement. > > I appreciate your response in this matter. You have helped me to see > > that it may in fact be happening. People do stupid things sometimes. [quoted text clipped - 3 lines] > who are working but low income, without good insurance, they're the > loser. Yep. Our government has established the State Childrens Health Insurance Program (SCHIP) to target helping children of low income working parents who are uninsured. Unfortunately, it is a difficult program to manage and cannot reach every child in need. > tonywes...@gmail.com wrote: >> > Without a crooked doctor to write the script incorrectly, it would [quoted text clipped - 22 lines] > doctor's office (it may be done electronically). Refills don't need to > be checked unless there is a change in dosage. I had to go back and find your original post on this point pharmacists do NOT validate the original script with the provider's office(and please release that many providers are NOT doctors...but NP and PA providers) if all scripts needed to be verified...the provider would have no time to see patients you MAY be referring to a very new system of electronic "sending " of scripts wherein patients do not receive a paper script...but the order is sent electronically to the pharmacy.. I have collagues all over the US...almost NONE use this system "yet".. just a thought...but HOW would scripts be verified on weekends,,after hours..or when the original prescriber is not available??? how many folks run right to the pharmacy ??? many hold on to the script for days...I know I do having written scripts for 20 years...the ONLY time I hear from a pharmacy is when an error has been made..ie the patient is allergic..I wrote the wrong dose...etc... "pre authorization" is a whole nother story...it is used for meds that are NOT on the patient's insurance formulary...in my experience that occurs maybe 2% of the time >> > they enter the patient's insurance information, the >> > Rx, dose and prescribing provider's ID: the payer's claim payment [quoted text clipped - 32 lines] > I appreciate your response in this matter. You have helped me to see > that it may in fact be happening. People do stupid things sometimes. <Hawk...@sbcglobal.net> wrote: > > tonywes...@gmail.com wrote: > >> > Without a crooked doctor to write the script incorrectly, it would [quoted text clipped - 28 lines] > office(and please release that many providers are NOT doctors...but NP and > PA providers) Correct. It depends on which drug and the presence of a Prospective Drug Utilization Review (ProDUR) alert. It is not a matter of routine practice - and, I mispoke when I said "with the doctor's office." I should have said, it is validated electronically through the patient history on record with the payer. > if all scripts needed to be verified...the provider would have no time to > see patients As it is, providers spend too little time with patients. > you MAY be referring to a very new system of electronic "sending " of > scripts wherein patients do not receive a paper script...but the order is > sent electronically to the pharmacy.. Correct. This system is live and available in some areas. > I have collagues all over the US...almost NONE use this system "yet".. The system is in use. > just a thought...but HOW would scripts be verified on weekends,,after > hours..or when the original prescriber is not available??? The scripts are checked for the presence of electronic data that validates it - just like ProDUR and Prior Authorizations are done today. The absence of some data does not prevent the script from being approved for the pharmacist to dispense - unless there is a contra-indicated or a negative contra-indicated audit alert. > how many folks run right to the pharmacy ??? many hold on to the script for > days...I know I do Doesn't matter. > having written scripts for 20 years...the ONLY time I hear from a pharmacy > is when an error has been made..ie the patient is allergic..I wrote the > wrong dose...etc... Yep. That is not likely to change. > "pre authorization" is a whole nother story...it is used for meds that are > NOT on the patient's insurance formulary...in my experience that occurs > maybe 2% of the time <<snip>> Agreed. However, some states have taken notice to the fact that they can use ProDUR alerts - enforced by boards and supported by legislation - to further their control in attempts to control costs. The board's decisions bind not only public health programs, but can extend to other payers. This authority is not uniform across the states. Up until now, the federal government and federal agencies, the state governments and state agencies have not done the best job at creating conformance across the states. We now believe that the lack of uniformity is an impediment at trying to get a handle on health care expenditures. It is not always clear to me whether legislation ameliorates the problem or exacerbates it. HIPAA has cost us billions of dollars, and will cost us billions more. -elgoog, still learning "Sto ancora imparando (I am still learning)" - Michelangelo > <Hawk...@sbcglobal.net> wrote: >> > [quoted text clipped - 44 lines] > should have said, it is validated electronically through the patient > history on record with the payer. ahhhhh....guess we were arguing apples and oranges here!! of course your above statement is true.....however your use of the word "validated" implied (to me,,incorrectly) that somehow the PRESCRIBER would be contacted to do the validating... what you meant (sorry)...is that the payor/insurance company is electronically "contacted" to make sure the drug is a/in their formulary b/ has not been filled in the recent past...usually 30 days and c/that the drug has no contraindications,,,for this patient..ie does not interfere with other drugs he takes,,,or d/ this patient has not been " flagged" in the realm of controlled substances.... all of this is of course done electronically...but it is a function between the insurer/payor and the pharmacist...by this time..the "writer" of the script is totally out of the loop a separate issue of course is the pharmacist calling the prescriber (me!!) if he discovers an allergy,,dosage error..or that the patient has had scripts filled for this med way sooner than is logical... >> if all scripts needed to be verified...the provider would have no > time to >> see patients > > As it is, providers spend too little time with patients. don't get me started on THAT!!! Personally I am lucky to have a doc who spends as MUCH time as he/we need...not uncommon for him to be in the exam room for 30 minutes!!! and he returns my phone calls HIMSELF....what a luxury >> you MAY be referring to a very new system of electronic "sending " of > [quoted text clipped - 3 lines] > > Correct. This system is live and available in some areas. actually what I meant to point out...that this "system" will most likely FIRST appear in the matter of controlled substances...in this state CAlif...we were one of the last 7 states to have "triplicates"...three copy special script blanks ......now we have a special "unable to alter" type holographic blanks...however...still done by writing on a piece of paper,,,,handing piece of paper to patient..patient hands piece of paper to pharmicist...this is not electronic in any shape or form.... the practices I know of and have worked in...are barely getting to electronic medical records!!!! ie...labs,, and diagnostic stuff auto delivered to provider's computer...being able to dictate or type patient encounter notes which are then incorporated into a permanent record... none of know of...and this is a very up to date area...is yet transmitting scripts to pharmacists.. remember that also involves the prescriber knowing WHERE to send the script!!! we probably have 100 pharmacies around here....not to mention that many mail order their meds...with our company..that entails mailing in that piece of paper called a script!!! progress!!! slow >> I have collagues all over the US...almost NONE use this system > "yet".. [quoted text clipped - 10 lines] > approved for the pharmacist to dispense - unless there is a > contra-indicated or a negative contra-indicated audit again..apples and bananas...what you describe is not validating a script...but validating that the holder of the script actually has a way to pay for it!!.....and yes..of course...other data are in the system... again...the writer of the script is NOT contacted ..electronically or otherwise...to validate every script we write....yikes alerw many folks run right to the pharmacy ??? many hold on to the > script for >> days...I know I do [quoted text clipped - 21 lines] > decisions bind not only public health programs, but can extend to other > payers. This authority is not uniform across the states. again...apples and bananas....if I write for drug A...and the pharmacist discovers it is not on the patient's formulary...he WILL call me...and we will decide upon an alternative....OR the patient can PAY for a drug they think they need...which doesn't happen that often!! a private practice may deal with dozens of different formularies..gotta admit that as a provider I do NOT spend the time to look up each med I write for...and make sure it is covered...if it is not..I will hear from the pharmacist...HE has the magic computer that will tell him in seconds if said drug is covered or not...the providers do NOT have access to drug formulary databases..what we get is a list..or a book of covered meds...usually is outdated by the time it is printed!!! of course some programs..such as Medicaid..have much more limited formularies...thus pre auths are more common then..also a huge pain in the *ss!!!....ah my older days of needing TAR's for nearly everything!!! (treatment authorization request...may be a new name for our state's system by now!!)... >> Up until now, the federal government and federal agencies, the state > governments and state agencies have not done the best job at creating [quoted text clipped - 7 lines] > > "Sto ancora imparando (I am still learning)" - Michelangelo <Hawk...@sbcglobal.net> wrote: > > <Hawk...@sbcglobal.net> wrote: > >> > [quoted text clipped - 64 lines] > a separate issue of course is the pharmacist calling the prescriber (me!!) > if he discovers an allergy,,dosage error..or that the patient has had > scripts filled for this med way sooner than is logical... > >> if all scripts needed to be verified...the provider would have no [quoted text clipped - 27 lines] > the practices I know of and have worked in...are barely getting to > electronic medical records!!!! ie...labs,, and diagnostic stuff auto > delivered to provider's computer...being able to dictate or type patient > encounter notes which are then incorporated into a permanent record... [quoted text clipped - 3 lines] > > remember that also involves the prescriber knowing WHERE to send the > script!!! we probably have 100 pharmacies around here....not to mention > that many mail order their meds...with our company..that entails mailing in [quoted text clipped - 22 lines] > > again...the writer of the script is NOT contacted ..electronically or > otherwise...to validate every script we write....yikes > [quoted text clipped - 52 lines] > > > > "Sto ancora imparando (I am still learning)" - Michelangelo Errr... yes, everything you said. Just one comment about the audits applied against the pharmacist's claim usually before dispensing the drug. A primary objective of the DUR alert system is to warn the pharmacist about drug interactions - not just payment, although payment is a significant portion as well. The alert audits check the patient's history for other drugs recently dispensed, for other diags; there are contra-indicated audits (the drug is not allowed due to something on history) and negative contra-indicated (the drug is not allowed due to the abscence of something on history). Your state's DUR board sets policy and determines alerts to be set for public assistance (MediCal). In your state, some insurer's DUR boards rely upon the state's policies to set their own. In other states, the state DUR board is able to set policies that insurers must follow. But, it is a minor difference - and in practice no difference at all since 99 percent of the time the insurers follow state policies. Now, the interesting thing, you would think the policies would be the same from state to state - after all its based on science, right? Well, some of it is and some of it isn't. Maybe we can fix it. > <Hawk...@sbcglobal.net> wrote: >> > [quoted text clipped - 270 lines] > > Maybe we can fix it. errr...yes to your reply!! policies same from state to state?? why should drug stuff be any different from everything else (sarcasm intended!!) I thought our Constitution placed state's rights over Federal?? and why make things easy..logical..etc etc...what would our legislators do with their spare time?? (sarcasm intended) actually I am glad to hear that more detailed data is provided by drug "computers'.....all the help we can get...as a lowly practioner..I am an NP..even reading journals non stop..it is impossible to keep up...so drug interactions and the like is a total headache...not to mention that in the clinical trial and review of new drugs enterprise...only two drugs are tested for "combination issues"...totally makes it impossible with the polypharmacy esp in the older folks... interesting discourse...I have enjoyed it!! <Hawk...@sbcglobal.net> wrote: <<snip priori length>> > errr...yes to your reply!! > [quoted text clipped - 14 lines] > > interesting discourse...I have enjoyed it!! Being wrong once in a while helps me to learn. Thank you. Which national newspaper? Give us a link to your last story please, and your editor's name and e-mail address. Zee > I am a reporter at a national newspaper researching a story about > pepole who share prescription drug medications to deal with rising drug > costs. Doctors and researchers say the elderly and chronically ill are > doing this most. Is there anyone who is doing this? Thanks. Dan. > danieljcostello@gmail.com. |
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