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Help needed CVS overnight Rph

Discussion in 'Pharmacy' started by pennidragon, Aug 26, 2016.

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  1. doublehh03

    doublehh03 Senior Member 10+ Year Member

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    Yes. And it's in the backroom now LOL.
     
    catalyzt and ldiot like this.
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  3. Apotheker2015

    Apotheker2015 2+ Year Member

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    That was EXACTLY her thought process. When I was an intern same thing happened. Pharmacists would not clean up after themselves. I would just leave them there. All I am saying is that if you are missing a limb, a hand or a few fingers and aren't able to, ask me kindly and I will likely do it once I have a chance. The Rphs that were at that store are floating now and that PIC got demoted to staff at a store that's really out of the way for her.
     
  4. Apotheker2015

    Apotheker2015 2+ Year Member

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    My drop off pet peeve... Technicians accepting scripts for C-IIs and promising a time without consulting with me. I always tell them to ask them for ID first and make a copy of it and then call me. I'll screen the script, the patient and decide if I'm to accept it. I still have to check the PDMP, etc.
     
    swatchgirl likes this.
  5. ldiot

    ldiot

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    Lol I'd get punched if I bother the pharmacist with every C2. They tell me to screen them myself, but regardless I can have it typed and in front of them before they would have time to walk over to drop off anyways. I've seen floaters do this and it was just annoying. My store won't hesitate to deny a narc but it's just a matter of workflow. But either way I'll do things however the pharmacist that's there wants... so if that's what they want then that's what I do they run the show as far as I'm concerned lol.
     
  6. doublehh03

    doublehh03 Senior Member 10+ Year Member

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    +1. I have CURES open at all times. Before even typing a C2 script (or any controls if a new or suspicious pt), the rph on duty has to cures the patient before anything else. And that rph would also determine the wait time (usually 1 hour at most if it's busy).
     
  7. zelman

    zelman 7+ Year Member

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    I think it prints both times.
     
  8. maria1oh

    maria1oh 7+ Year Member

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    There were some nights so bad at cvs the techs would turn away all drop offs or tell them it won't be ready until tomorrow morning. Also some nights they would turn away all c2s. Somehow always seemed to do over 3000/week despite this poor customer service.
     
  9. Apotheker2015

    Apotheker2015 2+ Year Member

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    I can only speak for the two states I am familiar with and in those two, the law does not allow pharmacy technicians to determine the legality of the prescription order.
     
  10. zelman

    zelman 7+ Year Member

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    I believe only a judge can technically do that.
     
  11. ldiot

    ldiot

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    I thought the same thing until I went to file the small stack of oddballs that have accumulated and none were duplicates. I was previously throwing them out too because I thought the same thing. Strange.
     
  12. ldiot

    ldiot

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    Technically the pharmacist is going to look at the script anyways so I'm more or less just filtering out the obvious ones that are 2 weeks early for for out of towners/out of state doctors, people that are walking into the pharmacy in a string bikini with a script for 500 methadone, etc.
     
  13. Apotheker2015

    Apotheker2015 2+ Year Member

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    I get it and if that's fine with your pharmacists, go for it. It does not work for me because I am the one who has to tell the person I will not fill after you kindly give them a promised time. It takes an extra minute but I also like to "meet" those people that you screen out. By doing that, I tacitly let them know I won't become their "candy man" ever AND I make a mental note of them. Pharmacists are also supposed to communicate with other pharmacies in the area alerting them of patients running around with a forged script. I also like to xerox it and call the prescriber, and let them know. All those extra steps drive the message to the Oxyheads, I won't reward their behavior. Then they won't think that if they don't see you there and they see me there, that there is a chance I won't remember them. Oh, I will. That's why patients rarely try to pull any stunts on me. Keeps them out of my pharmacy. No legitimate medical purpose = get the hell out of my pharmacy and don't come back.

    If they've filled with us before, I like to add a detailed note to their profile and hopefully, people within the chain will read it. If they've never filed with us and I REALLY don't want them to come back, I take the script, create the profile and then add the note on why I am not filling it.

    Have you noticed how the second the pharmacist refuses to fill the script, they immediately start texting? I call that the "Twitter feed". They all communicate with each other. We are all exchanging opinions here and I am, of course, not actually disagreeing with you because if I were, I'd be telling you what the right way is or how to practice pharmacy. That's not up to me. It simply does not work for me. What I'm doing keeps them out. Eventually the word gets out and those people and their Twitter friends know to not bother.
     
    swatchgirl likes this.
  14. ChalupaBatman86

    ChalupaBatman86 2+ Year Member

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    Are you a pothead Focker?
     
  15. Apotheker2015

    Apotheker2015 2+ Year Member

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    LOL
     
  16. ldiot

    ldiot

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    Just out of curiosity, do you give the patient a reason why you aren't filling it or do you just stick to the "I'm not comfortable filling it end of story" type response? Sometimes I see new patients who straight up look cracked out, but after checking state database everything checks out and they aren't early or anything. You can tell them that you aren't comfortable filling it but what can you possibly respond with when they ask why? From my understanding you don't technically have to tell them but just repeating "I'm just not comfortable filling it" tends to escalate the situation to the point that some of these people literally flip out. I personally only filter out the people that have a distinct reason (e.g. too early, out of state) because it's not my call to tell them that the pharmacist isn't comfortable filling it. I just give the pharmacist a heads up and let them make the call but I'm just wondering how you handle this conversation when it arises.
     
    Last edited: Aug 31, 2016
  17. Apotheker2015

    Apotheker2015 2+ Year Member

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    I always present them with the Spiel the company wants us to say. It should be on your training manual or online modules. I dont say why. I have them read it
    that way there is never a doubt about what I said or did not say. They can't say I said something I did not say. I give them a copy of the Spiel and that's it. And yes, you dont have to say why. Most people who want to know why and you tell them the DEA # is not valid, then they want to know how to figure out.

    No is a complete sentence.
     
  18. ldiot

    ldiot

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    Yeah I'll def have to print that off
     
  19. Apotheker2015

    Apotheker2015 2+ Year Member

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    I would let the pharmacist make that call, though. It's just easier to use the company's words when refusing to fill a dubious prescription. I found one of the 2 disclaimers I used to have handy. By saying "I am not comfortable accepting this prescription", you are conveying many things patients can misconstrue, complain to corporate and then have someone in a suit, without a PharmD, tell you that you have to apologize and fill it for the "customer" or "guest", depending upon whose Kool Aid you are drinking. You're saying "I wont fill it but maybe another staff pharmacist might when Im not here". You're also saying "I'm judging your appearance and the likelihood of your prescription being altered or forged, is quite high". So stay away from all that and sit behind the law and company policy.

    Here you go:

    "Pharmacists should not fill a prescription if they have reason to doubt that the practitioner has issued a prescription for a legitimate medical purpose in the course of a legitimate doctor/patient relationship, regardless of whether the prescription is otherwise “valid” on its face.
    It is illegal for a pharmacist to knowingly dispense a controlled substance pursuant to an invalid prescription. This includes prescriptions that:
    · are not issued for a legitimate medical purpose by a practitioner acting in the usual course of their professional practice.
    · Do not meet the technical requirements for a controlled substance prescription
    · Violate limitations on oral, facsimile or electronic prescribing
    · Appear to have been altered, forged or copied.
    A pharmacy colleague who violates state or federal law or who fails to take steps to verify a prescription when there is a reason to believe it is not valid and, instead fills the questionable prescription can be prosecuted criminally and/or lose his or her professional license in addition to being subject to disciplinary action by CVS/pharmacy up to and including termination of employment. If the prescription cannot be verified, it cannot be filled.
    If a pharmacist is unable to verify the prescription with the prescriber, or after speaking with the prescriber’s office believes, in the exercise of his or her professional judgment, that a prescription is forged, altered, or otherwise invalid, the Pharmacist must not dispense it."
     
    swatchgirl likes this.
  20. ldiot

    ldiot

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    Honestly if I said that the person would just demand the pharmacist call their doctor to confirm the script. Then you have to either refuse to call the doctor, or call the doctor and still refuse to fill it. Either way you just waste more time talking to the patient and increase the chance of them losing their cool. Just to clarify I don't make this call, only filter out the ones with a quantitative reason (too early, out of state, etc.)
     
  21. 6GodPharm

    6GodPharm

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    C2's are easy. Check the profile, and if it's my patient I fill it. I don't fill anything over #180 and it MUST go through INSURANCE. I don't care if it's norco #10 and you want to pay cash. If you don't fit the criteria we are out. Come check in 2 weeks when we get another order. That ends the discussion right there. So many people complicate C2's. Checking cures on every C2 patient is ridiculous and then some people wonder why you have stuff in red and can't meet metrics. We have a million things to do. Just be smart about your tasks and you can get stuff done.

    We had a overnight pharmacist when my store went through construction last year. No store wanted her so she became a overnight pharmacist to sit and watch construction. She told me how thorough she was on C2's and how she would explain how uncomfortable she was to patients and how some patients would take up 20 min in explanations lol. She was a weirdo who would check every C2 for about 15 minutes while everything is going red around her and people are waiting for scripts, flu shots, voicemails and DR offices on hold.
     
  22. Sine Cura

    Sine Cura 10 seconds or less 7+ Year Member

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    Those CII rules are quick and easy but some companies explicitly forbid arbitrary quantity limits, categorical denial of out of state, or mandatory insurance so you have to waste time going through the charade of practicing corresponding responsibility. I myself have gotten flack for 1 day early so YMMV

    Also be aware that the CA BOP has investigated complaints about claimed out of stock for people whose scripts you don't want to touch. They have requested invoices and counts around the time of claimed out of stock demonstrating attempts to order and true out of stock situation etc. Most patients don't want to waste time complaining (vote with your wallet please) but it only takes one jackass to make your life more inconvenient.

    At the end of the day, "If a pharmacist is unable to verify the prescription with the prescriber, or after speaking with the prescriber’s office believes, in the exercise of his or her professional judgment, that a prescription is forged, altered, or otherwise invalid, the pharmacist must not dispense it." Chains should not be able to touch you for your "belief" if you go through the charade. Remember that any pill mill prescriber can get California security prescription forms pretty easily. Put a fake address or P.O. box on there, your own cell phone number, and go to town.
     
    catalyzt likes this.
  23. doublehh03

    doublehh03 Senior Member 10+ Year Member

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    Just FYI I've caught many "regular" patients fill narcotics through insurance at the "home" store and cash it out at independents or other pharmacies. When I first took over my current store, the store would routinely fill #120 norco 10 for a regular customer with other maintenance meds. But b/c I was new at the store so I CURED her just b/c, and notice that she picks up another #120 in 2 weeks increments at an independent.

    You must be diligent with CURES b/c it's the easiest method to determine whether to accept or deny. It's not us pharmacists trying to complicate C2s, but many people know the system. Keep the CURES website open and it doesn't take that long.
     
    6GodPharm likes this.
  24. ldiot

    ldiot

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    Yeah I'm not graduated yet but I'm thinking:

    1) Can't be early
    2) Can't be out of state doctor or patient, or significantly far away in-state
    3) Holy trinity or Adderall + Xanax combos are going to have to be for a damn good reason
    4) Don't look high
     
  25. 6GodPharm

    6GodPharm

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    Thanks for the heads up i'll def look into that
     
  26. Apotheker2015

    Apotheker2015 2+ Year Member

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    Nah, that phrase was straight out of the statutes.
     
  27. zelman

    zelman 7+ Year Member

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    That techs cannot, or that pharmacists can?
     
  28. Apotheker2015

    Apotheker2015 2+ Year Member

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    *
    I guess Idiot is a pharmacy intern. Then, sure, either a pharmacist or pharmacy intern may determine the legality of a prescription. *Legality: the quality or state of being in accordance with the law".

    A technician should not make the call to turn down dubious prescriptions. The law does not allow that within the scope of practice of pharmacy technicians. That's all I am saying.
     
  29. Apotheker2015

    Apotheker2015 2+ Year Member

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    YUP... day pharmacists will tell patients medications are out of stock before refilling the cell in the script pro.
    I get it that somehow RX sups believe that there's all this time after midnight to refill the cells. Sure, no problem. However, the script-pro does top 200 drugs for you which makes their daytime job cake. If a cell runs out, you refill it. That's it. You don't create all this extra work for everybody because only the overnight RPH is supposed to.
     

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