Help

[Xarelto-10]

I have been a pharmacist for a while and recently went back to the three letter Come Satan company. Recently got moved up to PM position. I have a tech that’s out right bullying me into doing stuff I’m not comfortable with. Here is what I mean.

I had an rx for C-II for a 29 y/0 who’s been on the Med for about 2 years. While processing the script Insurance rejected it for PA. I faxed it to MD as per standard procedure. The tech in question was not around at the time. Then pt called an I explained that we were waiting for PA approval. Then tech got involved and in a demeaning and time in front of customers started questioning me why I did what I did. She went on patient had been a cash paying for her pain meds and doesn’t want her claims to go through insurance. Tech went on to say pt also pays cash to MD to avoid insurance. I thought the whole thing is questionable including a 29 y/0 being on long term pain med.

I called pts insurance who said PA is needed. Called corporate and they said the same. But the tech continued to pressure me to fill the script for cash regardless. After I heard a barrage of insults and so forth from pt, I finally filled the script as a once and last time, to avoid pt from potential withdrawal, and told pt next time it has to go through PA or I won’t fill future script.

I then followed up to docs office and future prescriptions for pt must go through PA or not to send C-2 script to me. The tech keeps at it and in condescending tone she said “why do you ask the doc not to send script?”

I don’t know what to make of this. Clearly I feel it is bullying and interfering in my decision making.
Question:
1. How do you deal with a tech like that. Who wouldn’t understand despite of me taking time to explain my side but keeps pressuring me doing stuff I’m not comfortable with?

2. Am I being in the wrong for refusing to fill in this scenario?

3. How do you deal with cash paying customers for control substances with or out insurance ?

🙏

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[JustFillIt]

1) Just don’t tell them your reasoning. Do not have that conversation. The decision has been made and you are the one to make it. Just put a lid on it after that. Make it clear its a decision, not a conversation. But, you appreciate their input of course…

2) Nah - your not in the wrong. I haven’t dispensed a controlled for many years so I am a little disconnected - but if it is standard of practice to refuse without insurance involvement/authorization then your just fine.

3.) I don’t…. But back in my day I would check the state PMP and do it if there are not issues, or refuse it if there was overlap. I would print and document the associated PMP data to prove just in case.

 

[Dred Pirate]

tell the tech to pound sand and stay in their lane,

I appreciate a good tech as much as anyone without them we sink, but everyone has to know their roll (this is including pharmacists as I often see some who also don't know when to stay in their lane)

 

[Xarelto-10]

1) Just don’t tell them your reasoning. Do not have that conversation. The decision has been made and you are the one to make it. Just put a lid on it after that. Make it clear its a decision, not a conversation. But, you appreciate their input of course…

2) Nah - your not in the wrong. I haven’t dispensed a controlled for many years so I am a little disconnected - but if it is standard of practice to refuse without insurance involvement/authorization then your just fine.

3.) I don’t…. But back in my day I would check the state PMP and do it if there are not issues, or refuse it if there was overlap. I would print and document the associated PMP data to prove just in case.

I appreciate your input. Yes I did check PDMP and didn’t find an issue there.

 

[Xarelto-10]

tell the tech to pound sand and stay in their lane,

I appreciate a good tech as much as anyone without them we sink, but everyone has to know their roll (this is including pharmacists as I often see some who also don't know when to stay in their lane)

I tried to deplomatically say that to the tech as well as plainly that it is mud duty and judgement. I hate to escalate this situation but tech was literally having pt stand at pick up while trying to confront me about the whole situation without me even knowing it was the patient at the pick up she was confronting me about. Tech was physically irritated with my decision I felt so uncomfortable. I appreciate your input and thank you.

 

[JustFillIt]

I appreciate your input. Yes I did check PDMP and didn’t find an issue there.

I never considered it my business if they pay cash, insurance, or whatever the heck.

I just made sure to do my due diligence to check their history and if I was not concerned with their history, and the Rx was legitimate, I would just fill it.

However - I stopped dispensing in 2018…. Not sure if what you describe is a rule or not..

 

[Dred Pirate]

I tried to deplomatically say that to the tech as well as plainly that it is mud duty and judgement. I hate to escalate this situation but tech was literally having pt stand at pick up while trying to confront me about the whole situation without me even knowing it was the patient at the pick up she was confronting me about. Tech was physically irritated with my decision I felt so uncomfortable. I appreciate your input and thank you.

not that I necessarily recommend this - but sometimes you have to bully the bully - and stand up for yourself. For example I had a tech once who used to always try to bully and intimate the pharmacists that rotated through the IV room. Once she was giving me some slack about something (I honestly can't remember what it was- but I was having some outside of work personal things going on)- but I just looked at her in the face and said "Today isn't the day to f^&# with me, just do what I tell you to". After that I had no issues ever with her -until a year later she got fired for leaving early without permission when I was the IV rph again.

 

[Dred Pirate]

I never considered it my business if they pay cash, insurance, or whatever the heck.

I just made sure to do my due diligence to check their history and if I was not concerned with their history, and the Rx was legitimate, I would just fill it.

However - I stopped dispensing in 2018…. Not sure if what you describe is a rule or not..

I haven't dispensed since probably 2012 so take this with a grain of salt - but cash payments is a red flag, but it is not an absolute no-no if you do your due diligence. With the PMP's now, you can find most issues (at least I do in the ED when there is a question). But inisiting on paying cash should at least send up your spidey sense.

 

[owlegrad]

It’s possible the PA won’t be approved and then you are back to square one. Personally I wouldn’t be so concerned about paying cash in that case.

Having said that do not put up with that tech for a second. It isn’t up to them which scripts you fill and if they aren’t there to support you then what’s the point of them?

 

[mentos]

If the PMP looks legit and fill history shows they paid with cash then just fill it.

You are the pharmacist, don't let a tech bully you. This is why people call pharmacists door mats.

 

[Xarelto-10]

I haven't dispensed since probably 2012 so take this with a grain of salt - but cash payments is a red flag, but it is not an absolute no-no if you do your due diligence. With the PMP's now, you can find most issues (at least I do in the ED when there is a question). But inisiting on paying cash should at least send up your spidey sense.

Yes that’s how I feel about patients insisting on cash for control meds. Even Come Satan has module where they have you take that cash payment, long term opioid therapy and younger age qualify as red flags. When I explained my decision at the beginning to my DM- he was supportive. But, the tech keeps escalating it and I don’t know if this is something I can do ethics line complains about or not. I just feel this is clearly my secession but hate to escalate it to where s/he muddles this into a problem for me.
Even the first day this came up, said tech was so upset left work without notifying me. I later found out from another tech what had happened and why tech left.
Said tech makes schedule and doesn’t even let me know when s/he will show up. I’m new to being PM and don’t want to make waves but this is getting messy. DM is out on vacation and hate to bring it up with a temp DM.

 

[Xarelto-10]

If the PMP looks legit and fill history shows they paid with cash then just fill it.

You are the pharmacist, don't let a tech bully you. This is why people call pharmacists door mats.

Thanks for your reply. I do feel a door mat indeed.

 

[Xarelto-10]

It’s possible the PA won’t be approved and then you are back to square one. Personally I wouldn’t be so concerned about paying cash in that case.

Having said that do not put up with that tech for a second. It isn’t up to them which scripts you fill and if they aren’t there to support you then what’s the point of them?

I appreciate your response. My concern is why would the MD avoid PA. A 29 yo being on long term opioid therapy. Although there might be exceptions to the rule. I also think there is a reason why these checks and balances are in place- to ensure pt safety and Pt/MD avoiding them seems to circumvent them.

 

[JustFillIt]

If the PMP looks legit and fill history shows they paid with cash then just fill it.

You are the pharmacist, don't let a tech bully you. This is why people call pharmacists door mats.

Exactly - the “due diligence” is in the pmp history itself. How they pay tells us nothing and just opens the door to speculation…

There could be a million reasons why they are paying cash and I really don’t care. It just tells me to look at their local/state history a little closer. And if they have out of state records - I would not hesitate to ask how long they have been taking the drug and they inevitably say, “oh forever”.. Then I would reply, “oh good where was the last place you filled. Then I would call the rph there and ask about history.

 

[rickyroxy]

If the PMP looks legit and fill history shows they paid with cash then just fill it.

You are the pharmacist, don't let a tech bully you. This is why people call pharmacists door mats.

NO you just don't "FILL" it. Don't ever tell that to a retail pharmacist. If if was me I would not just "fill" it. This is the kind of mentality that has brought on opioid epidemic. There is a reason its called Corresponding Responsibility. Just because its been happening in past is not the reason to continue happening in future. Pharmacist are not Door mats. If you can not respect your fellow colleague, don't practice to be a pharmacist. This is the reason there is no pharmacist union. Just bitching on each other will not get you anywhere. End of rant.!

 

[rickyroxy]

I have been a pharmacist for a while and recently went back to the three letter Come Satan company. Recently got moved up to PM position. I have a tech that’s out right bullying me into doing stuff I’m not comfortable with. Here is what I mean.

I had an rx for C-II for a 29 y/0 who’s been on the Med for about 2 years. While processing the script Insurance rejected it for PA. I faxed it to MD as per standard procedure. The tech in question was not around at the time. Then pt called an I explained that we were waiting for PA approval. Then tech got involved and in a demeaning and time in front of customers started questioning me why I did what I did. She went on patient had been a cash paying for her pain meds and doesn’t want her claims to go through insurance. Tech went on to say pt also pays cash to MD to avoid insurance. I thought the whole thing is questionable including a 29 y/0 being on long term pain med.

I called pts insurance who said PA is needed. Called corporate and they said the same. But the tech continued to pressure me to fill the script for cash regardless. After I heard a barrage of insults and so forth from pt, I finally filled the script as a once and last time, to avoid pt from potential withdrawal, and told pt next time it has to go through PA or I won’t fill future script.

I then followed up to docs office and future prescriptions for pt must go through PA or not to send C-2 script to me. The tech keeps at it and in condescending tone she said “why do you ask the doc not to send script?”

I don’t know what to make of this. Clearly I feel it is bullying and interfering in my decision making.
Question:
1. How do you deal with a tech like that. Who wouldn’t understand despite of me taking time to explain my side but keeps pressuring me doing stuff I’m not comfortable with?

2. Am I being in the wrong for refusing to fill in this scenario?

3. How do you deal with cash paying customers for control substances with or out insurance ?

🙏

You did the right thing. Never ever let your tech dictate your professional judgement. This is a classic case where you keep grudge on that tech and write them up for smallest mistake to keep then in line and not to cross their line of being a tech. I have had my share of those bullying techs. They will only respect another bully. So be a bully and give it back to them to show their place. You have to do it only once and then they will know who is the boss in the house and will start respecting you. Just little things you have to do to mark your territory.

 

[mentos]

NO you just don't "FILL" it. Don't ever tell that to a retail pharmacist. If if was me I would not just "fill" it. This is the kind of mentality that has brought on opioid epidemic. There is a reason its called Corresponding Responsibility. Just because its been happening in past is not the reason to continue happening in future. Pharmacist are not Door mats. If you can not respect your fellow colleague, don't practice to be a pharmacist. This is the reason there is no pharmacist union. Just bitching on each other will not get you anywhere. End of rant.!

I am not disrespecting my colleague. I called him a doormat because he is getting bullied by a subordinate technician. I'm telling him not to let that happen and to stand up for himself. He works at CVS where there are hundreds of scripts filled like this everyday. If you did due diligence like this for every single one, then there'd literally be no time for anything else.

 

[rickyroxy]

Exactly - the “due diligence” is in the pmp history itself. How they pay tells us nothing and just opens the door to speculation…

There could be a million reasons why they are paying cash and I really don’t care. It just tells me to look at their local/state history a little closer. And if they have out of state records - I would not hesitate to ask how long they have been taking the drug and they inevitably say, “oh forever”.. Then I would reply, “oh good where was the last place you filled. Then I would call the rph there and ask about history.

This is not the way you resolve red flags. There is process involved just in case you have not practiced retail in a while. You call Dr's office to get diagnosis. Ask for prognosis and detailed notes of treatment. Ask for MRI and date when it was done. If it was more than a year ago then its a concern. Talk to the patient. Find out their story and reasoning behind paying cash. Let them trust you and see if they are genuine or just a doucebag. You will see them every month if you decide to entertain them so let them know who is in charge and not to be overly demanding. Once you set these parameters, they will start respecting you and will come looking for you every month. You will replace loyalty for they had for tech to you.

 

[rickyroxy]

I am not disrespecting my colleague. I called him a doormat because he is getting bullied by a subordinate technician. He works at CVS where there are hundreds of scripts filled like this everyday. If you did due diligence like this for every single one, then there'd literally be no time for anything else.

Don't tell me you never got bullied by your tech. There are not hundreds of scripts filled like this every day at CVS. There are hundreds of scrips filled every day at all retail pharmacies not just CVS. Having not time is not an excuse not to do due diligence. You just have to do it first time when you are establishing your rapport. You document everything and then go from there. Don't know why it is such a hard thing to do or to be scared off. At least now a days corporate won't question your due diligence and proper documentation. You have to gain respect. Just having pharmacist title won't get you that.

 

[Chrish]

I have been a pharmacist for a while and recently went back to the three letter Come Satan company. Recently got moved up to PM position. I have a tech that’s out right bullying me into doing stuff I’m not comfortable with. Here is what I mean.

I had an rx for C-II for a 29 y/0 who’s been on the Med for about 2 years. While processing the script Insurance rejected it for PA. I faxed it to MD as per standard procedure. The tech in question was not around at the time. Then pt called an I explained that we were waiting for PA approval. Then tech got involved and in a demeaning and time in front of customers started questioning me why I did what I did. She went on patient had been a cash paying for her pain meds and doesn’t want her claims to go through insurance. Tech went on to say pt also pays cash to MD to avoid insurance. I thought the whole thing is questionable including a 29 y/0 being on long term pain med.

I called pts insurance who said PA is needed. Called corporate and they said the same. But the tech continued to pressure me to fill the script for cash regardless. After I heard a barrage of insults and so forth from pt, I finally filled the script as a once and last time, to avoid pt from potential withdrawal, and told pt next time it has to go through PA or I won’t fill future script.

I then followed up to docs office and future prescriptions for pt must go through PA or not to send C-2 script to me. The tech keeps at it and in condescending tone she said “why do you ask the doc not to send script?”

I don’t know what to make of this. Clearly I feel it is bullying and interfering in my decision making.
Question:
1. How do you deal with a tech like that. Who wouldn’t understand despite of me taking time to explain my side but keeps pressuring me doing stuff I’m not comfortable with?

2. Am I being in the wrong for refusing to fill in this scenario?

3. How do you deal with cash paying customers for control substances with or out insurance ?

🙏

Are they on Medicaid? If not, you can’t really tell pt that they have to run it through the insurance. Of course you can refuse to fill rx if it’s inappropriate dose or drug combination, but it doesn’t have to go through the insurance.

Also, pull tech on side and tell her that if she has question next time, please ask in person instead of arguing in front of the customer. Tell her it doesn’t look good either on you or her.

 

[Chrish]

This is not the way you resolve red flags. There is process involved just in case you have not practiced retail in a while. You call Dr's office to get diagnosis. Ask for prognosis and detailed notes of treatment. Ask for MRI and date when it was done. If it was more than a year ago then its a concern. Talk to the patient. Find out their story and reasoning behind paying cash. Let them trust you and see if they are genuine or just a doucebag. You will see them every month if you decide to entertain them so let them know who is in charge and not to be overly demanding. Once you set these parameters, they will start respecting you and will come looking for you every month. You will replace loyalty for they had for tech to you.

For the love of God, don’t ask for freaking MRI! If you have a concern about the prescription or drug combo, call and ask for diagnosis and see if they are aware of drug interactions. Then if you still don’t feel comfortable, just deny it.

Asking about imaging is just silly. And, you only need one MRI unless it’s something like cancer which is spreading. If someone had an issue with their back, their MRI won’t change after a year.

 

[Chrish]

I am not disrespecting my colleague. I called him a doormat because he is getting bullied by a subordinate technician. I'm telling him not to let that happen and to stand up for himself. He works at CVS where there are hundreds of scripts filled like this everyday. If you did due diligence like this for every single one, then there'd literally be no time for anything else.

Conflict between established tech and a new rph is unfortunately pretty common. Especially when rph doesn’t fully the know the system and have to rely on tech. Some techs do try to take advantage of this situation.

As an rph, knowing how to deal with such situations will only come with experience.

 

[RXDOC1986]

I have been a pharmacist for a while and recently went back to the three letter Come Satan company. Recently got moved up to PM position. I have a tech that’s out right bullying me into doing stuff I’m not comfortable with. Here is what I mean.

I had an rx for C-II for a 29 y/0 who’s been on the Med for about 2 years. While processing the script Insurance rejected it for PA. I faxed it to MD as per standard procedure. The tech in question was not around at the time. Then pt called an I explained that we were waiting for PA approval. Then tech got involved and in a demeaning and time in front of customers started questioning me why I did what I did. She went on patient had been a cash paying for her pain meds and doesn’t want her claims to go through insurance. Tech went on to say pt also pays cash to MD to avoid insurance. I thought the whole thing is questionable including a 29 y/0 being on long term pain med.

I called pts insurance who said PA is needed. Called corporate and they said the same. But the tech continued to pressure me to fill the script for cash regardless. After I heard a barrage of insults and so forth from pt, I finally filled the script as a once and last time, to avoid pt from potential withdrawal, and told pt next time it has to go through PA or I won’t fill future script.

I then followed up to docs office and future prescriptions for pt must go through PA or not to send C-2 script to me. The tech keeps at it and in condescending tone she said “why do you ask the doc not to send script?”

I don’t know what to make of this. Clearly I feel it is bullying and interfering in my decision making.
Question:
1. How do you deal with a tech like that. Who wouldn’t understand despite of me taking time to explain my side but keeps pressuring me doing stuff I’m not comfortable with?

2. Am I being in the wrong for refusing to fill in this scenario?

3. How do you deal with cash paying customers for control substances with or out insurance ?

🙏

I can't help you with the retail pharmacy processes, but I have dealt with Pharm.Techs for over 40yrs. From the time I was an intern at the VA, where the techs ran the place, to now. Always appreciated every techs hard work and dedication to patient care. Haven't been bullied since I was 25yo intern at the VA, although many have tried. The bottom line is, my license is always on the line. I shouldn't have to, and never will "explain" myself to a tech. You must be young. Just make it clear, you Do NOT have to explain anything to the tech. They need to stay in their lane, maybe re-read their Job Description when they report back to HR.. Being a senior citizen, has many advantages, nobody messes with a crazy, old pharmacist.

 

[Xarelto-10]

Are they on Medicaid? If not, you can’t really tell pt that they have to run it through the insurance. Of course you can refuse to fill rx if it’s inappropriate dose or drug combination, but it doesn’t have to go through the insurance.

Also, pull tech on side and tell her that if she has question next time, please ask in person instead of arguing in front of the customer. Tell her it doesn’t look good either on you or her.

Thanks for your response, yes, the patient has Medicaid as insurance. This particular tech seems to enjoy confronting people right in front of customers. Have seen it in the past s/he doing it to another tech.

 

[rickyroxy]

For the love of God, don’t ask for freaking MRI! If you have a concern about the prescription or drug combo, call and ask for diagnosis and see if they are aware of drug interactions. Then if you still don’t feel comfortable, just deny it.

Asking about imaging is just silly. And, you only need one MRI unless it’s something like cancer which is spreading. If someone had an issue with their back, their MRI won’t change after a year.

You must not have practiced in opioid capital of USA. It is a common practice here to ask for MRI. And to your surprise, typical pill mill operation has MRI lab in a van just outside their office and ready to read out impression on the cue. That does give a hint that it is a co-ordinated operation. Genuine PCP would question you why you are asking for MRI.

Have had multiple incidence where office had no prior MRI and just going by patient's response. When I ask them how do they know if it is lumbar radiculopathy at c1-c4, they hang up phone. lol.

 

[Chrish]

You must not have practiced in opioid capital of USA. It is a common practice here to ask for MRI. And to your surprise, typical pill mill operation has MRI lab in a van just outside their office and ready to read out impression on the cue. That does give a hint that it is a co-ordinated operation. Genuine PCP would question you why you are asking for MRI.

Have had multiple incidence where office had no prior MRI and just going by patient's response. When I ask them how do they know if it is lumbar radiculopathy at c1-c4, they hang up phone. lol.

It doesn’t matter. It’s not your job to inquire about MRI. As I said, if you don’t feel comfortable with the script, just deny it.

Pill mills are easy to spot. Multiple scripts for plain Oxy or combination of Norco/ Percs and Soma and benzos etc. I don’t need to ask about imaging in this scenario. I will just tell them to go elsewhere.

By asking about MRI, you are just trying to find excuse not to fill it. Why go through all the trouble? Just say no!

 

[Xarelto-10]

I can't help you with the retail pharmacy processes, but I have dealt with Pharm.Techs for over 40yrs. From the time I was an intern at the VA, where the techs ran the place, to now. Always appreciated every techs hard work and dedication to patient care. Haven't been bullied since I was 25yo intern at the VA, although many have tried. The bottom line is, my license is always on the line. I shouldn't have to, and never will "explain" myself to a tech. You must be young. Just make it clear, you Do NOT have to explain anything to the tech. They need to stay in their lane, maybe re-read their Job Description when they report back to HR.. Being a senior citizen, has many advantages, nobody messes with a crazy, old pharmacist.

I wish that was the case. But I hate tell you that I’m not that young either but not nearly as many years of experience as you do.
Thank you for your input.

 

[RXDOC1986]

I wish that was the case. But I hate tell you that I’m not that young either but not nearly as many years of experience as you do.
Thank you for your input.

Nice thread. Very respectful, helpful exchange of ideas. No negative remarks!
Good luck with everything!

 

[confettiflyer]

Legit question from a hospital pharmacist that doesn’t deal with insurance:

If all aspects of an order are legitimate (PDMP query, drug/quantity, etc…) why would insurance formulary dictate whether a pharmacist approves or denies the physician order?

 

[owlegrad]

Legit question from a hospital pharmacist that doesn’t deal with insurance:

If all aspects of an order are legitimate (PDMP query, drug/quantity, etc…) why would insurance formulary dictate whether a pharmacist approves or denies the physician order?

Not using insurance is considered a red flag for controls. It’s probably leftover from the days before PDMPs existed. I personally don’t think it makes any sense to use this as grounds for filling or not filling.

Especially when anyone who works retails knows how few PAs end up being approved.

 

[KidPharmD]

Not using insurance is considered a red flag for controls. It’s probably leftover from the days before PDMPs existed. I personally don’t think it makes any sense to use this as grounds for filling or not filling.

Especially when anyone who works retails knows how few PAs end up being approved.

I think billing for cash is a good flag to check the PDMP in states where it isn't required on every fill. Otherwise, I think a PDMP with a good fill history is enough to go on and fill.

 

[CetiAlphaFive]

I have been a pharmacist for a while and recently went back to the three letter Come Satan company. Recently got moved up to PM position. I have a tech that’s out right bullying me into doing stuff I’m not comfortable with. Here is what I mean.

I had an rx for C-II for a 29 y/0 who’s been on the Med for about 2 years. While processing the script Insurance rejected it for PA. I faxed it to MD as per standard procedure. The tech in question was not around at the time. Then pt called an I explained that we were waiting for PA approval. Then tech got involved and in a demeaning and time in front of customers started questioning me why I did what I did. She went on patient had been a cash paying for her pain meds and doesn’t want her claims to go through insurance. Tech went on to say pt also pays cash to MD to avoid insurance. I thought the whole thing is questionable including a 29 y/0 being on long term pain med.

I called pts insurance who said PA is needed. Called corporate and they said the same. But the tech continued to pressure me to fill the script for cash regardless. After I heard a barrage of insults and so forth from pt, I finally filled the script as a once and last time, to avoid pt from potential withdrawal, and told pt next time it has to go through PA or I won’t fill future script.

I then followed up to docs office and future prescriptions for pt must go through PA or not to send C-2 script to me. The tech keeps at it and in condescending tone she said “why do you ask the doc not to send script?”

I don’t know what to make of this. Clearly I feel it is bullying and interfering in my decision making.
Question:
1. How do you deal with a tech like that. Who wouldn’t understand despite of me taking time to explain my side but keeps pressuring me doing stuff I’m not comfortable with?

2. Am I being in the wrong for refusing to fill in this scenario?

3. How do you deal with cash paying customers for control substances with or out insurance ?

🙏

What leverage do they have over you?

Are you worried about getting written up by the tech? Do they have incriminating photos?
What gives?


Do you see the point I'm making? The only person allowing them to boss you around is you

 

[dmd20000]

I have been a pharmacist for a while and recently went back to the three letter Come Satan company. Recently got moved up to PM position. I have a tech that’s out right bullying me into doing stuff I’m not comfortable with. Here is what I mean.

I had an rx for C-II for a 29 y/0 who’s been on the Med for about 2 years. While processing the script Insurance rejected it for PA. I faxed it to MD as per standard procedure. The tech in question was not around at the time. Then pt called an I explained that we were waiting for PA approval. Then tech got involved and in a demeaning and time in front of customers started questioning me why I did what I did. She went on patient had been a cash paying for her pain meds and doesn’t want her claims to go through insurance. Tech went on to say pt also pays cash to MD to avoid insurance. I thought the whole thing is questionable including a 29 y/0 being on long term pain med.

I called pts insurance who said PA is needed. Called corporate and they said the same. But the tech continued to pressure me to fill the script for cash regardless. After I heard a barrage of insults and so forth from pt, I finally filled the script as a once and last time, to avoid pt from potential withdrawal, and told pt next time it has to go through PA or I won’t fill future script.

I then followed up to docs office and future prescriptions for pt must go through PA or not to send C-2 script to me. The tech keeps at it and in condescending tone she said “why do you ask the doc not to send script?”

I don’t know what to make of this. Clearly I feel it is bullying and interfering in my decision making.
Question:
1. How do you deal with a tech like that. Who wouldn’t understand despite of me taking time to explain my side but keeps pressuring me doing stuff I’m not comfortable with?

2. Am I being in the wrong for refusing to fill in this scenario?

3. How do you deal with cash paying customers for control substances with or out insurance ?

🙏

The tech most likely knows the patient and they know the patient pays cash all the time because of the PA. I listen to techs at new stores I am not familiar with because calling the doctor is enough so you know the patient has a legit script and is in pain. Paying cash is not always red flag. Calling corporate and the doctor and the insurance is just a waste of time in my opinion. Just calling the doctor alone is enough. If I were you I be nice to the technicians because when I worked retail for years I never had to work alone and the techs were nice to work with.

 

[RXDOC1986]

Legit question from a hospital pharmacist that doesn’t deal with insurance:

If all aspects of an order are legitimate (PDMP query, drug/quantity, etc…) why would insurance formulary dictate whether a pharmacist approves or denies the physician order?

Hospital pharmacist here, never heard of "insurance formulary" before this. Medication is either formulary or non-formulary. We are never engaged with PDMP, drug quantity is always ONE. We only deal with clinical aspects of the ordered medication. If non-formulary, we try to get it changed to formulary alternative, or kick it up to management to deal with inclusion/exclusion of drug.

 

[confettiflyer]

Hospital pharmacist here, never heard of "insurance formulary" before this. Medication is either formulary or non-formulary. We are never engaged with PDMP, drug quantity is always ONE. We only deal with clinical aspects of the ordered medication. If non-formulary, we try to get it changed to formulary alternative, or kick it up to management to deal with inclusion/exclusion of drug.

Yeah, my question was directed to my outpatient/retail brethren. You didn't know an insurance formulary existed before this thread? Sounds like you & your family are super healthy (never had to personally deal with health insurance Rx restrictions/preferred products) and you aren't involved in transitions of care/discharge at your hospital (e.g. new dx DM start on Humalog but tier 1 on pt's insurance in Novolog).

Things got wacky when all the biosimilars came out for onc, RA, etc... and every payer had its own preferred one as formulary, so much for streamlining inventory. Do you guys have an infusion center, and if so, what are your RPh's doing to facilitate this?

Also, you don't live in a state that requires PDMP submission for any ED/OP narc dispenses to home? Do you guys just not do it because you have good 24hr operating pharmacies nearby?

I'm just full of questions today, genuinely curious what other people are doing.