MD guide to RPh

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
The same could be said of Walgreens phone system, where I'm forced to wait 20 minutes listening to a stupid sales pitch about Flu shots.
Here's the difference: I can call a pharmacy while they're open and get a pharmacist eventually. The same is not true of physicians. Further, I can call any pharmacy while they're closed and leave a voicemail. When a physician's office is closed I can usually only talk to an answering service or a recording. It would make life a lot easier if I didn't need to make time while it's busy during business hours to call a doctors office to be told that I can't talk to anyone who can actually help me and that I need to leave a message and could just leave the message when I'm not so busy.

Members don't see this ad.
 
Here's another suggestion...always write for "epinephrine auto injector" instead of "EpiPen". That way we can fill for the generic device that the FDA doesn't technically consider to be a true generic for EpiPen.
 
  • Like
Reactions: 1 user
Members don't see this ad :)
hqdefault.jpg
 
Please don't select "dispense as written" unless you really mean it. And for the love of all that is good, make sure the quantity and frequency of use match. Keflex 500 mg #52 one tid for 10 days, dispense as written, will make pharmacists want to throw a stapler at your head, and ultimately delay the patient getting medication in a timely matter. If you think we make this stuff up, go to the Cynical Pharmacists Facebook page and look at some of the garbage people have shared with him over the years. It's entertaining, yet frightening
 
Last edited:
  • Like
Reactions: 1 user
Please stop writing for concentrated albuterol to be diluted with normal saline. There's a standard (and cheap) solution that's much easier to use that doesn't require dilution. I've stopped calling and just switch this one myself now...
 
  • Like
Reactions: 1 user

Oh sorry, because if you write the generic name then the pharmacist can fill the lone generic product that is cheaper. If you write EpiPen we can no longer substitute the old generic because the FDA has determined that it is no longer considered to be a generic for EpiPen. So then we'd have to call you back to request a change when you probably really don't care which one they get in the first place. At least in my state.
 
  • Like
Reactions: 1 user
Days supply, just put one on there.
 
  • Like
Reactions: 3 users
Make sure test strips, lancets and meter have the SAME FREQUENCY.
I get unmatching frequencys almost on a daily basis.
 
  • Like
Reactions: 1 users
Make sure test strips, lancets and meter have the SAME FREQUENCY.
I get unmatching frequencys almost on a daily basis.

Same topic with Sugar Testing supplies:
Please include the note that implies: Any brand okay.
If you write Brand Freestyle, when insurance changes their preferred brand to be OneTouch, we have pharmacist and techs calling you to waste your time. Just please include the magic note: Any brand okay.

Even better, for Albuterol inhaler, please also include the magic note: Any brand okay. If you write ProAir and insurances changes their preferred brand to Ventolin, we have seen pharmacists and technicians calling you to waste your time.

Why? Why? Why? They say state law requires that any deviation from prescriber's order must be approved by prescriber's office. We have back stabbers in pharmacy too so we can not just cross out what you wrote and simply change to what insurance pays...

So sometimes, for frivolous and stupid changes, we pretend to call you so we don't get stab in the back by our pharmacy co workers. But most of the time, we really call you for stupid changes because you forgot to put the magic words: "Any brand okay". "Tablet capsule okay"
Okay? Please?
:)
Be kind to your assistant, print this and share with all doctors and medical assistants...you know, your people that often clicks the software to send this to us....

or share with your computer programmers to program this in there. And yes, I have seen programed message of Discount Cards with every script so custom repeatable messages can be done in your software.

Thank you for your kindness.
 
  • Like
Reactions: 1 user
Please don't select "dispense as written" unless you really mean it. And for the love of all that is good, make sure the quantity and frequency of use match. Keflex 500 mg #52 one tid for 10 days, dispense as written, will make pharmacists want to throw a stapler at your head, and ultimately delay the patient getting medication in a timely matter. If you think we make this stuff up, go to the Cynical Pharmacists Facebook page and look at some of the garbage people have shared with him over the years. It's entertaining, yet frightening

It's sad how many M.D.s will write "Brand Name Medically Necessary" on prescriptions just because of patient preference.
Not only does it cheapen their profession by turning them into a Yes-man for annoying patients, but this practice wastes HUGE amounts of Medicare's money.

I've got one patient who, over the years, has harassed the staff at her M.D.s office to the point where they'll write "BNMN" and do Prior Auths before prescribing something for the first time.

As a result of allowing this behavior to continue, Medicare spends about $7,000 on her prescriptions every month. Every month.
The generics would've cost Medicare maybe $7-800. Maybe.
 
It's sad how many M.D.s will write "Brand Name Medically Necessary" on prescriptions just because of patient preference.
Not only does it cheapen their profession by turning them into a Yes-man for annoying patients, but this practice wastes HUGE amounts of Medicare's money.

I've got one patient who, over the years, has harassed the staff at her M.D.s office to the point where they'll write "BNMN" and do Prior Auths before prescribing something for the first time.

As a result of allowing this behavior to continue, Medicare spends about $7,000 on her prescriptions every month. Every month.
The generics would've cost Medicare maybe $7-800. Maybe.

I wish Medicare could go after such things as fraud since the brand is not "medically necessary." If the patient wants it that badly they should pay cash.
 
  • Like
Reactions: 1 users
Here's a non-disrespectful suggestion:

If you're writing a weight based script for a kid, please include the kiddo's weight. It allows me to do my job correctly. Not all pharmacists care enough to check weight based doses, but it's our job so we should.
 
  • Like
Reactions: 6 users
Members don't see this ad :)
Read what you wrote before sending rx. Garbage in is garbage out.
 
  • Like
Reactions: 1 users
Was reading this post on the Angry Pharmacist website. It got me thinking. I am not a pharmacist myself, but a 4th year medical student (who worked as a pharmacy technician for several years prior to med school). I was curious as to what SDN pharmacy forums prescribing tips would be to make life easier overall for the retail pharmacist. Perhaps we can get a repository of tips...
I know I'm reviving an old thread however....

I had a rx for Flovent 220 mcg 2-4 puffs q4-6hrs prn.

So I called on the rx because of the very high dose. I call and get a secretary who looks up the RX and says "yep, that's what the doc ordered" so I politely respond back, okay it's an extremely high dose so I need to make sure that all the information is correct can you transfer me to the docs nurse or someone clinical please? She puts me on hold then 10 minutes later picks the phone back up and states that the RN said that's what the doc wrote for the patient to get.... I reply back that I'm not going to be able to fill the RX until I speak with the doc personally. They have a little tizzy fit then finally say okay we will contact the prescriber directly. 30 minutes later I get a new script e-scribed for 220mcg 2 puffs bid.

So what am I trying to say here? Just be accessible please.
 
  • Like
Reactions: 4 users
I know I'm reviving an old thread however....

I had a rx for Flovent 220 mcg 2-4 puffs q4-6hrs prn.

So I called on the rx because of the very high dose. I call and get a secretary who looks up the RX and says "yep, that's what the doc ordered" so I politely respond back, okay it's an extremely high dose so I need to make sure that all the information is correct can you transfer me to the docs nurse or someone clinical please? She puts me on hold then 10 minutes later picks the phone back up and states that the RN said that's what the doc wrote for the patient to get.... I reply back that I'm not going to be able to fill the RX until I speak with the doc personally. They have a little tizzy fit then finally say okay we will contact the prescriber directly. 30 minutes later I get a new script e-scribed for 220mcg 2 puffs bid.

So what am I trying to say here? Just be accessible please.
I have lived a similar situation so many times in my life. It's infuriating. I just gave up and documented everything and started faxing the prescription back to the prescribers with my notes if they made it impossible to reach them in these situations.

Of course, let the patient know, too. If you tell them the normal dosing and how it should be used, they can contact the doctor themselves if the doctor won't speak with you.
 
  • Like
Reactions: 5 users
I know I'm reviving an old thread however....

I had a rx for Flovent 220 mcg 2-4 puffs q4-6hrs prn.

So I called on the rx because of the very high dose. I call and get a secretary who looks up the RX and says "yep, that's what the doc ordered" so I politely respond back, okay it's an extremely high dose so I need to make sure that all the information is correct can you transfer me to the docs nurse or someone clinical please? She puts me on hold then 10 minutes later picks the phone back up and states that the RN said that's what the doc wrote for the patient to get.... I reply back that I'm not going to be able to fill the RX until I speak with the doc personally. They have a little tizzy fit then finally say okay we will contact the prescriber directly. 30 minutes later I get a new script e-scribed for 220mcg 2 puffs bid.

So what am I trying to say here? Just be accessible please.

What I found out, it is easier (if you are not a floater, obviously) when you already know that secretary --"Hey, Susan, this is Rainbowdash from XYZ pharmacy, how is your day going? Listen, do me a favor and resend this script, let me tell you what to put in the sig."

Soft skills, collegues.
 
What I found out, it is easier (if you are not a floater, obviously) when you already know that secretary --"Hey, Susan, this is Rainbowdash from XYZ pharmacy, how is your day going? Listen, do me a favor and resend this script, let me tell you what to put in the sig."

Soft skills, collegues.

This is what I do with the interns on call in my hospital. Bless them.
 
  • Like
Reactions: 1 users
Um.... I would not do that ....you don't know the MDs intended order.

I don't know about other states, but here the Rx has to be approved by md first, before resending it...so either way, md will see/approve changes...when it is something benign like changing flovent sig or asking for frequency of testing for strips or a larger tube of cream, it is easier to "tell" the secretary what it is that you want from them...otherwise, you'll be playing phone tag...
 
What I found out, it is easier (if you are not a floater, obviously) when you already know that secretary --"Hey, Susan, this is Rainbowdash from XYZ pharmacy, how is your day going? Listen, do me a favor and resend this script, let me tell you what to put in the sig."

Soft skills, collegues.
Can you use your very good connection with Susan to speak with the provider? :)
 
  • Like
Reactions: 3 users
If it is a di or pt is allergic to a med, yes, it is necessary, no argument there. But for benign things--no. There is no point to waste time holding on the phone for md to personally switch cr to oint or give a flonase sig. A new corrected erx is enough.
 
Waiting for 20 mins...then tech says you need to talk to pharmacist...20 more mins

I once picked up a call from a physician whose first words were "I can't believe I had to go through all these prompts and then speak to a technician and then wait 5 more minutes just to speak to a pharmacist. This is unacceptable!"

It turned out she was calling to correct an antibiotic dose that didn't make sense that we called her about a week ago. So technically the patient and the pharmacy waited a week for her.
 
  • Like
Reactions: 3 users
Its on both ends but
I once picked up a call from a physician whose first words were "I can't believe I had to go through all these prompts and then speak to a technician and then wait 5 more minutes just to speak to a pharmacist. This is unacceptable!"

It turned out she was calling to correct an antibiotic dose that didn't make sense that we called her about a week ago. So technically the patient and the pharmacy waited a week for her.
Even if she had called one week ago, she still would have had to get through all the prompts
 
Its on both ends but

Even if she had called one week ago, she still would have had to get through all the prompts

But what does she expect, her calls to go straight to the pharmacist with no prompts? How many Medical Offices have phones that goes straight to the physician with no prompts?
 
  • Like
Reactions: 3 users
I'm lucky if I can get to a medical assistant on the phone to just verify the garbage the doctor sent over and mutter "that's what he meant".
 
  • Like
Reactions: 2 users
I know I'm reviving an old thread however....

I had a rx for Flovent 220 mcg 2-4 puffs q4-6hrs prn.

So I called on the rx because of the very high dose. I call and get a secretary who looks up the RX and says "yep, that's what the doc ordered" so I politely respond back, okay it's an extremely high dose so I need to make sure that all the information is correct can you transfer me to the docs nurse or someone clinical please? She puts me on hold then 10 minutes later picks the phone back up and states that the RN said that's what the doc wrote for the patient to get.... I reply back that I'm not going to be able to fill the RX until I speak with the doc personally. They have a little tizzy fit then finally say okay we will contact the prescriber directly. 30 minutes later I get a new script e-scribed for 220mcg 2 puffs bid.

So what am I trying to say here? Just be accessible please.


One time I call up a doctor for a very stupid script (Don't remember exactly what it was but the pharmacist and I, an intern, were cracking up at the script) and I called up the doc to get a clarification. I get hold of the doctor only for him to say "Hold on one second, let me pull up the profile real quick" and I proceeded to be put on hold till the office closed and I had to leave a message.

Explaining that to the patient was interesting.
 
Calling seems an unproductive use of time especially if you get interrupted every 3-4 minutes for mandatory counseling while still on hold. Fax much? Any critical errors explain on the fax, send it, move on. Then call the patient if time permits to explain the situation then they can go waste the prescriber's time. With faxes at least you have a paper trail as opposed to counting on people to remember conversations they do not record or transcribe.

You will never get a prescriber in 30 seconds unless they run a cash-only pill mill.
 
  • Like
Reactions: 1 user
In our state, mid-levels couldnt write for C-IIs until a few months ago. It was an incredibly stupid decision by the state legislature.

I think we are on a same boat, I hate this too, btw, can they write 90 days of C3-C5?
 
Let me clarify. The drug does not need to be AB rated to substitute, but therapeutically equivalent (same generic) as determined by the pharmacist's professional opinion. This might be different depending on your state. From my state's Board of Pharmacy:

"2)Except as limited by subsections (3) and (5) of this section, unless the purchaser instructs otherwise, a pharmacist may substitute as follows:

(a)A drug product with the same generic name in the same strength, quantity, dose and dosage form as the prescribed drug which is, in the pharmacists professional opinion, therapeutically equivalent.

(b)When the prescriber is not reasonably available for consultation and the prescribed drug does not utilize a unique delivery system technology, an oral tablet, capsule or liquid form of the prescribed drug so long as the form dispensed or administered has the same strength, dose and dose schedule and is therapeutically equivalent to the drug prescribed."

I wanted to be another voice on here to agree with others that I still don't interpret this as allowing pharmacists to substitute to a different drug in the same class.

A drug product with the same generic name in the same strength, quantity, dose and dosage form as the prescribed drug which is, in the pharmacists professional opinion, therapeutically equivalent.

I know it gets tedious but whenever I looked at the law, the conjunction AND always meant all parts of the phrase apply. Therefore you may substitute only if what you are dispensing has the same generic name AND same strength AND same quantity AND same dose AND same dosage form. With the most liberal interpretation, I read this as allowing substitutions between products like albuterol that have been mentioned in previous posts.

When the prescriber is not reasonably available for consultation and the prescribed drug does not utilize a unique delivery system technology, an oral tablet, capsule or liquid form of the prescribed drug so long as the form dispensed or administered has the same strength, dose and dose schedule and is therapeutically equivalent to the drug prescribed.

I read this as just allowing pharmacists to legally swap a tablet for a capsule or liquid.

Of course all of this is under the assumption that you're working retail or if you're at a hospital without therapeutic interchange policies in place. To the OP, there are many places with P&T approved protocols that allow a pharmacist to substitute to a different drug in the same class.
 
  • Like
Reactions: 1 user
I know I'm reviving an old thread however....

I had a rx for Flovent 220 mcg 2-4 puffs q4-6hrs prn.

So I called on the rx because of the very high dose. I call and get a secretary who looks up the RX and says "yep, that's what the doc ordered" so I politely respond back, okay it's an extremely high dose so I need to make sure that all the information is correct can you transfer me to the docs nurse or someone clinical please? She puts me on hold then 10 minutes later picks the phone back up and states that the RN said that's what the doc wrote for the patient to get.... I reply back that I'm not going to be able to fill the RX until I speak with the doc personally. They have a little tizzy fit then finally say okay we will contact the prescriber directly. 30 minutes later I get a new script e-scribed for 220mcg 2 puffs bid.

So what am I trying to say here? Just be accessible please.
Yes! I hate that! They don't get it. I don't need someone to read the prescription and tell me that's what the doctor wants since that's what they wrote. I'm calling because it's not right and I need to discuss it with the physician.
 
  • Like
Reactions: 1 user
Please check of a medication dosage exist before writing it. Once in a while, we get scripts where its you just wonder how the doctor comes up with these scripts. Like Nifedipine comes 30, 60 and 90 tablets but you see some abnormal strength of 37.5mg and just stare at it. Had one time where the doctor even demanded us to give a said non-existent strength even after we explained that said strength doesn't exist.
 
You must keep in mind:

Some states, such as Missouri, have language in their statues very explicitly stating that any change must be communicated to the provider prior to filling. So, pharmacist must choose to contact the prescriber for some asinine reason or risk their license during a board inspection.

During a board inspection the board physically reviews scripts (usually about 10% of weekly volume). They are very thorough.

Some pharmacists in my state will just make changes to rxs and write ok per MD. Which borders on practicing medicine.

Everyone has to decided either waste time or break some law.
Then there is the issue of not being reimbursed or being charged with Medicaid fraud for package size billing.

Not a great system.
 
Last edited:
  • Like
Reactions: 1 user
Calling seems an unproductive use of time especially if you get interrupted every 3-4 minutes for mandatory counseling while still on hold. Fax much? Any critical errors explain on the fax, send it, move on. Then call the patient if time permits to explain the situation then they can go waste the prescriber's time. With faxes at least you have a paper trail as opposed to counting on people to remember conversations they do not record or transcribe.

You will never get a prescriber in 30 seconds unless they run a cash-only pill mill.

Gotta love mandatory counseling...
 
Top