The Pharmacy Technician Blog

Within the past two weeks, I have witnessed pharmacists attempt to get prescriptions for Lovenox through insurance on three different occasions, for three different patients with the same astounding result. In all three cases, the insurance company would not pay for the medication unless it was put in for a longer supply. Let me explain.

In the first case, the doctor wrote the prescription for 5 pre-filled syringes of Lovenox, for a specific strength (it comes in a variety of strengths), for a 5 day supply. This is real simple - 1 syringe each day. The insurance company would not pay for the medication unless he put it in as a 7 day supply.

Does that make any sense? What happens if after 5 days the doctor decides the patient needs to continue the medication for a few more days? The insurance company would then refuse to pay for it on the grounds that it is too soon!!!

The other two cases were nearly identical, except one was a 4 day supply (insurance rep said to put it in as an 8 day supply) and a 7 day supply (insurance rep said to put it in as an 19 day supply!)

Most likely, if a refill was needed, the insurance company would require a PA (prior authorization) from the doctor. I would hope, but I wouldn’t be the least bit surprised if the insurance company refused altogether. Lovenox is expensive stuff. I guess it doesn’t matter much to them that it might save the patients life.

The third happened today and the pharmacist pointed out something interesting that I hadn’t thought of. When it comes time for an insurance audit, it is highly likely that if one of these prescriptions came up in front of an auditor, they would refuse to pay for it. Get this - on the grounds that it was not run through insurance according to the doctors directions on the prescription! Even though changing the days supply is exactly what the rep required for the insurance company to pay for it! I haven’t yet seen exactly this scenario play out, but from what I have seen of insurance audits, it is certainly possible.

By the way, the insurance company in all three cases was Humana, or as I like to call them, Inhumana.

We’re selling tons of masks.

Since our supplier can’t supply us with masks, one of our intrepid employees, actually the manager of one of our stores, went to Home Depot and bought masks by the box (20 or 50, I don’t know for sure) for us to sell. (Is it ironic that Cardinal Health can’t supply surgical masks, but we can buy masks with an equivalent rating by the box at Home Depot?)

Anyway, we marked them up and we’re selling them out. It doesn’t matter that they won’t be much help. People just want them. There are lots of travelers, but it’s amazing that some people come in for masks and they aren’t going anywhere. They’re just scared by the media hype.

Others come bearing Tamiflu prescriptions when they don’t even have any symptoms - they just demand that their doctor give them a prescription so that they are ‘prepared’ for the Great Pandemic of ‘09. We’re almost enjoying telling people “no, it’s for people who actually have the flu.”

And our Oxycodone calls are finally slowing down. I guess they got the point.

As our afternoon/evening clerk came in, she immediately took a phone call. I could only hear her side of the conversation, of course, but it’s one I had been hearing all day. They were asking about Tamiflu and surgical masks.

As she got off the phone, I explained to her simply - “treat it like Oxycodone - we don’t have any and we don’t know when we’ll be getting any.”

Our supplier was out of Tamiflu and masks almost immediately and we quickly sold what we had in stock as people watch too much TV and begin to panic before we have any real news on this Swine Flu outbreak. (Yes, it is just an outbreak. People (ie the media) are desperate to call it a pandemic. Can we please just call it an outbreak until we have enough cases to call it an epidemic and then maybe we can begin to consider calling it a pandemic?)

So, for us in the pharmacy, at least in the first days of this Swine Flu outbreak, Tamiflu and surgical masks are our new Oxycodone (without the conspiracy).

Today we were informed by a customer that the shortage of oxycodone is a “big conspiracy” and that we were a part of it. People watch way too much TV, even though he was right - there is a big conspiracy and we are a part of it.

The current oxycodone shortage is the US government’s way of limiting the supply of oxycodone to those who have ‘legitimate’ uses for it. They have determined that up to 50% of oxycodone use is illegitimate - either for supporting a drug habit or more seriously, for sale or distribution - so they’ve decided to take steps to curb that.

By limiting the supply, pharmacies are forced to limit the sale of oxycodone to only their regular customers, or to customers without any ‘red flags,’ that is, if they can get any at all. Those supporting their addiction to oxycodone or looking to sell it are forced to call pharmacy after pharmacy to find a supply for even a single prescription.

So, for the most part, the only ones being hurt are those with an addiction, or those looking to sell it, presumably to those with an addiction. Those with a real need can usually have their doctor write a prescription for an alternative. Addicts don’t want an alternative.

There we have it. We’re part of the conspiracy (actually we don’t have a choice, we can’t get any more oxycodone if we wanted to) and it doesn’t bother us. Anyone really have a problem with that?

Psychodyne Pharmaceuticals has announced the impending release of the long-sought-after Happy Pill. Once called the holy grail of pharmaceuticals, the Happy Pill may herald a new age of civilization.

Psychodyne Pharmaceuticals CEO Gerald Stokes has been unavailable for comment, but spokesman Michael (Mikey) Goodtimes says “dude, it’s awesome. We’re in the final testing phases now and it’s just the shiznit.”

Ever since the unexpected growth and success of Sarcasma, traditional pharmaceutical manufacturers have been struggling to come up with new medications with the same potential impact. But, makers of Xanax, Prozac and other medications are downplaying the effectiveness of the latest drug.

Says one anonymous representative of a major manufacturer and competitor of Psychodyne - “come on, who you gonna believe, us or them?”

We’ve seen the number of oxy/roxy calls go down a bit, but they’re being replaced. Instead, the same people (or at least the same ‘type’ of people) are asking for Percocet or Dilaudid.

I guess they’re starting to get the picture. We’re being told from our supplier (and anyone else in the know that we can get information from) that this shortage is expected to continue for several months, possibly toward the end of the year.

In any case, we’re handling it the same way - ’sorry, no gots.’

The clerk came back with the blue slip in her hands and snickered “I don’t know, she said something about her Afghanistan drops,” and walked away laughing. We all waited to see what the pharmacist would discover in the customers profile.

Yes, sure enough, the customer requested a refill for her Afghanistan drops. Eye drops, that is. Or Alphagan, depending on how you would like to pronounce it.

We all laughed. That one has to go in our ever-growing list of fumbled medication names. Techs and pharmacists have enough trouble pronouncing brand names and generic names for medications, and customers understandably have a harder time. But it’s always fun to hear what some customers can come up with.

The calls come every day. 10, 15, 20. They’re looking for Oxycodone. They always say the same things - they’ve been calling all over the place and no one seems to have it.

It’s been many weeks since the problem started, but people don’t want to accept it. Which, of course, makes us believe that most of these calls are exactly the people that don’t really need the Oxycodone. They just want it. Or are selling it. Which is most likely the point of this apparent shortage of Oxycodone.

Sometimes they even show up in person, bringing in the prescription with them. 9 times out of 10 we can identify them as they walk in the door. “No gots” we say to ourselves. They’re almost always the same type - young guys in their 20’s who could probably handle pain ok, yet don’t seem to be struggling with any. But they do have a prescription for a couple of hundred Oxycodone. Sorry, no gots.

Here are a few mispronunciations for relatively common medications :

Coudamin = Coumadin
Fonisopril = Fosinopril
Panatol = Patanol
Fenofexadine = Fexofenadine

All of these are understandable and believable. If you’re not in the business, who can tell the difference?

But how about Splenda? A customer asked for a refill of Splenda. They meant Plendil. That one’s pretty good, I think.

We noticed something unusual today. We found Lotrel labelled capsules in a bottle of the Lotrel generic - Amlodipine/Benazepril. It wasn’t just an accident on our part (ie someone returning capsules to the wrong bottle), but rather they were from a sealed bottle from the manufacturer. Furthermore, other bottles had them as well.

Now, if you’ve studied the concept of Misbranding, you would certainly come to the conclusion that this is such a case. Someone thinks this is legal, as the company that manufactured it did this intentionally. In most cases there would be no harm in it, but in the next few posts I’m going to give my case as to why this has to be illegal.