The Pharmacy Chick

Flying the coup in retail

I love Dr CC

Filed under: Uncategorized — pharmacychick at 11:06 am on Tuesday, January 24, 2012

You dont know Dr CC, and I haven’t actually met him personally, but I love him. WHY?  Because I rarely, if ever have to fax his office for a refill request.  And if I do, most of the time I get a denial anyway….which I actually expect but since some of his patients are slow learners apparently, I go thru the motions.

You see,  Dr CC issues all of his prescriptions on full sheets of paper.  All of them follow the same protocol and he has them computer printed so they are very easy to read and understand.  Best of all there is a disclaimer or EXPLAINER at the end of each on in bold face capitals that says the following ( paraphrased)

ALL PRESCRIPTIONS FROM THIS OFFICE ARE ISSUED WITH ENOUGH REFILLS TO LAST UNTIL THE PATIENT’S NEXT SCHEDULED VISIT. ALL PATIENTS ARE REQUIRED TO BE SEEN TO BE ISSUED ADDITIONAL MEDICATION REFILLS, AND REFILLS WILL NOT BE AUTHORIZED VIA PHONE OR FAX UNLESS CERTAIN CRITERIA HAVE BEEN MET

WE DO NOT ISSUE PRESCRIPTIONS FOR ANY MEDICATIONS ON THE WEEKEND. WE DO NOT ISSUE REFILLS FOR CONTROLLED MEDICATIONS OVER THE PHONE OR FAX

What this means to me is that if I get a refill request from a patient on a medication from Dr. CC that has expired, the patient has most likely either 1) skipped his appointment or 2) taken too much of his medication and run out before his next scheduled visit.

Dr CC has done it pretty well I think, and I wish more Dr’s would follow with some kind of refill policy, the most important of which is this: Issue enough refills to get your patient thru his/her next scheduled visit. It would make my life ( and his/hers too) much easier.  I have this one patient who gets only one prescription: Synthroid. EACH friggin month the dr only ok’s it one time….for 30.  WTF?  I feel bad for her because not only does she have to ask for a refill every month on a maintenance med that has O refills on it, but this Doc takes 3 days minimum to send back his auth.

Now, yes I understand that sometimes you want to TRY a med on a patient to see if it works.  Im OK with that.  AND if you aren’t sure if a patient is abusing a med, put a date restriction on the fills  ” may only be filled every 30 days”.  Ive never met a pharmacist who wouldn’t honor a request like that.

I also used to work for a pharmacist who originated from a state in central US.  He was amazed that the patients went to the pharmacy to request a refill. In HIS state, the patient had to call the DR when he/she was out of refills.  Then the doc took care of the request…called the pharmacy…which seems like a pretty logical procedure.  How did we become the step-n-fetch-it?

11 Comments »

Comment by R. May

January 24, 2012 @ 12:46 pm

My daughter’s dr. has taken to doing that lately with her singulair. for allergies. to dust mites. aka not seasonal. No idea why – it was written for something random like 5 months of refills. Doctor did not want to see her back unless it didn’t work. Well she’s out and now every month is time to call for refills. Fortunately she has her annual tonight where I will be requesting, nicely, a new prescription to cover the whole next year.
I didn’t realize pharmacies called for refills though until this issue – I’ve always called myself. My pharmacist actually said not to, just to call it in and they’ll take care of it.

Comment by Vagabond Rx

January 24, 2012 @ 1:02 pm

Our most common problems with these full-page rxs are
1. Dr doesn’t sign each page
2. Dr doesn’t actually know how to use the software and issues rxs with no sig, two sets of sigs, no quantity/duration etc
3. Dr doesn’t read rx before signing it (see #2 above)
and
4. Dr tells patient to use it differently but doesn’t issue a new rx with current sig.

But I do agree with you, and we all love our Dr’s who make our lives easier.“two sets of sigs”…dang…we have a clinic that does that too. their scripts do this all the time and it makes me nuts. we have learned to disregard the first one and use the second one. that appears to be the one that was “written”. Dr CC has it down to a science.

Comment by Gwyn

January 24, 2012 @ 7:39 pm

I wish we had more doctor’s like him.. we have a group of doctors here that refuse to write ANY refill rx in the office.. they send them to us for US to fax them. Then takes 2-3 days to get back to us. They won’t let us call them either, it’s always met with a “well just fax us *click*”

Comment by TECHnically Insane

January 24, 2012 @ 8:40 pm

We only have one darn doctor that does this! I kinda wish more would get on board. My coworkers hate it but to me it is pretty smart.

Comment by murgatr

January 25, 2012 @ 3:36 am

At the last pharmacy I worked at, staff could generate a refill request thru the software by tagging all the medications they were asking for refills on, add extra notes (such as asking nicely for a 3 month supply instead of just one month), then print it off and fax it to the Dr.’s office. This system worked great for patients that had regular maintenance meds, whose doses rarely changed, or were on dosettes/blister packs. It was not effective for patients who were non-compliant, or their doses changed often, or the patient was seeing their regular GP as well as specialists for all of their meds, or for Dr’s who never renew any Rx’s via phone or fax EVER. Even after numerous explanations, many patients still didn’t understand that fax renewals aren’t very successful for certain meds, like birth control pills, creams, antibiotics, narcotics or anything written as prn. We tell patients to call the Dr’s office after the fax renewal is sent just to check that it had been received 🙂

murgatr
Pharm.Tech RDC’06

Comment by dr-lasermed

January 25, 2012 @ 9:29 am

I wish we could get this written on the bottom of our prescription blanks instead of:
“This prescription may be filled with a generically equivalent drug product unless the words “Brand Necessary” or “Brand Medically Necessary” are written, in the practitioner’s own handwriting, on this prescription form.”
Also: Who thought up “prn” for prescription refills?
For patients who read this, there are some laws about only 6 months of refills for certain drugs.
And there are some conditions where we need to see you back before a year.
However, it’s as much of a pain to the doctor’s office to have you call as it is for the pharmacy:
http://dr-lasermed.blogspot.com/2012/01/example-of-just-medicine-refill.html

Comment by superdoc

January 25, 2012 @ 11:19 am

About ten years ago, we did a three month analysis of all pharmacy faxed requests for refills.

We found an 82% error rate in the requests. Most commonly:

1. patient already had a script for refillscommon for when they call in old numbers
2. patient no longer on that medalso common for auto fills..I hate auto refills
3. patient no longer using the same pharmacyor they use multiple pharmacies…a fan favorite
4. patient no longer our patient
5. patient had refused multiple requests for follow-up visitssomething we never know about
6. patient was deadthat doesnt’ happen much…
and so on.

The amount of useless work created for our office was ridiculous.

We now accept requests for refills only from the patient. Works great, except for a couple of pharmacies that still don’t get it, depite multiple certified letters we’ve sent them.in all honesty, its hard to keep track of that. especially with software that faxes your office as soon as the patient punches in the number. but good work doc! we appreciate your policy!

Comment by TxPharmguy

January 25, 2012 @ 12:10 pm

Let’s not forget the dreaded “Prior Authorization” request in large BOLD print at the top of the fax and MD signs fax “OKx 3” Winston, Turkey, Foxtrot? Did you even read the information?LOL. yes happens all the time!!

Comment by Frantic Pharmacist

January 26, 2012 @ 7:53 pm

That is the most awesome thing I’ve ever heard of! Unfortunately it requires the prescriber to think and act proactively and we all know how that goes. The comment by SuperDoc is interesting because I do feel that so much time and effort is spent on refill requests that are really unnecessary and waste a lot of people’s time.

Comment by Pharmaciststeve

January 26, 2012 @ 7:56 pm

So state boards actually DISCOURAGE refills.. I work in LTC and was talking to a doc calling in a controlled substance (refill) and wrote for 30 days plus 2 – I ask why just two refills.. he told me that when he renewed his state license all were asked if they routinely wrote for more than 90 days of a controlled substance. I can see a better monitoring of controlled. It makes me crazy to see Zolpidem 30+5. that’s just inappropriate prescribing….
I can see where this might be a concern in the ambulatory setting… but in the closed LTCF setting where not matter what the doc writes for.. there is normally 30 doses going out at one time.
Some of the nurses are worse that patients.. Monday night ~ 21:00 I had a nurse insist that I call the doc for a new Rx for Oxycontin 10mg.. the patient only took it at bedtime and we had sent out a 30 days supply mid-Nov.. I questioned the nurse… who hasn’t been giving the pt her meds? Got the excuse that she hadn’t worked this unit for a while…BUT.. she had just given the pt her last available dose and didn’t need any more until the next bedtime. I told the nurse that I would turn the issue over to triage to take care of the next day when the doc was in the office… I was not going to call the doc at home… and stat out meds for a dose that was not needed. Common sense seems to be in short supply

Comment by Woden

February 10, 2012 @ 3:33 pm

Another odd one that I’ve seen is some of the doctor’s offices in my area will routinely give, seemingly at random, different numbers of refills to non-controlled medications that were prescribed at the same time (and often on the same sheet).

And I mean something like: Synthroid #30, 5 refills; Simvastatin #30, 2 refills; Lisinopril #30, 3 refills; Hydrochlorothiazide #30, 4 refills. There seems to be no rhyme nor reason for it, as even drugs that would be using the same lab results seem to get different numbers of refills.

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