The Pharmacy Chick

Flying the Coop in Retail

DUR? or PITA?

Filed under: Uncategorized — pharmacychick at 9:51 pm on Monday, September 2, 2013

Every now and then I get comments from readers who disagree with something I have written or something a commenter has written.  Either way it sets off a maelstrom of activity, much of which has a similar thread.  ” All you do is put pills in bottles”…or ” Its none of your business WHY I take my meds or how many I take”.  I am sure if you have read pharmacy blogs over the years, you have read similar comments from people who have no idea about the rules and regs of pharmacy or have something they really want to hide.

Recently boards of pharmacies have flexed their regulatory muscles and are putting more and more emphasis on DUR…Drug Utilization Review.   For those of you that are confused by this, a DUR is a review of the prescription for NOT merely it accuracy, but for its appropriateness, dosage, OVER utilization &/or UNDER utilization, drug interactions, disease review, age appropriateness, etc yada yada yada.  Insurance companies do a rudimentary DUR every time they reject a claim for “refill too soon”. Truthfully, they dont care if you underutilize your meds, but they sure don’t want you to over utilize them.

I got an expanded definition of DUR sent to me by the board and I will spare you the verbiage.  Trust me, its boring and pretty much nearly impossible with the labor model that ChickVille pharmacy gives me.

To those patients/customers who think that all we do is put pills in bottle:  I only wish… Because if it was THAT easy my job would be cake. And to those who thinks its not my business why or how they take their meds:  actually it is my business…because its been inflicted on me by the board of pharmacy.This was most recently driven home in our national newsletter.

We even are supposed to verify that a drug is to be used for a legitimate medical use…which puts an interesting spin on narcotics being prescribed in questionable circumstances.  Technically its against the law to dispense a drug to a patient for which there is no legitimate medical need.  So, even if the prescription is written by a MD, if its for a patient who is using it because he WANTS it or is obtaining it under deceitful circumstances, I am technically breaking the law.   Nice…

Personally, I am a bit offended by this.  I think I have enough to worry about in making sure that I get the right drug to the right patient…counsel in a way they understand, bill properly so I am not audited by some piece of Sh$t insurance company, and do it all under my minutiae labor allowances my company allows.  I am also held responsible to divine which urgent care vicodin/norco/oxy script is for real pain or for some drug seeker looking for a quick high or some cash to spend by selling it.

In my opinion, humble as it may be, it should be the prescribers’ responsibility to ascertain whether the dude on the table has a real need or not…and if they are doubting it, prescribe some naproxen instead, instead of caving every time.  some states even have a registry that you can check to look at the drug history of the person sitting in front of you. That could be some very valuable information in the decision making process. Even given all that info, its not being utilized: the number one reason for not checking the registry?  ” too busy”.

Are the boards overstepping their boundaries?  Insurance companies have been overstepping their boundaries for years.They decide what they will pay, how much you can dispense and what drugs they will allow patients to receive.  They harass pharmacies with record keeping requirements that would confuse the most detailed bookkeeper. Fail to collect a signature and say goodbye to your payments.  Why am I to decide if a script is medically needed or not?  I am perfectly fine with determining if a script is LEGAL…for a legal person and signed by a medical doctor and written properly ( not altered, for forged).

RPH out there? sound off…tell me what you think about the DUR with respect to legit medical need provisions. I am interested to hear your perspectives.  Patients? if you wonder why we question or doubt?  now you know.

5 Comments »

Comment by pat

September 3, 2013 @ 9:11 am

it’s my feeling that part of this is driven by a need to remain relevant. patients are right, anyone can just dump tabs/caps into a bottle or slap a label on a box. if we don’t do DUR, what exactly do we do that can’t be done by someone else?

my last question is only rhetorical and i’m not saying i agree or disagree with what is being foisted upon pharmacists. it’s just a theory i have.

Comment by Jen

September 3, 2013 @ 10:15 am

I agree…we cannot be tasked with determining “legitimate” need as we do not have access to the necessary information. We do not have labs or the patient’s medical history. And, honestly, if I wanted that info I would have gone to med school.

Comment by Katherine Hill

September 3, 2013 @ 4:50 pm

As an rph for one of the chains recently fined by the DEA for questionable narcotic dispensing, there is a very fine line. The stores that got in trouble were literally dispensing 1000′s of oxy every DAY to out of state patients who would literally come into the state, pick up people off the street, pay them to get the scripts, and then take the medication and sell it. Clearly this requires us to use our brains and pick up the phone and call the dr. On the other hand, I’m not calling the dr on every single script. Also, it’s in the way you present it to the patient and doctor. “I’m trying to help you get the most appropriate care and the want to make sure this is correct/appropriate/good for you.” Also, most dr’s that I have explained how we are getting scrutinized by the DEA and wholesalers are very understanding about the calls.well i agree that if I got scripts for thousands of oxy i would probably call the board right off the bat! :-)

Comment by pharmacyburnt

October 21, 2013 @ 7:19 am

Here in my state we do have a Control Substance Reporting system that is very simple to register for as well as to use, although I have YET to encounter a physician that has taken the time to do so. I endure many calls from the MD offices as to when and how much of a medication their patient has filled. I refer them to the reporting system as a more accurate account, but alias, they are unaware or unfamiliar of its existence. How simple it would be if physicians took responsibility for their patients and their medication care plan set by them rather than add just another bullet point in our ever increasing pharmacist duties in an understaffed world!

Comment by coachrx

October 29, 2013 @ 6:20 am

please get any board of pharmacy to explain to us pharmacist type people how to conduct a proper DUR when patients get rx;s filled at walmart for four dollars and then get some at the dreaded mail order pharmacy and then get some at the dispensary (not a pharmacy but a dispensing station located inside a large doctor complex) and then pay cash for something at my pharmacy. how much time do we have in a day to acquire all this info from someone who cant even tell me what they take or why they take it. all they know is it is a little white pill from walmart. WTH.

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