Home Forums Discussions General Discussion More difficult to prescribe these days

Is it just me?

I'm having more problems trying to prescribe because prescriptions the insurance companies/PGMs don't match the correct NDC numbers for generics.

I write for a generic and it does not have Do Not Substitute. Shouldn't this allow them to switch to a more preferred generic?

Which inhaled corticosteroid do you like. I will write for generic fluticasone and it will be rejected with the recommendation that I should use QVAR but when I write for that it is also rejected. I call the PBM and of course talk to someone who has no clue of what an ICS is, they have to consult a pharmacist and it is recommended that Pulmicort flexihaler will not require prior auth (BUT ONLY FOR THIS PLAN).
But then I'll still get a fax from the managed care company recommending that the patient should be on a ICS despite the fact that I have written for several. And of course there's no longer Flovent HFA but a host of others some liked and some not.

Even generic albuterol inhalers? Come on! But there are eqv-pro-air, eqv-ventolin (x2) and just 90mcg/inh aerosols. Which one do they want???

And I haven't discussed the process of prior auth!

Use/empower your pharmacists. I had success with :
albuterol hfa
comment says : 1 inhaler any generic albuterol or proair or ventolin

Wendell you are not alone...........

Larry, you have some good pharmacists. (I'm married to one) I have done similar with prescribing as you stated but was told "we can't tell you until you write the prescription and try it". There is such a shortage of pharmacists in our area they travel in and just do not care. If there isn't a quick and easy fix,then the problem just gets dropped back on the prescriber.

I have had several replies from the pharmacy stating that a cephalexin tablet is not covered, please write for capsule. COME ON, just change it. I called a pharmacist about this and he said it was due to an automated computer issue and the tech sent it back to me as the prescriber. SO some of the name brand/generic issues may be due to an issue with automated computer responses and staffing problems.

For keflex and doxy comment “cap or tab” usually works for me.

My question is WHY, why do we even have to put that. If, in Texas, a pharmacist is able to move from brand name to generic unless DAW is written why in the world can they not use their discretion on cap/tab when insurance is the hold up. I think they can, it is just just an issue in the system that some one, not a pharmacist does not catch and just sends back to the prescriber.

No our pharmacists seem to go out of their way to make it hard. I think things they can do, they don't do. If you write for Amoxicillin 500 mg tablets and put capsules in Dispense, they don't fill it.

Or if you write amoxicillin 400 mg/5mL suspension

1 tsp po bid for 10 days

and

write Dispense 1000 mLs, they won't change it to 100 mLs.

Did you know that on an opioid, the only thing a pharmacist can't change is the drug name and amount. They can change anything else. But they won't.

Walmart refuses to fill pain medication unless you put if it is for chronic or acute pain. For acute pain they will only fill for 7 days.

They can change it but most of the work is done by pharmacy techs who are clueless and if the computer states not covered, they look no further.
You only need a high school diploma and some classes to be a pharmacy tech.

The opioid crisis was met by a pendulum that went too far. Even the CDC admitted that. Tylenol and Motrin are making a killing because all the ED will give you. We get a whole 14 days of Norco (2 times 7) before you have to put chronic. Again, the pharmacists can change it, but they like the power of making us send an entirely different script. (Sorry to all the pharmacists on here)

In most states they track every script you write. They don't notify you that you are writing too much, they just wait until you hit a certain limit, then they take your license, so all 100 of your patients on chronic oxycodone have to find it in the street. In New England the FBI has an opioid task force that goes after doctors. You have to have exemption codes to write for chronic opioids. Pretty much A) cancer and B) hospice care counts. Otherwise, you need a PA, which puts the task force on your trail. We have one doctor here where they took his license. He had one patient on 680 mg of oxycodone a day. She didn't do too well. His PA wrote the script and the board swooped right in. So no one writes for them. Or benzos.

Everyone is still blaming the doctors for the opioid crisis. Now in retirement I work part time for our local jail as the prescribing physician for MAT (drug treatment). I ask the inmates how they got started, and most of the time they claim it was a doctor who prescribed opiates for a minor injury. In a number of these cases I know it is not true -- but it is more acceptable to blame the doctor, not oneself.