Interview with a pharmacist
Interview:
Apparently, over the counter medications are those that can be sold to the client without necessarily having any prescription by the provider. The Food and Drug Administration has been at the forefront in monitoring the adherence to issues of over the counter medications so that pharmacists do not sell other medications not classified as OTC. Similarly, the FDA has over time made changes and reviews on the regulations and rules that guide OTC medication sales (West, Wilk, Rae, Muszynski, Stipec, Alter & Regier, 2015). One of the emerging issues that have affected the pharmacists is the introduction of a new regulation that some of the OTCs should only be kept behind the pharmacy counter or even so locked in the store. This move was necessitated by the realization that certain cold and flu medications such as Sudafed have methamphetamines as the key ingredient at a time when meth was rapidly being used widely as a drug for other purposes beyond the desired medical needs.
The cases of increased addiction to meth were high and there was a need to cut down the production of meth and that meant placing new strict measures on the distribution and sale. However, this has only been applied to those drugs that contain more than 60 milligrams of the pseudoephedrine which is the most recognizable ingredient of meth in every single package of the medication (Betses & Brennan, 2013). The primary reasoning behind this move is to ensure that the pharmacists play a key role in limiting and monitoring the possible cases of addiction to meth within the community that they serve. For instance, in my case, If a patient frequents my place for the medication, or requests to buy the meth-containing medication in large quantities, then I am required to record the details of their logbook; data that will finally be conveyed to the FDA and other respective authorities for follow up (Betses & Brennan, 2013).
What are some of the things a pharmacist wishes a provider never told their patients?
One of the biggest challenges that I have encountered as a pharmacists is that I seem to play a role that is delegated by the provider. The patients/clients will only want to stick to what the provider said and even when I may be offering a more affordable, sustainable or better alternative, the patient will most likely regard me as a crook. Providers always tell their patients that the pharmacist is a business person and imply that in the prescription that have indicated ‘as directed’ so that nothing changes at all. I always wonder what if the patient can afford half the dosage as at now and come back for the refill on another day? Would the pharmacists still be wrong? Not. But you know the provider’s word is God’s word and we have to live with it. But for me, this is a problem only when dealing with new clients and it is always my duty that I contact the provider and inform them of such issues before I enact any changes.
What is a prior authorization?
In my view, prior authorization or as we call it PA, is one of the most controversial areas for patients and their health insurance providers. By description, it is a method of cost-containment in which the insurance providers requires that for certain medications, the pharmacist has to contact the company to determine whether the insurance can go through. This is mostly applicable for the very expensive drugs and for which there is a more affordable alternative. Until the insurance company offers approval on such, I cannot sell to the client and no other pharmacist will do so without approval. Otherwise, if the client feels that they are at a position o pay-out-of pocket for such a drug, then I will be more than obliged to sell as required by the prescription (West, Wilk, Rae, Muszynski, Stipec, Alter & Regier, 2015).
How can we make it easier for a patient to get his/her medication, if the ones we (Nurse practitioners) prescribed are not covered by the insurance company?
For me, I have simple strategies to resolving this daily hassle for pharmacists. I always check the records of all my payers in regard to the cases of prior authorization that they have and the frequency as well as the length of time they usually take to pay. If I think that the particular payer is not consistent, then I drop them immediately and replace or deal with the more consistent because at times, I have interacted with payers who fully understand that the PA is not in the best interests of the patient. Secondly, I usually check to see the drugs that are listed by my payers as PA and ensure that I keep a generic of the same which is cheaper and affordable. This ensures that I can at any time assist the patient even when the insurer fails to approve the PA and the client cannot afford enough cash to purchase the actual product.
If I write "substitute" on the hard copy, what can you change it to?
I will definitely check whether the preferred original drug is in stock and if not I will substitute with a generic medication. Normally, this may be regarded as an ‘illegality’ by some state boards but it is not something that can actually cause harm. The state boards are more concerned about standardization and uniformity but as long as my payers have no issue with a certain generic then, I will substitute if such an option is provided.
What does "brand medically necessary” mean?
In some cases, there have been instances when the specific brand has tended to depict better results than the generic. In these instances, the provider indicates that the brand is medically necessary as prescribed and that no substitution is required.
Can a pharmacist change a medication without talking to the prescriber?
Shockingly, Yes. This is because there specific codes that the prescriber and the pharmacist will use to communicate and they are labeled under the Dispense as Written Codes. In the event that the prescriber did not indicate the DAW, then there could be a need for contact between the two.
If an Advanced RNPractitioner works with a doctor who's allowed to prescribe controlled medications and signs a controlled script for a patient, will you be able to fill this medication?
I will definitely not do so. I am within Florida and apparently, this is among the two states that prohibit the ARNP from prescribing controlled substances. It would be in contravention of Section 464.0012(3) of the Florida Statutes (the Nurse Practice Act) and that would place me at risk of suspension of my license as a pharmacist.
What type of medications cannot be called in or faxed in to the pharmacy?
The controlled substances regarded as Schedule II and especially those that have hydrocodone combination products and are used to treat pain. Even for refills, it is not possible to provide the patient with such until there is a written script (Cobaugh et al., 2014).
What haven't I asked you that I should have?
Probably as to whether the pharmacists have a role in the costs of drugs especially at a time when the prices of drugs are escalating. And on this one, I would say, the States and the federal government have placed many hurdles that cannot allow the pharmacists from their base to increase or alter the standard prices of medication while at the same time empowering the insurance companies to control the costs of medication. This is mainly due to the issue such as the prior authorization which and the aspects of brand ‘medically-necessary’ which we have discussed. For pharmacists we only have to play by these rules and get the fir share of our professional roles.
Thank you note:
Richard Peters,
MediMart Services,
3864 E 17TH STREET SARASOTA,
Office: 904-608 2029
Thank you for affording me an opportunity and sharing with you in your valuable time. I have learnt a lot from you especially in regard to the role of the pharmacist and the institutions involved in the pharmaceutical industry chain. Bye and I hope to talk to you soon. Regards.
Analysis
The pharmacist is probably the last in line on the list of inter-disciplinary professionals who manage the patient. The role of the pharmacist especially to the outpatient group cannot be underestimated. They have to balance the needs of the patient, the requirements of the insurer/payer as well as the recommendations or prescriptions by the care provider. A harmonious relationship has to exist between the pharmacist and the care provider at least for the benefit of the patient. The pharmacist despite being last in the line has to be regarded not as a person in a delegated role but a fully-trained professional who can significantly impact the course of patient care and ultimate progress (Peirce, Smith, Abate & Halverson, 2012).
In the interview, there are two things I regarded as critical to have discussed; one is on the role of the Dispense as Written (DAW) codes. The DAWs are the key elements that ensure uniform and standard communication between the provider and the pharmacist even when physical distance separates them. The provider has to ensure that they apply these codes so as to provide the pharmacist with an easy time when explaining to the patient the range of alternatives that are available to them at any given time. The second important issue is the role of the pharmacist and the provider in the facilitating the controlled-substances use; the care providers/the physicians are the sole authority that can prescribe controlled substances and their refills (Johnson, Paulozzi, Porucznik, Mack & Herter, 2014). The physicians even when delegating roles to the ARNPs or RNs in their stations have to indicate that prescription of such is only a role that can be accomplished personally by the provider. This will ensure that the pharmacists especially if they have a good relationship with the physician, such a relationship is not placed in jeopardy by a dilemma when an RN or ARNP from the physician’s station decides to sign a written script authorizing a refill of a controlled substance (Cobaugh et al., 2014).
References
Betses, M., & Brennan, T. (2013). Abusive prescribing of controlled substances—A pharmacy view. New England Journal of Medicine, 369(11), 989-991.
Cobaugh, D. J., Gainor, C., Gaston, C. L., Kwong, T. C., Magnani, B., McPherson, M. L., & Krenzelok, E. P. (2014). The opioid abuse and misuse epidemic: implications for pharmacists in hospitals and health systems. American Journal of Health-System Pharmacy, 71(18), 1539-1554.
Johnson, H., Paulozzi, L., Porucznik, C., Mack, K., & Herter, B. (2014). Decline in drug overdose deaths after state policy changes—Florida, 2010–2012. MMWR Morb Mortal Wkly Rep, 63(26), 569-574.
Peirce, G. L., Smith, M. J., Abate, M. A., & Halverson, J. (2012). Doctor and pharmacy shopping for controlled substances. Medical care, 50(6), 494-500.
West, J. C., Wilk, J. E., Rae, D. S., Muszynski, I. S., Stipec, M. R., Alter, C. L., & Regier, D. A. (2015). Medicaid prescription drug policies and medication access and continuity: findings from ten states. Psychiatric Services.
