Dr. KJ is a registered pharmacist who works as the head of the pharmaceuticals department in hospital M. He holds a baccalaureate in nursing from the Nova Southeastern University. He is currently pursuing a doctorate program in the pharmaceuticals field and has already completed four years plus the required pre-requisites. I sought to have a one on one with him with the intentions of having him expound on several issues surrounding the profession. To this effect, therefore, we planned for an interview with him in his office at hospital M to help in seeing to it that this objective is achieved. After introductions, we went directly to the questions session.
The first question that I posed to DR. KJ was aimed at getting the answers to the reasons why particular over the counter drugs are kept under lock and key or behind the counter. He told me that there are two primary reasons why such drugs are stored in such manner. The first one is based on the realization that the drugs are expensive and as such, they are highly vulnerable in matters concerning theft. As such, it is only fair that they are kept behind the counter as a way of controlling such incidences (Pomeranz, Taylor & Austin, 2013). The second reason that he gave was concerning the fact that the chances of the drugs being abused were very high. He touched on the need for keeping these drugs and lock and key as a way of fighting against the illegal production of medications. He gave an example of Sudafed as one of the drugs kept behind the counter. Dr. KJ pointed out that most of these drugs need to be stored in this manner since they contain pseudoephedrine as the primary ingredient. He informed me that pseudoephedrine is a major component of most over the counter products used in relieving complications such as hay fever, common colds plus other respiratory complications. He, however, added that the ingredient could also be used in producing methamphetamine which is a stimulant that is addictive in nature. This drug is usually produced, albeit illegally in home laboratories (Pomeranz, Taylor & Austin, 2013). As such, there is the need to curb such instances of abuse by limiting the usage of the drug. He added that the prerequisites that one needs to satisfy before being sold these drugs is producing photo identification and a signature. Additionally, the maximum amount of the drug that an individual is allowed to take per month is nine grams.
The second issue I wanted to understand concerning pharmacists and the profession was centered on the things that they would wish a medical provider never tells their patients. He informed me that most providers usually go wrong when they advise their patients concerning the side effects of particular drugs. Such a realization has in most cases resulted in patients being scared of the drugs and eventually ending up not taking them (Maddox et al., 2016). He added that there is the need for providers to encourage patients to take the drugs in spite of the side effects of the benefits that they stand to gain by using them outweighs the risks by far. Secondly, if a pharmacist understands the side effects of a particular drug and as such, declines to fill the medical prescription for a patient, the doctor usually tells their patients to call corporate office and relay their complaints. As such, he informed me that such an issue poses challenges to the workings of pharmaceutical technologists since any undesirable outcomes on the side of the patient may be solely directed at the pharmacist (Maddox et al., 2016). He informed me that under most health insurance plans, the drugs which are supposed to be covered are clearly spelt out ab initio. The third issue that I wanted Dr. KJ to shed more light on was in relation to the concept of prior authorization. As such, in the event that a physician wishes to prescribe a drug which does not fall under the required category of drugs covered, they will have to present a report to the insurance company on the need for including the medicine in the treatment regimen of the patient. In most instances, this process has been used as a safety strategy in addition to saving on costs (Lang & Schueth, 2016). Furthermore, insurance providers will require providers to furnish them with this information as a way of confirming the age of the intended user, checking for possible drug interactions and determining whether there is any generic alternative. After the required information is sent to the insurance provider, the drug may either be approved or rejected or may require the addition of further information at the request of the insurance company.
The fourth issue I wanted Dr. KJ to explain to me was how a patient could easily get their medication in case they are not covered by an insurance company. He informed me that the most appropriate action that a patient should take is to substitute the medicines which have been prescribed to them but not covered under the insurance policy. This process can be completed by the patient and the pharmacist informing the provider of the need for prescribing the medication that will act as a substitute and also the one which does not require any prior authorization (Lang & Schueth, 2016). He added that after the provider gives the go ahead concerning the use of such a drug, the patient then pays the full price for it. Dr. KJ informed me that this is the easiest and most appropriate method that a patient can use to obtain substitute medication in the event that the exact drug which they require is not covered by the insurance company. I also had questions for Dr. KJ concerning drugs and their generic substitutes. I specifically enquired from him what the term ‘’substitute’’ written on paper may be changed to. He informed me that the term can only be used to refer to the generic name of a particular form of medication (Minghetti, Rocco & Schellekens, 2015). He added that pharmacists are allowed by the law to change the brand name of a particular drug to its generic alternative but which has got the same effects on the patient. The drug which is substituted with the original drug belongs to the same class of medication with the original one and is also used in treating the same condition. He added that the problem which is likely to arise by the patient such substituted drugs is not getting the precise benefits that a patient is supposed to derive from them. The compounding consequence therefore is that the patient may suffer from unexpected side effects of the drug. However, in most cases, these substitute drugs are cheaper compared to the original brands. He, however, pointed out that, pharmacists need to inform their clientele when switching to generic medicines because it is the most ethical thing to do.
The sixth issue that I wanted Dr. KJ to explain to me was the meaning of the statement ’brand medically necessary’. He first of all informed me that even though generic drugs may serve the same purpose as the original drug, they may not actually achieve the required results. To this effect, therefore, it is important for the pharmacist to dispense what has been prescribed by the provider. Such a statement is usually written on the hard copy when the brand product is deemed medically necessary and, as such, there is no need for substituting them (Levinson & General, 2012). In most instances, the brand original drug results in better outcomes compared to the generic drug, hence the need for prescribing it. Furthermore, he pointed out the need for writing those terms by the pharmacists since it is a legal requirement. If a patient’s condition deteriorates as a result of utilizing a particular form of drugs, the legal repercussions in terms of fines may solely be directed to the individual responsible for such prescriptions. I asked Dr. KJ if it is possible for a pharmacist to change the medication prescribed for a particular patient without getting an approval from the individual responsible for spelling out the prescription. He informed me that it is legally possible for a pharmacist to take such an action provided that the drugs that they may wish to replace are in their generic form (Levinson & General, 2012). As it has been seen, generic drugs may serve the same purpose as the brand medicine though not exactly as the later. He added that the second instance through which a prescription may be changed by a pharmacists is when the term ‘’brand medically necessary’’ is written on the hard copy of order sheet. Modifying the prescription in such instances may not result in the required outcomes on the patient since the substituted drug may not be medically strong. He, however, pointed out that it is imperative for the pharmacists to keep the patients on updated concerning the substituted drug and the possible side effects that are likely to result from the usage of such drugs (Levinson & General, 2012). Additionally, pharmacists are under the obligation of making sure that they keep track of how the substituted drugs are being used by the patient by paying attention to their storage and their dispensing procedures.
I also sought to know from Dr. KJ If an ARNP working with a physician who is allowed to prescribe controlled medications and signs a controlled script for a patient, will be in a position to fill this drug. He informed me that currently, the law does not allow an ARNP to fill such medications up to a later date which will be 2017. Under the new dispensation, the requirements for prescribing such substances will be the name of the prescriber, and their address. He said that the name and address of the patient would also be required before filling these medications. Finally, the dynamics concerning the particular drug in question will also be taken down. To this effect, the name and strength of the drug, the required quantity, the dosage, and the number of refills if any will need to be addressed by the prescribing APRN (ANA, 2016). He added that there are, however, particular limitations which will guide how the APRN prescribes the drugs. For instance, it will be mandatory for the controlled substances to be registered or provided with the required licensure. Secondly, a written agreement will be needed between the APRN and the doctor concerning the prescription of the drugs (ANA, 2016). The APRN will also be under the obligation of limiting the quantity, duration of the substances which will need to be prescribed. He finished by saying that there a formulary for prescribing the controlled substances will be required of the APRNs.
My second last question to Dr. KJ was aimed at determining the type of drugs which could be faxed into the pharmacy or called in. He informed me that Schedule I, III and IV drugs are the only ones which can be directly called in faxed into the pharmacy. With the schedule II medications, however, the physician will be required to write down the prescription of such a drug on a paper otherwise known as hard copy or better yet transmit the dosage to a pharmacist by the use of secure electronic means (Reardan, Engel & Gagne, 2016). He added that the drugs could be called in only if the patient in question is under an emergency condition. This calling is supposed to be done within a period of seventy hours in addition to the production of a written prescription of the drug. Moreover, if the medication may not be sufficient for such an instance, a patient will be required to fill a new prescription that will allow them to be approved to use the medication. I finally asked him to shed some light on other questions which I ought to have told him concerning the prescription of drugs but had not included in the interview questions. He informed me that there was the need for physicians to take proper caution concerning the orders which they are supposed to process. To this effect, he said that it is essential for an individual to be on the look out concerning issues like whether the drug is the right one, the required weight, and if there are any allergies that are likely to emerge as a result of the usage of such drugs (Huynh et al., 2013). Additionally, the generic drugs which can be used in place of such orders need to be taken into consideration as a way of determining the effects they will have on their interactions. The specific individual characteristics, for instance, the age with which an individual will be required to use a particular drug should be addressed too (Huynh et al., 2013). He finished by saying that the interactions that such drugs have on the functioning of the renal part of the human body and in the laboratory should be accorded proper attention too.
Analysis of the interview
Conducting this interview has been a wake-up call to me both as a person and as a professional. The knowledge that I have gained from this exercise will play a significant role in my quest for making sure that the care that I provide to my patients will be top notch. I must admit that my knowledge concerning the reasons as to why some medications are kept behind the counter has in a major way expanded. I am now in a position to understand the kind and amount drugs that need to be provided to different patients suffering from various ailments. Such a comprehension will be critical in addressing the problems of drugs being abused by the patients to whom such meds would have been prescribed. One concept regarding the insurance policies that individuals have taken and the kind of medication that have been factored in such situations has also been broadly expounded to me. I have learned that the process of prior authorization is critical in making sure that patients are in a position to access the required medication essential for their wellbeing if the same medication has not been included in the insurance policy. Such a realization is a major step towards having patient receives proper care. I have also learned the role that the generic forms of medication play in addressing the different ailments which patients may be grappling with.
A factor that care providers need to understand is that even though the generic drugs may help achieve a particular objective concerning the addressing of different ailments, it is the original brand of the medicine that has got more desirable results compared to the generic forms of the drug. Finally, I have come to learn that Schedule II drugs have got a different approach as far as how they are handled is concerned. The realization that this group of medications may be easily abused by the individuals to whom they have been prescribed translates to them being treated with the utmost care. Such drugs may only be used in emergency situations, and proper paperwork may be required before they are faxed or called in. My interview with Dr. KJ has been very insightful one in that I have gained valuable knowledge concerning how I need to relate with my patients with the goal of achieving desirable outcomes from the care that I will be providing to them. Finally, I have learned the processes that pharmacists and providers have to follow in ensuring that patients receive the best regarding care from the medications that they receive.
References
ANA. (2016). Frequently asked questions about prescribing controlled substances. Retrieved from http://www.nursingworld.org/DocumentVault/APRN-Resource-Section/FAQ-About-Prescribing-Controlled-Substances.pdf
Huynh, S. M., Alshubaily, A., Mir, F. M., Smirnov, O., Thomas, M., Ogunyebi, J. O., & Fong, A. C. M. (2013, November). Pharmacy Drug Administration System. In Industrial Electronics Society, IECON 2013-39th Annual Conference of the IEEE (pp. 8437-8442). IEEE.
Lang, J. R., & Schueth, A. J. (2016). Electronic prior authorization and payers: Lessons from BCBS.
Levinson, D. R., & General, I. (2012). Generic drug utilization in state Medicaid programs. BiblioGov.
Maddox, C., Halsall, D., Hall, J., & Tully, M. P. (2016). Factors influencing nurse and pharmacist willingness to take or not take responsibility for non-medical prescribing. Research in Social and Administrative Pharmacy, 12(1), 41-55.
Minghetti, P., Rocco, P., & Schellekens, H. (2015). The constrained prescription, interchangeability and substitution of biosimilars. Nature biotechnology, 33(7), 688-689.
Pomeranz, J. L., Taylor, L. M., & Austin, S. B. (2013). Over-the-counter and out-of-control: legal strategies to protect youths from abusing products for weight control. American journal of public health, 103(2), 220-225.
Reardan, D. T., Engel, P. A., & Gagne, B. (2016). "Sensitive drug distribution system and method’’ U.S. Patent Application No. 15/014,831.
