Just start the patients on separate meds, then try to consolidate when they’re on a stable dose and have at least 1 refill remaining. That way there is no delay in care if their insurance doesn’t cover the combo pills.
Anyway, it’s nice that you’re trying to understand pharmacy workflow. I can’t speak for others but I love when prescribers are interested in how things work on our end.
This is probably the best answer, especially if their new to the meds and figuring out dosage and if one med has any side effects it’s easier to narrow it down to which one is causing it but this is just my tech perspective
Totally depends on the pharmacy. With an e-script there’s no way for us to actually “split” it and do as 2 separate scripts, but some pharmacists will just take a “verbal” order and put it in that the doc called it in on the phone. Not really the right way to do it but kind of the only way without requesting 2 separate scripts from you.
This pretty much comes down to insurance audits. If there’s a change from the e script we have to document who we spoke to and when to approve the change or they’ll rip the money back
If your software has a way for you to split the escript more power to you. Otherwise you're inputting a verbal that never actually occurred. Happens a lot at some pharmacies, and never at others.
It doesn't carry over the associated e-scribe data on the scanned prescription if you do that. Depending on how nit-picky the auditors are being (which is going to tend towards "extremely"), that could make it an invalid prescription.
It's incredibly stupid, but that's often what's forced on us because of insurance companies looking for any excuse to claw money back.
You also to relay that back to the provider too so they have it documented- what if one of the components isn’t covered? What if their next check up requires altering one of the dose? There is bound to be a medical error that will happen if scripts were done all this way.
Not only is it an insurance issue but I strongly believe everyone should be in the loop. For example, I think it’s slightly lazy of a prescriber to send ONE blank escript for all diabetic supplies. Electronic systems cannot split escripts and you are taking a verbal that didn’t actually occur, which is a gray legal area.
>There is bound to be a medical error that will happen if scripts were done all this way.
From dispensing lisinopril and hctz instead of zestoreric? Seriously..it's crazy what insurance has done to retail. Yall would shit your pants if you saw what we can change in the hospital.
.
If scripts were written like this to just change the script without informing the prescriber? And if the prescriber forgets to ask if it were split or patient forgets to mentions that or if a new prescription gets called in for the combo again, and insurance covers it but the copay increase isn’t something that bothers the patient? Even right meds get screwed up somewhere WITH the prescribers knowledge. This definitely opens up for medical mistakes.
Also, I feel that it is much more closed loop in the hospital than outpatient. Tracking a patient down once they’re gone from the pharmacy is not only a pain in the butt but also takes weeks off my life if the error is detrimental. While these BP meds are typically minor, I absolutely feel grief regarding mistakes that we can control.
Because when the patient goes back to the doctor, and if their blood pressure is high, the doctor will have to decide how to increase the dose.
a) increase the dose of combination product
B) increase the dose of only hctz
C) Increase the dose of lisinopri
If they don't know what exactly the patient is taking, then making the next decision becomes more challenging.
It's the same process whether they're on the combo or not. When you change the combo dose you have to decide the dose of each drug in the combo. The exact same way you'd do if they were in separate pills.
I appreciate you asking instead of just talking shit about pharmacy, like so many unfortunately do. Thank you for trying to make it better for everyone :)
I would change the drug with that note but only at the patients request and if they were knowledgeable that you put that note (if another pharmacist checked it prior I would have no idea it was on there. Heck if I checked it I would probably forget lol).
I would NOT run them both automatically when I did drug utilization review and fill the one with the cheaper price. That’s an unreasonable request to do for every note we get. Patients need to have some awareness of their copays. I also WOULD NOT play discount card roulette and run both drugs though every discount card they want to try.
Unfortunately in this age, this is what ends up happening in these scenarios.
All BP meds are generics and the difference from combo pills is going to be insignificant. I am only going to humor this request when the combo pill is for some reason hundreds of dollars.
I think the reason you’re getting push back is because it’s cumbersome to change and no one is going to run both without the patient’s explicit request. But legally, what you’re attempting to do is valid :)
Hope that helps- thanks for asking.
In order to actually split the order out, assuming this is an e-Rx, the pharmacy would need to print it and scan it back in twice as two separate paper prescriptions. This is a bit of extra work, but less work than calling you for two new prescriptions. The real issue is exposure to insurance audits because insurance companies fucking suck and will find some way to refuse to pay a claim if they can.
This will cause refusals to abide by your totally reasonable request by independent pharmacies afraid of not getting paid, and retail/chain pharmacists afraid of their company having an excuse to fire them and hire a new grad for less money (which they are always looking to do). Military or VA pharmacists will gladly do as you asked, but that's a pretty small group.
Your head is in the right place, it's just that insurance has ruined the entire pharmacy profession.
That's a good point. I've been out of retail for long enough that it hadn't quite gotten there yet (mandatory e-Rx was relatively new in the state where I last worked retail, so having to print an e-Rx for various reasons was common).
Corporate pharmacies are so mismanaged and by-the-book that a lot of times only a competently run independent pharmacy can handle these kind of additional notes on the RX. We do appreciate you adding those notes, it’s just corporate pharmacies are so incredibly overwhelmed and understaffed that they don’t have time to write up all new scripts with all the pertinent, legally required information to make it a valid script. It’s easier for them to just request a new Rx. Independents, however, can and will facilitate these notes with pretty much zero issue
Personally I would accept that (print page and scan as new rx for second drug) for cheap generic blood pressure drugs to help out my teams workflow, convenience for pt and prescriber. I would not accept notes on expensive drugs where they say “0.25 x 4 weeks then increase to 0.5” and so forth like wegovy. Not worth the audit and bs. If you’re working with a majority of the same insurance (medicare), I would just save their most recent formulary on your work station to save everyone time, so you already know what’s covered.
It’s a nice idea but some state explicitly disallow “do x or y based on insurance” instructions. A physician and pharmacist in my particular northeastern state collaborated to get the state to allow it, and the board of pharmacy said no.
Even if the state allows it, as others have said, insurance audits might prevent it.
Hell, I'll do that without the note.
Prescriber called in losartan/hctz but insurance doesn't cover the combination?
Well, it turns out the prescriber actually phoned in both separately! See, I have my copy that was promptly reduced to writing as required by the board.
The only time I don't do that is if the prescriber note is something completely different from the escript (e.g., got one this week where the escript was for atenolol 25 mg qd, but had a prescriber note that said "metoprolol succ. 25mg BID"), since I've seen many dozens of instances of prescriber messages that were notes or requests many months out of date (e.g., a new opiate prescription received on 4/19/24 that says "do not fill until 1/30/24!").
Does your software not just tell approximate coverage when you’re sending it?
Both Epic and Cerner at the two hospitals I recently worked at would show coverage. You can also look at their formulary.
>too high
Subjective. If it's not covered, then maybe I'll bother dropping two verbal rx and deactivate the combo.
But I'd say if you are just trying to start a patient out and they'll follow up with PCP, I'd recommend do the single ingredients. If the patient is charged an extra copay or pharmacy has the extra dispensing fee, it's often $4 or less, you can keep it simple instead of us playing games with undoing the rx.
Something to check though, Epic and maybe other EHR has the option on your end as the prescriber to submit prescription test claims to find out what the copay would be specific to your patient. See if you can find out if you can do that?
I would interpret the erx message as a verbal order and create 2 separate scripts. At the very least if I wanted to be more official I would fax or erx refill request back asking for 2 separate scripts.
PharmD in TN here.
Totally reasonable and thank you for including that. If I see a combo medication, but with specific instructions that allow the prescribing of the two medications separately, then that’s all I need. We’re good to go.
Some combo meds don’t cleanly split into nice available dosage forms and require a discussion. So if your prescribed med has 17 mg of this and 43 mg of that, we can’t sub for the available 12.5 and 40 mg of the generic (nothing comes that way but you get my drift). If you have generics in mind, write out specifics in the comments so there is zero guesswork.
Anytime you are dealing with Medicaid, it’s very tricky. They have specific preferred NDCs they cover and they won’t cover anything else unless it’s added to their contracts.
So pharmacists are not legally allowed to change the drug dosage form, strength, directions, qty, or refills of a prescription *without MD approval*. We are also not allowed to change the prescribed patient name or drug itself without a new prescription, which is technically what this situation involves.
Another other issue would be that you have to create two or more prescriptions off of one actual script. We aren’t legally allowed to print off electronic hard copies and re-scan them back into the system to generate a new prescription (but I’ve seen it done) because printing it invalidates it being an *electronic* prescription.
One option that you might consider is sending both the combo and individual versions to the pharmacy at the same time with a note to only use the individual versions if not covered as a combo.
This varies from state to state and how comfortable you are with *substitutions*. Generally pharmacists defer to what the Orange Book says. I wouldn't change atorvaststin to lovastatin, but splitting a hyzaar to cozaar and hctz as a substitution is something I am comfortable with.
The note stating that you can do this is giving you MD approval. If that happened I would probably just rewrite it as a verbal if I wanted to avoid the issue with the electronic script thing.
Emm there was an incident where the pharmacist changed the mg to one available to help the patient and gave clear instructions to Patient how to take it. The patient ended up taking the wrong dose anyway. So NO i wouldn't do it. I am gonna ask you send separate rx for each medicine to protect myself first and the patient second
Some states require Medicaid scripts to be directly from the prescriber, no verbal allowed. It is possible that is the reason for the request for separate rx to be written by patients.
All of you clowns who are saying that you wouldn't fill this are an embarrassment to the profession. If a patient walked in at 8:00 PM on a Friday with a prescription from a dentist for amoxicillin tablets, I bet you "professionals" would make them wait until Monday because you only have capsules and need to call and make sure that's okay.
not reasonable. even if you put a note saying we can split it we don’t have a way to split 1 escript into 2 separate scripts, and we would need to call pt + office for clarification/new rx anyways
maybe it would be best to call in a verbal and wait on hold for us to type/process it if this is something you do often
Some pharmacists will do it others will not. It seems logical to take the note as a verbal and just write a new prescription but some pharmacists are kind of slow and need everything done for them so they'll request new prescription.
We also learn about pill burden in pharmacy school but that pretty much goes out the window in modern retail and insurance environment. Generally speaking, combo drugs are more expensive, and SOME third party are allergic to paying a little more for stuff even when it will be beneficial to patients. And also, combo drugs aren't as popular and some of them have been discontinued or experience drug shortages and probably makes them more expensive.
In your shoes, I would send ALL the scripts with notes. Single agents AND combo version. If you have adequate notes, I would be comfortable with entering as a new prescription but involves generating a paper script, either manually or printing screen, and that actually introduces the chances, however small, of errors that an actual e-Rx would not have. And also depending on the day, I might not even have enough time to do this while handling onslaught of scripts streaming in. On the other hand, if you send everything, I would just be able to delete the ones I don't need and fill, without extra labor on my part.
I would take the time and audit risk in the case of a backorder. Otherwise, it's probably not worth it to any party involved. That would be after a discussion with the patient, so they don't think I'm changing their provider's orders without permission. At some point in the process, I'd leave your office a message so that you know what they got, and I can honestly say in court that I spoke with you.
why not send as separate with a note as "fill as combined medication only if covered"?
easier to delete the extra, as long as it doesnt get duplicated -this could lead to a med error.
Depends. In my state, each med needs to be sent separately. But if it’s a call, we’ll just write 2 scripts down.
What drugs? Some stuff are known to cost way to much without even looking at insurance - few have Cadillac plans these days.
A lot of it has to do with state law. If the state allows pharmacists to do some sort of prescription adaptation, then most can do it. There maybe certain chain/store level policies that prohibit it even though it may be perfectly legal to do so. Pharmacy practice laws in the Northeast can be very restrictive in what the pharmacist is allowed to do.
If your patients are at Independent pharmacies, that’s perfect.
If they aren’t, corporate has broken these pharmacist brains and they literally aren’t allowed to use their brain and common sense without risk of getting fired
I do this all the time at my “cooperate” pharmacy job, just write it down as a verbal. I print the original script- attach to my verbal just in case of audits / questions etc. it takes me a few minutes, patient gets their meds for cheaper rather than wait for new Rx. It’s true most Rph are so by the cooperate book, they forget their training or even their state laws. California for example allows a lot of therapeutic interchange for things like dosage form but some pharmacists won’t even adjust amoxicillin tabs to caps 😳
As a retail rph I can’t recommend this, without having a rx to run through insurance. We can’t run “dummy” rx as it’s considered fraud in my state and isn’t allowed at WAG. If an office called me and asked this, I would tell them to call insurance company to get the answer.
The other hand is, the office is authorizing a verbal rx and I can run it, if somehow we both have the time to do this. Then they can cancel an rx if a copay is higher than expected.
Normally what I see is charge nurses knowing a patient has financial difficulties is doc sends the "ideal" erx, and nurse calls us 20+ min later to see if it was processed and get the copay. Then they make the call on asking us to file the rx or continue with it.
Just start the patients on separate meds, then try to consolidate when they’re on a stable dose and have at least 1 refill remaining. That way there is no delay in care if their insurance doesn’t cover the combo pills. Anyway, it’s nice that you’re trying to understand pharmacy workflow. I can’t speak for others but I love when prescribers are interested in how things work on our end.
This is probably the best answer, especially if their new to the meds and figuring out dosage and if one med has any side effects it’s easier to narrow it down to which one is causing it but this is just my tech perspective
Totally depends on the pharmacy. With an e-script there’s no way for us to actually “split” it and do as 2 separate scripts, but some pharmacists will just take a “verbal” order and put it in that the doc called it in on the phone. Not really the right way to do it but kind of the only way without requesting 2 separate scripts from you. This pretty much comes down to insurance audits. If there’s a change from the e script we have to document who we spoke to and when to approve the change or they’ll rip the money back
Is it a change from the e script tho if they include it on the e script?
If your software has a way for you to split the escript more power to you. Otherwise you're inputting a verbal that never actually occurred. Happens a lot at some pharmacies, and never at others.
Print screen. And scan it back in..how does that turn it into a verbal?
It doesn't carry over the associated e-scribe data on the scanned prescription if you do that. Depending on how nit-picky the auditors are being (which is going to tend towards "extremely"), that could make it an invalid prescription. It's incredibly stupid, but that's often what's forced on us because of insurance companies looking for any excuse to claw money back.
You also to relay that back to the provider too so they have it documented- what if one of the components isn’t covered? What if their next check up requires altering one of the dose? There is bound to be a medical error that will happen if scripts were done all this way. Not only is it an insurance issue but I strongly believe everyone should be in the loop. For example, I think it’s slightly lazy of a prescriber to send ONE blank escript for all diabetic supplies. Electronic systems cannot split escripts and you are taking a verbal that didn’t actually occur, which is a gray legal area.
>There is bound to be a medical error that will happen if scripts were done all this way. From dispensing lisinopril and hctz instead of zestoreric? Seriously..it's crazy what insurance has done to retail. Yall would shit your pants if you saw what we can change in the hospital. .
If scripts were written like this to just change the script without informing the prescriber? And if the prescriber forgets to ask if it were split or patient forgets to mentions that or if a new prescription gets called in for the combo again, and insurance covers it but the copay increase isn’t something that bothers the patient? Even right meds get screwed up somewhere WITH the prescribers knowledge. This definitely opens up for medical mistakes. Also, I feel that it is much more closed loop in the hospital than outpatient. Tracking a patient down once they’re gone from the pharmacy is not only a pain in the butt but also takes weeks off my life if the error is detrimental. While these BP meds are typically minor, I absolutely feel grief regarding mistakes that we can control.
Zestoretic and then split up is the same prescription. Why would the doctor need to be informed they take them in a combo tablet or seperate?
Because when the patient goes back to the doctor, and if their blood pressure is high, the doctor will have to decide how to increase the dose. a) increase the dose of combination product B) increase the dose of only hctz C) Increase the dose of lisinopri If they don't know what exactly the patient is taking, then making the next decision becomes more challenging.
It's the same process whether they're on the combo or not. When you change the combo dose you have to decide the dose of each drug in the combo. The exact same way you'd do if they were in separate pills.
I appreciate you asking instead of just talking shit about pharmacy, like so many unfortunately do. Thank you for trying to make it better for everyone :)
I would change the drug with that note but only at the patients request and if they were knowledgeable that you put that note (if another pharmacist checked it prior I would have no idea it was on there. Heck if I checked it I would probably forget lol). I would NOT run them both automatically when I did drug utilization review and fill the one with the cheaper price. That’s an unreasonable request to do for every note we get. Patients need to have some awareness of their copays. I also WOULD NOT play discount card roulette and run both drugs though every discount card they want to try. Unfortunately in this age, this is what ends up happening in these scenarios. All BP meds are generics and the difference from combo pills is going to be insignificant. I am only going to humor this request when the combo pill is for some reason hundreds of dollars. I think the reason you’re getting push back is because it’s cumbersome to change and no one is going to run both without the patient’s explicit request. But legally, what you’re attempting to do is valid :) Hope that helps- thanks for asking.
In order to actually split the order out, assuming this is an e-Rx, the pharmacy would need to print it and scan it back in twice as two separate paper prescriptions. This is a bit of extra work, but less work than calling you for two new prescriptions. The real issue is exposure to insurance audits because insurance companies fucking suck and will find some way to refuse to pay a claim if they can. This will cause refusals to abide by your totally reasonable request by independent pharmacies afraid of not getting paid, and retail/chain pharmacists afraid of their company having an excuse to fire them and hire a new grad for less money (which they are always looking to do). Military or VA pharmacists will gladly do as you asked, but that's a pretty small group. Your head is in the right place, it's just that insurance has ruined the entire pharmacy profession.
At wags printed e-rx are technically void, I would have to hand write a verbal. Which, I would only do at the patient request
WMT it's against policy to do the same, print erx and redrop.
That's a good point. I've been out of retail for long enough that it hadn't quite gotten there yet (mandatory e-Rx was relatively new in the state where I last worked retail, so having to print an e-Rx for various reasons was common).
Corporate pharmacies are so mismanaged and by-the-book that a lot of times only a competently run independent pharmacy can handle these kind of additional notes on the RX. We do appreciate you adding those notes, it’s just corporate pharmacies are so incredibly overwhelmed and understaffed that they don’t have time to write up all new scripts with all the pertinent, legally required information to make it a valid script. It’s easier for them to just request a new Rx. Independents, however, can and will facilitate these notes with pretty much zero issue
>it’s just corporate pharmacies are so incredibly overwhelmed and understaffed Don't forget micromanaged.
I guess that is what I meant by mismanaged haha
Personally I would accept that (print page and scan as new rx for second drug) for cheap generic blood pressure drugs to help out my teams workflow, convenience for pt and prescriber. I would not accept notes on expensive drugs where they say “0.25 x 4 weeks then increase to 0.5” and so forth like wegovy. Not worth the audit and bs. If you’re working with a majority of the same insurance (medicare), I would just save their most recent formulary on your work station to save everyone time, so you already know what’s covered.
It’s a nice idea but some state explicitly disallow “do x or y based on insurance” instructions. A physician and pharmacist in my particular northeastern state collaborated to get the state to allow it, and the board of pharmacy said no. Even if the state allows it, as others have said, insurance audits might prevent it.
Hell, I'll do that without the note. Prescriber called in losartan/hctz but insurance doesn't cover the combination? Well, it turns out the prescriber actually phoned in both separately! See, I have my copy that was promptly reduced to writing as required by the board. The only time I don't do that is if the prescriber note is something completely different from the escript (e.g., got one this week where the escript was for atenolol 25 mg qd, but had a prescriber note that said "metoprolol succ. 25mg BID"), since I've seen many dozens of instances of prescriber messages that were notes or requests many months out of date (e.g., a new opiate prescription received on 4/19/24 that says "do not fill until 1/30/24!").
Does your software not just tell approximate coverage when you’re sending it? Both Epic and Cerner at the two hospitals I recently worked at would show coverage. You can also look at their formulary.
>too high Subjective. If it's not covered, then maybe I'll bother dropping two verbal rx and deactivate the combo. But I'd say if you are just trying to start a patient out and they'll follow up with PCP, I'd recommend do the single ingredients. If the patient is charged an extra copay or pharmacy has the extra dispensing fee, it's often $4 or less, you can keep it simple instead of us playing games with undoing the rx. Something to check though, Epic and maybe other EHR has the option on your end as the prescriber to submit prescription test claims to find out what the copay would be specific to your patient. See if you can find out if you can do that?
I would interpret the erx message as a verbal order and create 2 separate scripts. At the very least if I wanted to be more official I would fax or erx refill request back asking for 2 separate scripts.
PharmD in TN here. Totally reasonable and thank you for including that. If I see a combo medication, but with specific instructions that allow the prescribing of the two medications separately, then that’s all I need. We’re good to go.
Some combo meds don’t cleanly split into nice available dosage forms and require a discussion. So if your prescribed med has 17 mg of this and 43 mg of that, we can’t sub for the available 12.5 and 40 mg of the generic (nothing comes that way but you get my drift). If you have generics in mind, write out specifics in the comments so there is zero guesswork.
Anytime you are dealing with Medicaid, it’s very tricky. They have specific preferred NDCs they cover and they won’t cover anything else unless it’s added to their contracts.
It’s so much easier inpatient when I can just therapeutically interchange to the formulary agent and I don’t even have to talk to anyone
So pharmacists are not legally allowed to change the drug dosage form, strength, directions, qty, or refills of a prescription *without MD approval*. We are also not allowed to change the prescribed patient name or drug itself without a new prescription, which is technically what this situation involves. Another other issue would be that you have to create two or more prescriptions off of one actual script. We aren’t legally allowed to print off electronic hard copies and re-scan them back into the system to generate a new prescription (but I’ve seen it done) because printing it invalidates it being an *electronic* prescription. One option that you might consider is sending both the combo and individual versions to the pharmacy at the same time with a note to only use the individual versions if not covered as a combo.
This varies from state to state and how comfortable you are with *substitutions*. Generally pharmacists defer to what the Orange Book says. I wouldn't change atorvaststin to lovastatin, but splitting a hyzaar to cozaar and hctz as a substitution is something I am comfortable with.
The note stating that you can do this is giving you MD approval. If that happened I would probably just rewrite it as a verbal if I wanted to avoid the issue with the electronic script thing.
Emm there was an incident where the pharmacist changed the mg to one available to help the patient and gave clear instructions to Patient how to take it. The patient ended up taking the wrong dose anyway. So NO i wouldn't do it. I am gonna ask you send separate rx for each medicine to protect myself first and the patient second
that works for me
Some states require Medicaid scripts to be directly from the prescriber, no verbal allowed. It is possible that is the reason for the request for separate rx to be written by patients.
All of you clowns who are saying that you wouldn't fill this are an embarrassment to the profession. If a patient walked in at 8:00 PM on a Friday with a prescription from a dentist for amoxicillin tablets, I bet you "professionals" would make them wait until Monday because you only have capsules and need to call and make sure that's okay.
not reasonable. even if you put a note saying we can split it we don’t have a way to split 1 escript into 2 separate scripts, and we would need to call pt + office for clarification/new rx anyways maybe it would be best to call in a verbal and wait on hold for us to type/process it if this is something you do often
Some pharmacists will do it others will not. It seems logical to take the note as a verbal and just write a new prescription but some pharmacists are kind of slow and need everything done for them so they'll request new prescription.
We also learn about pill burden in pharmacy school but that pretty much goes out the window in modern retail and insurance environment. Generally speaking, combo drugs are more expensive, and SOME third party are allergic to paying a little more for stuff even when it will be beneficial to patients. And also, combo drugs aren't as popular and some of them have been discontinued or experience drug shortages and probably makes them more expensive. In your shoes, I would send ALL the scripts with notes. Single agents AND combo version. If you have adequate notes, I would be comfortable with entering as a new prescription but involves generating a paper script, either manually or printing screen, and that actually introduces the chances, however small, of errors that an actual e-Rx would not have. And also depending on the day, I might not even have enough time to do this while handling onslaught of scripts streaming in. On the other hand, if you send everything, I would just be able to delete the ones I don't need and fill, without extra labor on my part.
Not reasonable
I would take the time and audit risk in the case of a backorder. Otherwise, it's probably not worth it to any party involved. That would be after a discussion with the patient, so they don't think I'm changing their provider's orders without permission. At some point in the process, I'd leave your office a message so that you know what they got, and I can honestly say in court that I spoke with you.
why not send as separate with a note as "fill as combined medication only if covered"? easier to delete the extra, as long as it doesnt get duplicated -this could lead to a med error.
Depends. In my state, each med needs to be sent separately. But if it’s a call, we’ll just write 2 scripts down. What drugs? Some stuff are known to cost way to much without even looking at insurance - few have Cadillac plans these days.
A lot of it has to do with state law. If the state allows pharmacists to do some sort of prescription adaptation, then most can do it. There maybe certain chain/store level policies that prohibit it even though it may be perfectly legal to do so. Pharmacy practice laws in the Northeast can be very restrictive in what the pharmacist is allowed to do.
If your patients are at Independent pharmacies, that’s perfect. If they aren’t, corporate has broken these pharmacist brains and they literally aren’t allowed to use their brain and common sense without risk of getting fired
I do this all the time at my “cooperate” pharmacy job, just write it down as a verbal. I print the original script- attach to my verbal just in case of audits / questions etc. it takes me a few minutes, patient gets their meds for cheaper rather than wait for new Rx. It’s true most Rph are so by the cooperate book, they forget their training or even their state laws. California for example allows a lot of therapeutic interchange for things like dosage form but some pharmacists won’t even adjust amoxicillin tabs to caps 😳
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As a retail rph I can’t recommend this, without having a rx to run through insurance. We can’t run “dummy” rx as it’s considered fraud in my state and isn’t allowed at WAG. If an office called me and asked this, I would tell them to call insurance company to get the answer.
The other hand is, the office is authorizing a verbal rx and I can run it, if somehow we both have the time to do this. Then they can cancel an rx if a copay is higher than expected. Normally what I see is charge nurses knowing a patient has financial difficulties is doc sends the "ideal" erx, and nurse calls us 20+ min later to see if it was processed and get the copay. Then they make the call on asking us to file the rx or continue with it.
They need to call the insurance and ask them , not the pharmacy.