The "I Can't Believe There's No Abortion Thread" Part Deux: Electric Boogaloo

[Swansong]

Yeah, 90-day supplies basically error out on the CVS website. "LOL YOU WANT WHAT?"

Again, to the contrary. Depending on your insurance, it may be cheaper to have a 90 day supply than a 30. The Flovent I was on until last summer when my insurance decided they knew better than my doctor and stopped covering it was $40 for a 90 day supply or $120 for a 30 day supply. Not even exaggerating. (Now I use our internal pharmacy and my copay is $5 for 30 days)

[Swansong]

That's not what I'm saying.

If I have an eScript, they get sent first to the pharmacy and put on hold. Once on hold, I can call them up and request one of them be filled. If they don't have it, I have to sent a MyChart message to my doctor (you can't call anymore) and ask to have that eScript cancelled and sent to a new pharmacy. In the time it takes for me to send that message, have her write a new script, and the pharmacy receive it is usually a 12- to 24-hour process. In the time it takes that system to turn around, the pharmacy could be out of that medicine. Wash rinse repeat.
When I do an eVisit via MyChart, it specifically says "Do not ask for refills. Call your pharmacy first." So it's not like I can just call around every month and then call my doctor and say send it to HyVee this month.

If I had a paper script, I could walk into target and say, do you have this? No? I can drive to Hy-Vee and check there. Or I could call and drop it off. No bouncing back and forth. That's entirely the fault of the system and the legislatures forcing the system on everyone.

Obviously this is a situation where shortages are straining a system, but it's not like this isn't common. There's a massive shortage! It's very common!

I guess I'm still unclear on the situation. So the office won't let you call them? They have phones, right? Then you can call them. The turn around time might be even longer though.

Again, the situation is related to the frustrating lack of supply. I get that if you had a paper script you could walk up and say "hey do you have this now" or call and say "do you have this" and if so, just go straight there. And in that case, I guess yeah it's a bit frustrating. But considering for like 99.99999999999% of prescriptions it improves speed and reliability - while helping reduce abuse of controlled substances in most states - I think your situation is annoying as hell but certainly not an exhibit as to why eprescribing in general is bad.



Counter example. In our new Epic system we're currently developing, I'll be able to refill prescriptions by logging in, clicking "refill". And 3-4 days later the inhaler shows up in the mail. This will be true because I'll use our internal pharmacy and commercial pharmacy customers would have a slightly longer lead time, but there are a lot of me. And even for CVS customers, we'd probably direct them to CVS directly and cut out the middle man entirely.


Plus, again on the opioid epidemic. ED provider thinks a patient needs a painkiller. Gets the order queued up for CVS. Checks the PDMP and see the patient is on a **** TON of it through multiple providers. Cancels the order and follows their doctor shopping policy and works on addiction treatment instead of "here's your script" and out the door.

[dxmnkd316]

I don’t know enough about any of this to be dangerous. But I do know that many insurance companies, esp my former employer, can make it a nightmare to get 90 day supply of certain drugs

Yeah, 90-day supplies basically error out on the CVS website. "LOL YOU WANT WHAT?"

[dxmnkd316]

Again, what you're describing is not a systems issue. It's a stock and cost issue. Almost no pharmacy is going to share stock levels outside their own company, so even if Epic (or any EHR) had the capability to pull this in, pharmacies won't share unless legally obligated to.

Having a paper script doesn't change your need to call around.

That's not what I'm saying.

If I have an eScript, they get sent first to the pharmacy and put on hold. Once on hold, I can call them up and request one of them be filled. If they don't have it, I have to sent a MyChart message to my doctor (you can't call anymore) and ask to have that eScript cancelled and sent to a new pharmacy. In the time it takes for me to send that message, have her write a new script, and the pharmacy receive it is usually a 12- to 24-hour process. In the time it takes that system to turn around, the pharmacy could be out of that medicine. Wash rinse repeat.
When I do an eVisit via MyChart, it specifically says "Do not ask for refills. Call your pharmacy first." So it's not like I can just call around every month and then call my doctor and say send it to HyVee this month.

If I had a paper script, I could walk into target and say, do you have this? No? I can drive to Hy-Vee and check there. Or I could call and drop it off. No bouncing back and forth. That's entirely the fault of the system and the legislatures forcing the system on everyone.

Obviously this is a situation where shortages are straining a system, but it's not like this isn't common. There's a massive shortage! It's very common!

[Deutsche Gopher Fan]

I don’t know enough about any of this to be dangerous. But I do know that many insurance companies, esp my former employer, can make it a nightmare to get 90 day supply of certain drugs

[Swansong]

Again, what you're describing is not a systems issue. It's a stock and cost issue. Almost no pharmacy is going to share stock levels outside their own company, so even if Epic (or any EHR) had the capability to pull this in, pharmacies won't share unless legally obligated to.

Having a paper script doesn't change your need to call around.

[dxmnkd316]

DX - your provider has not adapted to a new process. It's so much easier than they're making it.

Write a one month script and they should be able to send to a mail order pharmacy, who you can talk to and ensure you get 3-month supplies.


One of the PCPs I used to work with struggled with the same thing - he had a patient on a fairly obscure med that he'd do what yours does. So they found a mail-order pharmacy that always had it in stock (or could get it in sufficient time), and just ordered it there, and the pharmacy took care of the rest. No need for constant re-ups or "on-hold" scripts.

Respectfully I disagree. I've talked it over with her several times. And the pharmacy. None of this is unique to any of them. Other people I know who have this condition also run into the same problems. It's a system issue.

I also implicitly trust my doctor. She's also a professor at the U and is fairly tech savvy. We talk over EHR stuff once a year or so. She flies through Epic like no one I've seen.

unfortunately I can't get 90-day supplies, my insurance doesn't cover them. Might even be a law against it IIRC.

The other issue is the cost. I've priced it out at dozens of locations and only CVS has it for under $200/mo. They're half that. Online doesn't even come close.

[Proud2baLaker]

I'm on 4 different maintenance meds. My doctor can order a full year at a time (4 refills at 3 months each) no problem. I use Walgreens and they actually email me when its time to refill and will actually auto refill them most of the time. If not, then I can easily sign in and request the refill and its ready the next day. But that is for generics and for common things. I actually get 3 of the 4 medications at no cost (and the 4th is like $8 for 3 months).

[Swansong]

Excellent question. I don’t know the answer to that since I’m on actually-care-about-the-patients side of the equation, but the bulk of our payer sources are Medicaid and Medicare, so we must have some kind of workaround that keeps the money flowing.

Interesting.

We just implemented this micro-printing structure for when we do need to print scripts, to ensure that controlled substance scripts are actually legit and actually honored. But on the digital side, eRX for controlled substances, combined with databases like the Prescription Drug Monitoring Program have helped reduce and identify pill-mill doctors as well as patients doctor shopping.

[Swansong]

DX - your provider has not adapted to a new process. It's so much easier than they're making it.

Write a one month script and they should be able to send to a mail order pharmacy, who you can talk to and ensure you get 3-month supplies.


One of the PCPs I used to work with struggled with the same thing - he had a patient on a fairly obscure med that he'd do what yours does. So they found a mail-order pharmacy that always had it in stock (or could get it in sufficient time), and just ordered it there, and the pharmacy took care of the rest. No need for constant re-ups or "on-hold" scripts.

[ScoobyDoo]

At my current company it went:

1. Hire consultants
2. Plan for 2 years
3. Realize it's too many different systems and too complicated so only do partial rollout
4. Push back dates a year, get informed you're 50% over budget
5. Second partial rollout
6. SAP doesn't communicate with your other systems that you didn't convert, creating a lot of duplicated work for everyone
7. Delay full roll out indefinitely
8. Sell division to a diferent company, now it's someone else's problem

That's my great failure in my IT career. You want to be the SAP consultant. You continually get bank for accomplishing nothing.

[RaceBoarder]

Yes but it's a gamble if I can get a stupid eMessage to my doctor in time and have her write the script. They can't transfer even within the same chain. Usually takes the pharmacy a week or two to order and receive.

That's interesting that they don't allow you to just go to another location without involving the doctor. But after Psych's comment, I can understand that there are medications out there that would require hoops.

My experience is with different forms of Insulin, so it's also something is dispensed almost daily.

[psych]

ePrescriptions are the worst ****ing thing on earth. I hope the person who invented them got run over by a goddamn bus.

They've made my life, my doctor's life, and pharmacists lives a living hell

Our psychiatrists and nurse practitioners only use escripts for stimulants or opioids. Otherwise, simple ol’ paper scripts with a month’s supply of Seroquel, Prozac, what have you.

[psych]

Wow. Crazy.

In MA, you can't even prescribe via paper without indicating that the eRX system is temporarily down.


How does this impact Medicare payments? They require all sorts of things related to digital validation and attestation.

Excellent question. I don’t know the answer to that since I’m on actually-care-about-the-patients side of the equation, but the bulk of our payer sources are Medicaid and Medicare, so we must have some kind of workaround that keeps the money flowing.

[dxmnkd316]

Do you not go to a chain pharmacy like CVS/Walgreens? They don't look in their system and track down your script and allow you to pick it up at another location or have it shipped to your current location?

The locations by me can get anything within a day or two if there isn't any of it at one one the 10 or so locations within an hour of me.

Yes but it's a gamble if I can get a stupid eMessage to my doctor in time and have her write the script. They can't transfer even within the same chain. Usually takes the pharmacy a week or two to order and receive.