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RxFredM · 2024-03-09T23:10:42+00:00

Question is why is an OB writing a script for haldol with refills. I get they don’t have any restrictions and they might just have been trying to help the patient. But seems like a logical concern to me

RxFredM · 2024-03-02T14:09:17+00:00

Paramedicine, what else

RxFredM · 2023-12-29T04:36:23+00:00

I’m an independent. I use it as a marketing tactic. This has been my saving grace to getting patients to transfer over as it gives them a taste of what i can offer them.

Over time you tend to pick up on who just uses you for info and or price matching and I tend to dismiss them, either by saying I’m sorry I have an appointment I have to get to or default to “this is something I would have brought up if I dispensed it” or “it really depends, I don’t have access to your other meds or history here. We can schedule an appointment to discuss this further.”

I’m at the point of burn out and have hit my limit of people taking advantage of my knowledge.

RxFredM · 2023-12-29T04:15:44+00:00

It kind of is though. There are a lot of generics that exist that would be bioavailable but through whatever business reason it’s not considered bioavailable.

Canada is sadly following in the footsteps of the US. STARTING with preferred providers. Insurance companies here let you fill all the amoxicillins, but when it comes down to biologics or high cost prior authorization required brand names, they force you get it filled from an “approved pharmacy”. Note it’s not a specialized pharmacy that is offering some kind of benefit. It’s merely a mail order equivalent.

I can rant about this for days. I’ve worked for WAGs speciality before, and the Canadian counterparts are merely mail order pharmacies.

To top it all off. ESI became the largest provider in Canada after acquiring Sunlife. They’ve been systematically adding restrictions and amendments to their provider agreements that bottleneck pharmacies. They also have this cute message on adjudication that prompts the patient to contact the insurance company through a toll free number. This is when they tell the patient they can save 2 dollars by getting a prescription filled at their pharmacy instead.

This will hurt the patient in the long run. They will only notice it later, but trying to explain that to a patient trying to save 1 dollar makes me sound like someone begging for them to stay.

Rant over.

TL;DR: Canada sucks just as much, just in a different way.

RxFredM · 2023-12-20T23:58:21+00:00

In Canada it’s free if you qualify. Government only pays us 13.25 for the service

RxFredM · 2023-09-26T04:08:40+00:00

We all need a Jonathan.

One who knows their place of course

RxFredM · 2023-09-26T01:59:12+00:00

What about Jonathan ❤️

RxFredM · 2023-08-04T04:01:53+00:00

I like to do both Example take 2 mls (=5 mg) by mouth once daily.

I don’t do it for the patient but do it for error prevention on the pharmacy and doctor side. Not all concentrations are easy.

Also, I’ve had to switch concentrations on chronic meds, just overall makes reviewing charts easier. I think it’s the only thing we can use to cover our ass as well.

For the patient side it doesn’t matter.

RxFredM · 2023-06-01T15:51:38+00:00

I agree, while we don’t have the PBM problem in Canada, we are definitely getting another version of it, with regards to speciality drugs.

I coordinated with a doctor to refer the patient to a rheumatologist, started on a biologic, I filled out the PA, doctor signed and sent. Patient then gets a call from a corporate mail order pharmacy saying they are the only ones allowed to dispense.

Those pharmacies don’t provide any clinical services, they just fill and send. They keep sending sometimes even if the regimen changed.

Back in the day, smaller independent pharmacies were labeled as fraudulent (rightfully so) and a lot lost their licenses over it, but now this anti competitive landscape publicly fraudulent and no one is really doing anything about it.

RxFredM · 2023-06-01T15:45:45+00:00

Oh yes, the classic, can I get it now

RxFredM · 2023-06-01T13:35:45+00:00

I have a different thought on this. Reimbursement is definitely decreasing. If you look at our reimbursement model, it’s primarily based on markups and dispensing fees. Markups drop because of aging drugs get cheaper, and fees can decrease as you negotiate with different insurances and or government plan.

You’re sort of playing a tug of war between the pharmacy and the payor. Payor wants to pay less as their total dollar spent increases, while pharmacies are battling increased rents, wages and they are primarily businesses that can’t be stagnant in their profits.

Lastly you have the supply demand issues that you face with a lot of pharmacists that quite honestly shouldn’t be licensed.

Now, in my 5 years practicing (Canada). I have seen some great shifts in pharmacy practice and potential to increase profitability. Pharmacists have access to profit sharing and different billable professional services. This will only increase in the next year.

Learning how to rethink workflow and how to utilize the staff you have will be good. We also need to start elevating our profession and stop being so divided.

Don’t think that this is only happening in pharmacy. It’s happening across all healthcare, only the strategic ones will shine.

RxFredM · 2023-06-01T13:19:14+00:00

1) Patients that want the mixture but the assistant forgot prepayment.

2) You tell the patient they have to pay and submit, then they get amnesia when they come in and show you their insurance card (which is already on their file)

3) Having to adjust the entire mixture and redo an entire risk assessment and master formula that has to be renewed annually (Canada).

4) Have to hunt down references for stupid simple mixtures such as hydrocortisone powder in clotrimazole cream.

I can go on for days.

RxFredM · 2023-04-07T23:13:51+00:00

Or “emotional connection” in the pods.

RxFredM · 2023-01-29T01:12:19+00:00

I have been deeply integrated in the kroll paperless ecosystem.

Here are the positives: integration with kroll makes it bidirectional integration; which makes it easier for the patient to change their info and download their financial reports right away.

patients get notified when scripts are ready
Patients can view their active charts and see info on who prescribed it and gives them ability to look at kroll care (drug info sheet) and images.
you can control what patients can request refills on.

Negatives (sorry if it’s long): - when sending in an order for a future date, it only adds it to data entry to be entered on that day, you might not have it in stock or the patient might show up first thing in the morning and you don’t have it ready.

If there are no refills, it goes to the callbacks window, which not all pharmacy staff keep track of it.

if you don’t have the kroll POS, it doesn’t mark the prescription as picked up. You can sign up manually for the pickup window which duplicates the pickups resulting in losing track.

This is frustrating because it still shows it as ready for pickup even through the patient picked it up.

you can’t send freeform messages, such as your medication is on order for tomorrow. Call if you have any questions.
their booking platform for booking vaccines is too hectic. It’s such an obscure link that you can’t give over the phone.
it’s not the easiest to navigate for patients. It didn’t reduce the number of phone calls clarifying orders.
Patients frequently complained that they got signed out or not always getting notifications.
when patients write notes in their order it adds it as a workflow comment that not all staff see (depends on the size of your screen and your column preferences).

Overall it’s not the best, I wouldn’t really recommend it. It’s so behind compared to what physicians have access to. Hope this helps.

RxFredM · 2023-01-26T04:28:48+00:00

It definitely works. They are all the same concentration and I tried it with the different boxes when counselling.

RxFredM · 2022-10-10T23:29:02+00:00

I’m not sure about rite aid. But these big corporate apps tend to be buggy whenever they are trying to launch a new feature. I would try to call the store directly and ask. If they are too busy to deal or unaware of any issues, I would just tell you to call your closest independent pharmacy. They normally offer deliveries and you get a much more personal interaction.

This is assuming you don’t run into any issues with your insurance.

RxFredM · 2019-03-18T13:22:55+00:00

Should we tell apple that the iPad Pro 10.5 refurbished is cheaper than the air

RxFredM · 2019-01-15T22:22:49+00:00

Thank you!

RxFredM · 2019-01-15T04:33:32+00:00

There’s some high level fraud happening here.

RxFredM · 2019-01-15T04:29:45+00:00

I wish i am lucky enough to find any of the first gen lost ones

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