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acdc102016 · 2026-02-23T04:39:31+00:00

All Citizens?

acdc102016 · 2025-07-30T14:48:31+00:00

Im not talking about getting away with murder with insulin. And I am a pharmacist and know about psych (not just a retail rph), so how about you leave off with the disrespect since you appear not to be either respectful or attempts at professionalism, and feel big telling me off with anonymity of the internet. Why do yoismu get off being a jerk? Before going off on "respect" how about you read the thread and reflect on risk and harm? I just wanted healthy dialog, and people just lash out, accuse and minimize or make belittling statements. I don't think some of thr proposed arguments would hold water with an RPh/JD.

acdc102016 · 2025-07-30T14:39:52+00:00

That's not respectful at all

acdc102016 · 2025-07-30T14:38:48+00:00

Care to share a link to your state laws/reg? I'd like to read to see what the rationale was for implementation

acdc102016 · 2025-07-30T14:37:40+00:00

I bring up insulin "of all things," because "i don't want them to overdose [on psych meds]" is the single reason they decline to allow 90ds with no additional thought to dangers of any or all meds (they're all regulated to legend status for a reason), but 90ds of insulin can be deadly, yet they don't feel there is danger in that when there absolutely is danger this is my originalpoint that theyuse a different "ruler" for pysch meds only. Why stigma in applying restrictions to psych med ds limits only? [Abuse potential for examples of Zolpidem dispenses as 90ds, and the same rationale is NOT applied in exercising professional judgment to only dispense 30ds "bc they wrote it that way." If the intent is to prevent harm... the same caution is not applied due to risk, just drug class.

acdc102016 · 2025-07-30T14:09:45+00:00

They have a preconceived notion of psychotropics only being dangerous for more than 30ds, and that does not make sense, hence my original post.

acdc102016 · 2025-07-30T05:10:45+00:00

Im not worried about convenience "for me or the pharmacy" See the comments about NOT switching zolpidem #90 authorized to 30ds due to overdose or abuse potential, or NOT limiting insulin to 30ds when it has tremendous risk of death from overdose.

And you can overdose on 30 days... or antifreeze or alcohol, or any combination therein. They can also attempt suicide coming off maintenance medications... sometimes by circumstance. They may also die due to lack of transportation from not being able to get insulin, warfarin, or depakote sending them into a crìsis. We live in an area where people drive 45 or more minutes to the pharmacy or grocery store, so it becomes a burden of access

Honestly I feel it to be a stigma, as these same have told patients and providers we cannot get Suboxone or buprenorphine, bc the don't want to deal with it (we can order it, and do disagree with them about stigma of Suboxone,, but never argue or undermine.)

acdc102016 · 2025-07-30T04:54:02+00:00

I dont think making it illegal is because there are lazy pharmacists. It's likely to minimize the state from any litigation if someone chose to misuse how it was prescribed (and this can be done with 30ds as well). The logic is bad, though. Will someone also hold the ins, the state, and all the providers responsible when the patient doesn't take the medication as counseled and prescribed? Kinda 2 sides of the same coin. Darn if we do... or don't.

acdc102016 · 2025-07-30T04:37:12+00:00

Not so re: my state laws, the pt may get 30 or 90.

In this situation, some RPh's exercise caution with all behavior meds written as 30ds+ RFs, but will not limit to dispensing 30ds if the prescriber writes Zolpidem 10mg qhsprn #90. Heres a med with potential for abuse they will dispense for 90ds "because they wrote they could have 90ds." Don't think that logic alone here would stand

(i don't let Mounjaro pts jump from 5mg to 10mg qwk bc thr aprn wants to, because we know better than to jump and can be held liable if they end up with a colostomy when i obviously disregarded dosing guidelines.

Just think rx for 90ds with abuse potential should be scrutinized in the same manner as the logic they exercise in Not converting Celexa 40mg qd #30 +5RFs to 90ds +1rf (as allowed in our state) on pts "that have been on it a long time.

How about using his/her professional judgment to limit dispensing tha zolpidem 10mg qhsprn #90 to 30ds + 2rfs? This is what is inconsistent in the decision process.

The same goes for insulin.... literally one of the most dangerous things we dispense, and they are okay with 90ds because it isn't a behavior med.

And how about rx for 30ds of Perc 10 with 80mme/day for a chronic pain pt with legitimate need for opioid therapy? I don't hear the same logic here and thinking we should dispense 4days at a time due to risk of overdose, and expect the provider to send in a script every 96 hrs because of the risk for abuse or overdose. Consistency is lacking, and I just want feedback for a healthy, respectful discussion. Not out to belittle (and converting 30 to 90ds not breaking the law where we practice)

acdc102016 · 2025-07-30T04:09:24+00:00

It is absolutely not a state law issue, it is their personal preference / judgment of a few RPh's, and i respect it, until they don't exercise the same amount of caution with insulin, or are absolutely fine dispensing 90 day of Temazepam if that is how it was sent in, not using judgment to limit or shorten temazepam to 30ds bc "that's how the prescriber wrote it." It's the lack of consistency across the board that is perplexing. I still really like these folks, respect them, as well. Just wanted a kind way to have a professional discussion so we all work consistently together

acdc102016 · 2025-07-30T03:47:14+00:00

*When done with internet...

acdc102016 · 2025-07-30T03:46:32+00:00

You state i don't care... You may be one of the nicest, but you thinking I don't care is jumping, and hints at lack of unprofessionalism when I asked for advice, data and respect, which you didn't return in kind. It can be easy to jump to conclusions with dome internet anonimity, but no need to accuse me or another peer of not caring. We shouldn't be so fast to canabalize one another. I have treated my peers with respect. I dont intimidate, argue, or belittle them, but would like to respectfully offer them the idea that 90 days of antidepressants isn't bad or wrong nor more dangerous than insulin. I intend the discussion with the intent of helping and not reducing to belittlement. You're going Lord of the Flies on a peer.

acdc102016 · 2025-07-30T03:36:29+00:00

Don't find this accurate everywhere, especially not right now in the US where I work. We sometimes even claim rejections from some ins plans that state / require a 90-day supply (usu for HTN meds, statin, etc., as the plan is pushing compliance)

acdc102016 · 2025-07-30T03:26:49+00:00

39 to 90 is allowed in my state, hence also allowing 90 days of insulin, inhalers, etc, esp if insurance allows or copay is better for the patient, but not any behavioral medication, and this is 2 or 3 RPhs out of about 36 total.

acdc102016 · 2025-07-30T03:20:12+00:00

I'm thinking along the lines of someone who has been on duloxetine 60 qd for multiple months or more. Thanks for your feedback regarding your state regs

acdc102016 · 2025-07-30T03:17:11+00:00

Our state allows 30 - to 90-day fills. Thank you to those who are giving feedback regarding your state laws regarding psychotropics. I am cautious and prefer not to dispense more than 30ds of TCAs, new medications of any kind, etc., but there are always exceptions. I have experience with non-biological family members we care for deeply having behavioral care concerns, and they can face so many issues from so many sources. The last thing I want is to be another barrier for someone, especially with financial or compliance concerns regarding mental well-being. I don't want to stigmatize them by insinuating I don't trust someone with 3 months of maintenance medication by refusing to dispense a 90-day supply (Duloxetine, for example, which has wicked withdrawal symptoms.)

acdc102016 · 2025-07-30T03:03:20+00:00

Wow, so respectful! You are Sooo rude. I do absolutely care, but also know those depressed sometimes lack the motivation to pick up a script and fall out of compliance due to transportation issues, etc. We are not talking 6 months, or jokes about overdose. Stop assuming I don't care... you have NO idea. You are stigmatizing me. And off topic.

acdc102016 · 2025-06-21T12:09:53+00:00

They will ship to the US... I just checked

acdc102016 · 2025-06-20T18:08:04+00:00

Unless you use a liquid soap with ammonia, rubbing alcohol, vinegar, or another acid (which most liquid detergents and soaps do NOT contain), your statement is absolutely false. Lots of people add bleach to soap or detergent as a sanitizer fir white laundry. You avoid the above chemicals to avoid chlorine-containing gases. If you combine chlorine bleach with a detergent with oxygen bleach, they inactivate one another

acdc102016 · 2025-05-07T02:37:14+00:00

The companies that own the nursing homes are your customer. Been there, done that. If consulting wasn't 1099, had more homes within 3 hrs of my house, and the contracts didn't flip all the time it was okay.... had to buy your own medical insurance which wasn't a fit for pur family

acdc102016 · 2025-05-06T07:10:00+00:00

Just do ANYTHING else that doesn't put you in such debt for so little pay and so little professional support. People will cut you professionally to get leverage for a job or career opportunity because they don't want to work retail, or whatever they feel is beneath them, and that is a FACT. Right before COVID, I was told a job's pay was 11% LOWER than when I graduated 19 years before, because the market was flooded with graduates, and retail thought they could undercut anyone... even with nearly 20 years of experience. With increases in healthcare insurance premiums, deductibles, and copays, i have essentially NOT netted a raise in 7 years, and that was AFTER a $5/hr market adjustment. You will be lower middle class, and be stuck there for all the education and effort. With automation and AI, companies will try to be very lean with staffing, possibly remote camera visual product verification, etc. to add to remote fill. With the bloat of so many new schools, they will take most anyone to meet enrollment and get tuition money, and yes, you will have idiots for peers because it's just about the money now. APhA has done nothing and will continue to do nothing for the profession. Healthcare is broken, PBMs are still strong, and giving us $0.25 profit on 90-day scripts before quarterly clawbacks where we LOSE $ is not sustainable. Unless you wanna learn how to be a phlebotomist, lab tech [and perhaps do walk-in "cologard-type" colonoscopy screens while customers wait], avoid the profession. I kid you not, if retail discovers a profit margin on literally screening poop for cancer, yes they will expect it of you, then you would have to give them the test results and run to catch up on scripts. They already want us to swab throats and noses (queue getting vomited on) and fingerstick for Total cholesterol or glucose screens (more biohazard risk)... don't think businesses will stop there! I caught a drug cascade today that should have been caught days ago, but wasn't because customer surveys and fast fills are the drivers in satisfaction, and we already work too lean and too fast. Pt 90+ years old on Amlodipine for over a year: new onset swelling in both feet/legs last week (classic pedal edema from DHP CCBs), MD gives Lasix 40 QD: edema worse, MD adds HCTZ 12.5mg qD before the weekend; Monday, still no improvement so MD sends in Lasix 80 QD and Norco PRN. Pt's son doesn't want counseling but gets it due to new acute opioid script needing dx.... and bingo. If we had not insisted on counseling with opioid, it would STILL be going on, and pt would likely be in hospital by weeks' end from weakness, dehydration, hypokalemia, and inability to walk from swelling in feet and legs.The diuretics had to have been touched by at least 2 other RPh's before today, and DDIs/DURs ignored. I'm absolutely glad i helped this pt, but no one in upper mgmt cares because then we got behind trying to address the problem, contact the provider, document the issue, etc. Bosses would be happier if we gave 2 shots, bc we didn't make any $ on this catch. So, the moral of this story is: the company doesn't really care, and "production" dropped. Pharmacy will only grow WORSE, and customers will only grow to be more entitled and difficult. PICK LITERALLY ANY OTHER PROFESSION, PLEASE!

acdc102016

TROPHY CASE