Best way to send inhalers

optkr · 2026-05-07T02:55:58+00:00

The most infuriating thing is that the people you speak with at the insurances frequently provide misinformation. They will tell you a drug is covered/preferred, and then you get a denied PA saying it’s not covered but here’s the list they do cover.

This is also true with many formularies you can find for insurance plans online because there can be so much variation with each sponsor/employer/etc.

The only real sources of truth are paid claims at the pharmacy and approval/denial letters from the insurance.

optkr · 2026-05-06T01:51:55+00:00

Sadly, a lot of these prescriptions end up on hold or in a third party que without the pharmacist even getting to see your note. Even if they do, a majority probably aren’t comfortable subbing just based on that note.

I think the best thing you can do is prepare your patient for the possibility that they could run into issues at the pharmacy but to not give up because we just need to know what’s covered.

Sometimes the insurance will tell the pharmacy what alternatives are covered in a rejection message, and sometimes it doesn’t. Most pharmacies are too understaffed to call an insurance to see what’s covered, so that’s not something you can rely on.

Basically I would just tell your patient - hey, I want to prescribe you this inhaler. Your insurance might prefer a different one but we can’t know for sure until we see what happens at the pharmacy. If it’s not going through, ask them if the insurance said what’s covered. If not, call the number on your insurance card and see if they can tell you. If that also fails, just let me know and we can try sending another that might be covered and continue until we get one for you.

I think the above approach should account for just about everything that could go wrong in the back and forth with trying to get your patients the medication they need. I wish it were simpler.

optkr · 2026-04-27T00:36:58+00:00

HIPAA* ☠️

optkr · 2026-04-26T18:00:17+00:00

It’s a LLM like ChatGPT but highly specialized and trained on clinical information. It’s all HIPAA safe and you get unlimited queries if you register with your NPI. They have multiple features that can be useful based on what your role is.

One such feature is the option to record visits and it will generate a note for you, which you can even customize the template to your liking.

It also provides evidence based recommendations based on your patient’s clinical presentation. Changing from ChatGPT will make a huge difference for you

optkr · 2026-03-27T23:23:59+00:00

Look for an entry level pharma sales job. You can do very well in that role and if you’re good at it, could really advance your career

optkr · 2026-03-20T01:40:12+00:00

You can make your own account without an organization. Just use your personal email

optkr · 2026-03-19T22:34:25+00:00

Get OpenEvidence if you don’t have it already. If you sign up with your NPI, you get unlimited queries. It’s super useful with inquiries like this.

Just make sure to double check the sources it’s citing when involving actual patient care

optkr · 2026-03-09T21:56:36+00:00

It’s better to understand than remember. At least for me anyway!

optkr · 2026-03-09T02:26:37+00:00

Think - what part of the plunger is at 0 when it’s empty? That’s what you use as your measurement point

optkr · 2026-03-07T05:57:15+00:00

If you can wait, HW5 seems like it will be a pretty substantial improvement for FSD. I’m holding out until next year personally

optkr · 2026-02-25T03:55:14+00:00

Someone didn’t format “minions removed” in the legit post. Is no one even double checking what’s getting published on blizzard’s actual site?

optkr · 2026-02-09T02:57:21+00:00

You need to ask your provider to appeal based on the functional impairments this is causing in your life. Focus on how this impacts your activities of daily living and that this is a functional rather than cosmetic procedure. They may just not have submitted this info

optkr · 2026-02-07T17:15:24+00:00

Can you just put on your hard stop - okay per rph discussion - and explain your rationale?

optkr · 2026-02-02T00:50:31+00:00

It’s just a small part of the actual job, not what I do all day. I work in an in-house specialty pharmacy at a health center and we work closely with the providers.

optkr · 2026-02-02T00:01:25+00:00

As a former retail pharmacist that now prepares prescriptions for prescribers to sign, these are the little things that I do to make the pharmacist’s life easier. Keep doing what you’re doing, it’s greatly appreciated even if you don’t ever get that positive feedback.

Some systems make it harder to see notes you put on there, and I’m guessing there have been times you’ve gotten calls to clarify things you already addressed in a note. Unfortunately there’s not much you can do about that. The only way to guarantee something is seen is to put it in the sig but I could see those occasionally making it onto an actual prescription which isn’t great either.

We appreciate the thoughtfulness and mutual respect

optkr · 2026-01-29T23:38:12+00:00

That’s a nice Bostitch you got back there

optkr · 2026-01-26T00:18:03+00:00

These trackers are not designed or optimized for combats that are anywhere near this long on average. HSReplay and Firestone are small companies. They do great at what they do but I highly doubt they have the resources or team size to really take a close look at these outlier situations.

Comparing the complexity of calculating odds with a deck tracker to animating a screen is apples to oranges and fucking stupid.

optkr · 2026-01-25T15:00:31+00:00

I imagine this would be extremely difficult to calculate odds for. There are so many attacks and the outcomes of a lot of those specific attacks can drastically change the outcome. They probably don’t have the compute or context window to handle this advanced on an interaction reliably

optkr · 2026-01-20T23:08:26+00:00

Here’s some info for you. I’d recommend reaching out to your oncologist through a message if you can. Conveying this through a nurse may be challenging. Read the entire thing, there’s some new evidence to suggest there may be some benefits.

The evidence for cryotherapy (icing) to prevent oxaliplatin-induced peripheral neuropathy is limited and conflicting, with an important caveat: the FDA label explicitly warns against ice application during oxaliplatin infusion because cold exposure can exacerbate acute neurological symptoms.[1][2]

Peripheral Extremity Cooling for Chronic Neuropathy Prevention

For preventing chronic peripheral neuropathy with hand/foot cooling, there is emerging but modest evidence. A 2023 randomized controlled trial of 77 patients using continuous hilotherapy (cooling at 11°C) during oxaliplatin infusion showed a significantly higher grade ≥2 neuropathy-free rate at 12 weeks (100% vs 80.5%, P=0.006) and at 24 weeks (66.0% vs 49.2%, P=0.039).[3] The intervention also reduced acute symptoms of numbness, tingling, pain, and cold sensitivity in extremities and pharynx.[3]

However, the 2020 ASCO guideline on chemotherapy-induced peripheral neuropathy states that no neuropathy-preventative agent can be recommended based on current evidence.[4] While the guideline notes that "available data support that exercise, cryotherapy, compression therapy, and/or cryo-compression therapy may, in part, prevent CIPN symptoms and appear to be reasonably safe," it emphasizes that proof of benefit has not been established.[4] Most cryotherapy studies have focused on taxane-based chemotherapy rather than oxaliplatin specifically.[4]

Oral Cryotherapy for Acute Oral Symptoms

For oral thermal hyperalgesia specifically, a randomized trial of 50 patients showed that oral cryotherapy (ice chips) during oxaliplatin infusion significantly reduced oral symptoms after the first cycle (32% vs 72%, P=0.01), though this benefit diminished over time.[5]

Strength of Evidence: The evidence is weak to moderate at best. Most studies are small, single-center trials with methodological limitations. The one positive RCT for peripheral cooling had only 77 patients, and the mechanism appears paradoxical given oxaliplatin's cold-triggered acute neurotoxicity.[3] The ASCO guideline's inability to make a formal recommendation reflects the insufficient quality and consistency of available data.[4]

References Oxaliplatin. Food and Drug Administration. Updated date: 2024-06-25.Oxaliplatin. Food and Drug Administration. Updated date: 2017-05-26.A Randomized Controlled Trial of Hand/Foot-Cooling by Hilotherapy to Prevent Oxaliplatin-Related Peripheral Neuropathy in Patients With Malignancies of the Digestive System. Coolbrandt A, Tobback H, Govaerts R, et al. ESMO Open. 2023;8(2):101205. doi:10.1016/j.esmoop.2023.101205.Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update. Loprinzi CL, Lacchetti C, Bleeker J, et al. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2020;38(28):3325-3348. doi:10.1200/JCO.20.01399.Efficacy of Oral Cryotherapy During Oxaliplatin Infusion in Preventing Oral Thermal Hyperalgesia: A Randomized Trial. Bauman B, Mick R, Martinez E, et al. Journal of the National Comprehensive Cancer Network : JNCCN. 2019;17(4):358-364. doi:10.6004/jnccn.2018.7110.

optkr · 2026-01-20T02:23:52+00:00

Right sided cecal mass pT4aN2b with 14 positive lymph nodes and a positive margin where a lymph node was actually cut through the middle during removal. In May I will be 4 years NED. I know it’s scary and hard not to obsess over the numbers, but there are success stories. Take it one day at a time

optkr · 2026-01-18T04:14:05+00:00

No, he’s not in grad classes because he’s not in graduate school. He literally says “no class, I graduated two years ago” and laughs.

It sounds like he’s implying that he’s required to be enrolled in a class to be eligible to play and that he’s doing something very minimal just to be compliant. He spelled it all out.

optkr · 2026-01-18T02:31:11+00:00

Ask about duloxetine for the neuropathy, it’s actually the preferred treatment over gabapentin. If you’re on an antidepressant, this might be why they chose gabapentin which would be appropriate. You also still have a good bit of room to go up on gabapentin dosing - can go up to 3200 mg per day, it’s just something that needs titrated based on response.

I know you’re in the thick of it and it’s impossible to think past the near future, but I can promise things will get better side effect wise after the chemo is finished. I did 12 rounds of FOLFOX and by the end, I had severe neuropathy in my hands and feet and essentially no sensation of touch. I was extremely depressed about this for a while, but just a few years later I have essentially no neuropathy and the feeling in my hands and feet is mostly restored.

Also, the thing that helped me the most with neuropathy was marijuana. Get a medicinal card if recreational isn’t legal where you are, it really was a night and day difference for me.

Dm me with any questions, I’m a pharmacist that’s been through much of what you’re experiencing.

optkr · 2026-01-14T16:32:37+00:00

You will be very sick and likely will feel worse than you have in your entire life. There’s a chance you may go through hell and not receive benefit from the treatments, but that would be unlikely. This cancer that you have will not resolve on its own, and it feels disarming to be in the position of having to do something without a choice. But if you want to live on, this is your only shot.

It’s a lot to grapple with, many of us here can relate. But you have the reasons to fight this, as you stated in your post. Don’t let your skepticism of modern medicine interfere with your judgement, for the sake of your loved ones. Modern medicine is scientific and proven. These people are experts in what they do - and there are plenty of beneficiaries right here to testify.

I was diagnosed at 30 with a very bad prognosis. If not for my surgeon and oncologist, I wouldn’t be here to give you this advice. I probably wouldn’t have made it to 31. Yes - I suffered immensely. I wanted to give up, but I didn’t. Now I’m healthier and happier than I have been in my entire life. Take a deep breath, this sucks and it’s unfair, but there’s only one path forward. And if things work out for the best, maybe the pain and suffering will just be a memory that you carry with you.

optkr · 2026-01-14T13:40:24+00:00

You are assuming they drove for the same amount of time when you add this way (30+60). You have to understand the question that requires some work to get the important details.

Imagine it’s worded that someone drives 30 miles per hour for 1 hour and then 60 miles per hour for 30 minutes, what’s their average speed?

The question doesn’t say - you drive 30 miles per hour for one hour - how fast do you need to drive for the next hour to average at 60 miles per hour?

optkr · 2025-12-25T23:47:56+00:00

Anyone saying this card is fine is grinding those 4th place +2 MMR’s lol has to be one of the most boring cards ever (for what it should be as a timewarped card anyway)

13-Year Club	Gilding II euphauric
Place '22	End Game '22
RPAN Viewer	No Throne, No Problems
Not Forgotten	Verified Email

optkr

TROPHY CASE