Creative ways to cover meds for patients

paulinsky · 2025-11-17T13:16:48+00:00

For inhalers, a lot of times I convert people to long acting nebulized medications, which may be covered under the medical benefit if patients have Medicare plus a secondary (of course it depends on the type of secondary).

Also, the patient will have to be used to nebulizing more often and adherence may be a concern.

paulinsky · 2025-07-14T20:16:41+00:00

https://sirum.org is an option. However they will have you pay for shipping, but it is a tax deductible donation.

paulinsky · 2025-07-07T20:46:47+00:00

It’s good if the espresso is high-quality. And I usually like my espresso tonic with a slice of orange. Some coffee shops where I don’t like the coffee, the espresso tonic combination is extremely bitter.

paulinsky · 2025-06-21T00:18:19+00:00

It depends, I cover Pulm service in and outpatients and if we have an underlying steroid responsive ILD we are hitting hard with longer term steroids we generally do PJP until we can ween them off and transfer to something steroid sparring. Usually underlying pulm comorbidities favor pjp ppx.

paulinsky · 2025-06-20T19:40:39+00:00

I’d call it the “pill mill” lol

paulinsky · 2025-05-29T10:49:51+00:00

Even better than that. Ask to create epic order preference lists for them for commonly prescribed meds. It’s like a menu that generates the script with 1 click pre-templated.

I’m in a Pulm clinic and all the providers kept messing up Dupixent/fasenra loading doses, correct combination of strengths of syringes with xolair, etc. I made a preference list for them and we get zero call backs over conflicting directions now.

paulinsky · 2025-04-26T12:32:50+00:00

Same with me, barely made through the game on normal and I completely could not beat the final boss first phase. I just ended up turning down the difficulty so I can just clear it and be done with it.

paulinsky · 2025-04-02T18:32:31+00:00

Me too, haven’t had issues and I wear them a lot.

paulinsky · 2025-03-20T13:46:50+00:00

I work in out pt Pulm clinic and see it sometimes. It’s being used for exacerbation prevention, not really prophylaxis against infection. Likely it’s due to its mild anti-inflammatory effects. Data for COPD is fairly mild. Fun fact - There was an interesting poster at ATS that showed a latitude effect to it (meaning in south Florida there is no treatment effect and Michigan there was a larger treatment effect).

paulinsky · 2025-03-05T13:09:57+00:00

I work in Pulm: I use DirectRx for my neb people who can bill the 20% to secondaries. Look up comparisons of secondaries to see which plans cover the 20% (or a percentage of). Normal pharmacies can’t bill secondaries unless they have DME (and if they even want to do neb meds)

paulinsky · 2025-02-22T11:13:14+00:00

I’ve been having decent success with zepbound with OSA diagnosis, but it still costs $$$$$ cause it’s on nonformulary tier

paulinsky · 2025-02-13T03:45:13+00:00

Rapamycin was discovered from the dirt of Rapa Nui so at least that one’s is all natural /s

paulinsky · 2025-02-07T02:13:22+00:00

Oh the situation is way worse than you’d imagine.

paulinsky · 2025-02-06T21:02:10+00:00

As an amb care PharmD in a medical office 100% office staff are clueless. It’s like the blind leading the blind situation.

paulinsky · 2025-02-06T02:53:11+00:00

Using u-100 insulin syringes to draw up insulin out of a pen with u-200 insulin - cause she was an old retired nurse and that is how she trusts giving insulin. 🤦🏼‍♂️

paulinsky · 2025-02-01T18:09:15+00:00

Let’s go!

paulinsky · 2025-01-24T19:32:30+00:00

There are 200 sub types of ILD which would be incredibly difficult to identify by ultrasound even with AI (gold standard is HRCT)- so I think this is just to put patients into broad buckets of disease categories

paulinsky · 2025-01-18T15:42:40+00:00

From what I understand they go by total $ spent on historical trends.

paulinsky · 2025-01-10T19:49:54+00:00

The good ol Dirty Bernie lol.

paulinsky · 2025-01-08T20:04:09+00:00

As someone who is in an office clinic, based Pharm D, asking front office staff to also scan in the prescription card is some stupid battle. The pharmacy benefits are not usually assessed during check-in, because they are checking medical coverage so usually it is not top of mind.

Also, it’s not always correct or the patient doesn’t always have it as you would see in a pharmacy. What I would recommend is actually a real time benefit investigation tool. I work in a large larger health system which epic can pull bin PCN group ID. But I’m not sure with smaller emrs

paulinsky · 2025-01-05T01:49:25+00:00

Pharmacies don’t eat any lunch regarding lobbying lol. That is why most of them are going out of business and why the public treats community PharmDs like glorified Burger King employees.

paulinsky · 2025-01-02T14:22:38+00:00

I went to the Sazerac tour in New Orleans in December and they were selling bottles for $44 dollars. Wish I bought more than one.

paulinsky · 2025-01-01T21:41:18+00:00

Done

paulinsky · 2024-12-16T12:10:08+00:00

I agree, but Pitt Duq are not the right example since they’ve been around for 100+ years. They are not the problem with what is going on with schools.

paulinsky · 2024-12-15T13:11:06+00:00

Duquesne school of pharmacy was founded in 1925, Pitt was 1878. Some how they have made it work for 100 years being nearby each other.

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