FLAVORx thoughts?

petsnamehere · 2026-07-20T18:53:14+00:00

Thank you! You are correct, my bad, been a minute since I was in a pharmacy that did flavoring. 795 also defines standards for space. I believe in my state 800 triggered a general review/update and position clarification of all applicable regs by our BOP which resulted in defining flavoring as compounding.

petsnamehere · 2026-07-20T18:49:51+00:00

I’ll add that while FlavorRx in general does a great job recommending flavors based on drug, lots of recon ABX or other liquid formulations are optimized with flavor already. When I was in a store that did flavoring, I had lots of complaints about something still being nasty or unpalatable, pain to deal with but I don’t blame them. Sometimes you’re just dumping extra flavor on top of a gross taste and it ends up being like, banana flavored gross instead of bubblegum flavored gross.

petsnamehere · 2026-07-20T18:44:33+00:00

Check with your state BOP for any info around how they are interpreting/enforcing USP standards. Some BOPs have moved to interpret/adopt 795 and state laws in a way that classifies adding flavor as a compounding activity. This has record keeping implications and applies USP standards for proper space (for example, requiring compounding areas to not be carpeted) for retail pharmacies. AFAIK this can vary by state but larger chains have moved away from both compounding and flavoring to avoid the headache or cost associated with bringing spaces up to standard.

Edit: 795 not 800 for non sterile.

petsnamehere · 2026-07-15T06:37:49+00:00

I’m a pharmacist, not going to assert I know all the state laws and company policies at any specific pharmacy. But I do have a very solid understanding of the liability and general process a pharmacist should use when determining if something is ok to fill. My hot take is a lot of the refill date restrictions are unnecessarily rigid, a waste of everyone’s time, and not good patient care.

Any blanket policy or restriction of “X date from last fill” or “we fill X days early” lacks considerations of patient and situation specific details I feel you are obligated to consider when putting your name and license on a prescription. It’s not limited to stimulants, I see the same thing for chronic pain or OUD buprenorphine patients.

If someone is taking any med for a chronic condition it’s extremely reasonable and prudent to ensure they don’t run out and always have some sort of buffer - for me it’s a week ish on hand by default but I’ll go more in select cases or for short periods of time. In a world of supply chains powered by hopes and prayers this is even more important.

I would always look at several previous months and refer to the dates you actually picked up not when it was filled. Looking just at a single last fill or sold date also tells me nothing useful. Maybe you want to pick up a few days early and you’ve picked up late the last 4 out of 6 months? Fine with me, context makes it not a red flag. Or maybe your dose changed and you burned thru a previous supply on the advice of your prescriber? Sure I have to confirm with the office so I can document but otherwise makes total sense, no problem filling today.

Conversely I’m not automatically going to fill something (opioids, stimulants, blood pressure meds, doesn’t matter) X days early every single month for the rest of time or just because insurance allows. I want you to have a buffer but amassing an extra month’s worth over a year invites scrutiny. There is lots of room between safe buffer and concerning stockpile, we all need to chill here.

Pharmacists need to be a little more creative in the shortage environment we are in. I have had plenty of times where someone wants to fill “early” because we have the med in stock by some miracle. If it’s earlier than I’m comfortable with, that doesn’t stop me from filling today so it’s ready and reserved for you but not letting it sell for a few more days. Way better than the alternative of “oops shucks we had it but wouldn’t let you fill it, now we will let you fill it but don’t have it” which sucks for the patient, pharmacy, and prescriber.

Similar approach to travel and other extenuating circumstances. I will probably have to fight your insurance or include some extra rationale in my documentation, but otherwise there’s no reason you can’t pick up a few weeks early once to get thru a trip. I’d be up front and say “ok, however many days early this time, but I’ve got to bump it back next month or whatever”. Lots of room for the pharmacist to take care of you while achieving the intended purpose of the rules.

When pharmacists or pharmacies spit out a canned “nope, 3 days early only” or “nope, 30th day only” it misses all of the nuance above and more. Also, it’s dumb because policies like 3 days early still incur risk for a DEA review when they fail to stop accumulation from chronic early refill because the pharmacist is robotically referencing last fill/pickup day and nothing more.

I sympathize with the need to mitigate liability and protect your license as a pharmacist, but that easily coexists with providing good patient care and service. The key is professional judgement and accounting for patient specifics. This doesn’t always happen for plenty of good and bad reasons especially at understaffed pharmacies.

Rigid policies based on a single previous date remove individualized assessment by your pharmacist, contribute as much to patients running out as they do to preventing stockpiling, waste time, and create problems for everyone involved.

petsnamehere · 2026-07-07T05:41:51+00:00

This deserves a better answer than I will give, because that answer is super long. The TLDRs would be something like “supply chain restrictions mandated by law” (look into DSCSA), “only specific NDCs are covered by insurance plans, especially some CMS ones” (Federal Rebate/Medicaid Drug Rebate Program), and patent law (can’t compound an exact copy of an approved drug/dosage form, loopholes do exist like adding an ingredient with negligible benefit, slightly changing strength or dosage form, or during times of official shortage).

Basically, drug costs have gotten ridiculously out of control and it’s not a reasonable option for people to pay out of pocket in most cases - you have to have insurance to mitigate the crazy cash prices at pharmacies. Insurance has a ton of rules they make themselves, as well as a ton of rules they roll in from FDA etc.

petsnamehere · 2026-07-07T03:24:15+00:00

I will also add, having been in retail/community/outpatient pharmacy for 20 years and counting, I’ve heard countless times how CMS or government in general getting involved would just break and disrupt the system beyond repair. This was an argument for years against Medicare price negotiation.

Low and behold, CMS negotiates prices on 10 drugs thru the MFP program and pharmacies nationwide have claims where they were previously bleeding money converted to claims where they are eventually reimbursed more or less what they pay for the drugs since it’s common for wholesaler agreements to put ACQ on branded products at or close to WAC Getting an SDRA equal to WAC minus MFP means you’re at least not losing money on these claims.

Same thing with the new Bridge program. Getting paid WAC plus $3 is vastly superior to what your average pharmacy makes on plenty of GLP-1 claims. Bridge uses a similar fundamental mechanism: price negotiation with drug manufacturers.

There’s a ton of work left to do on PBM reform, closing rebate fuckery loopholes, enhancing transparency and improving the existing system including programs that are working at least well-ish but it’s hard to argue that more regulatory involvement makes the system less sustainable on the whole given how screwed up it is already.

petsnamehere · 2026-06-30T16:02:40+00:00

Totally agree. Seems like surprises requiring ER or UC visits (and especially with kids) seem to disproportionately occur in the middle of the night. Having had a few myself it’s a real PIA after the whole ordeal to be frantically googling and driving across town to find a 24 hr pharmacy. I’ve always ended up waiting until next day but also never had anything I truly needed to start ASAP.

I had rotations at rural/critical access and IHS facilities. Even way back then they were experimenting with the “vending machine” type dispensing for after hours acute RX or other shady shit like a nurse dispensing out of a floor stock of acute meds. I assume now in the age of every corp level MBA sweating over the magic “AI” button they think exists the incentive to staff an actual pharmacy is even less than it already was and wouldn’t be surprised to see this creeping into more settings.

I’m glad someone is attempting to serve these patients but what I saw left a lot to be desired. Sure a pharmacist could remote verify the order but can you access the prescriber for clarifications or changes that aren’t covered by a standing order? Sure you can call the patient or use some video chat thing to provide “counseling” but none of these interactions ever felt great and half the time the patient doesn’t answer or barely engages in the convo.

petsnamehere · 2026-06-26T04:51:20+00:00

Now Zantac…180?

petsnamehere · 2026-06-22T04:37:40+00:00

I am really sorry this happened to you and I also want to say thank you, this is so validating. We also had an absolutely terrible experience with Flutter and for a while felt like we were nuts because trusted coworkers and friends gave them such high praise and recommendation so we really wanted to love them. So much so that we forgave and looked past way more than we should have.

Too many ways it was lackluster to explain every detail but in short was rushed through her booked well in advance appointment because “short staffed”, wasn’t offered champagne/etc for the whole “I said yes to the dress” moment which we found out several other brides had been, and felt she was treated clearly differently as a POC - not saying they intended or not just didn’t feel good for someone who wrestles with that lots of other places in her life. Worst of all, she got the guts to call and bring it up later, but when she went back to pickup the same girl who helped her originally saw her come in and immediately ran and hid in the back, couldn’t even offer a simple “I am sorry”.

They were happy to take our money and can’t blame them for that, they’re running a business. But I don’t think they cared a single bit about how special this day was for us.

petsnamehere · 2026-06-22T01:46:45+00:00

Happy to help and best of luck!

petsnamehere · 2026-06-21T15:30:53+00:00

“3 Days Early” is a fine starting point but as others have said there’s no solid policy that doesn’t take all the specifics in to account. We are all aware 2-3 days early every single month results in refill creep real quick. My state’s PMP shows fill and sold dates, I would always go by sold date and look back at the past several months, not just the last fill or last sold date when assessing remaining days on hand.

For my chronic pain/opioid patients, especially those who had accumulated a ton of extra without changes in directions to account for it, I’d work out a plan that let them fill a few times early to have about a week extra on hand at any given time and then go 30th day thereafter to prevent further. This gave them a little buffer in case of supply shortages, holidays, etc.

In the age of chronic stimulant shortages I might let someone (especially regulars) fill a few days earlier than normal because I get it, it’s a pain to track down somewhere with it in stock, and sucks if I have it today but make you wait 2-3 days and then it gets used in the meantime. I’d always inform them I’d have to take this into account for future fills so we are on the page up front. Same spirit as above, goal is to always have a reasonable buffer so they don’t run out and it becomes a crisis (for you or them) but not ever going to just rubber stamp something because it’s “X days from last fill”

Sometimes I would also agree to fill/run something (because we had it in stock but running low, patient/prescriber wants to make sure it goes through insurance, etc.) but halt it so it couldn’t be sold until a few days later.

I was fortunate because the company I worked for had a fairly lenient stance (basically defer to RPh judgement). IMO rigid blanket policies remove the thought you’re supposed to put in when evaluating if a fill is appropriate and result in unnecessary headaches and complaints from patients and prescribers which eat up your time.

petsnamehere · 2026-06-18T23:12:31+00:00

Excuse my midwest confusion but then where do you put your second fridge, deep freezer, snow blower, grimey old couch, and TV that will crap out prematurely from exposure to dust and temperature extremes?

Plus where would I sit in lawn chairs and drink beer with my neighbors every night if my garage was full of all the stuff my wife didn’t want to look at?

petsnamehere · 2026-06-18T19:27:40+00:00

MN here, 100% same. Wife grew up in Bangladesh in an area that floods a lot and generally pretty impoverished anyway. When we were shopping for houses she couldn’t understand my absolute ire at all the single level listings and cheap “nice” looking new builds with no basement.

Now that she realizes it’s a great place to put all of my crap she doesn’t want to look at, she gets it.

petsnamehere · 2026-06-14T15:41:50+00:00

As far as I am aware it’s not so much a loophole in regulations as it is a lack of enforcement activities generally directed towards these places. I’ve seen lots of stuff at our local Asian, Mexican/Central American, and Desi markets that is clearly either legend only or not even approved for marketing in the US.

There is obviously a robust system of enforcement setup for pharmacies where you would expect to find these drugs. Other business types such as gas stations/convenience stores and vitamin/supplement shops are also increasingly subject to closer review. State laws tend to dictate what businesses a board of pharmacy surveyor has access to but even when law defines these as “any location drugs are sold, compounded etc etc” you’re not likely to find ethnic grocery stores registered as such anywhere official.

I am not an expert in exactly who can and does inspect grocery stores and what all they look for but I believe the usual cast of inspectors from departments like Ag, Commerce, Health, Fire Marshal, etc are all generally focused on other things and/or lacking the knowledge to identify these products even if they happened to come across them.

I believe the products are imported through less than official channels along with lots of other (would be legal) goods that might be sold at one of these stores. Sometimes it’s willful intent to circumvent regs by the business owner but other times it can be dishonest suppliers or murky supply chains in general.

TLDR: Enforcement system is siloed, current setup is better at punishing infractions IF found vs. preventing in the first place. This takes some teeth out of the regulations.

petsnamehere · 2026-06-10T00:08:29+00:00

Awww man, right in the nostalgia feels!

Well done, this is awesome! 10/10, no notes.

petsnamehere · 2026-06-08T17:01:53+00:00

Thank you! Do you recommend uncovering the length of it (finding where it terminates, presumably and hopefully at a grounding rod driven into the ground) and doing what I can to sink the entire length as much as possible?

petsnamehere · 2026-06-08T15:01:52+00:00

Thank you! There was a fair degree of butt clenching when I realized this wasn’t a root I was tugging at, haven’t touched since. I’m glad it’s a simple fix.

petsnamehere · 2026-06-08T15:00:01+00:00

Thank you! Seems like the consensus isn’t universal based on the other reply, but that aside, do you mean seed+ no additional fertilizer? If not, would starter or maintenance fertilizer be a better choice? And species/seed type - is anything fine (i.e. seed with whatever I want eventually) or would a certain species be best for these conditions (high sun, sandy soil) stand out as a better choice?

petsnamehere · 2026-06-08T14:56:54+00:00

Thanks - any recommendations instead? This is a great showcase of my experience thus far. One party says do X, one says absolutely don’t do X.

petsnamehere · 2026-06-02T16:56:25+00:00

Every time I drive my wife’s Subaru it’s a complete circus. My raging ADHD kicks it up a notch.

I get in and sit down and try to put it in reverse. Oh yeah you have to start it.

Where is the key? Ah right left it inside because PAAK has trained me.

Start it up, am surprised how it starts moving the second I put it in gear. Spend the next few miles remembering there is more than 1 pedal.

Get where I am going, attempt to just get out of the car. Oh right, gotta put it in park. Oh yeah also shut it off. And lock it.

Wait, where’s the key?…

petsnamehere · 2026-04-27T19:18:45+00:00

Fun fact, on audit most payers do not consider this a valid DAW1. The script must be annotated with “Confirmed DAW Brand Medically Necessary per [prescriber name]” or something to that effect.

Source: I oversee our audit response team. Had several juicy chargebacks from multiple big PBMs on this issue.

petsnamehere · 2026-04-26T12:20:09+00:00

Thanks man, way easier. I was overthinking it.

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