How to get a Prior Authorization — RN-style

Posted on March 15, 2011

This is a message for all you nurses out there. This post is now the PREMIER AUTHORITY on how to get prior authorizations -- in STEP BY STEP FASHION. It's an overly simple 4 and 1/2 step process. As a wonderful "side effect" of this process, you will waste at least one week of a pharmacist's time and, an added bonus, really piss them off as well. It's a win-win for every RN!

4) REPLY TO ALL FAXES REQUESTING YOU GET A PRIOR AUTHORIZATION BY SIGNING IT AND AUTHORIZING "1+2" REFILLS. This is a GREAT way to both waste a pharmacist's time and really frustrate them. In most instances, they've told the patient 48-72 hours. By replying to the fax with refills, you show that you really want the patient to get the medicine, but it shows the pharmacy that you've got better things to do than read their stupid faxes. To really put a cherry on top of this one, schedule the fax to send at 4:55pm. This will ensure that even if the fax even goes through successfully in the first place, the pharmacy can't contact you again until the next day because the phones cut off at 5pm on the dot (and you cut out at 4:30pm in the first place)!

3) When they call you the next morning, make sure they have to leave you a voicemail. If you're feeling particularly randy, respond to that with a copy of the fax from the day before and a SNARKY NOTE at the bottom of the fax. Some suggestions for the note are:
"Authorized (1+2) yesterday. Is your fax machine working?"
"I got your VM -- here's the auth you need. Thought I faxed this yesterday. WEIRD!!
You could also just skip the reply all together...

2) When they finally get a hold of you at the end of the second or the third day, tell them your office's standard is at least 3-5 business days on a PA Request. Tell them you'll get back with them at the beginning of next week. After you say this, don't do anything. Don't even ATTEMPT to get the prior authorization. Why you ask? Duh -- the pharmacist will probably call and remind you again on Tuesday or Wednesday when you actually need to do it anyway. Out of sight out of mind! [If you wanna be a real bitch, at this point you need to send another refill authorization in to pharmacy. No note this time -- you don't want to appear "catty."]

1) After they call you Wednesday, if it's a different pharmacist than the one you talked to the previous week you need to go off on him. Make a huge scene. Act as if everything that was sent in and you cannot figure out why the pharmacy refuses to fill the prescription. When they explain the PA Process to you, acknowledge it, say you'll get right on top of it, and completely ignore every word of it. At this point you need to go straight to your doctor and tell them the following, "Doc, I don't know what the heck is wrong with Walgreens. They are pretty much refusing to fill Mr. Johnson's _________. I've dealt with several different members of their staff. I've faxed in the prescription at least two different times, called it in once, and I can't seem to get them to fill it!" Then, the doctor will call and ABSOLUTELY TEAR THAT STUPID PHARMACIST A NEW ONE! Sit back and laugh. You've done a good job. You've waste almost a week of the pharmacist's time, and you've not had to do much work or call for the PA.

Final Step) Now, when the doctor returns to you, he'll explain to you that they just need you to get a PA. They'll be so scared of the doctor, they won't say anything about your prior shenanigans. Your response should be, "Well, why didn't they just SAY THAT!?! STUPID PHARMACISTS!" He will agree and, at this point, you need to call the pharmacy again and have them fax you the information on how to get the Prior Authorization. They will probably say something about how they sent you the information -- just tell them you never got anything. Now, buckle down and actually get the PA...dag nabbit!!

And that is how you get a PA!

Filed under: Courtesy, Doctors, Education, Insurance Companies, Lazy People, Me being a dick, PHARMACY SECRETS!, Prescriptions, Stupid Doctors, Stupid Nurses, Technicians, Work Sucks 12 Comments

“I’m never coming here again!!!”

Posted on March 7, 2011

The title of this post really says it all, amiright? If you've worked in service of customers/patients, in any field, some jackass has uttered (or hollered) these words in an outlandish attempt at getting their way by bartering all of their money for future services rendered in exchange for instant gratification in the form of (most likely) you compromising your better judgment.

Obviously, this has happened to me quite recently...and it pissed me off royally because I was the nice guy being lied to and this fat bitch was the fat bitch that altered her prescription and lied to a(nother) pharmacist.

She presented a prescription from a doctor for that read as follows:

Pt: Janice Sanveritas

Hydrocodone/APAP 5/500
Sig: 1-2 tabs po q4-6h prn pain.

Dr. Ima Schmuch, DDS

Now, most reasonable people can see that this prescription LACKS A QUANTITY. She brought this to me at, we'll say 1pm on Sunday. After I IMMEDIATELY pointed out that it lacked a quantity and would require a phone call the next day, she remarked that she thought that this was the case, but she convinced herself that the word "SIG" which was scribbled was in fact the word SIXTY. Of course, this would be ridiculous because it is very UNcommon for a dentist to write for SIXTY FUCKING VICODIN. So, we argued about this a bit and decided that she was mad at the dentist for not writing a quantity and not me, but she was pretty sure he told her sixty....considering this lady had been a problem in the past, I didn't care what she thought, I wasn't even gonna give her 1 or 2 for that night (which I might CONSIDER, for a second, if she was a consistent, good, nice, polite patient).

So, she left script in tow. She came back at about 3pm. Now, the script had a convenient #60 written in right beneath the Sig. The ink didn't match. The hand writing didn't match. The story made no sense. She told me the drove over to this dentist's office and caught him just as he was leaving and he apologize profusely as he wrote in that #60 in a different handwriting from 6 or 7 days prior. I called his office the first time she came in and of course, nobody answered. In fact, it went straight to voicemail as if no one were in the office. I left a message at that time, but I knew no one would get it until Monday. Luckily he was there, right?

I told her, right when she handed it to me that I was going to have to call and verify the quantity...and the drama and bullshit began. You all know how this went.

"I have to call and verify this."
"Why? He wrote the quantity in plain as day. You can see it right there."
"Yes, but you must understand why I have to verify this. It's Sunday afternoon. I've seen this script without a quantity and you bring it back and now it has a quantity written on it. If your dentist DID write this in, he should have called or at least initialed next to the quantity that he wrote it in a different colored ink. He knows better. He knows how things are these days with all those druggies out there."
"Ohh so now you're calling me a druggie?"
"I don't recall saying that specific phrase. Did I say that?"
"Well, you might as well. I'll tell you what I'm fucking sick of this place. Every time I have fucking problems because you're a fucking idiot. I'm NEVER COMING HERE AGAIN!"
"And that's completely fine with me. I just want you to at least accept that you know where I'm coming from. I have to verify that quantity on that script. You've had it for several days. What's 18 more hours? I can call in the morning before I even open."
"No, just give it back to me. I'm going somewhere else. This is ridiculous. I've been coming here for 10 years. [Note: this pharmacy has only been open for 4-5 years] I'm going somewhere else, and I'm transferring all my meds away, and I'm never coming here again. Someone else would be more than happy to accept my business."
"Okay...fine...good bye" [and good fucking riddance]

-=+=-

I wanted to say, "Do you really think, for one second, that I'm not going to call every pharmacy in town the SECOND you walk out of here and let them know that you are leaving here with a prescription that I believe to be altered?" But, that would ruin all the fun of wasting her time! I WANTED her to take it to another pharmacy -- or several if possible -- only for her to be turned away for the EXACT same reasoning. I also wanted to write something on the prescription, but that would've also kept her from mustering up the gaul to take it elsewhere.

So, I took to calling all 8 pharmacies in my vicinity. Turns out this fat bitch was already BANNED from Wal-Mart, a Medicap, and a Medicine Shoppe. Now, she can add one more pharmacy to that list for her bullshit.

The winner of the "where this bitch ended up" contest was CVS. I'd talked to their pharmacist Remy, and she politely called me back. She let her drop it off and return 30 minutes later. Remy told her that the quantity's ink did not match the rest of the prescription and that she had no choice but to call the next day and verify it. This bitch politely said, "Okay, thanks a lot!" and putted her ass right on out of there...after showing her ass real good right in front of my eyes!

Today rolls around and I head in there and first thing call that dentist's office and apprise them of the situation. I told them that I believe that she modified the prescription, but CVS currently possessed the hard copy and would be calling. I just wanted to tell them my side of the story. Their side of the story? He intended on giving her 20 tablets and was nowhere near the office on Sunday.

Cut ahead to Remy calling me later on...She verified the script was altered by someone, and the DDS intended on 20 tablets. However, he went ahead and AUTHORIZED TWENTY TABLETS TO BE FILLED! I could not fucking believe it. Remy couldn't believe it. Hell, the fucking patient probably couldn't believe. This was the only doctor in the fucking NATION that would approve that script. He is enabling her addiction -- no doubt about it. This fucking doctor is a problem. I am debating whether or not to call the Board of Pharmacy and the Board of Medicine. I'm not sure if there's grounds for any sort of investigation -- or if I would just end up looking like a tight ass, punk pharmacist...

What are your thoughts?

Filed under: Doctors, Drug Seekers, Forgery, Just a question, Laws, Me being a dick, Me hating others, Prescriptions, Stupid Doctors, Stupid Nurses, Stupid People, True Story, Work Sucks 29 Comments

Requirements versus Services

Posted on January 8, 2011

The smart alecks that post wise guy comments on my, and other pharmacist websites, usually only have one or two things they say regarding the worth of pharmacists. The root of their hatred for the profession that does so much for the common citizen is seeded in their jealousy of the wages paid to such highly trained professionals. Along the same lines, they only see pieces of paper (money and prescriptions) coming in and bottles filled with 30 pills each going out. Haters see it as overly simplified. Exoterically, from the outside looking in, it is, but for those of us that spent 6 to 8 years getting a doctorate, we don't agree. Compared to backbreaking labor outside in the hot sun, I can at least understand.

I've also had a recent brash of problems with patients being rude/uncaring about the difference between requirements of a pharmacist versus services provided by a pharmacy. Some things we do are required by laws, federal or state, while some things are done to ensure patients have a good pharmacy experience and return with more pieces of paper.

Requirements:

1. I take the prescription from you. I ensure it meets all legal requirements (Name, Date, Drug name, directions, quantity, refills, doctor signature, and in my state, the Rx symbol on the face of the prescription).
2. I input in the computer (the computer system is not required. I could use a typewriter or even hand write the labels).
3. A prospective DUR (Drug Utilization Review) is performed by either the pharmacist manually and/or the computer system automatically ensuring that there are no drug-drug, drug-disease, or drug-patient interactions requiring concern. If there is, the physician in contacted. The patient is educated or the drug is changed to an alternative at this point. If there is no problems, we move on:
4. A label is generated and placed on an amber bottle.
5. The appropriate drug is counted and placed into the bottle.
6. Final check is performed by pharmacist and all aspects of the process is verified again. Finalized product is bagged and put into the pharmacy's WCB (Will Call Bin).
7. Patient picks up medicine. Patient is provided the opportunity to ask a pharmacist any questions concerning the medicine with the magic question, "Do you have any questions for the pharmacist?" -- this requirement not being added until 1990.

Services:

1. Billing your prescription insurance (or Medicaid) for the cost of your medicine (I don't have to take any insurance - let alone YOUR insurance). Some compounding pharmacies refuse to accept insurance and are cash-only.
2. Calling your insurance if their is a problem such as them not wanting to pay for the expensive name-brand drug your doctor wrote for, the quantity he wrote for, or for any of millions of other reasons they could dream up. Perhaps you remember when CVS made the decision to not call your insurance for problems any more. They accomplished this by placing a phone in the waiting room. It didn't go over well, but it proves my point.
3. Calling your doctor for refills when your prescription runs out. This is the job of the PATIENT that has been performed by pharmacy's striving to merely keep patients from having the opportunity to take their pieces of paper elsewhere if they are forced to visit the doctor for refills.
4. An easy open lid is placed on your bottle instead of the safety lid which is the legal requirement. (Screw your arthritis - I don't have to cater to you!)
5. Paging your name overhead when your prescription is ready -- that's all southern hospitality, buddy!
6. Taking checks or credit cards is also optional. Cash is the only requirement -- read the dollar bill. Does your credit card or check say that I *have* to take it? Nope.
7. Flavoring your child's antibiotic with out FlavorRx system.
8. Anything or everything related to having a drive-thru or providing services through it.
9. Being nice to you in any way, shape, or form. I just have to be there and be sober...I don't have to be my normally delightful self...

I'm sure this second list has a BUNCH more items on it. Fill in the holes for me...I'll add them to the list.

Filed under: Courtesy, Doctors, Education, Insurance Companies, Laws, Lazy People, Me being a dick, Patient Education, PHARMACY SECRETS!, True Story, Work Sucks 12 Comments

Do you want me making assumptions on all your prescriptions?

Posted on January 3, 2011

Late this afternoon, I got an electronic prescription sent in from, let's call him Dr. Lou Pressor. It was written as follows:

Metoprolol 50mg
1t po qd #90+0rf

What's missing here? That's right -- a salt! We have two different drugs we could fill this with. It could be Metoprolol TARTRATE (Lopressor) or Metoprolol SUCCINATE (Toprol XL). Both are available in a 50mg dose, but since the doctor did not specify, we have no idea.

Upon looking at the patient's history, we have no way to guess what the patient should get as this is an entirely new drug for him. I called the patient to see if he could tell me exactly what he was getting, and unfortunately, he had a touch of elderly dementia / senility and was unhelpful. I will, from time to time, ask a patient to fill in the blank here. If, without any prompting, they can tell me exactly what medicine they are supposed to be getting I will go ahead and fill it based on that fact with a quick note jotted down. Now, if that's correct or not, I don't know, but it sure beats the hell out of waiting on hold for a nurse for 20 minutes and waiting 3 HOURS for their return call!

So, since Mr. Magoo was unhelpful, I reluctantly made the call to the doctor's office. I relayed the message to the nurse and about an hour later, a jerk ass doctor called me back.

"And what was your question about Mr. Magoo's prescription?"

"Well, we got an electronic prescription that just said Metoprolol 50mg, one a day, #90, but it did not say succinate or tartrate. So, I wasn't sure which it would be. The patient wasn't capable of filling me in so...."

"Well, you must have been able to assume it was succinate since it was a once a day dose..."

"Not necessarily. There are tons of people that take the tartrate once a day and do just fine."

"That's ridiculous. Tartrate has to be dosed B-I-D. "

"You'd be surprised. In any event, I simply can't make assumptions in my position. Would you want me making assumptions on all your prescriptions? If you wrote Diltiazem 240mg daily, would you want me to assume you meant CD or XR because it makes sense to me? While the world should operate based on logic and reasoning, it simply doesn't..."

"Guess not...Thanks for calling..."

The Angriest Pharmacist -- converting doctors into pharmacy fans one at a time....

Filed under: Doctors, True Story, Work Sucks 7 Comments

Page 2 of 4123 4

Click here for a Random-Post

TAestP Twitter

I'm ashamed of myself -- so embarrassed. I let down my friend. They were dependent on me, and I have failed. Strive to be better than me. 11 hrs ago
I hate when I'm dependent upon someone else to open a store for me when I'm floating -- especially when *they* are late. 23 hrs ago
Ya know, I gotta admit, Madonna didn't suck. It was *much* better than we have become accustomed too. 1 day ago
Does anyone else find it sickening that more than 1300 people give a shit what my thumbs say here? I'm proud and amazed. 3 days ago
Another show that I think is funny: MTVs "I just want my pants back." So, I'm 18. Fuck me. I just like the show. Watch it. Or don't. IDGAF. 3 days ago
Anyone that doesn't love #TheFinder GFY! 4 days ago
"I'll do anything! I'll get in my bra and you can throw nails at me..." 1 week ago
I don't know exactly why but I fucking love #FranklinAndBash 1 week ago
More updates...

Loading ...

Polls Archive

^ Use this image to advertise this site! ^

The *Angriest* Pharmacist You want your prescription filled when? Eat shit…