And after 5 months...

Well, its been an education almost every day, working as a floater pharmacist, and I think that's probably why I enjoy floating so much. I'm never bored, and I love going to new stores, and meeting new staff, and if I'm really lucky I get to add another store fridge-magnet to my growing collection! (I'm up to 12 although I think I've been to 18 different stores now).

Since most of the time any insurance related issues are dealt with by others (thankfully), most of the issues I have to deal with are one's of a legal or quasi-legal nature. However, recently there has been a real clamp-down on processing rx's through insurance with much greater care, mostly related to COB's (when patients have more than one insurer) and also in regard to Medicare Part B issues, where patients have to be informed of any potential reasons for not being provided with their medication, resulting in streams of new paperwork. All very ugly and time-consuming, but I guess we'll get used to it.

However, on a day-to-basis I don't really find those issues very interesting, or not as interesting as I find the legal issues which crop up every so often. And on that basis, I'd like to share two issues today which any aspiring pharmacists should really learn like the back of their hand, and not have to think about.

1. CII's are often written without the patients address on, and that is OK as long as the patients address is already stored on the computer. However, there is an interesting situation which crops up in particular in one location locally where the residents, for some strange reason, do not use street addresses but only use P.O. Box numbers - it is ILLEGAL to supply a CII without a patients physical street address - a PO Box # is not sufficient.
The first time I came across such a rx I phoned the pharmacy help desk to double check and they confirmed that the rx needed a physical address. So I phoned the prescriber who said that (for patients in that area who only ever used PO Box #'s) he had always written PO Box #'s o the rx, and in all the many years he had been writing these rx's I was the first pharmacist to ever tell him that this was illegal and he was very interested to know why nobody had told him before. So I went back to the pharmacy's legal department and asked them if we were able to write the patients address on a CII rx - yes - it is the ONLY thing you can add to a CII rx. So that's fine and dandy, but I would bet you a large sum of money that almost every previous rx for a CII written in that area has NOT had the patients physical street address added to their computer records, and that if the Board of Pharmacy fancied, they could get a lot of pharmacists in a lot of legal trouble. You have been warned!

2. The other legal issue, I may have already mentioned, but I will mention again. Controlled meds CIII thru CV's are allowed refills - either to a maximum of 120 days supply or 5 refills. So if a script comes through (I wont start the discussion on what is or is not an electronic signature but that is another valid discussion point) as follows:

Temazepam 30mg i qd #10 + 5RF

It would be OK to fill all 6 times, since the total would only be a 60 day supply.

However, if it had read:

Temazepam 30mg i qd #30 + 5RF

Then legally, you could only supply for a maximum number of refills to cover 120 days - that's the original rx plus 4 x 30 days of refills - so the 5th refill must be cancelled.

I cancel these every now and again, but the computer system we use doesn't automatically catch this error by itself (it does catch some errors - say if someone brings in a rx for temazepam which was written over 6 months ago it will not let you fill it). But this error on the 5th refill it does NOT catch, and if you give it out you are breaking the law people. Once again, don't say I didn't tell you :-P

Well, that's the legal update for this post. The only other thing I wanted to add, much in the manner of my entire blog series, is once again I have hit another problem in my paperwork. This time its my employer deciding not to post my application for permanent residency, as written in stone in my contract. They have a fairly good reason for saying they can't sponsor me at this time as there are now a sufficient number of pharmacists in the area, and that I should check back with them in 6 months to a year to see how the situation may have changed by then. I'm not worried about it much at this time, as they have just put in the papers to extend my H1B visa, but even so, it does add to the almost never-ending list of things that haven't gone quite according to plan for me in my journey to becoming not just an American pharmacist, but an actual American (or at least a green card holder).

As always I will update when I have more to say, but until then good luck to you all,

Steven C