Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, June 13, 2008

Planning Ahead

This is Dr. Dinosaur calling in a refill for a patient's Evista.

Sure, Doctor. Is it ok if we substitute a generic for that?

Uh, there is no generic for Evista.

Oh, I meant in case a generic version of it comes out, may we substitute? This way we won't have to call you.

Um, ok.

Now THAT'S planning ahead.


At Fri Jun 13, 08:45:00 PM, Anonymous Anonymous said...

LOL.... Are you serious? I'm an intern at a pharamcy and find that hard to believe! Although so far this week I've had a doctor ask if he was able to call in a presciption for Lexapro or if we needed a hard copy for "that class of medicine" and also a "brand name necessary" on Cymbalta.

At Fri Jun 13, 08:55:00 PM, Anonymous Anonymous said...

Hrm. They have to call you when a generic comes out? Sounds like a waste of everyone's time.

At Fri Jun 13, 09:06:00 PM, Anonymous Anonymous said...

I'd have said, "Sure, but only if you promise to hold your breath until the generic is available."

At Fri Jun 13, 09:44:00 PM, Blogger #1 Dinosaur said...

I changed the drug, partly for anonymization and partly because there was actually a generic available in the class I happened to be calling in, so I wanted to make it perfectly clear that yes, I was asked for advance approval for a not-yet-available generic.

At Sun Jun 15, 03:03:00 AM, Anonymous Anonymous said...

Many insurance companies require a DAW code for processing - Aetna is particularly difficult about that, but more & more are going that route.

If you happened to check the box DAW-1, the pricing is different than if you had not checked that box.

By not marking DAW-1 on the rx, then the rx becomes automatically substitutable when the generic is on the market. If your pt says she wants the brand (when the generic becomes available), then it becomes a DAW-2 which forces the price to the pt up.

The DAW code often will change the pricing, generic availability or not. I have one derm who only writes for DAW-1 drugs & makes the pt pay & pay & pay. They often leave his practice too - does he ever wonder why????

At Sun Jun 15, 09:05:00 AM, Blogger #1 Dinosaur said...

Anon 3:03: Rx forms and laws differ by state. We don't have a "DAW box" in PA, and if we did I would never check it. All scripts here are automatically substitutable with generics unless the words "Brand medically necessary" are handwritten on a special line at the bottom; which I also never write. Hence the increased stupidity of the question, "May we substitute?"

At Sun Jun 15, 09:39:00 AM, Anonymous Anonymous said...

Indeed - that does increase the stupidity.

I'm the manager of my pharmacy & if I heard one of my employees ask such a stupid question he/she would be off the phones & on the computer without access to any human contact unless I was present.



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