tag:blogger.com,1999:blog-5883634615775822475.post5800786144416206270..comments2024-03-18T09:00:31.992-04:00Comments on Doctor Grumpy in the House: Drug 'R UsGrumpy, M.D.http://www.blogger.com/profile/09858110332436246760noreply@blogger.comBlogger85125tag:blogger.com,1999:blog-5883634615775822475.post-72450708779787005232020-08-16T09:24:26.833-04:002020-08-16T09:24:26.833-04:00I write generic names - fluoxetine 20 dly po and l...I write generic names - fluoxetine 20 dly po and leave it at that. Let the pt and their pharmacist and their insurance fight it out. As long as my pt gets the drug, I don't care.ayeekazhttps://www.blogger.com/profile/03963454910789250507noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-24082335503700019262011-05-04T22:38:40.243-04:002011-05-04T22:38:40.243-04:00I have to say that as a veterinary assistant that ...I have to say that as a veterinary assistant that deals with clients being picky about this very thing and having to, not only relay this to our doctors, but fill the scripts and explain that it's the SAME THING, I sympathize. I was also thinking the other day about this when I saw an add for a rosacea drug that is, "brand new!" and was labeled as plain old Doxy-freaking-cycline. Pharmaceutical companies can spend thousands to get rid of rosacea with a darn antibiotic that's been on the market for years, but can't come up with a more effective drug to treat my pituitary tumor? Sad.It'sAllGoneToTheDogshttps://www.blogger.com/profile/16527453810063489343noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-12922018660941313562011-04-20T01:41:17.428-04:002011-04-20T01:41:17.428-04:00Independent Coumpounding CPhT
Funny, no one menti...Independent Coumpounding CPhT<br /><br />Funny, no one mentioned Xopenex/albuterol. <br /><br />Also, those co-pay rebate cards cost the pharmacy money to process, lowering our already pitiful profit margin.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-64710324917199355182011-03-18T01:19:25.530-04:002011-03-18T01:19:25.530-04:00That really pisses me off!! Drug companies rather ...That really pisses me off!! Drug companies rather make a few bucks and waste their time on drug combos and upping and lowering doseage and calling them flexmed (example whatever its called) they need to be out there finding a cure for AIDS, cancer and Childhood diseases, like a cure for VCD, ADHD and tracheal malasia (which my child has) man!!! That makes me so effin mad!!Missynoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-61109764013960517152011-02-25T13:53:26.040-05:002011-02-25T13:53:26.040-05:00My favorite part of dealing with discount cards is...My favorite part of dealing with discount cards is when the patient 'forgets' to mention that they have one until I've rung their rx and the transaction is complete... even when I make a point of telling them the price beforehand.<br /><br />Me: "Alright, your total is $50."<br /><br />[complete sale]<br /><br />Pt: "Hey, was that with my coupon? It's only supposed to be $20."<br /><br />Me: ". . . manager to the pharmacy please, manager to the pharmacy."Parchment, CPhTnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-14391861447019707082011-02-25T11:24:30.350-05:002011-02-25T11:24:30.350-05:00hahahaha that last sentence made me laugh. Good o...hahahaha that last sentence made me laugh. Good one, Dr. Grumpy, that was one of the funniest punchlines I have ever read.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-16014592082588036212011-02-21T23:36:43.089-05:002011-02-21T23:36:43.089-05:00Ahem. This might be quite extensive.
I'm the ...Ahem. This might be quite extensive.<br /><br />I'm the dark side here. The PBM. Prior Authorizations. And Dr. Grumpy has hit the nail head on here. This is a massive snarl of horror that makes victims out of the patients, the MDs, and even the insurance plan. My job would be far less necessary, and far more pleasant if this mess didn't exist to wrangle with. What goes on behind the scenes is a convoluted mess of fighting with rebates (both negotiated and federally mandated (Drug companies aren't so fond of those!), legal squabbles and regulatory messes.<br /><br />I work principally on a state Medicaid. We are dirt poor, on a per patient basis. We have more than a million people, most of whom are dirty poor on a personal basis. A huge number of them are very sick, and more than half our children.<br /><br />Yet how often do I get a PA request for Doryx (at it's lovely $500/month price), because that's what samples were on hand. Of course the patient's been started on the medication by those samples, and now the state's expected to pick up the rest of it. Advair is almost as bad an offender.<br /><br />@Txtpharmguy, the reason for that on Quinine (the dx part) is the big fat blackbox on the drug:<br /><br />"Quinine sulfate use for the treatment or prevention of nocturnal leg cramps may result in serious and life-threatening hematologic reactions, including thrombocytopenia and hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP). Chronic renal impairment associated with the development of TTP has been reported. The risk associated with quinine sulfate use in the absence of evidence of its effectiveness in the treatment or prevention of nocturnal leg cramps outweighs any potential benefit (Prod Info QUALAQUIN(R) oral capsules, 2010)."<br /><br />You'd be surprised how many prescribers do not read black boxes. Horrified might be closer.<br /><br />@Lovinmyjob, Oh yes. 'Branded' and 'licensed' generics. Some of the big brand name companies have 'pet' generic manufacturers that exist pretty much to sell licensed versions of generics. The effects of this are quite widespread, as the licensed generics are often priced only slightly lower than, or even higher than the brand name. This encourages insurance to show a preference to the brand, and retards generic competition. In one case, a brand owner licensed generics to over a half dozen companies, utterly FUBARing the pricing of the generic during a legal spat with a company that busted their patent.<br /><br />Drug rebates are also calculated based on brand originator or generic status. By licensing their products as generics, under some circumstances a drug maker will pay less in rebates. In the case of Medicaid, these rebates are mandated and calculated by federal law, and the drug makers take a sadistic glee in gaming and abusing the system that makes it possible to afford drugs for people who have no resources at all.PAShttp://twitter.com/PASlavenoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-71545371423976416892011-02-21T22:43:14.015-05:002011-02-21T22:43:14.015-05:00Hey, the good news is that the drug companies don&...Hey, the good news is that the drug companies don't spend very much money in R&D to extend the half-life of these drugs--the technology is well known. <br /><br />Still...The Motherhttps://www.blogger.com/profile/15157821003454766570noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-64340494726618479542011-02-20T20:00:38.984-05:002011-02-20T20:00:38.984-05:00This subject drives me crazy! A local derm prescr...This subject drives me crazy! A local derm prescribed time release Doryx 150 mg at $540 per 30. The patient was having trouble swallowing it, so this IDIOT doctor told her to just crush it - essentially turning it into $10 worth of doxycycline.Old Rhpnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-14592563297607663642011-02-20T19:58:47.912-05:002011-02-20T19:58:47.912-05:00Don't forget Soma 250 and the "new" ...Don't forget Soma 250 and the "new" tamsulosin/finasteride combo.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-21264548679327642402011-02-20T14:19:27.710-05:002011-02-20T14:19:27.710-05:00Another big issue to consider is that most generic...Another big issue to consider is that most generics aren't really generics. They are what is refered to in the industry as CLONES. That is when the name brand company makes and distributes the so-called generic. That results in a very minor cost savings to the patient. Case in point: Omnicef vs Cefdinir. The capsules in the generic bottle actually say Omnicef on them. Who doesn't see that as just repackaging the same product and charging a different price. There are many insurance companies who are now recognizing this trend and only paying for the name brand product. Does this seem bass-ackwards to anyone but me?lovinmyjobhttps://www.blogger.com/profile/02251424092621233215noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-70627992541681772372011-02-20T02:39:00.588-05:002011-02-20T02:39:00.588-05:00I think jmacc77 had the BEST comment!! It actually...I think jmacc77 had the BEST comment!! It actually made me laugh out loud!Smiley :)noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-38335323531697711422011-02-19T18:46:02.662-05:002011-02-19T18:46:02.662-05:00An excellent summary of the entire process! I get ...An excellent summary of the entire process! I get a kick out of submitting those Fukitol ER claims to insurance -- I can almost hear the insurance company computer laughing maniacally.<br />By the way, that "white pill with the line through it"? Its spironolactone, I'm SURE of it...Frantic Pharmacisthttps://www.blogger.com/profile/15804872250102867314noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-89723468733954919952011-02-19T11:12:49.109-05:002011-02-19T11:12:49.109-05:00Robin Williams had a great routine based on Fukito...Robin Williams had a great routine based on Fukitol. I only wish it were a real drug, I could use some of that, since antidepressants either don't work or make me *more* depressed. (Been through damn near a dozen of 'em over the years. It gets old.)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-29626836513845647962011-02-19T01:02:14.349-05:002011-02-19T01:02:14.349-05:00My favorite is BeYaz: let's add folic acid to ...My favorite is BeYaz: let's add folic acid to our contraceptive, just in case you get pregnant while on it.wormpharmdnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-23093810250091760912011-02-18T23:13:46.502-05:002011-02-18T23:13:46.502-05:00Me: "Oh, I see the doctor has given you a co...Me: "Oh, I see the doctor has given you a coupon for this new medication. Have you activated it yet?"<br />Patient: "Activated? Whaddya mean? Doc just told me to get my medicine with the coupon."<br />Me: "See the big sticker on the front of the card? It says "Must be activated before use." You'll have to call this 800 number on the card before it will work."<br /><br />I *really* love it when a Medicare Part D patient comes in with a coupon card, and I have to tell them I can't use it because they are covered by Medicare. "But...but...my doctor gave it to me to use! You must use it!"<br />It's no fun telling them their doc didn't read the fine print on the card and is probably handing those cards out to everyone who comes in the office.<br /><br />ThatLadyDruggistAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-4272268717391261262011-02-18T16:31:35.711-05:002011-02-18T16:31:35.711-05:00My current favorite is Aricept 23mg. Why 23mg? B...My current favorite is Aricept 23mg. Why 23mg? Because 23 is a prime number and you can't get a 23mg dose using generic 10mg and 5mg tablets. The genius at pfizer who thunk that one up got a big bonus, I bet.was1noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-40015823876969705632011-02-18T14:55:49.506-05:002011-02-18T14:55:49.506-05:00A great thing about the NHS in the UK. Because it ...A great thing about the NHS in the UK. Because it is a financially limited system where money can be better used elsewhere in the system, all doctors have to prescribe generic drugs. It's really a good system for stopping abuse of resources by drug companies.<br /><br />The drug companies still try to get away with it though so we still get regular drug lunches which is nice.<br /><br />For example yesterday there was a drug rep in an anaesthetics lunchtime CME meet, advertising sub-lingual Fentanyl for chronic cancer break through pain. There are so many issues with this drug that even myself, a med student, could tear apart reasons for why it's less viable than currently available drugs.Mr Mobiushttps://www.blogger.com/profile/03806554696099631208noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-67167940262757800132011-02-18T14:41:21.994-05:002011-02-18T14:41:21.994-05:00Kudos, Doc. Excellent. Those silly coupons/copay...Kudos, Doc. Excellent. Those silly coupons/copay cards just drive up costs and are a pain in the posterior to process. This is a wonderful blog entry.<br /><br />PharmacyJimAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-19350082046245091892011-02-18T13:38:10.970-05:002011-02-18T13:38:10.970-05:00I do have to say that I find a massive difference ...I do have to say that I find a massive difference between Claritin and Clarinex. Claritin knocks me out. As in, totally non-functional for hours. I can breath, but not much else. Clarinex lets me breath, but doesn't make me at all drowsy, and I only have to take it every other day since it has a much longer half life.<br /><br />I do use generic prilosec which we get from the Navy Base pharmacy. It comes as capsules, 20mg. Once when I ran out, and we couldn't get a refill for almost a week, I tried the OTC tablet form. And it didn't work anywhere near as well. <br /><br />But in general I have to agree with everyone here, but no one has mentioned my pet peeve on dosing, which is the osteoporosis drugs. I mean, really, by the time you need to take one of those you already have at least one daily maintenance drug, so how hard is it to remember to take the second? But first we have the weekly dosing (which would be much harder for me to remember), and then the monthly (harder to remember than the weekly), and now they've come up with an annual one, which I can sort of understand.Library-Gryffonhttps://www.blogger.com/profile/06446982343602702829noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-40368680946373150972011-02-18T12:58:34.352-05:002011-02-18T12:58:34.352-05:00so... if i combine two generics to get a NEW drug,...so... if i combine two generics to get a NEW drug, does that count as an artisan drug? ;)<br /><br />if you do that w/ dogs, take two purebreds and mix 'em, you get a "designer dog"... so this could be a designer pill! Eh... or a mutt.jmacc77noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-10048517703368612462011-02-18T07:15:57.711-05:002011-02-18T07:15:57.711-05:00Dermatologists - Need I say more? How many differ...Dermatologists - Need I say more? How many different ways can you reformulate tetracycline derivatives and benzoyl peroxide in order to gouge patients?<br /><br />WV - larph: Laugh so hard you barf?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-63180357324701566732011-02-18T04:49:51.734-05:002011-02-18T04:49:51.734-05:00I'm surprised that in 53 comments, nobody'...I'm surprised that in 53 comments, nobody's mentioned finasteride (Proscar/Propecia).<br /><br />Proscar (finasteride 5mg, for enlarged prostate) is available in generic. It's not quite on the $4 value menu yet, but at around $10 a month is still pretty inexpensive.<br /><br />Propecia (finasteride 1mg, for male pattern baldness) is brand-only. A month's supply costs somewhere in the neighborhood of $100... which means a cost of roughly 10x more per tablet (or 50x more per mg).<br /><br />A couple of doctors around here kindly write scripts for generic Proscar, 1/4 tablet once daily. Close enough, I'm told, to make it worth not having to pay the Merck tax on brand Propecia.Unknownhttps://www.blogger.com/profile/17246692166974720109noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-17718044051610664872011-02-18T02:56:19.295-05:002011-02-18T02:56:19.295-05:00As much as it annoys docs, pharmacy folk etc, I th...As much as it annoys docs, pharmacy folk etc, I think that free samples and coupons do have their place when used with discression. I am very very sensitive to meds and no longer have drug insurance. When trying out a new class of drugs I never know if I am going to have side effects or not. I tend to have to cycle through several drugs before finding one that works. This recently happened with Nexium, Prilosec and the related drugs. Doc sent me home with various sample packs. I used some of each until I found one that worked for me and then he wrote a scrip for the generic form. This worked out great for both of us. We also did the coupon trick with Cymbalta which would have cost me a fortune out of pocket only to discover that I am allergic to the stuff. We are moving on to try other FM drugs so I'm off coupon hunting on the internet....Baffledhttps://www.blogger.com/profile/16763003920036754454noreply@blogger.comtag:blogger.com,1999:blog-5883634615775822475.post-80913539129001594132011-02-18T01:38:48.164-05:002011-02-18T01:38:48.164-05:00WellIllBe brought up Nexium: it does in fact have ...WellIllBe brought up Nexium: it does in fact have a 20mg strength, but nobody prescribes it. (As a joke, I've lately been referring to omeprazole as "Previous-ium".) <br /><br />(On the subject of imaginary drug names, I had one professor who came up with "Putyermycin". I leave you to guess what yer putting them into, probably some sort of homogenizer.)<br /><br />Sorry this rant turned out so long; you can edit for length if you want to.Shalomhttps://www.blogger.com/profile/13667927130052597028noreply@blogger.com