Not “ha ha” funny. More like inexplicable: A cynical pharmacy stopped by a doctor pushing back.
A few weeks ago I received a fax from Tracy at PayLess Drug:
“We do not have a current monitoring frequency for your patient for the CBC with differential blood draws required for Clozapine. Our records show the frequency for your patient as being drawn every 4 week(s). If this is not correct, please indicate the monitoring frequency. This authorization will be good for one year from the date signed, unless a specific lab has shorter duration.”
“*For non-residential clients, this authorizes PayLess drug to dispense all routine auto fill medications at the above indicated frequency as well in order to assist the client with compliance packaging for their medication.”
With a phone call I discovered that CVS/Caremark had transferred its clozapine (Clozaril) business to Payless. (I informed them that the grammatical errors that render the “form” nonsensical.) Because the drug frequently causes potentially fatal reduction in blood counts the patient must have blood tested every 1-4 weeks depending on how long they have been using it. My patient had been using the drug long enough to qualify for monthly testing. But what possessed PayLess to ask me about this? I do not determine the frequency which the FDA and a national clozapine registry specify.
I wondered whether PayLess intended to withhold the order from the patient, a potentially devastating blow and whether a pharmacy can simply make up a questionnaire and require the physician to sign it before dispensing the drug. I suspect the vast majority of physicians would just sign it and return it without question. I can almost hear the conversation:
Pharmacist #1: “How can we limit our liability regarding the blood tests?”
Pharmacist #2: “Just create a form. Doctors will sign anything you put in front of them.”
Before I could get an answer I received a revised, but hardly improved, version:
“CVS/Caremark has requested that PayLess Drug provide Clozapine dispensing and monitoring services to your client. Payless Drug is the largest most respected Clozapine monitoring program on the west coast.
In order to make this transfer as clean as possible we are requesting for you to please verify the frequency that you would like to have the blood drawn for CBC and medication dispensing.
“Please indicate the correct monitoring frequency below for blood draws.
We will make sure that the laboratory performing the test has valid orders to draw the blood using this information. We will contact you immediately if the CBC results indicate a problem. This authorization will be good for one year from the date signed, unless a specific lab has shorter duration.
Payless drug also has available adherence packaging for all medications that your client is taking if you think this could help your client in their recovery.”
Somehow I suspect the laboratory itself will want “valid orders.” The authorization will be “good?” I hate “bad” authorizations. Did they mean “valid?” “Adherence packaging?” Do they need a doctor’s order for packaging now? “Client?” How about “patient?”
I contacted the Board of Pharmacy for my state, Washington, where the pharmacy must be licensed. (The PayLess store is located in Oregon.) The investigator pointed me to the relevant regulation which the pharmacy would violate by failing to honor my order only based on my refusal to sign their form.
Prepared to threaten to file a complaint I called the pharmacy again. They confirmed they had shipped the drug.
Push back. Sometimes it works.