Pharmaceutical Opinion or Insurance Fraud?

D1F507CE-3D45-41A1-8CEE-2B48ADDDF9BC.jpegHighlighting a drug interaction isn’t a pharmaceutical opinion. It’s an insurance fraud.

I often see a fax back of notification that the new prescription for ciprofloxacin has a drug interaction with the patient’s quetiapine. Or a patient’s new prescription for fluconazole will be dispensed, only to be told that the patient should contact the prescriber what to do with her current methadone dose, knowing that fluconazole has an interaction with methadone.

This isn’t a pharmaceutical opinion. This is professional tardiness, or passing the buck or fail to live up to your professional responsibility. Honestly, how can a pharmacist be charging a fee for professional opinion when there is no opinion given for the drug interaction noted?

Suggest few options if feasible, or identify risk factors that may render the drug interaction relevant or more significant.

In the case for drug interaction between ciprofloxacin and quetiapine, the minimum suggestion is to see if there is a recent ECG to assess for baseline QTc interval. Also review any relevant risk factors such as electrolyte abnormalities or cardiac arrhythmia. If one feels the management is beyond his or her scope, say so!

As for the interaction between fluconazole and methadone, the single dose treatment is likely for a vaginal yeast infection for which topical option could easily avoid the issue. Why ask the patient to take the dose and consult the physician how to manage the interaction?  What if the patient cannot contact the prescriber in time to manage the interaction?

A pharmaceutical opinion should have the following components:

1) Identify the drug therapy problem

2) Describe the significance and relevance of the problem. Sometimes it is irrelevant and should clearly state this if it is the case.

3) Provide some suggested management options.  Sometimes it only entails  monitoring with symptoms; other times, it may require lab investigations. In significant issues, identify alternative treatment options or dose reduction.

If a pharmacist isn’t willing to provide a complete pharmaceutical opinion, then don’t bill for the associated fee because it is an insurance fraud. It is also a professional disgrace.

Maybe my tone is a little harsh. But do you agree with me?

Thank you for reading my post.


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My name is Cynthia Leung and I am a practicing pharmacist in Kingston Ontario, Canada. This blog is for me to share my ideas, opinions and perspectives on how medications are used in our health care system. Note that these posts are my own opinions and do not represent the opinions of my current or former employers and / or organizations that I may belong to. Any possible case scenarios described in my posts would be modified to maintain patient confidentiality. This blog is not a platform for professional advise for patients or health care providers and the content is not meant to support any clinical decisions or replace professional opinions. Also the images are either taken or created by the author, or adapted with permission. I hope you will enjoy reading my posts!

2 thoughts on “Pharmaceutical Opinion or Insurance Fraud?”

  1. Technology has made the drug interactions automatically available in the pharmacy. But the same technology is already in the EMR of many physicians and has already been considered and discussed with patient. eg got a couple of calls on adding carbamazepam to phenytoin re reducing phenytoin levels. Had already arranged phenytoin blood levels to follow. Also cipro with coumadin combo short course prompted extra INR level.
    When prescribing away from EMR, Epocrates on smart phones has an excellent interaction program, almost always used when drug added to multiple therapies.

    Liked by 1 person

    1. This is where I think adding a note in a prescription to indicate that one is aware of the interaction and has made arrangement to manage or monitor or whatever the plan is. Not all clinicians are on top of them but for individuals like yourself it really takes the guesswork out as well as avoiding unnecessary phone call or communication. I also suggest the same thing for allergies. If one is aware of the penicillin allergy and knows the patient has tolerated Keflex before, then it will save a phone call for everyone. community pharmacists don’t always know which EMR has the feature to detect drug interactions and whether they are reliable, often times to err on the side of caution they may communicate duplicate info or info not necessary relevant. This is why communication is important always.


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