Guest guest Posted July 23, 2002 Report Share Posted July 23, 2002 Chris- If memory serves me correctly, the OBRA 90 law (Omnibus Reconcilliation Act of 1990) was established because there was to be a standard for patient counseling for patients under Medicaid. the Federal Government, however cannot regulate individual states professional practices. Therefore, to cover their own behinds, retail pharmacy technicians are usually required to ask all patients, under Medicaid or not if they need counseling on their meds. Usually, there is a log which I know in the state of Ohio is to be kept for 7 years where all patients are to sign for picking their prescriptions up and to either accept or deny counseling which patients are allowed to do. if any of this sounds vague let me know. I hope this information helps. Pankey, CPhT Dayton, OH Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2002 Report Share Posted July 23, 2002 Hi: Yes, they have to ask but we can refuse. I thought the answer I was given when I asked the estrogen question earlier was that all patients had to be counseled the first time a prescription is filled. I think Jeannette said that, after years of filling a prescription, patients often forget what they were told the first time. That's why I wondered if it was different state by state. In case you weren't part of the forum when I asked this question about estrogen- I asked why package inserts had to be included with estrogens and not the other drugs listed on the practice test question. I was told it was because estrogen is considered to be a cancer causing drug. So I wrote back and said I bet women don't know why that's why the package insert is included and the answer was that all patients must receive counseling when they first fill a prescription. So I wrote back and said no one had told me that the drug was considered to be cancer causing! (not that it would have changed my mind) Anyway, that's how this discussion came about. Can Medicaid patients refuse counseling? Thanks for your help! Chris Re: patient counseling > Chris- > If memory serves me correctly, the OBRA 90 law (Omnibus > Reconcilliation Act of 1990) was established because there was to be > a standard for patient counseling for patients under Medicaid. the > Federal Government, however cannot regulate individual states > professional practices. Therefore, to cover their own behinds, retail > pharmacy technicians are usually required to ask all patients, under > Medicaid or not if they need counseling on their meds. Usually, > there is a log which I know in the state of Ohio is to be kept for 7 > years where all patients are to sign for picking their prescriptions > up and to either accept or deny counseling which patients are allowed > to do. if any of this sounds vague let me know. I hope this > information helps. > > Pankey, CPhT > Dayton, OH > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2002 Report Share Posted July 23, 2002 Dear Unless Federal has changd it is my understnading that all new prescriptions (that means that the pt has never been on that drug before, not new to a specific pharmacy) must be counseled. I should like to hear from retail techs who practice this every day to hear whether or not the Fedlaw has changed. Thanks in advance, Jeanetta > Hi Jeannette: > > On a reply to one of my posts you mentioned that all patients must receive > drug counseling with a new prescription. I know that all Medicaid patients > must, but is it according to state law if other patients receive it or not? > I answered that here in Maine we can sign a refusal. I can't remember > receiving any counseling except for one time so this must be the case. I > guess individual states can decide whether or not to allow non- Medicaid > patients to refuse counseling? The signature indicates we were offered. > > Chris Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2002 Report Share Posted July 23, 2002 Hi Jeannetta: I take quite a few prescriptions-in fact had a new one that I had never taken before filled this past May and I didn't receive any counseling. I know they always ask " is this a new prescription " and " do you have any questions for the pharmacist " . I do remember that . I just sign the log indicating that it was offered but I refused. I remember receiving counseling with one-not sure why I agreed, but I remember having to leave the line and go to a special area (I guess for confidentiality?) I thought the Federal Law was for Medicaid patients but some states decided to extend the counseling to non-Medicaid as well. Maybe some states require it, others its a choice (for non-Medicaid)? Questions- how do you " make " someone have counseling? What if a Medicaid patient didn't want it? And-what was the purpose of requiring counseling? I don't mean going over the schedule, telling the patient how to take the drug properly. That is reasonable, but all the areas to be included in the counseling strikes me as excessive. What about when you pick up a new prescription for another person? I often pick prescriptions up for my mother. Lots of questions :>) Its interesting CHris Re: patient counseling > Dear > > Unless Federal has changd it is my understnading that all new > prescriptions (that means that the pt has never been on that drug > before, not new to a specific pharmacy) must be counseled. I should > like to hear from retail techs who practice this every day to hear > whether or not the Fedlaw has changed. > > Thanks in advance, > Jeanetta > > > > > Hi Jeannette: > > > > On a reply to one of my posts you mentioned that all patients must > receive > > drug counseling with a new prescription. I know that all Medicaid > patients > > must, but is it according to state law if other patients receive it > or not? > > I answered that here in Maine we can sign a refusal. I can't > remember > > receiving any counseling except for one time so this must be the > case. I > > guess individual states can decide whether or not to allow non- > Medicaid > > patients to refuse counseling? The signature indicates we were > offered. > > > > Chris > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2002 Report Share Posted July 24, 2002 Dear On thing for sure is what is done in practice may not always be within the law. Again I still believe that the Federal law is that each patient who is on a drug for the first time must have counseling. It is the resonsibility of the technician to acertain the fact that the patient has never been on this drug before. If the patient tells the truth and says 'yes', then the package of drugs should be witheld until the patient is led to the counseling area for first time counseling by the pharmacist. Purpose is multifold. The pharmacist has the right not to dispense the drug for many reasons. Bu the pharmacist is mainly interviewing the pt to find out what other Rx drugs the patient may be taking, what herbs, vitamins and minerals the pt may be on and what OTC drugs does the pt take. The pharmacist may want to evaluate thepts mental and emotional health and or physical health. the RPh has this right. So even if a pt refuses subsequent counseling, th pharmacist may still try the witholding the med tactic in order to trick the pt in to subsequent counseling. Again I do not think it is lawful for a new Rx t go without counseling. It is the license of the RPh, and they have the right and also I thought the Fed stepped in and said that this had to be. Jeanetta Allow me to clarify my intent of an earlier post: BCP and other estrogen containg drugs must have an accompaning package insert with each and every fill and refill. Why? BECAUSE they are known carcinogens. They must also have first time counseling. I think if you reread my post you will see my intent. I did howver continue with my thoughts on all new Rxs. > > > Hi Jeannette: > > > > > > On a reply to one of my posts you mentioned that all patients must > > receive > > > drug counseling with a new prescription. I know that all Medicaid > > patients > > > must, but is it according to state law if other patients receive it > > or not? > > > I answered that here in Maine we can sign a refusal. I can't > > remember > > > receiving any counseling except for one time so this must be the > > case. I > > > guess individual states can decide whether or not to allow non- > > Medicaid > > > patients to refuse counseling? The signature indicates we were > > offered. > > > > > > Chris > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2002 Report Share Posted July 24, 2002 smithy <smithy@...> wrote: Hi: Yes, they have to ask but we can refuse. I thought the answer I was given when I asked the estrogen question earlier was that all patients had to be counseled the first time a prescription is filled. I think Jeannette said that, after years of filling a prescription, patients often forget what they were told the first time. That's why I wondered if it was different state by state. In case you weren't part of the forum when I asked this question about estrogen- I asked why package inserts had to be included with estrogens and not the other drugs listed on the practice test question. I was told it was because estrogen is considered to be a cancer causing drug. So I wrote back and said I bet women don't know why that's why the package insert is included and the answer was that all patients must receive counseling when they first fill a prescription. So I wrote back and said no one had told me that the drug was considered to be cancer causing! (not that it would have changed my mind) Anyway, that's how this discussion came about. Can Medicaid patients refuse counseling? Thanks for your help! Chris estrogen is a cancer causing drug it can cause breast cancer and ovarian cancer That is why a women over 40 must have a yearly mamagram in order to get here yearly refills on the drug i know this for fact since before i can get my yearly supply this time i have a mamagram. and when you don't have insurance thats about $110.00 but it is all worth it i could never get ovarian cancer but the possibility of breast cancer is there since it is the family. and i take premarin. gale(red) Re: patient counseling > Chris- > If memory serves me correctly, the OBRA 90 law (Omnibus > Reconcilliation Act of 1990) was established because there was to be > a standard for patient counseling for patients under Medicaid. the > Federal Government, however cannot regulate individual states > professional practices. Therefore, to cover their own behinds, retail > pharmacy technicians are usually required to ask all patients, under > Medicaid or not if they need counseling on their meds. Usually, > there is a log which I know in the state of Ohio is to be kept for 7 > years where all patients are to sign for picking their prescriptions > up and to either accept or deny counseling which patients are allowed > to do. if any of this sounds vague let me know. I hope this > information helps. > > Pankey, CPhT > Dayton, OH > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2002 Report Share Posted July 24, 2002 Hi: I'm not trying to be argumentative here, so please don't take it that way. Actually I find this most interesting. I want to know! Since I have had multiple prescriptions filled for years (probably since 1990 when the law came about) I really doubt that my pharmacy (well known national chain) plus the hospital pharmacy (that I used before my insurance changed so that all I pay is the co-pay ,before that I had to pay up front, then be reimbursed.) is consistently in violation of the law. I just rechecked my text and apparently the " offer " of counseling applies to Medicaid patients as well-that they can refuse it (must sign to document they've been asked) The book states " the patient may decline couseling and if so, this should be documented " I'm almost certain that what I am asked when picking up a prescription is " Is this a new prescription? (or have you taken this prescription before? " (so they do ask that) and I answer that and then they say " do you have any questions for the pharmacist " What is odd is that a little later the book also states " written information may also be given to the patient but may not take the place of counseling " To be consistent, that should read " written information may not be substituted for an *offer* of counseling " . It isn't until later the book gets into " extension of standards " meaning for non-Medicaid patients so apparently all of this discussion applied to Medicaid patients. The one time I did accept the session I was told how to take the drug, what side effects I might notice, what to do if a dose is missed etc which all seem reasonable to me. However, there was no way the pharmacist could know for sure what other drugs I was taking unless I had them fiilled at that pharmacy. I would not have to reveal this information. SInce I am free to have prescriptions filled at 12 different pharmacies if I want, there is no way he could be sure I was telling the truth. I realize this isn't smart and that counseling has a purpose, I'm just saying it would be impossible for the pharmacist to do determine what other drugs I am taking. However, I agree that he/she has the professional right to refuse to release a med should there be a reason why he thinks the patient is not capable of understanding how to use it properly. " My doctor has explained it to me " should suffice. Also, if it is the case that patients *must* be counseled with the initial fill, then I would not be allowed to pick up prescriptions for my mother. I recently picked up a new prescription for her, the Advair disk thing, and I was asked " do you (or they might have said she) have any questions on how to use this medication " (they know me and know it was for my mother) I said that I thought she knew how to use it but if there were any questions we'll read the insert. They added " she can always come in and ask us if she has any problems " and I said yes, thank you. I know I have never been counseled at the hospital pharmacy because I can't recall the face of any pharmacist there, as they are all behind the scenes unlike the drug store where you can see them behind the counter. Yes, I knew that's what you meant when you answered my question on estrogen and package inserts. Chris Re: patient counseling > Dear > > On thing for sure is what is done in practice may not always be > within the law. Again I still believe that the Federal law is that > each patient who is on a drug for the first time must have > counseling. It is the resonsibility of the technician to acertain the > fact that the patient has never been on this drug before. If the > patient tells the truth and says 'yes', then the package of drugs > should be witheld until the patient is led to the counseling area > for first time counseling by the pharmacist. Purpose is multifold. > The pharmacist has the right not to dispense the drug for many > reasons. Bu the pharmacist is mainly interviewing the pt to find out > what other Rx drugs the patient may be taking, what herbs, vitamins > and minerals the pt may be on and what OTC drugs does the pt take. > The pharmacist may want to evaluate thepts mental and emotional > health and or physical health. the RPh has this right. So even if a > pt refuses subsequent counseling, th pharmacist may still try the > witholding the med tactic in order to trick the pt in to subsequent > counseling. Again I do not think it is lawful for a new Rx t go > without counseling. It is the license of the RPh, and they have the > right and also I thought the Fed stepped in and said that this had to > be. > > Jeanetta > Allow me to clarify my intent of an earlier post: BCP and other > estrogen containg drugs must have an accompaning package insert with > each and every fill and refill. Why? BECAUSE they are known > carcinogens. They must also have first time counseling. > > I think if you reread my post you will see my intent. I did howver > continue with my thoughts on all new Rxs. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2002 Report Share Posted July 24, 2002 Hi: I realize that estrogen has been shown to cause cancer in research studies. Like you, hearing this would not have changed my mind. My doctor had already given me the lecture. I'm just amazed that this is the reason why package inserts must be included. (I believe that this is the reason, I'm just amazed) It is highly doubtful that the average person reads the package insert considered the size of the print and the technical language. Had I accepted the offer of counseling on this drug I doubt the pharmacist would have told me that I should have annual exams and mammograms. I think that is stepping over into the physician's role. That reminds me of something. One time I was using a dexamethasone elixir as a rinse for a mouth irritation and the pharmacist said to me " do you realize this is a steroid? " and I said " yes, I do " Chris > smithy <smithy@...> wrote: Hi: > > Yes, they have to ask but we can refuse. I thought the answer I was given > when I asked the estrogen question earlier was that all patients had to be > counseled the first time a prescription is filled. I think Jeannette said > that, after years of filling a prescription, patients often forget what they > were told the first time. That's why I wondered if it was different state by > state. > > In case you weren't part of the forum when I asked this question about > estrogen- I asked why package inserts had to be included with estrogens and > not the other drugs listed on the practice test question. I was told it was > because estrogen is considered to be a cancer causing drug. So I wrote back > and said I bet women don't know why that's why the package insert is > included and the answer was that all patients must receive counseling when > they first fill a prescription. So I wrote back and said no one had told me > that the drug was considered to be cancer causing! (not that it would have > changed my mind) Anyway, that's how this discussion came about. > > Can Medicaid patients refuse counseling? > > Thanks for your help! > > Chris > > estrogen is a cancer causing drug it can cause breast cancer and ovarian cancer That is why a women over 40 must have a yearly mamagram in order to get here yearly refills on the drug i know this for fact since before i can get my yearly supply this time i have a mamagram. and when you don't have insurance thats about $110.00 but it is all worth it i could never get ovarian cancer but the possibility of breast cancer is there since it is the family. and i take premarin. gale(red) > > Re: patient counseling > > > > Chris- > > If memory serves me correctly, the OBRA 90 law (Omnibus > > Reconcilliation Act of 1990) was established because there was to be > > a standard for patient counseling for patients under Medicaid. the > > Federal Government, however cannot regulate individual states > > professional practices. Therefore, to cover their own behinds, retail > > pharmacy technicians are usually required to ask all patients, under > > Medicaid or not if they need counseling on their meds. Usually, > > there is a log which I know in the state of Ohio is to be kept for 7 > > years where all patients are to sign for picking their prescriptions > > up and to either accept or deny counseling which patients are allowed > > to do. if any of this sounds vague let me know. I hope this > > information helps. > > > > Pankey, CPhT > > Dayton, OH > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2002 Report Share Posted July 24, 2002 Hi: So, are you saying that it is just the *offer* of counseling that has to be made even with first time prescritpions, Medicaid or non-Medicaid. Chris Re: patient counseling > Chris- > If memory serves me correctly, the OBRA 90 law (Omnibus > Reconcilliation Act of 1990) was established because there was to be > a standard for patient counseling for patients under Medicaid. the > Federal Government, however cannot regulate individual states > professional practices. Therefore, to cover their own behinds, retail > pharmacy technicians are usually required to ask all patients, under > Medicaid or not if they need counseling on their meds. Usually, > there is a log which I know in the state of Ohio is to be kept for 7 > years where all patients are to sign for picking their prescriptions > up and to either accept or deny counseling which patients are allowed > to do. if any of this sounds vague let me know. I hope this > information helps. > > Pankey, CPhT > Dayton, OH > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2002 Report Share Posted July 24, 2002 smithy <smithy@...> wrote: Hi: I realize that estrogen has been shown to cause cancer in research studies. Like you, hearing this would not have changed my mind. My doctor had already given me the lecture. I'm just amazed that this is the reason why package inserts must be included. (I believe that this is the reason, I'm just amazed) It is highly doubtful that the average person reads the package insert considered the size of the print and the technical language. Had I accepted the offer of counseling on this drug I doubt the pharmacist would have told me that I should have annual exams and mammograms. I think that is stepping over into the physician's role. That reminds me of something. One time I was using a dexamethasone elixir as a rinse for a mouth irritation and the pharmacist said to me " do you realize this is a steroid? " and I said " yes, I do " Chris > smithy <smithy@...> wrote: Hi: > > Yes, they have to ask but we can refuse. I thought the answer I was given > when I asked the estrogen question earlier was that all patients had to be > counseled the first time a prescription is filled. I think Jeannette said > that, after years of filling a prescription, patients often forget what they > were told the first time. That's why I wondered if it was different state by > state. > > In case you weren't part of the forum when I asked this question about > estrogen- I asked why package inserts had to be included with estrogens and > not the other drugs listed on the practice test question. I was told it was > because estrogen is considered to be a cancer causing drug. So I wrote back > and said I bet women don't know why that's why the package insert is > included and the answer was that all patients must receive counseling when > they first fill a prescription. So I wrote back and said no one had told me > that the drug was considered to be cancer causing! (not that it would have > changed my mind) Anyway, that's how this discussion came about. > > Can Medicaid patients refuse counseling? > > Thanks for your help! > > Chris > > estrogen is a cancer causing drug it can cause breast cancer and ovarian cancer That is why a women over 40 must have a yearly mamagram in order to get here yearly refills on the drug i know this for fact since before i can get my yearly supply this time i have a mamagram. and when you don't have insurance thats about $110.00 but it is all worth it i could never get ovarian cancer but the possibility of breast cancer is there since it is the family. and i take premarin. gale(red) > > Re: patient counseling > > > > Chris- > > If memory serves me correctly, the OBRA 90 law (Omnibus > > Reconcilliation Act of 1990) was established because there was to be > > a standard for patient counseling for patients under Medicaid. the > > Federal Government, however cannot regulate individual states > > professional practices. Therefore, to cover their own behinds, retail > > pharmacy technicians are usually required to ask all patients, under > > Medicaid or not if they need counseling on their meds. Usually, > > there is a log which I know in the state of Ohio is to be kept for 7 > > years where all patients are to sign for picking their prescriptions > > up and to either accept or deny counseling which patients are allowed > > to do. if any of this sounds vague let me know. I hope this > > information helps. > > > > Pankey, CPhT > > Dayton, OH > > > >I've been taking hormones for 9 years and today i went to pick up my rx it was called in by the doctor it is actually a refill but could be considered a new script al;l i got was the ordinary insert that comes with all rx's no special inserts, and not even asked if i wanted to be counseled but maybe it was not because it wasn't a real new script technically. gale(red) > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2002 Report Share Posted July 24, 2002 Yes this is amazing, since many other drugs are also known carinogens. But thre is nothing that has a direct carcinogenic effect quite like this hormonal replacement, none quite as aggrssive, due to the types, ativity and number of estrogen receptors. And it is done to protect women from the " old boy " school of tought that kept women in the dark. It is considerred the patient's " right to know " . Hope this helps Jeanetta Hi: > > > > Yes, they have to ask but we can refuse. I thought the answer I was given > > when I asked the estrogen question earlier was that all patients had to > be > > counseled the first time a prescription is filled. I think Jeannette said > > that, after years of filling a prescription, patients often forget what > they > > were told the first time. That's why I wondered if it was different state > by > > state. > > > > In case you weren't part of the forum when I asked this question about > > estrogen- I asked why package inserts had to be included with estrogens > and > > not the other drugs listed on the practice test question. I was told it > was > > because estrogen is considered to be a cancer causing drug. So I wrote > back > > and said I bet women don't know why that's why the package insert is > > included and the answer was that all patients must receive counseling when > > they first fill a prescription. So I wrote back and said no one had told > me > > that the drug was considered to be cancer causing! (not that it would have > > changed my mind) Anyway, that's how this discussion came about. > > > > Can Medicaid patients refuse counseling? > > > > Thanks for your help! > > > > Chris > > > > estrogen is a cancer causing drug it can cause breast cancer and ovarian > cancer That is why a women over 40 must have a yearly mamagram in order to > get here yearly refills on the drug i know this for fact since before i can > get my yearly supply this time i have a mamagram. and when you don't have > insurance thats about $110.00 but it is all worth it i could never get > ovarian cancer but the possibility of breast cancer is there since it is the > family. and i take premarin. gale(red) > > > > Re: patient counseling > > > > > > > Chris- > > > If memory serves me correctly, the OBRA 90 law (Omnibus > > > Reconcilliation Act of 1990) was established because there was to be > > > a standard for patient counseling for patients under Medicaid. the > > > Federal Government, however cannot regulate individual states > > > professional practices. Therefore, to cover their own behinds, retail > > > pharmacy technicians are usually required to ask all patients, under > > > Medicaid or not if they need counseling on their meds. Usually, > > > there is a log which I know in the state of Ohio is to be kept for 7 > > > years where all patients are to sign for picking their prescriptions > > > up and to either accept or deny counseling which patients are allowed > > > to do. if any of this sounds vague let me know. I hope this > > > information helps. > > > > > > Pankey, CPhT > > > Dayton, OH > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2002 Report Share Posted July 24, 2002 I do believe it is a state specific thing. I know here in Texas, we, as techs, are not allowed to " ask " if the patient wants counseling. Unless the patient says on their own, they don't want counseling, they get counseled. > > Hi Jeannette: > > > > On a reply to one of my posts you mentioned that all patients must > receive > > drug counseling with a new prescription. I know that all Medicaid > patients > > must, but is it according to state law if other patients receive it > or not? > > I answered that here in Maine we can sign a refusal. I can't > remember > > receiving any counseling except for one time so this must be the > case. I > > guess individual states can decide whether or not to allow non- > Medicaid > > patients to refuse counseling? The signature indicates we were > offered. > > > > Chris Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2002 Report Share Posted July 25, 2002 Dear Thank you of you input. This seems to be the concensus of posters. Jeanetta > > > Hi Jeannette: > > > > > > On a reply to one of my posts you mentioned that all patients > must > > receive > > > drug counseling with a new prescription. I know that all Medicaid > > patients > > > must, but is it according to state law if other patients receive > it > > or not? > > > I answered that here in Maine we can sign a refusal. I can't > > remember > > > receiving any counseling except for one time so this must be the > > case. I > > > guess individual states can decide whether or not to allow non- > > Medicaid > > > patients to refuse counseling? The signature indicates we were > > offered. > > > > > > Chris Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2002 Report Share Posted July 25, 2002 Hrmmm we just had Retail Pharmacy in my class.. and we were told we SHOULD ask the patient if they would like counseling here in WA state. And I know for fact, it's asked to me with NEW meds at the pharmacy I go to on a regular basis. Vickie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2002 Report Share Posted July 26, 2002 Hi Jeanetta and Everyone, The federal law has not changed. OBRA '90 as it is known is U.S. legislation which requires pharmacists to offer to provide counseling services to all Medicaid patients. Variations of this law are in effect in each state. In some states, the pharmacist must physically make the offer to counsel. In others the technician or cashier may make the offer. I would like to add that the offer to counsel applies to all prescriptions filled - new or refills. Speaking now specifically for the state of New Jersey, the person finalizing the prescription the sale is the person responsible for making the offer to counsel. That person must specifically say " Do you have any questions about this medication for the pharmacist? " Depending on how the patient answers, they are then asked to sign a log book with 2 columns. The left hand column states they were asked but had no questions. The right and column states they were asked and DID have questions and were counseled. There is also a column for the person making the offer to counsel to enter their initials and column for the pharmacist who did the counseling to sign. I say this because several pharmacies in my area were fined by the pharmacy board for improperly executing the law. Here, one cannot simply say " Do you have any questions? " or place the rx # on the log book and say " Sign here for your prescription. " Many patients are under the incorrect assumption that the log book is for insurance purposes, for legal purposes about who actually picked up the prescription or just for store records. And while I mention it, if someone other than the patient picks up the prescription, we have what we call " OBRA bag stuffers " which are just little notes that state our pharmacist is always available to answer questions about this or any medication you have followed by the pharmacy phone number (the message is written in English, Spanish and I think Portuguese.) Again the latter part of this applies to New Jersey only. Re: patient counseling Dear Thank you of you input. This seems to be the concensus of posters. Jeanetta > > > Hi Jeannette: > > > > > > On a reply to one of my posts you mentioned that all patients > must > > receive > > > drug counseling with a new prescription. I know that all Medicaid > > patients > > > must, but is it according to state law if other patients receive > it > > or not? > > > I answered that here in Maine we can sign a refusal. I can't > > remember > > > receiving any counseling except for one time so this must be the > > case. I > > > guess individual states can decide whether or not to allow non- > > Medicaid > > > patients to refuse counseling? The signature indicates we were > > offered. > > > > > > Chris Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2002 Report Share Posted July 26, 2002 Dear Thank you for you input, Yes I agree Obra has not changed since I last teched in l995. Been teaching since then. Because the responses have varied greatly and because I did not express the 'offer' to counsel must be done but instead I refered to the act of counseling, I decided to ask my dear buddy Fox. And now TEXPERT also responds it just great! However I would like to explain my position one more time!!! I have always said that the law requires that the pharmacist MUST counsel the patient first time that the patient gets the medication. What I have found is that this is about the 'offer' to counsel that must be carried out. I would liketo make another point: I am familiar with the OBRA bag stuffers because I pick up my dad's meds sometimes. Recenty a tech put the wrong stuffer (wrong drg med info) in my dad's medicine bag. These as well as auxiliary labels must be final checked by the pharmacist. Thankyoufor your timely input! Jeanetta Mastron CPhT BS Chemistry Pharmacy Tech Eductor Founder of this PTCB Study Group! > > > > Hi Jeannette: > > > > > > > > On a reply to one of my posts you mentioned that all patients > > must > > > receive > > > > drug counseling with a new prescription. I know that all > Medicaid > > > patients > > > > must, but is it according to state law if other patients > receive > > it > > > or not? > > > > I answered that here in Maine we can sign a refusal. I can't > > > remember > > > > receiving any counseling except for one time so this must be > the > > > case. I > > > > guess individual states can decide whether or not to allow non- > > > Medicaid > > > > patients to refuse counseling? The signature indicates we were > > > offered. > > > > > > > > Chris > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2002 Report Share Posted July 26, 2002 Hey Jeanetta, Our OBRA bag stuffers don't have any med info on them, just the pharmacy phone number and the offer to counsel. Do you mean the pharmacy actually gave you a monograph with information about a drug other than which your father was prescribed? That's sounds scary. I speak only for CVS here, our monographs are attached to the back side of the pharmacy label (the big label with the price on it for the cashier) so that couldn't happen here. Re: patient counseling Dear Thank you for you input, Yes I agree Obra has not changed since I last teched in l995. Been teaching since then. Because the responses have varied greatly and because I did not express the 'offer' to counsel must be done but instead I refered to the act of counseling, I decided to ask my dear buddy Fox. And now TEXPERT also responds it just great! However I would like to explain my position one more time!!! I have always said that the law requires that the pharmacist MUST counsel the patient first time that the patient gets the medication. What I have found is that this is about the 'offer' to counsel that must be carried out. I would liketo make another point: I am familiar with the OBRA bag stuffers because I pick up my dad's meds sometimes. Recenty a tech put the wrong stuffer (wrong drg med info) in my dad's medicine bag. These as well as auxiliary labels must be final checked by the pharmacist. Thankyoufor your timely input! Jeanetta Mastron CPhT BS Chemistry Pharmacy Tech Eductor Founder of this PTCB Study Group! > > > > Hi Jeannette: > > > > > > > > On a reply to one of my posts you mentioned that all patients > > must > > > receive > > > > drug counseling with a new prescription. I know that all > Medicaid > > > patients > > > > must, but is it according to state law if other patients > receive > > it > > > or not? > > > > I answered that here in Maine we can sign a refusal. I can't > > > remember > > > > receiving any counseling except for one time so this must be > the > > > case. I > > > > guess individual states can decide whether or not to allow non- > > > Medicaid > > > > patients to refuse counseling? The signature indicates we were > > > offered. > > > > > > > > Chris > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2002 Report Share Posted July 26, 2002 No this is not a package insert or monograph. It is the patient information/education. The law actually is that (at leastin Ca) couseling may be in verbal or written form. Kaiser uses the writtenform to cover their butt if a pt refuses counseling or if thepatient meds are picked up by someone other than. And the law is that the patient or his/her agent must be counseled (offered to be) not the patient only. I believe the above is Federal Law (either). Recall that if your state is requiring verbal only that this would be more stringent than " written or verbal " . Respectfully, Jeanetta Mastron CPhT Pharmacy Tech Educator Founder JPSG > > > > > Hi Jeannette: > > > > > > > > > > On a reply to one of my posts you mentioned that all > patients > > > must > > > > receive > > > > > drug counseling with a new prescription. I know that all > > Medicaid > > > > patients > > > > > must, but is it according to state law if other patients > > receive > > > it > > > > or not? > > > > > I answered that here in Maine we can sign a refusal. I can't > > > > remember > > > > > receiving any counseling except for one time so this must be > > the > > > > case. I > > > > > guess individual states can decide whether or not to allow > non- > > > > Medicaid > > > > > patients to refuse counseling? The signature indicates we > were > > > > offered. > > > > > > > > > > Chris > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2002 Report Share Posted July 26, 2002 Oh yes , in addition, the bag stuffers do suggest that if you have further questions to call the pharmacy. Jeanetta > > > > > > Hi Jeannette: > > > > > > > > > > > > On a reply to one of my posts you mentioned that all > > patients > > > > must > > > > > receive > > > > > > drug counseling with a new prescription. I know that all > > > Medicaid > > > > > patients > > > > > > must, but is it according to state law if other patients > > > receive > > > > it > > > > > or not? > > > > > > I answered that here in Maine we can sign a refusal. I > can't > > > > > remember > > > > > > receiving any counseling except for one time so this must > be > > > the > > > > > case. I > > > > > > guess individual states can decide whether or not to > allow > > non- > > > > > Medicaid > > > > > > patients to refuse counseling? The signature indicates we > > were > > > > > offered. > > > > > > > > > > > > Chris > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2002 Report Share Posted July 26, 2002 Hi: According to the textbook Manual for Pharmacy Technicians put out by the ASHP " OBRA 90 mandates that pharmacists must perform drug therapy review and provide counseling for individuals (or their caregivers) receiving MEDICAID pharmaceutical benefits. " and " ALthough OBRA 90 standards apply only to Medicaid patients, it is likely that in cases involving non-Medicaid patients, the standards will be viewed by the courts to determine if the pharmacist has acted with reasonable care. Some states have passed laws that enact Obra-type standards for all patients. " In Maine it is as Marie describes for NJ, except I don't know if the tech or pharmacist has to initial the log as well. I have never seen that happen in front of me. It is as I have posted before -the person giving the prescription to the customer asks " do you have any questions for the pharmacist " Sometimes they will ask " is this a new prescription " first. I still don't understand how this can be enforced among non-Medicaid patients as most insurances allow a person to go to any pharmacy to fill their prescriptions. (I have no experience with Medicaid rules and regulations so can't comment on that situation) What good is a pharmacist review and subsequent counseling IF the pharmacist can't be sure the patient is telling him the whole picture. Sounds to me as if pharmacists are being asked to do something that should not be their responsibility. In my opinion it is the prescribing physician or practitioner who should be responsible for reviewing medication use. Instructions about that particular med or interactions with other drugs in the pharmacy files is legitimate. Chris Re: patient counseling > > > Dear > Thank you of you input. This seems to be the concensus of posters. > Jeanetta > > > > > > > Hi Jeannette: > > > > > > > > On a reply to one of my posts you mentioned that all patients > > must > > > receive > > > > drug counseling with a new prescription. I know that all > Medicaid > > > patients > > > > must, but is it according to state law if other patients > receive > > it > > > or not? > > > > I answered that here in Maine we can sign a refusal. I can't > > > remember > > > > receiving any counseling except for one time so this must be > the > > > case. I > > > > guess individual states can decide whether or not to allow non- > > > Medicaid > > > > patients to refuse counseling? The signature indicates we were > > > offered. > > > > > > > > Chris > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2002 Report Share Posted July 26, 2002 Hi everyone, It was my understanding here in Texas,not just Medicaid, that ALL new prescriptions have counseling given. The bag stuffer simply did not " do away " with the act of counseling. Also, I want to clarify something I said about the signature log. When Obra went in to effect, the signature log was developed to insure the patients right to counsel and to sign whether they accepted counseling or if they didn't want to receive it. Then the insurance giants decided they would practice medicine without a license and then they started playing a role in the signature log. If a pharmacy gets audited, and I have been through it before, the insurance company in all probability ask for the signature log to verify the patient or their designated agent picked up the med.Since reimbursement is so low from the insurance companies, retailers and other healthcare providing pharmacies neccessitate keeping the logs, " for insurance purposes " . Now if memory serves me correctly, and depending on what format is used to print the logs, usually there is the signature line for the patient's " Hancock " , and a spot that says (wording may vary), accepted_________/refused____________, and either of those lines would be checked indicating counseling preference. Just thought I would clarify yesterdays post by me. Thanks, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2002 Report Share Posted July 26, 2002 Hi Thanks for the info--I have a couple of questions that stray off the track a bit...and I understand that you can answer for only your pharmacy-not the practice at large. You say many customers have incorrect assumptions about the log books purpose---do you/rph educate about the actual purpose of the book before they sign off? And secondly,isn't there a breach of confidentiality if the customers are signing off on a common log book where previous signatures/activities are in view--or do you obscure previous entries in some way? Just curious- Dora > Hi Jeanetta and Everyone, > > The federal law has not changed. OBRA '90 as it is known is U.S. legislation which requires pharmacists to offer to provide counseling services to all Medicaid patients. Variations of this law are in effect in each state. In some states, the pharmacist must physically make the offer to counsel. In others the technician or cashier may make the offer. I would like to add that the offer to counsel applies to all prescriptions filled - new or refills. > Speaking now specifically for the state of New Jersey, the person finalizing the prescription the sale is the person responsible for making the offer to counsel. That person must specifically say " Do you have any questions about this medication for the pharmacist? " Depending on how the patient answers, they are then asked to sign a log book with 2 columns. The left hand column states they were asked but had no questions. The right and column states they were asked and DID have questions and were counseled. There is also a column for the person making the offer to counsel to enter their initials and column for the pharmacist who did the counseling to sign. I say this because several pharmacies in my area were fined by the pharmacy board for improperly executing the law. Here, one cannot simply say " Do you have any questions? " or place the rx # on the log book and say " Sign here for your prescription. " Many patients are under the incorrect assumption that the log book is for insurance purposes, for legal purposes about who actually picked up the prescription or just for store records. And while I mention it, if someone other than the patient picks up the prescription, we have what we call " OBRA bag stuffers " which are just little notes that state our pharmacist is always available to answer questions about this or any medication you have followed by the pharmacy phone number (the message is written in English, Spanish and I think Portuguese.) > Again the latter part of this applies to New Jersey only. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2002 Report Share Posted July 26, 2002 Hi: I'm not but I'll add my two cents. No, in the pharmacy where I frequently fill prescriptions, they don't tell us why we are signing. They mark an x on two blocks and say " sign here please " . I'm not sure why I am signing but since they instituted this practice about the time they started offering counseling (which must have been early 90's) I assumed it had to do with the counseling offered. Come to think of it, the one time that I can remember accepting counseling I don't recall signing anywhere different. Yes, I can see the signatures before me.The pharmacists also call out the customers name (loudly) when the prescription is ready. Many times I've recognized a name, however if that person was waiting for their prescription I'd recognize them in line. They don't identify the drug either by voice or in the log book. However, when I fill my prescription at the hospital pharmacy we are instructed to stand back of the next person in line several feet because of " confidentiality issues " (sign saying that) There is also a glass partition with a small hole to speak/reach through. Chris Re: patient counseling > Hi > Thanks for the info--I have a couple of questions that stray off the > track a bit...and I understand that you can answer for only your > pharmacy-not the practice at large. > You say many customers have incorrect assumptions about the log books > purpose---do you/rph educate about the actual purpose of the book > before they sign off? And secondly,isn't there a breach of > confidentiality if the customers are signing off on a common log book > where previous signatures/activities are in view--or do you obscure > previous entries in some way? > Just curious- > Dora > > > Hi Jeanetta and Everyone, > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2002 Report Share Posted July 26, 2002 hello..in new jersey, patients sign in order to show who is picking up the script and also for the benefit of the insurance companies...in case of an audit. --- smithy <smithy@...> wrote: > Hi: > > I'm not but I'll add my two cents. > > No, in the pharmacy where I frequently fill > prescriptions, they don't tell > us why we are signing. They mark an x on two blocks > and say " sign here > please " . I'm not sure why I am signing but since > they instituted this > practice about the time they started offering > counseling (which must have > been early 90's) I assumed it had to do with the > counseling offered. Come to > think of it, the one time that I can remember > accepting counseling I don't > recall signing anywhere different. > > Yes, I can see the signatures before me.The > pharmacists also call out the > customers name (loudly) when the prescription is > ready. Many times I've > recognized a name, however if that person was > waiting for their prescription > I'd recognize them in line. They don't identify the > drug either by voice or > in the log book. > > However, when I fill my prescription at the hospital > pharmacy we are > instructed to stand back of the next person in line > several feet because of > " confidentiality issues " (sign saying that) There is > also a glass partition > with a small hole to speak/reach through. > > Chris > > > > Re: patient > counseling > > > > Hi > > Thanks for the info--I have a couple of questions > that stray off the > > track a bit...and I understand that you can answer > for only your > > pharmacy-not the practice at large. > > You say many customers have incorrect assumptions > about the log books > > purpose---do you/rph educate about the actual > purpose of the book > > before they sign off? And secondly,isn't there a > breach of > > confidentiality if the customers are signing off > on a common log book > > where previous signatures/activities are in > view--or do you obscure > > previous entries in some way? > > Just curious- > > Dora > > > > > Hi Jeanetta and Everyone, > > > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2002 Report Share Posted July 26, 2002 Hi Dora, The prescription labels (at CVS/Pharmacy) have a few stickers on them - one for the bottle, one with doctor information and one for the signature log. The sticker for the signature log has the Rx number and the date on it, that's all. The patient is signing his/her name next to a number which can be identified later through the computer. Neither the technicians nor the pharmacists actually educate the public about the OBRA law. We do have a sign hanging in plain view of the rx pick up area. We just ask whether or not they have any questions about their medication which they would like to discuss with a pharmacist. If they do, the log book is signed in the appropriate areas by everyone (patient, tech and RPh) and the patient is taken to a counseling area where they can speak privately. I'd like to clarify something that someone else wrote also. While the signature logs are used for insurance audits and to show a prescription has been picked up they are also used as part of the OBRA offer to counsel law. CVS doesn't use the log books for verification of pick up because we have a tracking system built into our computer. Please excuse the italics up there. I hit a button and couldn't get it back the way I started out. It wasn't done for emphasis or anything. Re: patient counseling Hi Thanks for the info--I have a couple of questions that stray off the track a bit...and I understand that you can answer for only your pharmacy-not the practice at large. You say many customers have incorrect assumptions about the log books purpose---do you/rph educate about the actual purpose of the book before they sign off? And secondly,isn't there a breach of confidentiality if the customers are signing off on a common log book where previous signatures/activities are in view--or do you obscure previous entries in some way? Just curious- Dora > Hi Jeanetta and Everyone, > > The federal law has not changed. OBRA '90 as it is known is U.S. legislation which requires pharmacists to offer to provide counseling services to all Medicaid patients. Variations of this law are in effect in each state. In some states, the pharmacist must physically make the offer to counsel. In others the technician or cashier may make the offer. I would like to add that the offer to counsel applies to all prescriptions filled - new or refills. > Speaking now specifically for the state of New Jersey, the person finalizing the prescription the sale is the person responsible for making the offer to counsel. That person must specifically say " Do you have any questions about this medication for the pharmacist? " Depending on how the patient answers, they are then asked to sign a log book with 2 columns. The left hand column states they were asked but had no questions. The right and column states they were asked and DID have questions and were counseled. There is also a column for the person making the offer to counsel to enter their initials and column for the pharmacist who did the counseling to sign. I say this because several pharmacies in my area were fined by the pharmacy board for improperly executing the law. Here, one cannot simply say " Do you have any questions? " or place the rx # on the log book and say " Sign here for your prescription. " Many patients are under the incorrect assumption that the log book is for insurance purposes, for legal purposes about who actually picked up the prescription or just for store records. And while I mention it, if someone other than the patient picks up the prescription, we have what we call " OBRA bag stuffers " which are just little notes that state our pharmacist is always available to answer questions about this or any medication you have followed by the pharmacy phone number (the message is written in English, Spanish and I think Portuguese.) > Again the latter part of this applies to New Jersey only. > > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.