I saw a patient in clinic who needed better rate control of their afib. I added some long acting Dilt. Thankfully, he texted me to let me know that the Walgreens switched it to Amlodipine for insurance reasons. He wanted to know if it was ok!
THIS IS NOT OK!!
THIS IS NOT OK!!
This happened yesterday during a busy clinic and I was most focused on simply getting him the correct med. I posted on Twitter to vent later. Due to the seriousness of the issue I did speak with the patient and the pharmacist today to figure out what happened.
Apparently, the formulation of long-acting dilt that I e-rx’d wasn’t covered by the pt’s insurance/PBM. The pharmacist today says she’s wasn’t there, and that someone must have just told my patient what the formulary alternative of the PBM was - Amlodipine!
When I called my patient yesterday in response to his text, he said they gave him the Amlodipine, but today, when I asked if my name was on the bottle, he said they didn’t actually give it to him, but suggested. So the pharmacists who responded with “impossible”s were correct.
My patient said he was angry (and likely quite tachycardic by now) because he was told that “your doctor must have ordered the wrong medicine” as he and I have a strong report. He’s also a former paramedic and didn’t think the amlo sub was correct either.
He was further irritated because HE was told to contact his doctor rather than an attempt to help him. After we spoke, he went back in with renewed conviction and insisted he get diltiazem. He left minutes later with the correct pills (Dilt 240 XR).
My frustration with this incident is primarily directed at the insurance company formulary/PBM. Judging by the response to this tweet, many feel similarly. We are continually asked to substitute meds solely due to insurance preference, even for non-brand meds.
I am secondarily annoyed at the standard practices of Walgreens and CVS to hire fewer and fewer actual pharmacists and replace them with protocols and low-paid techs. Anyone with any clinical understanding could have avoided this. Im pro-pharmacist and love independent pharmacies
I dont know what we do about the insurance based formulary problem though. The list of “recommended” substitutions are getting stranger and stranger. I’m just glad no actual calcium channels were harmed here. And most thankfully, the pts HR was well controlled when we spoke today
