TRxADE Rx Guru. Blog for Independent Pharmacies, Pharmacist, and Pharmacy Technicians


Contraceptives Prescribed By Pharmacists

California and Oregon Lead the Charge

Contraceptives Prescribed By Pharmacists

Two groundbreaking laws have passed in California and Oregon allowing Pharmacists to prescribe contraceptives for birth control without a doctor’s prescription. After a quick screening process which includes a questionnaire about their health and medical history. Insurance companies will cover it as usual. This is not only convenient for the client, it is a great opportunity for Independent Pharmacies in these two states to capitalize and increase foot traffic and build a new personal one on one relationship with a new demographic that may have just come in for a quick prescription fill in the past.

Although overall support for these changes have been great this far, it does not come without opposition including The American Congress of Obstetricians and Gynecologists which believes contraceptives should be available solely over the counter as it is in other countries with the downfall being the issue whether it will be covered under the Affordable Health Care Act which is requiring insurance companies to cover contraception. Will that remain if they are over the counter? Nobody knows.

Beverly Schaefer, co-owner of Katterman’s Sand Point Pharmacy in Seattle charges a $35 fee to prescribe contraceptives due to it being uncertain if Insurance companies will pay for the time that a Pharmacist spends with a patient. A Physician out of New York chimed in on a New York Times blog post regarding this topic which was encouraging as if anyone would have an issue with a change like this would be them as they lose the additional revenue:

“This move to allow Pharmacists to prescribe birth control pills seems a welcome development. But there should be some oversight by a Physician such as the women are prescribed by a Physician after a physical and some risks like proclivity to Deep Vein Thrombosis is eliminated. Also, any complaints or side-effects reported to the Pharmacist should immediately be conveyed to a Physician and the requirement that the woman will see her Physician. That would make this a fool-proof plan, cutting down costs as well.”

Although my personal favorite post was from C. Camille Lau out of Eagle River, Anchorage

“It seems reasonable to assume that making contraceptives easier to obtain should result in fewer unwanted pregnancies which should result in fewer abortions, medical risks and costs. Excuse me, but did something political just make sense? I’ve forgotten that could happen!”


To 340B or Not To 340B

To 340B or Not To 340B

340B, Is It For Me?

There’s been a lot of hype about Public Health Service Act, Section 340B. The purpose of this program is to enable covered groups to provide more comprehensive services and allocate scarce Federal resources to eligible patients I need of expensive medication. The 340B RX Program “requires manufacturers to provide outpatient drugs to eligible health care organizations/covered entities at significantly reduced prices” (

Medications that are dispersed via 340B are preferred drugs that are priced lower than the typical retail value for patients that quality to be recipients by using a 340B-approved physician or group. A patient’s eligibility is not income-based, unlike many other programs out there In order for the patient to receive the lower pricing, they must go to a pharmacy that has a contract with a 340B-approved facility ( The two scenarios that a patient can receive their medications this way are seen in the excerpt below:

Scenario 1:
An uninsured patient sees 340-B physician and takes their prescription from this physician to a retail pharmacy. If the pharmacy has an agreement with a 340B-approved group, the pharmacist gives the patient the medication at the discounted price based on the 34B price.

Scenario 2:
All of the circumstances of the above apply, except this patient has some type of insurance coverage. This category of patients is where a lot of money can be made. This pricing process is a little more complex and can be better understood through an example (


The pharmacy adjudicates a prescription in accordance with contract pricing (i.e. AWP-15% + $2.00) and is paid based on this contractual amount. Assuming the AWP of the drug is $200.00 then the pharmacy would be paid:

AWP -15% + $2.00 =
$200.00 – $30.00 +$2.00 = $172.00 total approved for the prescription

If the patient pays a $30.00 copay, then the pharmacy would receive $142.00 in payment from the third party payer (i.e. $30.00 + $142.00 = $172.00 total payment to the pharmacy).

Assume that the 340B price for the drug is $20.00. The pharmacy would receive the 340B drug in replacement for the dispensed drug. The pharmacy would agree to pay the $172.00 back to the 340B entity less an agreed upon dispensing fee (for purposes of this example, assume an $18.00 dispensing fee).

$172.00 – $18.00 = $154.00 would go back to the 340B entity
$154.00 – $20.00 (340B cost of the drug) = $134.00 profit or “spread” to the 340B entity.

The one unknown in this process is how much the “middleman,” the 340B PBM, makes in the equation. Whatever amount that is will reduce the “spread” to the 340B entity by that amount. If that amount were $15.00 per claim then:
$134.00 – $15.00 = $119.00 final profit or “spread” to the 340B entity (

With this program, it encourages providers and insurance companies to work with community pharmacies more. This system can cause an increase in business for a lot of pharmacies and can improve access to care for many patients.

On The flip side, billing with insurance companies can be more complex, time consuming, and result in an inventory overhead cost. This can also cause issues with existing contracts with wholesalers. Big Pharma is concerned that if a lot of pharmacies participate in this program and get paid by PBM’s at this lower price, that people will start to question the PBM’s originally inflated prices (

Eligible groups of healthcare organizations can include; HRSA-supported health centers, Ryan White Clinics, Medicaid and Medicare Disproportionate Share Hospitals, Children’s Hospitals, State AIDS Drug Assistance Programs, and other safety net providers. (See the full list of eligible organizations/covered entities.) To get enrolled with this program, healthcare organizations must register with the 340B Program and comply with all regulations. Registration for this program can be done at the beginning of each Quarter; October 1-15, January 1-15, April 1-15, and July 1-15.

We know that all providers and pharmacies want to help their patients the best they can and increase the quality and access of care, but sometimes this can cause added stress and challenges on pharmacists and other healthcare organizations. The 340B Drug Pricing Program is no exception to the rule. Do you think that this is a good or bad thing for the pharmaceutical industry? Is this the direction independent pharmacies should go in? “The cause is incredibly worthwhile, but the reality of what’s required of health systems to make such a program happen is infinitely complex. Policy rules, emerging requirements, inventory management, and billing can be overwhelming, even for the most experienced pharmacy director” ( Proposed guidelines for this program can be found through HRSA of the U.S. Department of Health and Human Services.


The Future of the Pharmacy World

The Future of the Pharmacy World

The Future of the Pharmacy World

Technology, Knowledge, Medicine

The wave of the future may not include the hover boards as predicted in the popular, 1989 film, Back To The Future II, but the Pharmacy World will be seeing the implementation of tele-pharmacies, pharmacogenomics, smart lenses and the use of radio frequency technology. An incredible service that is being discussed is using radio frequencies via beacons in the parking lot of a pharmacy that will alert the pharmacist via an iPad of typical products that patient buys. This can help increase profitability and repeat customers. As you can see the Pharmacy world is growing and changing rapidly. As independent pharmacists it’s important to stay informed and progress with the times. “The pharmacist’s role has grown and evolved over the years to become more inclusive of patients’ health care needs as a whole. Patients can now look to their pharmacy as a total health care provider, and today’s pharmacists play an important role in improving patient outcomes…

Pharmacists are definitely thinking, talking, and evaluating what the future holds for their profession in the context of all the recent sweeping changes in health care policy” (Pharmacy Times). Dan Benamoz, RPh and CEO of the Palm Beach, FL-based Pharmacy Development Services shared that Alcon and Google are creating a “smart contact lens” that will revolutionize the way patients manage their Diabetes. This lens will be a minimally invasive way to continuously monitor blood glucose levels from a patient’s lacrimal fluid which will communicate these readings with a mobile device via Wi-Fi. Another product, the Hololens by Microsoft, allows Pharmacists to access medical information and prescription information via eyeglasses. It took 5 years to develop and was announced in early 2015. This gives Pharmacists the ability to give immediate counseling and education to patients.

Pharmacogenomics, or the study of the role of genetics predicting drug response, is another up-and-coming theme for Pharmacists and Providers. “The DNA Medical Institute created rHealth, a portable handheld device that can diagnose hundreds of diseases using a single drop of blood. Now, we could be looking at biomarkers to identify early indicators of serious ailments. I think the technology will be used by national labs such as Quest Diagnostics”, Benamoz stated (Drug Topics). About ten million people are currently using tele-pharmacy services, and the number is rising, especially due to the Obama Administration endorsing it. To stay competitive, it’s good to think about offering this service to patients, but make sure the Pharmacy Board in your state approve.

Extra: Step Into The Future With USF’s Health Pharmacy Plus

Not too far from Trxade headquarters, University of South Florida in Tampa is introducing Pharmacy Plus. The Pharmacy of the Future revolutionizes the Pharma industry and catapults it into the future with tools to improve and maximize profits, while minimizing risks. USF Health Pharmacy Plus is a national prototype giving us a preview of what may become the standard for the future, today.

Below are some bullet points from USF’s website on how using technology, knowledge, and medicine the pharmacy of the future plans to improve the quality of the patient’s needs.

Imagine a future where:

+ The pharmacist plays an integral role on your healthcare team.
+ You keep the healthy conversation going with both technology and human interaction.
+ It’s about more than taking a pill. It’s about how we will use innovative new tools to help you live healthier.
+ You receive health advice from your mobile device.
+ Your doctor’s prescription sends you to an online, multimedia learning experience as often as it does to the pharmacy.
+ Medication is personalized specifically for you.
+ You can check your health as easily as you check your email.

YouTube Video:

Old Drugs, New Uses Is A Trend

Old Drugs, New Uses Is A Trend

Old Drugs, New Uses Is A Trend

Ursodeoxycholic Acid

It is becoming more and more common to prescribe existing drugs for new uses. Take Lyrica for example; this drug was originally used to treat depression, but it was later discovered that it has therapeutic effects for patients that suffer from pain disorders, such as Fibromyalgia.

This same concept is being suggested for another drug called Ursodeoxycholic Acid (UDCA) or Actigall. The intended use of this drug is for liver disease. It has successfully reduced liver jaundice, ascites, and biliary stasis in patients for decades. It is now believed that this medication can actually slow the onset and progression of Parkinson’s disease. Researchers from the Sheffield Institute of Translational Neuroscience (SITraN) and the University of York studied the effects of this drug on mutated nerve cells of the LRRK2 gene in fruit flies.

This mutation is the most common cause of inherited Parkinson’s disease. Mitochondria in each cell gives the cell energy it needs to function. The LRRK2 mutation prevents mitochondria from functioning properly, leaving is susceptible to neurological diseases, like Parkinson’s. It is estimated that at least 500,000 people in the U.S. have Parkinson’s disease.

Dr. Heather Mortiboys of SITraN reports; "We demonstrated the beneficial effects of UDCA in the tissue of LRRK2 carriers with Parkinson’s disease as well as currently asymptomatic LRRK2 carrier. In both cases, UDCA improved mitochondrial function as demonstrated by the increase in oxygen consumption and cellular energy levels” (Medical News Today).

Expect this drug to be in high demand in the near future.

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