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Ambulatory Care Pharmacy Update, Vol. 1 Fall 2014

Ambulatory Care Pharmacy Update, Vol. 1 Fall 2014

Vol. 1 Fall 2014

Download this newsletter here.

Pharmacy graphic


Welcome to the “Pharmacy Update,” a periodically-published notice of pharmacy-related issues within the SF Health Network.  As a pilot, this first issue will be distributed to providers and nurse managers within the SFHN Primary Care Clinics.  This will not take the place of the SFGH Formulary Update, but will provide other pharmacy news relevant to primary care providers.

To introduce myself, I am the new Ambulatory Care Clinical Pharmacy Supervisor.  I have been in my position for six months now and have learned how lucky I am to work with a great group of pharmacists in a great health network.  Some of you have told me that you really appreciate the updates you get from the clinical pharmacists working in your clinics.  In order to spread that knowledge more broadly, I hope to make this publication a forum for consistent communication on pharmacy issues.

Please don’t hesitate to contact me if you would like to see a topic covered in this newsletter or have any suggestions for improvement.  I look forward to working with you all more closely in the future.

By, Jeanette Cavano, (415) 206-2504, Jeanette.cavano@sfdph.org

Pharmacy Anticoagulation Clinic warfarin 2

As you may know, we have had several pharmacy staffing changes in the Anticoagulation Clinic at GMC.  Steve Echaves retired and Linda Banares moved to a position with ED Case Management.  We currently have three pharmacists working in anticoag now.  Shin-Yu Lee was hired by DPH and started in August of this year.  She comes to us from St. Louis, where she held a position as Assistant Professor in the St. Louis College of Pharmacy.  During this transition time, we had some extra help from Monica Bidwal, PharmD, who has been working in GMC since 2013.  Monica is a faculty member of Touro School of Pharmacy and works in GMC part-time.  Her counterpart from Touro, Melissa Kirkpatrick, just started at GMC in November.  Monica and Melissa each provide part-time coverage, making up a total of one full-time pharmacist position.

We see this transition as an opportunity to re-evaluate and improve pharmacy practice in GMC.  Please make note of the following changes:

Anticoag Clinic Schedule

 Regular in-person visits Mon, Tue, Wed morning
Phone follow up for stable patients Tue, Wed, Fri afternoon
Urgent follow-up and new patients who need urgent visits (per pharmacist approval) Fri morning
  • Patients must have an appointment for anticoagulation services
  • New patients and those who need to be seen urgently for bridging must be referred to the clinic through the e-referral system
    • Please be sure to complete all e-referral fields
  • Patients who miss three or more anticoagulation clinic visits in a row will be referred back to their primary care provider for future management. If the the patient is to be referred back to anticoag clinic again, a new e-referral must be completed.

If you have questions, feel free to contact Shin-Yu in the clinic at 206-4904.  She can also be reached by pager at 327-1660 during regular business hours.

This is a work-in-progress.  More updates to come!

glucometerNew Glucometer for Anthem Blue Cross

As of August of this year, Anthem Blue Cross changed its preferred diabetic meter and test strips from Breeze2, Contour and Contour Next to TRUEresult meter and TRUEtest Strips made by Nipro diagnostics.

Nipro Diagnostics will provide one meter to each member free of charge at a maximum of one meter per member every 18 months.  Members may get the meters through home delivery by contacting Nipro Diagnostics at 1-866-788-9618.  Members may also get the meters at the pharmacy, however, this is not billed as a pharmacy benefit.  If the pharmacy needs information about how to bill, they should contact Nipro Diagnostics at 1-800-510-4836.

If you believe it is not appropriate for a member to switch to the TRUEtest and TRUEresult products, you can request prior authorization for  alternative meters and strips by calling the Express Scripts Prior Authorization of Benefits Center at 1-866-310-3666.

You can obtain product support, clinical information or patient education materials at www.accuracyonTarget.com/hcp.

Medicare Part D for 2015 Medicare Part D

For Medicare patients, enrollment into the 2015 Medicare Part D prescription drug plans (PDP) started on October 15, and will last until December 7, 2014.  This is the time to enroll or change PDP for 2015.  Patients who are dually eligible (Medicare/Medi-Cal), however, can change plans every month.  There are six  benchmark plans in California this year.  Patients who are eligible for the low-income subsidy will not have to pay a monthly premium and can get medications at a much lower copay (up to $2.65 for generics and up to $6.60 for brand-name drugs).  For more information about coverage and prior authorization, please visit the SFHN pharmacy Medicare Part D website.

Watch Out for Fraudulent Prescriptions pharmacy fraud

If you receive a call from a pharmacy and discover that a prescription has been written fraudulently under your name, what do you do?  The San Francisco Health Network has outlined a step-wise procedure to follow in these situations.  It is important to notify the Sheriff’s Office and the SFGH Director of Pharmacy.  Details of the procedure to follow are posted on the intranet in the provider section of the www.sfhealthnetwork.org site.  You can get to them here.

New Prior Authorization Formsprior authorization

You may not have heard of SB 866, but you probably have noticed that prior authorization forms for some insurance drug benefits have changed recently.  This new California law went into effect 10/1/14.

Highlights of the law include:

  • All health insurers must use the same standard 2-page prior authorization form
  • The form must be electronically available on the insurer’s website
  • Insurers must only request the minimum amount of material information necessary to approve or disapprove the request
  • Medi-Cal programs are exempt from this regulation, but all other insurers in California must implement the new form no later than January 1, 2015.

Our own Healthy San Francisco and Healthy Workers programs have implemented this new PA form.  We have posted a version with our own logo and an option to choose Healthy San Francisco/Healthy Workers/Sliding Scale at the top on the intranet in the pharmacy section at http://in-sfghweb01.in.sfdph.net/pharmacy/forms.htm.  This will also be available through ECW soon.

And speaking of wonderful resources in the pharmacy section of the intranet, please see the next article….

Pharmacy pt didn't get meds

NEW Drug Formulary Resources

Do you discharge patients? See patients in clinic? Don’t let this scenario happen to you….use the new FORMULARY RESOURCES for providers and makes sure you rx meds are covered!




QUICK FORMULARY REFERENCE GUIDE for most common meds. It looks like this, and is available in following ways:

Diuretics in LCR

  1. Electronic PDF to download
  2. 4-fold brochures hard copy from your Chiefs
  3. Posters in work areas (inpt only)


Diuretic resource page

  • Handy links to all Prior Authorizations forms, online formulary searches
  • How to find/interpret insurance coverage in LCR
  • Determine #days to rx from Discharge Pharmacy (it isn’t always 10 days!)
  • Extra bonus: DM supply and bubble pack guidance

WHERE TO FIND these awesome resources?

  • LCR:  Med Rec > Pharmacy  Resources
  • eCW:  E-links > Pharmacy Information



Removal of Advair from SFHP Formulary for Adults and Children > 12 YO

San Francisco Health Plan has announced that effective 12/1/2014, Symbicort HFA and Dulera HFA will be their preferred inhaled corticosteroid and long-acting beta-agonist (ICS+LABA) combination therapies.

SFHP patients who are currently on Advair Diskus and Advair HFA products will need to be switched to Symbicort HFA or Dulera HFA.

  • Symbicort HFA is a combination of Budesonide and Formoterol and comes in two strengths, 80/4.5 and 160/4.5.
  • Dulera HFA is a combination of Mometasone and Formoterol and comes in two strengths, 100/5 and 200/5.
  • Both of these medications are metered-dose inhalers so consider prescribing a spacer if your patient does not already have one.


Refer to the table below when switching your adult patients from Advair to Symbicort or Dulera.  It is based on estimated comparative daily doses for ICS.

Current Therapy Comparable Alternate Therapy
Low Dose ICS Advair 100/50 Diskus 1 inh Q12 hr
Advair 45/21 HFA 2 puffs Q12 hr
Symbicort HFA 80/4.5
2 puffs Q12 hr
Medium Dose ICS Advair 250/50 Diskus 1 inh Q12 hr
Advair 115/21 HFA 2 puffs Q12 hr
Symbicort HFA 160/4.5
2 puffs Q12 hr
Dulera HFA 100/5
2 puffs Q12 hr
High Dose ICS Advair 500/50 Diskus 1 inh Q12 hr
Advair 230/21 HFA 2 puffs Q12 hr
Dulera HFA 200/5
2 puffs Q12 hr



***PLEASE NOTE: SFHP does NOT require switch from Advair for pediatric patients < 12YO***

Advice from the Pediatric Asthma Clinic:

Clinical Implications of the Change:

  • As far as we know, there are no significant differences in safety or efficacy between salmeterol and formoterol. Both are approved in kids > 12, but have been studied in kids as young as 5.
  • While fluticasone has been our preferred ICS for children, due its favorable side effect profile, budesonide and mometasone are well-studied and safe in kids. There may be more of a growth effect from budesonide in comparison to fluticasone, and the effect on growth is dose-related.
  • Both of these medications are metered-dose inhalers and should be used with a spacer

Refer to the table below when switching your pediatric patients ≥ 5 years old from Advair to Symbicort or Dulera.

For children < 5: Please consult with Asthma Clinic provider (TE to Kim Honda if unavailable)

1 puff BIDSymbicort HFA 80/4.5
2 puffs BID*

Current Therapy Comparable Alternate Therapy
Low Dose ICS Advair 45/21 HFA 1 puff BID Symbicort HFA 80/4.5 1 puff BID
Low Dose ICS Advair 100/50 Diskus 1 inh BID
Advair 45/21 HFA 2 puff BID
Symbicort HFA 80/4.5 2 puffs BID*
Medium Dose ICS Advair 250/50 Diskus 1 inh BID
Advair 115/21 HFA 2 puffs BID
Symbicort HFA 160/4.5
2 puffs BID*
Dulera HFA 100/5
2 puffs BID*
High Dose ICS Advair 500/50 Diskus 1 inh BID
Advair 230/21 HFA 2 puffs BID
Dulera HFA 200/5
2 puffs BID*

*Max daily dose of formoterol is 20 mcg daily: do not exceed 4 puffs/day

Thanks to Stephanie Tsao and Shonul Jain for their input on Advair conversions. Thanks to Rita Lam, Lenny Chan, David Smith and Shin-Yu Lee for their input on other articles in this newsletter.

2017-11-16T12:16:43+00:00 December 4th, 2014|