Letter from FirstScript Regarding Tramadol Rx

[PAnewgrad50]

I got a letter from firstscript pharmacy regarding a patient I had prescribed Tramadol for.  Essentially the letter states that Tramadol should only be used for "severe pain" and that they strongly encourage review of this patient's pain management treatment.

 

My patient fell and had a scaphoid fracture, and multiple contusions of the knees and back.  I think a week of Tramadol is well warranted?  

 

What gives them the right to send this letter?  How would they even have information on the patients case?

[Guest Paula]

They don't have info on the patient's condition.  You will get lots of these types of letters throughout your career for practically every script you write.  Now that Tramadol is a scheduled drug they will be warning all prescribers of the danger of the drug and when it should be used.  I get letters weekly from the pharmacy companies that our patients use.  I get letters when there are multiple prescribers involved in the care of the patient (even when we are all in the same practice) asking if I am aware of the other prescribers.  The other prescribers get the same letter.  

 

Take it for what it's worth.  Occasionally I see the value in it....especially with the elderly patients who tend to have such long drug lists and many of those drugs are on the Beers List.  I have at times reassessed my geriatric patient's meds due to letters like yours, and made changes. 

 

PAnewgrad50: Get prepared for the paperwork.

 

 The pharmacy letters I get are put in the shred pile. 

[PAnewgrad50]

Thanks Paula.

 

I just wanted to make sure they were not questioning my patient care.  I have gotten a lot of crazy paper work in my first few months of practice, but had not seen this one yet.

 

Thanks for the info/advice.

[SocialMedicine]

People do not understand the risk of tramodol for dependence/addiction. While certainly not at the level of hydrocodone..it does exist. This might be a plan they have with the insurance company to reduce costs and health issues. 

[ventana]

Ultram is a naroctic and needs to be treated as such

 

to many providers think it is safe - it is not!

 

BUT  I no longer even read beyond the  first few sentences of letters from insurance companies - if it deals with me getting paid I read it, if it deals with them telling me how to practice, in the round file it goes.....

 

Every once in a while a script history comes from an insurance company - read those - sometimes there is good stuff in them!

[gbrothers98]

This is a risk management tool these pharmacy benefit managers use. They can go back to the DEA and FDA and prove they have a program in place, are good stewards concerning the responsibility to dispense pharmaceuticals to the public. They also know from experience that there are plenty of prescribers who practice unsafe prescribing and will take a pattern of prescribing and intervene. I have seen more than one candy man's prescriptive abilities and medical license be censured not by peer review (even though everyone knew he/she was that person) but by the local pharmacist mailing a complaint to the state medical board.

All of this is a good time to review your state statutes concerning controlled substance prescribing and get registered in the prescription monitoring system of your state. You may be on the hook for specific CME or should have taken some other action when prescribing that tramadol such as completing a narcotic contract.

G Brothers PA-C