Prior Authorization

One of the most frustrating experiences as a patient is arriving at the pharmacy to pick up your medication and being told that a prior authorization is required. If you have never experienced this before the process can be especially confusing and aggravating. Unless you decide to pay cash for your medication or your doctor decides to change your therapy it can also involve a significant delay before you can actually get your medication.

Prior authorization is a process where the insurance provider wants more information from the doctor before they will pay for a medication. This process typically starts at the pharmacy when the staff there try to bill an insurance plan for a drug. The insurance will then send the pharmacy a rejection notifying them that a prior authorization needs to be completed. At this point the pharmacy will contact the doctor to let them know they must complete a prior authorization if they want the insurance company to cover the cost of the prescribed drug. The doctor must then answer some questions about the use of the prescribed medication and send those answers to the insurance provider. Finally, the insurance provider must review the doctor’s response and decide if they will pay for the medication or not. Thankfully this process is quicker than it used to be as many of these interactions are automated or electronic. Typically this process can take anywhere from a day to a week to complete, although times may vary. If a patient stays on their medication for an extended time it is likely that the prior authorization will need to be completed again at some point. Many plans require prior authorizations annually while some require them more often.

The main reason insurance plans institute prior authorization is cost savings. Plans want to review the use of high cost medications and make sure they are being utilized appropriately. A common way they do this is called step-therapy. Step therapy means that the insurance provider will require a trial of one or more lower cost medications before they will pay for a high cost drug. Many insurance providers require prior authorization for brand name drugs if a generic is available. Insurance plans often prefer a certain drug within a medication class due to cost and require providers to complete a prior authorization if they write a prescription for a different drug in the same class.

Prior authorization can be frustrating for both patients and healthcare workers. Despite that the practice isn’t going away anytime soon. If you want to be more informed about which drugs will require prior authorization on your health insurance you can request a copy of your insurance formulary which will show you which drugs your insurance plan prefers. Drugs on this list will be less likely to require a prior authorization.

Michael Kowalczyk

PharmD candidate 2018

Meningitis B

It seems like every year there are several outbreaks of meningococcal infections on college campuses across the country. This disease is caused by a bacterium called n. meningitides which can infect both the brain and the blood. Although meningococcal infections are rare even with treatment this infection can be deadly in 10-15% of patients. Those who survive can experience permanent disabilities like amputation, hearing loss, brain damage, kidney damage, and scarring from skin grafts. As a student at The Ohio State University you are required to be vaccinated for meningitis before you can live in university housing. This vaccine covers meningitis type A,C,Y, and W-135. It does not cover meningitis B which causes nearly half of meningitis cases in patients aged 17-22. There are currently two vaccines on the market for meningitis B, Trumenba and Bexsero. Both vaccines are approved in the United States for patients aged 10-25 for the prevention of meningococcal type B infection. Although the medication is approved for 10-25 the Advisory Committee on Immunization Practices and the CDC give these recommendations.

These vaccines are recommended for patients ten years and older who:

  • Are at risk due to a type b outbreak
  • Have a damaged or removed spleen
  • Have an immune system condition known as “persistent complement component deficiency.”
  • Are taking eculziumab (Soliris)
  • Routinely work with N. meningitides.

There is an additional recommendation that the vaccine may be given to anyone aged 16-23 with a preferred age of vaccination being 16-18. This allows patients and their healthcare providers to determine if they want the vaccine.

Both vaccines require multiple doses. Bexsero is a two dose series with the doses being administered at least one month apart. Trumenba can be a two or three dose series depending on your risk level for meningococcal B infection.

 

Michael Kowalczyk

PharmD candidate 2018

Prescription Refills

Are you on a daily medication or learning to handle your own prescriptions for the first time? Do you have a prescription that you need to continue taking but you are out of refills?

In most cases, if you are out of refills it means that your provider felt at the time of writing your prescription that a follow-up visit was indicated in this period of time. We generally write most on-going prescriptions with the number of refills that fits the standard of care for following that health condition. Sometimes there are lab tests or physical findings that need to be checked periodically.

You don’t have time to come in for an appointment right now?

Ideally you would be able to make the time to come in for a visit so that we can provide the best possible care. However, we too were students once and understand your crazy schedules, so you can either message your provider through MyBuckMD or call the health center to leave a message with your provider asking for an extension until you can make it in for an appointment.

How to avoid running out of medications?

Plan ahead! If you notice that your medication is running low, take a look at the bottle for any refills. If you see no refills remaining, make an appointment with the prescribing provider as soon as you can.

Don’t see an appointment on-line that fits your schedule?

All available appointments do not show up for on-line scheduling. So if you are having trouble finding an appointment with your provider, please call our appointments line at 614-292-4321. Our appointments associates will be happy to help you find the next available appointment that fits your schedule.

Ryan Hanson, M.D.

Combatting the Freshman 15

Make healthy choices to avoid the Freshman 15

Make healthy choices to avoid the Freshman 15

Welcome to college! The next 4 years will be the best years of your life. There’s nothing like leaving home for the first time, jumping into the bliss of independence and making bad decisions. You’ll be able to stay up as late as you want, over sleep your alarm, and consume way too many empty calories while tailgating the football games. College seems amazing! You have access to all the food you want and no parental supervision….I mean come on who wouldn’t want to have a late night slice of pizza, three servings of ice cream at traditions or even a warm chocolate chip cookie when you’re finished with lunch. But if you’re not careful the dreaded freshman 15 can catch up to you real quick and those brand new jeans you just bought, to look good at the game next weekend, will no longer button. So here is some advice on how to avoid gaining those extra 15 pounds no one wants to admit to gaining.

  1. Hire someone to smack that cookie out of your hand you pick up at the dining hall after every meal.  Since most students have no self control over the delicious sweets that are put in front of them, you can put someone else in charge of keeping your diet more healthy.
  2. Set an alarm for 5 minutes before a huge exam. This way when you wake up late and freak out that you’re not going to make it to your exam on time it forces you to run to class. You’ll realize how out of shape you are and get yourself back into the gym.
  3. Speaking of the gym, you may join a club sport to play recreationally since you use to play in high school. After practice you’re going to want to sit down and eat with your friends. Remember starting left bench is not the same as actually playing in high school. You can’t expect to eat the same and lose weight.
  4. In high school you were probably use to your parents cooking you dinner every night, making sure it was somewhat healthy…well in college they’re not here to cook your meals. So if you live close enough, go home to have them feed you. That way you won’t have to worry about consuming 1,000 calories from a loaded potato pizza from the PAD.
  5. If you don’t live close enough, it’s time to start paying attention to what you are eating. Everything has calories. Maybe you should rethink your order of an asiago cheese bagel with cream cheese, a cookie and a large buckeye mocha latte. If you eat that every morning I can promise that you will not be able to button your pants in a couple of weeks.
  6. Dining halls have so much delicious carb heavy food. Who wouldn’t want to eat pasta, with broccoli cheese soup and churro cupcake every single day? I can tell you it feels really good walking around feeling extremely full and bloated…But maybe try adding some plants into your diet. A good fresh salad (not smothered in ranch, bacon and cheese) or a side of vegetables instead of french fries can taste delicious and help combat that disgusting bloat you’ve been feeling for the last 4 days.
  7. Remember that water is your best friend. The first sign of thirst is hunger. You may have no insight as to whether you’re hungry or thirsty. Next time your stomach is growling after you consumed gross take out Chinese, try drinking a full glass of water. You maybe more thirsty than hungry (since we all know Chinese food is filled with salt and MSG).
  8. Water is also essential for keeping our body healthy. Granted a nice refreshing pop or juice can taste delicious at times but depriving your body of water can do more harm than good. Water has this magical power to make you feel full, especially when bored. Try increasing your water intake to 8 glasses a day. Rule of thumb is you want your urine be light yellow to clear. So when you go to the bathroom next and your urine is bright to dark yellow, you know you’re not drinking enough water.
  9. It is inevitable to not feel stressed while taking 12 credits and going out every night. I mean why would you start studying for a test now when you can put it off until the night before and cram. Try to eliminate getting too stressed out. An increase in stress can lead to stress eating as well as increased hormones. This can ultimately lead to weight gain and acne you haven’t seen since you hit puberty.
  10. Make sure you are getting enough sleep to be productive. It may not be a good idea to go see “IT” if you know you’re not going to sleep for the next 10 days. Many times when you’re over exhausted you start grabbing for sugary substances to keep you awake. This does not help with trying to avoid gaining weight.
  11. But when you don’t sleep enough, energy drinks always sound like a great idea. Next time you grab one why don’t you flip the can around and look at the calories. With over 200 calories in a Monster energy drink, you may want to rethink grabbing those empty calories. Opt for some black coffee or tea. But if you have to have that energy drink maybe try grabbing for one of the sugar free or low calorie ones.
  12. When all else fails just go out and buy bigger clothes. Your student loans will really appreciate being spent on new clothing that one day you’ll have to payback at 5% interest.

Remember as a student it is really easy to fall into a bad routine since it’s a lot of people’s first time away from home. While many people joke about gaining the freshman 15, it happens to the best of us. Just be conscious about what you consume. You are probably not working out as vigorously as you did in high school, so you can’t eat the same way. College can be a stressful at times. Find ways to cope with stress whether it’s meditation, exercise or a hobby. It is best if you don’t turn to food during the stressful times. And if all else fails, go talk to someone about getting healthier. Take advantage of the registered dietitian at Student Health Services. They are here to help discuss your diet and encourage you to make the lifestyle changes you want to make. And if scheduling an appointment with the registered dietitian doesn’t fit into your schedule there are other options available on campus at the wellness center in the RPAC. You do not have to gain the freshman 15…it is up to you.

Dayna Gewolb, PharmD Candidate Class 2018

 

My Journey into Mindfulness Based Stress Reduction

I was browsing the internet when a statement caught my eye and it stated “Do you want to
relieve stress related symptoms, promote a sense of well being and peace of mind”? I was
intrigued and thought I would love to relieve stress and also learn ways to help my patients too.
I clicked on the link and was taken to a course description titled “Mindfulness-Based Stress
Reduction program (MSBR) that was being offered for 8 weeks over the summer.

I signed up for the program without really knowing what the course was going to be about.
The first night of class I was in a room with 15 other participants who were of different ages,
backgrounds and occupations with our instructor Kevin who was a licensed social worker. We
were given the book “ Full Catastrophe Living” by Jon Kabat-Zinn along with a workbook and a
CD. He had us imagine that we had a rock in our hand and walked up to a well and dropped it
in and then he went around the room and asked us what that symbolized to us. I remember
that I had said that it symbolized throwing away the stressful feelings and discomfort. He also
asked us not to set a goal or expectations for the course.

The program focused on attitudinal qualities that would relieve stress including: non-judging,
patience, beginner’s mind, trust, non-striving and acceptance. Non-judging is being an
impartial witness to our own experience and not having a reaction to the experience. Patience
is allowing letting things unfold in good time and make a connection to the present. Beginner’s
mind is not allowing our beliefs and thinking from seeing things as they really are. Trust is to
listen and trust our own being through meditation. Non-striving is about trying less and
through meditation we are non-doing. Acceptance is seeing things as they are in the present
and not trying to force things to the way we want them to be which causes more stress and
prevents positive change.

We had daily meditations on our CD that guided us through body scan which focused our mind
on each body part starting with the head and then ending at our toes or sitting or laying
meditations or meditative yoga. We had a log in our workbook to document our feelings and
reactions to different situations that may have given us distress or pleasure. We had a retreat
day after our sixth week in which we did not speak during that time. Our instructor gave us
directions during the day and guided us through different types of mediation. We ate our lunch
mindfully and took our time tasting and chewing our food more times than we would normally
and did not pick up the fork before we swallowed our bite. I was a little anxious as well as
some of the other participants of not talking or using our phones for a whole day and staying
focus on the present, but it actually was easier than I thought and at the end of the day I felt a
sense of peace.

This type of course is not for everyone, but it is evidenced based and taught internationally.
The course has taught me a way of being. It is not a philosophy, it is a be practiced by being
mindful and carrying out the meditation practices daily. It takes commitment and is to be
practiced daily in order for it to be available when needed.

At the end of the eight weeks, I am better at being more mindful and at mediation, but it is a
work in progress. After the eight week course I had learned that my initial response to the first
question of dropping the rock into the well throwing away stress thoughts and feelings was not
mindfulness, it is about learning to live with all the thoughts or feelings good and bad and
acknowledging them and not reacting to them. “ Life is not the way it’s supposed to be. It is
the way it is. And how we relate with this truth is what makes all the difference. “. Virginia Satir

Submitted by Edith Chang, M.D.

Medication Disposal Day – Don’t rush to flush!

The Student Health Services Pharmacy will be holding our 6th annual DEA-approved Medication Disposal Day Thursday, October 26th, from 9:00 a.m. to 2:00 p.m. 

All students, staff, and faculty are invited to bring unused or expired medicines to be disposed of in a safe, legal, and environmentally-friendly way.  This service is entirely free of charge and is completely anonymous.  No questions asked!  We will take any expired, damaged or unused medications (even if they are a controlled substance like narcotic pain medication or ADD medication).

Please note: Do not remove medication labels before drop-off.  Syringes, needles, and thermometers will not be accepted.

Our goal is to address a vital public safety and public health issue by removing potentially dangerous prescription drugs from your backpacks and medicine cabinets.

  • Since 2007, more Ohians have died from unintentional drug overdosing than motor vehicle accidents.
  • More than 7 million Americans currently abuse prescription drugs, according to the 2009 Substance Abuse and Mental Health Administration’s National Survey on Drug Use and Health.
  • Each day, approximately 2,500 teens use prescription drugs for the first time to get high, according to the Partnership for a Drug Free America.
  • Studies show that a majority of abused prescription drugs are obtained from family and friends, including the home medicine cabinet.

These expired medicines can be as bad for our environment as they are for our health.  Measurable quantities of some common medications are showing up in lakes, reservoirs, and municipal water supplies, thought to be due in large part to improper flushing of medications down sinks and toilets.

So make the right choice and join us for our 5th Annual Medication Disposal Day!  It’s a great way to keep yourself healthy and our campus safe!

This event is jointly sponsored by Student Health Services (Office of Student Life), Department of Public Safety, and Generation Rx.

Candace Haugtvedt, RPh, PhD
Student Health Services
The Ohio State University

Changing your eating habits

Changing Eating Habits

So how does one start to eat healthier? No matter what your end goals are changing what you are doing is where you have to start. One way to start is by using the website ChooseMyPlate.gov.

Its start you on a basic eating concept that can be applied in the dining halls or at home. You quarter your plate each quarter containing one of the following: vegetables, fruit, protein and grain or starchy vegetables. To the right of the plate there is serving of dairy which is designed to remind you to have a calcium source. Eating this way naturally balances out your meal and controls your calories. The website coaches you on what foods fit into each area. For vegetables, there are recommendations for how many servings of green and red and orange vegetables over the week and how to incorporated starchy vegetables such as potatoes and corn. Under protein, you can find meat and meatless sources to select in your diet. This is also a discreet method to evaluate your plate.

MyPlate on Campus

Wondering about size of plate or how high you can stack your food? This is where you use common sense. Women can use a lunch or smaller dinner plate (8-9 inches) and men can use a larger dinner plate (10-11 inches). Beware our plate size has grown for around 8-9 inches up to 13 inches in some restaurants. You have to keep your plate from looking like the first trip at Thanksgiving. Normally, a plate would be a 1-3 inches high depending on the food.

Remember to eat the vegetables and fruit first and stop when you are comfortably full.

Kristina Houser, LD

Diet is a four-letter word!

Losing Weight

Dieting is a word that should not exist! It’s depressing to say the least. Our mind begins to focus on what we can’t have. Then, we mess up, give up and we try again. If you have struggled with your body weight all of your life, the cycle is frustrating. Perhaps you’re someone who has never had a weight problem but seems to have gained weight in college and is unsure of how to go about losing weight.

Everyone seems to want to start with the 1200 calorie diet and hopes for the best. In about 3 days, it’s not going well. Why? Because 1200 calories is too low for almost everyone but if you go on line that is what you will find. The websites suggest this will permit fast weight loss which everyone wants!

Weight loss is about being healthier. If you can match your food intake to your body’s needs, weight loss will happen. The trick – figuring out what works for your body. If done correctly, you aren’t dieting; you are eating well for your body and you continue to eat that way when you’ve reached your goal weight.

Some people need to reduce portion size, others need to manage carbohydrates, some eat out less, and others move more. The list goes on with changes in habits or food that need that you need to incorporate. A dietitian is the best way to get personalized help. Student Life Student Health Services has a dietitian on staff that can help with your weight loss goals.

So how to you start on this adventure on your own: keep a food log for a week.

Then, go to Choose My Plate.gov and compare how you are eating with what is suggested.

Kristina Houser, LD

From meal plan to apartment plan

Its apartment time!

You put in your dorm time, but now you are free.  Free to find an apartment and free from the food plan and you are certain this will save you money. Think carefully about what lies ahead in this department and ask yourself some questions.

Where is the closest

Adjusting from meal plan to apartment plan

full grocery store?

 

Do I know who much groceries cost?

How will I get there? Do I have a backup plan if the first one does not work?

Do I know how to menu plan so I can create a grocery list?

What, if anything, do I know how to cook from scratch or a box?

What will be my budget for food including groceries and eat out?

How big is the refrigerator and how will we divide the space?

Will my roommates and I keep food individual or will we make group meals?

Over the summer, before you move into that apartment, practice grocery shopping and acquire a sense for cost. Think about meal planning. Learn what to keep on hand in your college pantry. Practice packing lunches over summer if you will do that in the fall. Build a library of 15 minute meals for when you are pressured for time.  Research college friendly cooking.  Here’s a great book to get you started:

The $5 a Meal College Cookbook: Good Cheap Food for When You Need to Eat by Rhonda Lauret Parkinson, B.E. Horton.

Kristina Houser, LD

GI Issues: Could you join the Pepto Bismol lineup?

Your GI tract is causing you trouble:

Does this Pepto Bismol lineup describe you?  Everyone has times in life when their GI tract seems to revolt: upset stomach, bloating, diarrhea, constipation and the list goes on. Sometimes the symptoms are severe and you need to get to a doctor but often you can try a few things yourself. Before you panic and think you have colon cancer or celiac disease, try some simple steps to see if you can improve your situation.

If you have recently taken antibiotics, you may have diarrhea or if you get it every time you take them, start taking a probiotic when you start the antibiotics. You will be amazed at how much better it goes. For this, a basic probiotic from the store will work.

Constipation is an issue no one likes to bring up but it can make life very uncomfortable. Often the cause is low fiber or not enough water or a combination of both. College students often average only 10 grams of fiber a day and it should be between 25 and 35 grams for good health. Water intake can be low if you don’t carry a water bottle or you don’t like water.

There several action steps that can be taken to improve reflux, IBS, and other GI issues as well but talking to a dietitian to personalize your plan is best.

Kristina Houser, LD