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Old 11-09-2015, 11:16 AM   #41
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For those suggesting that mailing in paper is best, does your Doc have a direct electronic link (not just a 1980's era FAX system) to the mail-order pharmacy?

IME, the direct link is great - I get confirmation within hours, often by the time I get home. No more than 24 hours in any case I can recall. It's no effort on my part, the Doc clicks a few buttons, and I get the closed-loop confirmation quickly - I can't imagine how snail mail would be preferred to this.

I suspect the problems people are talking about are with FAX based systems - FAX doesn't really have much (any?) of a closed loop control on it, so problems may go undetected until you realize you haven't seen any shipping notices, or your pills never show up.

-ERD50
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Old 11-09-2015, 11:49 AM   #42
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Slightly off the subject should you ever have to have a prescription that Express scripts considers "specialty" (aka expensive) and you have a choice of specialty pharmacies google them before you pick. I did not and paid for it by running out of the medicine I take for a life threatening condition. They swore they had shipped it finally just in time after over a month of delays. It never came and by the time I realized they had lied there was a delay in getting it locally for cash because it had to be ordered by the pharmacy here. I then tried my other specialty pharmacy option and it arrived in less than a week. I only did the search afterwards and found many other stories like mine and involving life or death type drugs as mine was ( chemotherapy for cancer was common including chemo for young children).
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Old 11-09-2015, 11:54 AM   #43
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Originally Posted by ERD50 View Post
For those suggesting that mailing in paper is best, does your Doc have a direct electronic link (not just a 1980's era FAX system) to the mail-order pharmacy?

IME, the direct link is great - I get confirmation within hours, often by the time I get home. No more than 24 hours in any case I can recall. It's no effort on my part, the Doc clicks a few buttons, and I get the closed-loop confirmation quickly - I can't imagine how snail mail would be preferred to this.

I suspect the problems people are talking about are with FAX based systems - FAX doesn't really have much (any?) of a closed loop control on it, so problems may go undetected until you realize you haven't seen any shipping notices, or your pills never show up.

-ERD50
+1

I've never been in express scripts location but I spent too much time in other large mail centers. These places are amazing but... Many receive pallets of mail from USPS, there is a certain amount of sophistication and planning involved to receive that volume and process it, without it getting thrown out. That's no joke the places that deal with huge volumes always have an issue regarding how do you know all the mail got received and into the systems. I've heard all kinds of horror stories on how hourly employees can become very creative at losing work. These horror stories came from people willing to sign off on large development projects $$ to eliminate the issue.

Not that it can't be done with tools and processes, but of you can avoid a manual step often times helps. That same issue occurs in many paper intense business transactions.
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Old 11-09-2015, 12:21 PM   #44
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Originally Posted by ERD50 View Post
For those suggesting that mailing in paper is best, does your Doc have a direct electronic link (not just a 1980's era FAX system) to the mail-order pharmacy?

IME, the direct link is great - I get confirmation within hours, often by the time I get home. No more than 24 hours in any case I can recall. It's no effort on my part, the Doc clicks a few buttons, and I get the closed-loop confirmation quickly - I can't imagine how snail mail would be preferred to this.

I suspect the problems people are talking about are with FAX based systems - FAX doesn't really have much (any?) of a closed loop control on it, so problems may go undetected until you realize you haven't seen any shipping notices, or your pills never show up.

-ERD50
You're completely missing the point. People are not suggesting snail mail is more reliable than fax or IME. They're suggesting that not 100% turning over the task of securing a prescription renewal to the drug provider is best. Go see the doc yourself and get a new prescription, especially with critical drugs where missing a few days would be a big deal.


The common link in most of the mail order drug supplier horror stories seems to be failures in the process where the drug supplier contacts doc directly (often via IME) for a renewal but does not get a prompt response. In my case, doc wanted to see me before extending the prescription to draw blood and get some data. But noooooo..... he gets a request from a third party to extend the prescription before he hears from me. Now it's turning into a party game. I need my prescription renewed and tell the drug company via their web site. The drug company requests an extension from doc via IME. Doc pulls my file and refreshes himself on my status and decides he wants to see me first. He responds to the drug company. The drug company, not in the business of relaying detailed messages, just sends me a form email saying doc won't renew the prescription. WTF? It's Friday. I call doc's office Monday and plead for mercy but he insists he needs/wants test data and will not blindly renew. I get an appointment for the next day. Several days after that we have test results and doc writes me a new prescription.


Assuming that because doc wrote the prescription for drug X once, he'll renew it again and again without seeing you works sometimes, but not always. When doc doesn't renew and the communications is being relayed via the mail order drug provider, things bog down.


Lesson learned. Now I just make an appointment and go in when I need prescription renewals. I've been walking out with paper prescriptions but I'd be OK If I could watch him or his assistant submit via IME. (There's nothing magic about using US Mail other than I'm in the communications stream and not relying on a third party to keep me informed of what my doc is saying/doing.) The point is having knowledge of what's going on and being in control as opposed to turning the process over to the drug provider and hoping for the best until you hear otherwise.

It has NOTHING to do with fax, snail mail or IME being more reliable. It does have to do with control and having direct vs relayed communications.

When I rely on the drug provider to contact my doc with a refill authorization request, I'm stepping back from a process which would likely take some time and which I will not know the results of until something goes wrong. Pharma contacts doc for refill authorization. Doc either promptly drops everything, has your file pulled, reviews your situation and makes a decision of whether to renew or not. Or doc's system is such that someone else pulls your file and just gives him a summary. Or doc does these requests every other Thursday so you'll have some time to wait. Or..... whatever. You just sit back and wait to see how it works out.

When I go into the office with an appointment and ask doc for a new prescription and walk out with paper, I'm in control. I make a copy of the prescription and send the original in via snail mail. Despite the vagaries of the Post Office, I've never had an issue.

Again, no one here is talking about the technical superiority of electronic communication formats. The discussion is about getting prescription refill authorizations done. OP had an issue when he counted on the drug provider to contact his doc for him (I have too). Now I just coordinate needing refill authorizations with semi-annual trips into see doc and use paper and snail mail keeping myself in the loop.

In my case, doc is close by and I carry zero deductible, zero co-pay insurance so only my time is at issue.
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Old 11-09-2015, 12:44 PM   #45
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You're completely missing the point.

It has NOTHING to do with fax, snail mail or IME being more reliable. It does have to do with control.

When I rely on the drug provider to contact my doc with a refill authorization request, I'm stepping back from a process ....
I think there are two issues being discussed, and likely getting crossed. The one I was addressing in that post was that IME (In My Experience), the closed-loop electronic connection between Doc and mail-order pharmacy has been superior to snail-mail and/or FAX.

The other issue is what you describe with the pharmacy contacting Doc for refill authorization, and you are out of the loop - that's a potential problem, for all the reasons you mention.

Here's what my Doctors have done - they electronically submit the 'script, and at the time they submit it, they specify the number of refills they are authorizing. So 3-4 weeks before I'm out on the initial 'fill', and while I have a valid refill, I just go on-line and click 'refill' and they send it to me, usually within 24 hours, and I get shipping confirmation and tracking number by email. My Doctor is not involved in the refill process - the Doctor authorized it upfront.

This process seems to alleviate the problems being discussed here, for the most part? Maybe people here should check with their Docs to see if they can specify the number of refills at the time they submit the 'script, and verify that they can trigger the refill themselves? I think my mail-order pharmacy also allows an 'auto-refill' - they will ship when they estimate you need it, but I'd rather control that timing myself.

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Old 11-09-2015, 12:46 PM   #46
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The common link in most of the mail order drug supplier horror stories seems to be failures in the process where the drug supplier contacts doc directly (often via IME) for a renewal but does not get a prompt response.
As a postal clerk I'll add another one.... pharmacies that don't include tracking on the medications they send, and inevitably someone will complain about not receiving their medicine which was sent in an untracked parcel, and there's almost nothing we can do to help the customer find it, or have any idea where it was last seen.

This is particularly galling since it's been well over a year since *all* package services through USPS receive tracking at no additional charge, and they *still* send medicine untracked. No excuse for sending medicine untracked, IMO, save for laziness.
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Old 11-09-2015, 12:55 PM   #47
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youbet: A little more detail on one point (you may have edited your post while I was replying - and I edited mine a bit as well):

My Docs have normally wanted a blood test before issuing a new 'script, but they have generally written each new 'script for a 90 day supply, with one or two 90 day refills specified upfront on that 'script. So there is never a case where the Doc will say he won't allow the refill w/o a blood test, because he already pre-approved X refills.

Now when I need that new script, I know he's likely to want a blood test, since he didn't get one for the past refills, so I allow a little more time for that phase of the cycle. Though for me at least, he's always written the 'script, and checked the blood work after the fact. I assume he'd call and let me know if he saw issues.

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Old 11-09-2015, 01:04 PM   #48
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As a postal clerk I'll add another one.... pharmacies that don't include tracking on the medications they send, and inevitably someone will complain about not receiving their medicine which was sent in an untracked parcel, and there's almost nothing we can do to help the customer find it, or have any idea where it was last seen.

This is particularly galling since it's been well over a year since *all* package services through USPS receive tracking at no additional charge, and they *still* send medicine untracked. No excuse for sending medicine untracked, IMO, save for laziness.
Seems I've always got a tracking #. I just checked on mine, due to be here tomorrow the 10th, from my Doc appointment on the 5th. So 5 calendar days from seeing the Doc, which is 3 business days. Pretty good.

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Old 11-09-2015, 01:11 PM   #49
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Here's what my Doctors have done - they electronically submit the 'script, and at the time they submit it, they specify the number of refills they are authorizing. So 3-4 weeks before I'm out on the initial 'fill', and while I have a valid refill, I just go on-line and click 'refill' and they send it to me, usually within 24 hours, and I get shipping confirmation and tracking number by email. My Doctor is not involved in the refill process - the Doctor authorized it upfront.
Yes, you've described the standard "original prescription + X refills" process. It's worked well for me for decades whether I'm using mail order, walk-in, phone-in or whatever. What OP is talking about is a breakdown in communication when his mail order drug provider attempts to go directly to his doc to get additional refills beyond the original number and the request is not promptly authorized or other complications arise, such as doc wanting tests done.
Quote:

This process seems to alleviate the problems being discussed here, for the most part? Maybe people here should check with their Docs to see if they can specify the number of refills at the time they
No, not at all. What you've described is the decades old process of doc writing a script with designated number of refills. That's never been a problem that I know of. Today's problem is that when the designated number of refills has been utilized, can you trust the system where you authorize the mail order drug provider to request directly from your doc authorization for additional refills? This is where the problem seems to pop up as in OP's case. I've learned to go to doc myself and get a fresh prescription. This gives him a chance to review my case, do additional testing or at least look me over and ask me how I'm doing on the drug. [/QUOTE]
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Old 11-09-2015, 01:13 PM   #50
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Seems I've always got a tracking #. I just checked on mine, due to be here tomorrow the 10th, from my Doc appointment on the 5th. So 5 calendar days from seeing the Doc, which is 3 business days. Pretty good.
It's usually the smaller, local pharmacies that do mail order who don't do it. The big players always do. I think what they do is just use their own postage meter in-house, weigh the package and put a meter strip on it. Then they just give it to the mailman when the incoming mail is delivered. At least that's what I suspect they do.
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Old 11-09-2015, 01:20 PM   #51
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Now when I need that new script, I know he's likely to want a blood test, since he didn't get one for the past refills, so I allow a little more time for that phase of the cycle. Though for me at least, he's always written the 'script, and checked the blood work after the fact. I assume he'd call and let me know if he saw issues.

-ERD50
OK, this sounds like you're agreeing with me. Like me, you'd go to your doc's office and have him write a new prescription rather than authorizing the mail order drug provider to contact him (via EME or whatever) to authorize additional (beyond the number on the original prescription) refills.

This has been standard for as long as I can remember (which is a really long time).

The new issue, which you seem to be struggling to get your head around, is that now drug providers encourage you to allow them to contact your doc directly and ask for additional refill authorizations when you've run out of the number allowed on the original prescription. I've learned not to do that.
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Old 11-09-2015, 01:30 PM   #52
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EDIT - I think I missed your post #49...

So let me update this - So what I'm missing is - why not just do the "standard "original prescription + X refills" process" that we are both describing? MAybe I'm misreading, and you are doing that, but I'm not sure about the OP.

Bottom line, it seems we are saying the same thing - get out from the MO Pharm contacting the Doctor for refills. What I'm not sure we are on the same page on is - are we all able to get the Doc to write the " the standard "original prescription + X refills" process."?

OK, we are agreeing - get the new script when 'pre-approved' refills are out. I guess it wan't clear to me if OP was getting those pre-approved refills, or not.

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OK, this sounds like you're agreeing with me. ...

The new issue, which you seem to be struggling to get your head around, is that now drug providers encourage you to allow them to contact your doc directly and ask for additional refill authorizations when you've run out of the number allowed on the original prescription. I've learned not to do that.
Yes. But on the 'new' issue - all I can say is what I put in those other posts - my Doc submits the 'scripts with X refills noted, so they are essentially pre-approved, and my mail-order pharmacy has no reason/need to contact the Doc for a refill. That circumvents the issue, right?

Now once the pre-approved refills are 'used up', yes, I go to the Doc for a new 'script, which he will again write with 2-3 pre-approved refills (and order a blood test if he wants).

It sounds like you are going back to the Doc for every fill, so that every refill is essentially a 'new' 'script? Would your Doc do the pre-approval of one refill like my Docs do, so that you could cut that effort in half, and your Doc still has an opportunity every six months (assuming 90 day mail-order fills/refills) to ask for a blood test?

Just seems easier on everyone.

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Old 11-09-2015, 01:54 PM   #53
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We originally had Medco. When the merger with Express Scripts took place, there was an immediate fall off in service and changes in policy. They suck!
BINGO! +1 or 2

DFW, maybe they have it in for those of us who live in Texas? We had Medco too before they merged. Medco was OK. When you say "they suck", you are being far too kind. Why do these mega corps sign contracts with these idiots? (No need to answer that!)

What really makes me mad is they seem to get really close to practicing medicine or knowing better than your doctor. Don't believe it, just try ordering a brand name drug when a much cheaper generic is available and the doctors prescription says "do not substitute". I realize, some generics work ok (maybe) but many do not. They will try to force you to the cheaper drug regardless. YMMV
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Old 11-09-2015, 02:04 PM   #54
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So let me update this - So what I'm missing is - why not just do the "standard "original prescription + X refills" process" that we are both describing? MAybe I'm misreading, and you are doing that, but I'm not sure about the OP. [
Yes, you are misreading. (And this is my last post on this since you seem to have a pre-conceived notion of what I'm saying that I can't change.) I am doing exactly what you are doing. I DON'T allow the MO provider to contact my doc directly for authorization to extend the original script beyond the number of originally authorized refills. This has eliminated my problems.
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Bottom line, it seems we are saying the same thing - get out from the MO Pharm contacting the Doctor for refills.
Yes!
Quote:
What I'm not sure we are on the same page on is - are we all able to get the Doc to write the " the standard "original prescription + X refills" process."?
I can't remember doing it any other way. When doc wants me to take a drug, he writes a prescription for an original quantity and X number of refills. I'm 68 yo and that's the only way I ever remember doing it.
Quote:



Yes. But on the 'new' issue - all I can say is what I put in those other posts - my Doc submits the 'scripts with X refills noted, so they are essentially pre-approved, and my mail-order pharmacy has no reason/need to contact the Doc for a refill. That circumvents the issue, right?
Nope. The new issue is the the MO pharms want to authorize them to contact your doc to get an extension on the number of refills originally authorized. That keeps your business with them. It sounds convenient but apparently has pitfalls which we've been discussing in this thread.

When you're on your MO pharm's web site, doesn't it offer you an opportunity to let them get your prescriptions extended? For example, mine says something like: "Dear youbet, You have now used all refills on this prescription. Check this box and we'll contact your doc and get the prescription extended for additional refills. You need to do nothing!"

I checked the box. That's when the trouble started. So going forward, no box checking for me! I go and see doc myself.
Quote:

It sounds like you are going back to the Doc for every fill so that every refill is essentially a 'new' 'script?
Absolutely not and I have been very clear in that regard.
Quote:
Would your Doc do the pre-approval of one refill like my Docs do, so that you could cut that effort in half, and your Doc still has an opportunity every six months (assuming 90 day mail-order fills/refills) to ask for a blood test?
This is how it's done. Again, for the ninety-fifth time, the issue is with the MO pharma contacting doc to extend the number of originally authorized refills without the patient (me) being in the loop. I now reject this innovation. I've had too many issues.
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Old 11-09-2015, 02:07 PM   #55
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BINGO! +1 or 2

What really makes me mad is they seem to get really close to practicing medicine or knowing better than your doctor. Don't believe it, just try ordering a brand name drug when a much cheaper generic is available and the doctors prescription says "do not substitute". I realize, some generics work ok (maybe) but many do not. They will try to force you to the cheaper drug regardless. YMMV
When you ask for a brand name in lieu of a equivalent generic and you say they try to "force" you to take the generic, what does that mean? They absolutely refuse to give you the brand name? Or they give you the brand name but charge you a higher price than the generic?
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Old 11-09-2015, 02:08 PM   #56
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DFW, maybe they have it in for those of us who live in Texas?
I used ES for years in Louisiana before we moved to Texas and no problems. When I went to a doctor here to get examined and prescribed the same medicine I had been receiving in Baton Rouge he wrote me a paper prescription and I said, "Paper!! The doc in Baton Rouge simply asked me which pharmacies I used and put in the orders on his hand held device. First month supply at my local pharmacy, and then 90 day refills with ExpressScripts. "

All the problems I've had with ES are since 2010 when we moved back to Texas (Houston) and I was back to paper and fax.
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Old 11-09-2015, 02:12 PM   #57
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When you ask for a brand name in lieu of a equivalent generic and you say they try to "force" you to take the generic, what does that mean? They absolutely refuse to give you the brand name? Or they give you the brand name but charge you a higher price than the generic?
Usually "they" (generically in terms of drug benefits) try to force you into the generic and refuse to cover the brand name unless there are medical reasons why the generic can't work for you. In such a case, you should be able to get the brand name but you would pay 100% of the difference in cost.

If a generic costs $5 (fully covered) and the "tier 2" name brand drug costs, say $100, if you insist on the name brand you will pay the $95 difference. But if you get it documented form your doctors that you can't take the generic for whatever reason and it's approved, you will have it fully covered, though you would still have a larger "tier 2" copayment or coinsurance, most likely, than for a "tier 1" generic.
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Old 11-09-2015, 02:21 PM   #58
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Yes, you are misreading.

...Nope. The new issue is the the MO pharms want to authorize them to contact your doc to get an extension on the number of refills originally authorized. That keeps your business with them. It sounds convenient but apparently has pitfalls which we've been discussing in this thread.

When you're on your MO pharm's web site, doesn't it offer you an opportunity to let them get your prescriptions extended? For example, mine says something like: "Dear youbet, You have now used all refills on this prescription. Check this box and we'll contact your doc and get the prescription extended for additional refills. You need to do nothing!" ...
There's the disconnect, I think.

No, I've never seen that 'opportunity'. Or maybe I just never noticed, as I knew my Doc would want another blood test done when he fills out the new script. He was big on a blood test every 6 -9 months, and would authorize 2-3 refills. So even if that 'opportunity' appeared - (and I don't recall seeing it, and I'm pretty sure it just told me I was out and needed a new script), I would have ignored it, knowing the Doc would reject it anyhow.

So don't hit a button and count on the MO Pharmacy to contact your Doctor and process an extension of the original prescription. Got it. And agree. Good advice.


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Old 11-09-2015, 02:24 PM   #59
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Originally Posted by ziggy29 View Post
Usually "they" (generically in terms of drug benefits) try to force you into the generic and refuse to cover the brand name unless there are medical reasons why the generic can't work for you. In such a case, you should be able to get the brand name but you would pay 100% of the difference in cost.

If a generic costs $5 (fully covered) and the "tier 2" name brand drug costs, say $100, if you insist on the name brand you will pay the $95 difference. But if you get it documented form your doctors that you can't take the generic for whatever reason and it's approved, you will have it fully covered, though you would still have a larger "tier 2" copayment or coinsurance, most likely, than for a "tier 1" generic.
Clear explanation. Thanks Zig.

I guess I'm comfortable with that. If anyone could order the expensive brand name instead of the generic equivalent just on a personal preference, I guess most folks would stick with the brand name. Premiums would have to go up. Brand name pharmas would make lots of profit.

As long as your doc can submit a requirement explaining why you need the brand name, the system seems OK. If we're talking true generic equivalents, the number of these should be minimal.
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Old 11-09-2015, 02:32 PM   #60
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Originally Posted by ERD50 View Post
There's the disconnect, I think.

No, I've never seen that 'opportunity'.

-ERD50
Whew....... It's always a relief to finally discover the difference in inputs that's causing folks to be talking past one another.
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