Wednesday, December 30, 2009

Prescripton Drug Ad: Book One, Chapter One

I was thumbing through my copy of Newsweek recently. The magazine seems to have gotten less interesting and the 'look' of it has become stark and kind of bland, in my opinion. So, there wasn't much goin' on, but in the middle of this slender package of print was a SIX page ad for Seroquel XR. Four of those pages were fine-print, package insert stuff.

Holy crap, I just stared at this monstrosity. Of course, there are many ads in Newsweek for prescription drugs, but this was ridiculous. I'm guessing it's not cheap to run a 6-page ad in any magazine. This is certainly reflected in the price of Seroquel XR, your extended-release version of the already expensive Seroquel that's out there now.

I'm conflicted about direct-to-consumer advertising. I don't think prescription drugs should be a black hole of mystery to people. There may be times when one of these ads gets someone to actually go to the doctor for help, or to have their cholesterol checked, or whatever. We Americans watch our media, you gotta say that. But of course the argument is that if the drug companies weren't paying for this advertising, maybe they could lower their prices. Somehow I don't have a lot of faith in that either.

I do think that every drug ad should be required to state the price of the drug. In a big red box, right at the top of the ad --- the average, cash-paying American customer price. Then maybe people won't look wide-eyed at their Advair/Lipitor/Plavix/Seroquel XR receipt, next to the copay price, and say "Wow, is that how much it REALLY is?"

It sure is, Pharmacy Customer, it suuuurrrre is.

Friday, December 25, 2009

Merry Christmas

Merry Christmas Pharmacy (and Medical) Folk!

May your patients behave,
Your claims be paid,
Your printers unjammed,
Your bladders expand....

Hope springs eternal!

Sunday, December 20, 2009

Counsel Me

The law requires that a pharmacist be available to 'counsel' patients on all prescriptions, new and refill. All of us in Pharmacy Reality World know that this is practiced somewhat loosely. It may take the form of a technician asking, "do you have any questions for the pharmacist?" Customer glances at it, says no, and is out the door. In a pharmacy that's filling, say, 600 scripts a day with 2 pharmacists, there is no possible way the pharmacist can babysit every new prescription going out. It's just not physically possible. I have picked up prescriptions for myself and had no interaction whatsoever with anyone except the cashier telling me the price.

I'm realistic about this. I do, as best I can, try to at least perform a "show and tell" (as our State Board calls it.) "This is amoxicillin, you'll be taking one capsule 3 times a day for 10 days". In many cases, that's enough. Most importantly, it gives the customer a chance to say "Wait a minute, I thought I was getting (insert name of totally different drug here.)" Yikes. OK, then either we made a mistake, or the doctor did, or the person's confused. Once in awhile, disaster is averted, it's true.

Or, the customer may say, "but I thought I was supposed to take it six times a day," and then I can do my awesome pharmacist intervention and set them straight, because apparently they have no plan to read the label. ( By the way, don't you love it when someone says "does it say that on there somewhere?" after you have told them the directions?) Uh, yeah, that's why we put that silly little label on there.

Anyways, I do hate it when I reinforce some directions to a patient and they tell me that the doctor told them to do something different than the prescription says. We see this fairly often with e-prescriptions, because the prescriber either doesn't know how to change the directions or can't be bothered. Sure, if it says Celexa 20mg tab once a day but the doctor told them to start with 1/2 tablet for the first week -- that's not inappropriate, I get that.

But last week a customer said they had been given verbal directions which did not match their prescription. This was a drug which most assuredly was NOT usually given in the way the patient was 'verbally' told. Now, I know medicine is not black and white and there might have been a reason. I need to clarify this. It's Friday. The doctor is unavailable and everyone has left the office. In fact, the pharmacy is about to close too. We're not supposed to pull any overtime. I'm sweating bullets because I really don't want this person to kill themselves over the weekend.

I strongly suggest they follow the prescription as written until we can follow up on it but they are argumentative. It's going to be a nightmare to find someone who can clarify this -- the doctor on call can't do much -- there probably won't even be a note transcribed in the patient's chart till Monday or Tuesday.

Long story short, it bugs me all night and I call the patient at home the next day. I explain why I'm worried about it and he agrees to do what I ask, and even thanks me.

Well, it doesn't have a fancy name like "medication therapy management", but for most of us pharmacists it's the best we can do, and sometimes it even works.

Tuesday, December 15, 2009

Thinking about gifts

Well, the Christmas shopping is almost complete. Now is the time I usually remember I've got to buy some gifts for my technicians. I float a little bit so I don't feel obligated to buy for everybody, but there are some regular technicians that I've worked with for quite a while and I do like to get something for them. In fact, there are a few of them who are REALLY good, and at Christmas I really want to show my appreciation for them helping me out so consistently. And obviously, I know they don't make the salary that I do. Sometimes you work in a place where you know one or two techs really well, and the others not so much. It's a little awkward but sometimes I have to slip them a gift out of sight of the others.

I usually go with gift cards. If I know they like to shop at a certain place or eat lunch at some favorite spot, I get those. Failing that, I figure everyone can use a Target or a Wal-Mart card. It's not too imaginative, but I feel weird about just giving someone money. You chat with people all year long but unless they have some over-riding passion that you identify with them, it's sometimes hard to remember (what was that restaurant she said she really liked??) I hope it's not too much of a cop-out. I just want to give them something they can use.

Any technicians out there who got a gift they really liked?

Tuesday, December 8, 2009

Following the Bouncing Check

I've always been really meticulous (OK, kind of anal) about recording all the checks I write and balancing my checkbook with my bank statement. I never write a check without knowing there's enough money in the account. We just got another alert from the head honchos about one of our customers bouncing checks, and it disturbs me when this happens with our regular customers (ie, not the criminal element one-timers who we will never see again.) And usually they have written at least a couple of checks before we catch up with them --- I mean, how do you come in and write that second check when you know darn well the first one was no good? And you KNOW you'll be back again... like, what's the deal? We know you by name, for God's sake (and frankly, you can be a bit of a pain in the arse.) I've had people ask me to hold their check for a day or two, and we can work with them on stuff like that.

Seems to me it's just not worth the hassle -- I mean, they gotta pay attention. We're now put in the position of telling them we won't accept their personal checks any more. I know it's not my fault, but I still feel bad. We have one husband/wife regular pair who now have to come in and pay cash right out of their ATM envelope. I think I would feel kind of embarrassed. I just wouldn't let it happen.

Wednesday, December 2, 2009

I'm Mad at Centrum

(I had a crappy Thanksgiving so maybe bitching about some trivial thing will be therapeutic....)

As a consumer, I hate seeing the word "NEW!" on my long-standing favorite products. DON"T mess with mah PRODUCTS !! Like the shampoo I've always used -- all of a sudden it's got a 'new' formulation and my head feels like a complete greaseball. My 'new' deodorant that doesn't work anymore. My new and improved moisturizer that smells funny and makes me break out. It never fails --- when I get really attached to something, they change it.

I've always taken a multivitamin/mineral supplement every day. There's always controversy about whether they are really needed, but I believe they do contribute to better overall health. This is especially true when I'm subsisting on coffee, granola bars, and luxuriating in half a pack of Life Savers for lunch. I've used Centrum for a long time --- just stuck with it; it's a good brand, doesn't cause me any GI side effects, and so on.

So recently the bottle says "New! Smaller Tablet Size Formula." Uh-Oh. Well, inspecting the label I find they dropped the folic acid from 500 mcg to 400mcg, and dropped the lutein and lycopene altogether. ( Gee, those seemed like a big deal when they first added them --- eye health and all that.) I kind of liked having those in there, although I admit they probably weren't present in large enough amounts to do anything. These changes alone resulted in a smaller tablet? Why couldn't they take out the boron? the vanadium? the nickel?? Or dammit, even the tin?

Well, I don't mind checking out some of the other formulations. Centrum Ultra Women's bumped up the calcium to 500 mg -- well, sometimes that gives me, uh, problems, and I don't want to be stuck with a bottle of 100 if it does. Centrum Silver has lutein and lycopene but NO iron. NO iron?? I still need that. Centrum Silver Ultra Women's has too much calcium and not enough iron, although I do like the 800 units of Vitamin D.

Anyway, long story short --- the porridge was neither too hot nor too cold. It was juuuuusttttt right. Why'd they have to change it??

Sunday, November 22, 2009

Swallowing Forum

We had to prepare (what felt like) a half-gallon of amoxicillin suspension the other day. It was a prescription for a teenager. Yes, Mom said, she "can't swallow pills."

Come on now. Sometimes I have a hard time --er--- swallowing that story. I am just somewhat disbelieving of these teens and adults who claim the total inability to swallow a tablet or capsule. I'm not talking about people who are handicapped or developmentally disabled or have some anatomical defect or injury. I'm talking about the normal folks who, somewhere in their past, gagged on a dry tablet or had something go down the wrong way and are now totally convinced it's beyond their capability. Sometimes they don't tell you until the prescription is all ready -- they look at you wide-eyed and say, "oh, I can't swallow THOSE !!" Well, what the heck did you think you were going to get after coming in for a doctor's appointment, receiving a prescription and waiting for it at the pharmacy --- a smoothie, a Big Gulp, what? They act kind of outraged that you would even present them with this daunting task.

The suggestions I give for this problem --- wetting the tablet or capsule and using a straw to drink the liquid needed to swallow it --- are sometimes accepted and sometimes not. Sometimes you can crush the tablet or open the capsule, but not always. But if a person has convinced themselves they can't swallow a tablet or capsule at the age of 15 it will be a difficult pharmaceutical road ahead, for sure.

Anyone have any favorite tips for our non-swallowers? I need some.

Saturday, November 14, 2009

This Week's Snapshots, Pharmacy Style

1. Flu Paranoia?--- Naaahhh.....

I'm standing in line at the bank and it's pretty busy. A woman is sitting off to the side in one of the chairs waiting for someone, and starts coughing loudly. The place goes quiet and EVERYONE standing in line turns to look at her. She smiles, laughs, and announces "Don't worry, it's just smoker's cough!" Well, thank goodness.
2. Things that make me go WHAT THE.....????
A woman calls the pharmacy to check on whether one of her meds is safe in pregnancy.
Not because she is pregnant, but just in case. She tells me, "ya know, I don't use birth control but I AM sexually active. " Well, that's what we like to hear.
3. Just plain aggravating...
A guy who's out of refills on his glyburide and who hasn't filled it since JULY is annoyed because we won't 'spot' him a few tablets. I mean, if you haven't been too concerned about your blood sugar for the past 3 months, what's the big emergency all of a sudden?
4. When in doubt, dispense a placebo....
A woman calls and says the new generic brand of acyclovir we gave her does NOT work.
She says she wants the other ones, and implies we have given her some sort of bogus fake acyclovir. I don't even try to argue because there are some battles you're just not going to win. We give her the last few tablets we have of the old brand and wish her happy shopping to find any more. I wish I knew of a better way to deal with this type of thing.
5. Laugh to keep from crying.....
Working with a very slow and kind of unpleasant technician this week who's been given every chance to get up to speed. Waiting for her to crank out a simple Vicodin script that the other techs would have done in about 30 seconds. The other (dryly humorous) pharmacist I'm working with mutters, "What the hell is she doing, harvesting the opium poppies or something?"

Monday, November 9, 2009

A Bit O' the Ugly

We have a customer who comes in every few weeks -- nice squeaky-voiced little elderly lady, early 80's, who seems really sweet. She refills a prescription which is used for possible Alzheimer's symptoms or at least early signs of confusion/dementia, but she comes in unassisted and neatly writes a big fat check for this medication.

The other day I heard her asking the technician about some lab results she had been mailed from her doctor's office. I went over to see if I could help with the question and looked at the letter she had in her hand. There was a serum creatinine result and also an estimated GFR, so these were obviously kidney function tests. There were two results for the GFR, however, and one was labelled "Afr-Amer" or something like that. I don't deal with this a whole lot, but I told her I thought it was because a correction factor is applied if the person is African-American -- there's a different 'normal' range, and the lab printouts show this as a matter of routine so the correct result can be applied. These printouts can be confusing for anyone to read, no doubt, and I figured she just didn't know what the heck any of it meant.

Well, I quickly realized it wasn't the numbers that she was questioning, it was the "Afr-Amer" part. This little mouse of a lady, always pleasant small talk, usually in and out in a minute or two, got kind of upset. She got this hard edge to her voice I never heard before, and said "Why is THAT on there? Are those even my results? I just don't think THAT should be on there!" and repeated these comments several times. We finally offered to call the lab and have them explain it to her. "YES, I would like to do that," she said firmly.

Wow. After she left we all looked at each other, kind of taken aback. One of the techs ventured a comment about "people from a certain era and age group" . It was just weird to see this little bit of ugliness coming out of this (presumed) nice little old lady.

Just another interesting observation from another day at the pharmacy.

Friday, November 6, 2009

My Love Affair with Canadian pharmacies

I have some ties to Canada (specifically, Ontario) and just got back from a trip across the border. Why do I enjoy my occasional visits so much? Is it the unfailing politeness and intangible feeling of civility I encounter there? The lower prescription prices? The health care system that is equally accessible to both the minimum wage-earners and the CEOs? The notices smartly posted in the banks and other public buildings about protecting yourself from the flu?

Yes, all those things, but as a pharmacist I really enjoy snooping around in the Canadian pharmacies.
First of all, there are a number of items that are over-the-counter in Canada that we still need a prescription for in the U.S. -- things like Allegra, Clarinex (although it's called something else) & scopolamine patches, to name a few. I stock up on those for my allergies and airplane flights. Sudafed products are still out on the shelves in Canada. They even have "extra strength" Advil (400 mg per tablet -- sweet!) I don't know what the meth situation is in Canada, although the pharmacy I visited did have two large signs in the front window stating that "narcotics such as Oxycontin are available by special order only." I wouldn't have a problem with that at all.
Then I proceed to the checkout where the candy is, and this is the part I really like.
The uniquely Canadian candy bars like Coffee Crisp, Aero (the bubbly chocolate), Smarties (cousin to M & M's), and the tooth-rottingly delicious Crunchie Bar (sponge toffee coated in chocolate). The clerk must have thought I was loading up for the trick-or-treaters but no, it's all for me to take home and hoard.

Instead of "Dancing with the Stars" they have "Battle of the Blades". It's a show where skating pairs compete, and the male half is an ex-NHL hockey player! You gotta love it.
Oh, and the ubiquitous Tim Horton's coffee and donut shops ---- heaven.
I know I should be thinking about larger issues than these, but not today. I'll take a large coffee and a honey-glazed, and all's right with the world in the arms of our neighbor to the north.

Saturday, October 24, 2009

The flavor of flu

Geez, and it's only October. We are compounding a lot of Tamiflu suspension these days because of the shortage of the commercial product. It takes a little longer but I feel pressured to speed it up just to get the sick person out of the pharmacy. For myself, I alternate between soap and water, hand sanitizer and the foamy stuff (which is kind of wet and sticky but more fun to use). It's probably going on 2 years since I've had even a cold --- I'm thankful for that but it makes me nervous that I'm overdue for something nasty.

This guy is waiting for prescriptions for himself and his kid. We're busy and going as fast as we can. He comes up to the counter TWICE and loudly asks if it's ready yet. I really don't appreciate that especially when he's sitting there watching us run around like maniacs. We told you we would call you up as SOON as it's ready. It's not just a matter of pulling the next cheeseburger off the grill, you know what I mean? Finally I go to ring him up. All of a sudden he's asking about adding flavoring for the kid's antibiotic liquid. Oh really? NOW you're gonna tell me you want it flavored, huh? Well guess what, it comes already flavored. Whatever it is, your kid's gonna love it. Mr. In-a-Hurry-and-it's-taking-too-long. Now YOUR time is up. I don't know why this irritates me so, but damn, it really does.

By the way, that Tamiflu suspension I have to compound? ---- No, it's not available in banana, watermelon or bubble gum flavor. There are 2 vehicles that the manufacturer tells us we can use --- cherry flavor, no substitutions. For crying out loud, if my kid really needed Tamiflu I would be glad it's available to me and I would get it into my child no matter what flavor it was....

In a similar vein, I'm annoyed when I hear news reports about the government's 'sputtering' response to the production of H1N1 vaccine. Growing virus to make a vaccine is not something we can do in our kitchen sinks. I'm thankful to live in a country that has the capability and scientific know-how to produce MILLIONS of doses of a vaccine in a few months' time. The people at high risk are getting it first, and the rest of us will follow.

There are an awful lot of places around the world where, if a pandemic breaks out, the people are pretty much on their own. I think we take it for granted sometimes.

Tuesday, October 20, 2009

Let's Talk Trash

Most days I am bowled over by the amount of trash we produce during one workday in the pharmacy. We have multiple receptacles and by the end of the day they are all overflowing. A lot of it is packaging material and empty bottles, but the majority is just paper. Every prescription that is processed results in some form of discarded paper. There is always some unused portion of the label or receipt as well as backing from labels that gets peeled off and thrown away. The patient information leaflet is often discarded (my diabetic customer who's been coming in for 10 years doesn't need or want the patient info sheet on the 1000th refill of his One Touch Ultra Test Strips. ) But the computer system prints it anyway, and theoretically I'm supposed to provide it, but that's another story. Anyway, I've had people at the cash register pull the medication vial out of the bag and hand everything else back to me and tell me to toss it. If I decide I need to reprint JUST a label for some reason, my crappy computer system reprints everything else too --- receipt, patient leaflet --- which goes right into the trash.

We are supposed to separate 'confidential' stuff (anything with a person's name on it) from other trash but compliance with that is pretty spotty. When you have people filling in at your store who don't normally work there, they don't pay attention to it. And when I see the trash collected at the end of the day I don't see the various containers handled any differently. It all seems to go into the same big bin. I find this worrisome, but to be honest, having a protocol for this is the job of someone with a more important title than me.

Then when I got home today I picked up my own mail from the mailbox. I looked through it, and EVERYTHING went into the recycle bin. There were a couple of credit card applications, some grocery leaflets, some investment prospectus(?) or something, a free magazine that I don't even look at, and a subscription renewal reminder that I already sent in. Some days I just hate all this waste.

If we had a better computer system at work it might help, but don't even get me started on that.

Saturday, October 17, 2009

Naughty and Nice

One of our long-term Oxycontin/Vicodin regulars, who we've long suspected of some funny business (early refills, lots of 'trips out of town', insurance rejects cause it's filled somewhere else, etc.) gets his refills denied by the doctor. Apparently they learned he had been supplementing his prescriptions with some alternate source, or in the words of someone at the doctor's office, "He's been naughty."

"Naughty?" Really. That's a funny way to put it. I really don't understand why some prescribers are so slow to put the hammer down. They accept excuse after excuse from these people. The pharmacy howls and they don't want to hear it. It's not being 'naughty.'
It's WASTING the time of the people who are trying to treat you. It's lying. It's breaking a contract. Maybe I'm not able to look at it from the viewpoint of the medical practitioner, but I don't think 'naughty' is quite the right word. I think "no more prescriptions, buh-bye" at the first sign of trouble, is the way to go. And without guilt, too --- these people want to get it, they'll find a way.

And then there are the 'nice' people. Friday afternoon is full of last-minute calls. A customer calls and asks me to look up some medications he got in the past for excessive sweating. I find Drysol and generic Robinul in his file. He sounds really happy and excited and tells me he has an interview next week and would like to refill them. I tell him the Robinul is out of refills and I can request more from the doctor, if it's still a few days from the interview. He apologizes for the last-minute request, says he'd rather start it right away --- but don't bother, he'll work something out and check to see if he may have some left somewhere. The guy was so nice about it and if he had really pushed I probably would have told him to come in and get a few tablets.

I hope he gets the job, I truly do.

Tuesday, October 13, 2009

Open Enrollment -- That Most Wonderful Time of the Year

My guess is that when open enrollment for benefits rolls around soon, people will be taking an especially close look at their health insurance premiums. This new 'report' paid for by AHIP ("America's Health Insurance Plans" -- totally impartial, I'm sure) warns that insurance rates will skyrocket if the current health reform bill gains momentum. My first thought was, so what else is new? My premiums go up EVERY year. As for prescriptions, my non-formulary copay will be going from $30 to $50. Does anyone look at their premiums for the next year and find they have gone DOWN? Ever??

Now we have both pundits and high government officials on TV constantly throwing numbers around --- for example, Senator Kyl's "We could save 100 billion to 200 billion dollars a year with malpractice tort reform." The individual interviewing that person should have two questions:

1. Which is it, 100 billion or 200 billion? ( That's a fairly big spread there, cowboy.)
and, 2. Quote me your EXACT SOURCE on those numbers.

ANYONE who goes on TV and throws numbers around should be required to specifically quote their source, or just outright admit they made it up. The Daily Show did a brilliant piece on their Oct 12th show on just this topic, and on the lack of diligence by the news media (and CNN in particular) to make people "show their work." Check it out at their website -- I thought it was great.

Saturday, October 3, 2009

Somebody Missed the Memo

Our clinic system is bracing for the big flu outbreak. We are beseiged with memos and e-mails with flu news. We've had tons of people coming in for flu shots. Employee absenteeism has not materialized yet, though. Some areas seem to be heavily into the Tamiflu dispensing and others are not --- when they do get a rush of scripts they are usually for an entire household at a time.

I've been trying to keep my hands washed and foamed and Purell-ed. A lot of the customers use our hand sanitizer, and everyone seems acutely aware of the hygeine issues --- well, almost.

This guy brings a bottle of Tylenol to the register, tells me it's for his wife who is at home with "confirmed" H1N1. He then proceeds to let loose with a rip-roarin' sneeze, and not into his sleeve either. I ducked. I sure hope I was fast enough. Thanks a whole HELL of a lot.

Monday, September 28, 2009

H1N1 is not on my calling plan

OK, so we're at an impasse here --- you can't come up with any insurance information and have decided to annoy everyone who's waiting while you pace around in front of the counter with your cell phone, calling God knows who to demand that information because heaven forbid you should be responsible for having a clue.

Even if there was not a pandemic flu going around, I would issue the same warning:
Do not, I repeat, DO NOT hand me your icky-sticky cell phone and expect me to talk to whoever is on the other end because you "don't understand what I need." Today, I could not think of anything more obnoxious. Ugh.

PS... What I need is your damn card.

Saturday, September 26, 2009

Today it was all about the depression

We get some weird calls in the pharmacy, and I'm sure the calls that come into the nurse triage line are even weirder. One of the nurses calls me and says she has someone on the line who wants to know if he can take "L-E-V-A-T-R-A" instead of Prozac. She is aware that "Levitra" is, of course, for erectile dysfunction -- but, she's just checking if there's something she's missing here, perhaps a misspelling. Well, I guess maybe taking Levitra would assist with depression, but not in quite the same way. We conclude maybe he's thinking of Lexapro.

A customer wants to switch to the brand name of her antidepressant instead of the generic, and has convinced her doctor to write the DAW. Her reason: "I've heard it works better." Her insurance doesn't cover it. I explain that it's unlikely there will be a difference in effectiveness or that the insurance will approve it unless there's some other circumstances involved. She still wants us get the doctor to ask for a prior auth. Awwwww......dammit!.... you know, this is one of the things that makes health care expensive! It is PEOPLE'S TIME. I'm going to fill out a request, send it to the doctor..... his nurse will look at it, amongst a pile of other stuff. She will be obliged to pass it on to the doctor. Then she may have to get on the phone and sit on hold with the insurance. If it even gets that far, someone at the insurance company will have to review it. The doctor will have to fill out some form, faxes will go back and forth.... all because she just 'heard it works better.' And it will probably be denied after all that.

There ought to be a way to bill this woman for everyone's TIME, just like lawyers bill by the hour. As it works now, it's just too easy for people to ask for this nonsense -- it doesn't cost them anything.

Tuesday, September 22, 2009

Hacking through the OTC jungle

Heading into cough/allergy/flu/cold season always brings out the folks navigating the aisles for over-the-counter remedies.

I feel bad for the mom who scours the shelves for some magic elixir to help her kid's (and hers) relentless, sleepless nights. She excitedly brings me a bottle of NEW!!!! Pediaminic Just Fer Kidz Cough/Cold Nighttime So Your Child Can Rest Bubblegum Berry Liquid, and asks me what I think. I hate having to break the news that it's just, well ----- Benadryl.
I don't blame people for being totally confused about OTC stuff, and I can't imagine the money that is wasted because people don't know what they are buying, or that the product is no different from ten other products they already have in their medicine cabinet.

NEW Zyrtec Itchy Eye Drops -- "Nothing Works Better!!"
Well, maybe nothing works better, but there's a whole bunch of stuff that works as well, because it's the same drug. That would be Alaway, Zaditor, Claritin Eye, and probably other stuff I haven't seen yet. But people are genuinely baffled that all these things appear on the shelves next to each other as though there is actually a choice to be made between them. Sometimes I think people believe I'm pulling the wool over their eyes. I guess I am in a way, but if I had the power to dictate what was on our OTC shelves about 75% of that stuff would be gone.

My point is if you ask your pharmacist about an OTC product and they say, "Don't waste your money, get this one," don't be surprised, or suspicious. Just because it's on the shelf doesn't mean it's any good. Very seldom does "NEW" mean new. The FDA only approves certain products for OTC use and to see something genuinely new is rare.

Sunday, September 13, 2009

No real theme to this post

The staffing cutbacks and tightened hours are starting to come back and bite us in the ass. Summer's over, school's in, and it's getting busier. The frenzied feeling, although it's always in the background, is getting more acute. And I am damn tired of being a highly-paid cashier. My technicians are swamped with inputting prescriptions and waiting on people 'dropping off' with all of their usual issues. They don't give us a cashier, so that leaves me to man the 'pick up' window as well as being the final check on prescriptions -- when I get a break from cashiering, that is. Our retail people feel that the more non-pharmacy crap we have to sell, the more profitable we'll be. That makes cashiers like me very busy.

A young man came in and requested a refill on his Claritin (for him, covered by insurance).
We determined that he had gone through 30 Claritin in a week. Obviously a huge misunderstanding on how often he was supposed to take them. Of course there was a language barrier there too. I asked if he felt he had any of the adverse effects mentioned in the Claritin 'overdose' information, and he said no. I advised him to stop the medication for a few days, and then resume at one per day. A little unsettling, though -- what is that expression about closing the barn door after the horse has bolted?

We had a guy who proclaimed he had not been to the doctor for 22 years. He could provide no insurance information but was completely perplexed as to why he had to pay for the prescription when he 'HAS insurance.' He ended up taking the prescription back, I assume to look for another pharmacy that would take his word for it.

People wanted to keep me on the phone for precious, excruciating minutes while they had think-out-loud conversations with themselves.

"Hmm, OK, my prescription's ready to pick up .... how much is it? What are your hours?... Hmm. maybe I could send my cousin to pick it up...Oh no, wait, he works till 7....I have to be somewhere at 3, but maybe I could come on the way there.... you're at the corner of Main and Main, right? Is that near the K-Mart? I used to shop at that K-Mart. I'll probably wait till tomorrow. But, I might decide to come today. I have some other errands to run. Hey, did I order my Albuterol too?"

Please God, just get me off this phone, I'm drowning here.......

On the health care reform front, a writer named Joe Conason had an interesting idea.
Let's yank the federal health insurance from these obstructionist Congressmen and Senators and send them out in to the marketplace to buy their own. Look at some of those people and tell me there aren't some MAJOR pre-existing conditions there. It sure would be an interesting exercise !!

Saturday, September 5, 2009

The Bureaucrats in my Pharmacy

One of the biggest problems with the current health care debate, especially at the 'town hall' level, is that people can't discuss REFORM in an intelligent fashion because they don't understand how the system works right NOW. This was demonstrated early on by the people on Uncle Sam's Medicare who nevertheless are screaming against government-run health care.

The idea of "No bureaucrats standing between me and my doctor" gives all us pharmacists a chuckle because we spend a large portion of our time trying to dance around insurance company rules, restrictions and formularies when trying to fill prescriptions. I can only imagine what it's like on the doctor's side of things with treatments, procedures, diagnostic tests, etc. but I'm sure it is similar.

So I am dispensing a 3-week prescription for Cefuroxime. This is an expensive prescription, costing hundreds of dollars. In talking to the customer, I learn that it is for possible Lyme disease -- he says they're not 'sure' if he has a bug bite, but they're 'not going to take any chances and just treat for it.'

Well, sounds a little thin to me, especially with a drug this expensive, but OK. Now surprisingly, the guy has a reasonable co-pay, but what if his copay was really high and he balked? And if I called the doctor and got it changed to doxycycline (far less expensive but still totally effective)? And keep in mind we don't even know if he's got Lyme disease. So is it bureaucratic interference that the doctor had to change his prescription because of the insurance company's high copay to the patient? Well, I don't think so. It is an effort to contain costs. We have two drugs that will do the same thing, one expensive and one not, so we are going to use the cheaper one first. Pharmacists see this ALL THE TIME.

People want lower costs, lower premiums and lower copays. But there's a certain contingent who don't want that to interfere with their God-given Consitutional rights to get whatever they want. Guess what? --- the only people who get whatever they want are the ones who pay straight-up cold, hard cash or whose insurance plan covers EVERYTHING. I don't think there are too many of those people, though.

I am not sticking up for the insurance industry. When they don't have to pay hundreds of dollars for cefuroxime they should pass that savings on to somebody. I just don't think people realize this is the way it works NOW. Your insurance doesn't cover a drug, so we call the doctor and 95% of the time he changes the prescription to something else in the same drug class, that is covered on the insurance formulary, and does the same thing. Obama tried to touch on this in his "red pill, blue pill" analogy, but you can sense the skepticism --- people get the impression this is some sort of rationing, or substandard care.

Is there a parallel universe I don't know about that doesn't have bureaucrats? I guess people believe that government bureaucrats (with their reputation for waste and inefficiency) are worse than private-insurance bureaucrats (whose goal is making a profit and finding a way to NOT pay your claim). Is that it?

It seems to me it's just a given. There's ALWAYS someone standing between me and my doctor. That would be whoever is paying the bill.

Sunday, August 30, 2009

Small Victories

For people who deal with the public, cell phones are the bane of our existence. Just when you think you've seen the height of rudeness with those things, someone goes one better ---- even with all the talk about cell phone etiquette, I'm standing in line to pay for a clothing purchase the other day and watched while everyone in line AND the sales clerk stood and waited while the woman at the counter took a cell phone call.

That's why I cherish the small victories so much. It's a little strategy game I like to play.
A woman brings a couple of prescriptions in yesterday and wants no interaction with us other than "How long will it TAKE??" She sits down and starts yapping loudly on her cell phone, recounting every detail of her day so far as well as details of the doctor's appointment that we would rather not hear. In other words, unimportant blabbing. This is NOT a vital conversation, and SHE initiated it.

So her prescriptions are ready and I call her name. She looks right at me, and gives me the one-finger "hold on a minute I-can't-come-up-there-cause-I'm-on-the-phone" salute.

No. This is a non-starter, of course. I put her stuff down and walk away to continue my very busy pile of work. Just then a little old lady comes in to pick up some prescriptions, and to my total delight, settles in to ask about a thousand questions and recount a litany of problems that she had last month with some hip surgery. I was delighted because Miss Cell Phone has now finished her call and is shifting her weight impatiently and looking sour-pussed behind my little old lady, who I take LOTS of extra time with, move just a little slower with, ask if she's got ANY more questions, and chat a little about the weather and what she's doing on the weekend.

You lost your place in line, Miss Cell Phone, and I'm gonna take my SWEET time gettin' back to ya !!

That'll teach you ----- oh, who am I kidding, of course it won't.....

Tuesday, August 25, 2009

Let's Save Some Money!

I was struggling to open a bottle the other day and ripped off the quadrillion-folded glued-on little package insert that came stuck to it, as I often do. A while back I remember reading that the cost to the drug company of printing, processing and attaching these little manufacturers' drug information inserts to each bottle is phenomenal ---- I don't remember the exact figure but I was really amazed by it. I also thought there was talk of discontinuing these things to the tune of millions in savings, since all this information is accessible on-line, on handheld devices or yes, -- the ol' PDR.

I'm not sure if this is still in the works, but it seems like a great way to save money and decrease waste. How often does anyone look at these things? I can't say I've never painstakingly unfolded one, put on the 18x magnifying lenses and searched whether or not it contains red dye #2, but whenever I do it's kind of a last resort. My main concern is that the patient has the instructions for use, as for an inhaler, or (if I'm really on top of things) a Med Guide --- but these things are usually separate anyway.

I bet if the drug companies did away with those things AND direct-to-consumer advertising, they might just be able to lower the prices on a few of their products.

And while we're at it, I don't need the bottle of tablets to come inside a little box, too. I bet those little boxes cost money to make...

Wednesday, August 19, 2009

Side by Side Effects

I have actually had people pick up prescriptions and say, "Now, this doesn't have any side effects, right?" Where the heck would someone get that idea? Obviously, anything one puts down the gullet has the potential for side effects, I tell them, although I try not to be too harsh about it because they were so bright-eyed and hopeful......

People often ask about side effects from their prescriptions. Usually they call on the phone when we are extremely busy and want to to launch into a fairly long description/ timeline of what they're having and when they have it. To me, it doesn't matter if the side effect shows up anywhere in the fine print of the package insert, Micromedex, or anywhere else --- my rule of thumb is 'proximity'.

So if someone calls and says, "I just started atenolol 4 days ago. Today I feel like the end of my nose is burning and my toenails are all of a sudden growing really fast. Is that a side effect of atenolol?" My response pretty much has to be, "Well, if there have been no other changes in your medications, diet, lifestyle, laundry detergent or general environment, I guess we can't rule it out."

And really we can't, even though I could never produce a shred of documentation to support it. It goes under "anecdotal."

I think about this as we're asked to make sure the latest FDA warning goes on all our prescriptions, either on the bottle or in the patient leaflet:

"Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088."

Boy, they may want to re-think that. Or hire some more FDA operators darn quick.

Saturday, August 15, 2009

Pharmacy Graffiti 4 Ever

On my way to work I drive past an old mill with a large warehouse and usually some boxcars sitting along side it. It's a place that's ripe for the graffiti artists. The other day I noticed spray-painted high up on one of the buildings "I Love Xanax".

I'm waiting for someone to come along and add "DAW."

Wednesday, August 12, 2009

Pharmacy Funnies

Thanks to the commenter who sent me this link to his web series pilot called "Hard to Swallow".
It's a 6-minute video about life at "Sunland Pharmacy". Funny! Check it out at:

Tuesday, August 11, 2009

Bursting the Bubble

We spend so much time in the pharmacy 'bubble' that it helps to be reminded we're not alone. While waiting in the optometrist's office today I overheard all of the following going on at the reception desk:

-- People without their insurance cards
-- People who were 1/2 hour late for their appointment and wanting to "still get in."
-- People who were completely OUT of contacts and needed the receptionist to come up
with some for them.
-- People bitching about prices.
-- People bitching about their insurance.
-- People who needed everyone to hurry up for them because they were on the way to

Ahh, healthcare. It's everywhere you wanna be.

Friday, August 7, 2009

The Perils of Slowness

We had about a day and a half this week that was super slow --- summer time, vacations, whatever the reason. In all my time in pharmacy I've always found it funny that some of the same staff who complain about being stressed out and swamped all the time will turn around on a dime and complain bitterly when it's suddenly too slow. I can certainly handle a slow day -- heck, take advantage of it, cause you know it isn't going to last. If nothing else, I feel we can use the time to clean up the pigsty around us.

But pharmacy workers are hard-wired to be running like crazy. The good ones can be kind of a restless bunch. It's a strange phenomenon on a slow day to watch some of your co-workers become disoriented and sluggish. It's like everyone loses their edge, or gets out of the rhythm, or something. And I find more errors than normal on the few prescriptions I do check.

The final indignity after a slow day is coming in the next morning and finding that no one sent the drug order.

Sheesshhh...... it's like we're all on crack and somebody took the pipe away for a day!

Saturday, August 1, 2009

Sometimes It's Just Not Worth Arguing

We filled an Albuterol HFA inhaler today and we had to select one brand (Proair HFA) over another because the patient's insurance only covered that one. While being rung up she protested that she didn't want Proair, she specifically wanted Ventolin HFA because she has a gluten allergy and needed to get away from all gluten-containing products. The Proair apparently caused some sort of facial swelling or other reaction of some sort.

Now, I'm no expert in this area but my inspection of the package insert revealed that the inhaler contains albuterol, propellant and "no other excipients". I seriously don't think there could be anything gluten related in there. But this customer was so insistent and so positive this reaction was connected, she wanted us to request a prior auth. for the Ventolin. And observing a long line of impatient people forming behind her I thought sure, go for it.....

Reminded me of the guy who wanted a refund on his Erythromycin after one dose because it upset his stomach. After our negative response to that, he declared he was going to call his insurance company to get that copay back. Sure, go for it!

Sometimes, you just have to punt.

Wednesday, July 29, 2009

One for ALL and ALL for one

OK, valued customer, you've just come out of your doctor's appointment and are feeling really guilty that you haven't taken any of the medications you have been prescribed. Perhaps the doctor or nurse scolded you, or you just feel bad about lying to them. So you come over to me and say, "I need refills on all my meds."

Every pharmacist out there can say it with me: "OK, which ones would you like us to fill?" And we all know the answer, and it will include one or all of the following:
" I don't know the names of them."
" I don't know how many there are."
"Just whatever I got last time."
"It should be in my records."
"I might have filled some of them at Walmart."

We pharmacists get really crabby with this. We don't like to play guessing games. And we've ALL been burned on this too many times. Same story with "Can you transfer all my meds from (other pharmacy)?" We spend all kinds of precious time pulling everything together only to find that you just wanted the Ambien. People have no idea how time consuming this is --- they figure we'll just put together a grab bag of stuff and they can figure it out later, no big deal. And we keep trying to make people understand that knowing what medications you are on is not just for our convenience, it's for your own SAFETY.

And don't even TRY bringing it back to me for a refund saying "I didn't order this."

Saturday, July 25, 2009

aWash in OxyContin

This past week I worked in one of my usual pharmacy locations -- a nice area, nice clinic. I could not BELIEVE how many C-2's we blew through on this one day. Percocet, oxycodone, MS Contin and Oxycontin by the shovel full. In fact we blew through our entire stock of one strength of Oxycontin and all of our oxycodone 5's.

In no way am I suggesting there are people who don't need these medications to have a reasonable quality of life. But I gotta believe the prescribing of Oxycontin has gotten way out of hand. We are forced to increase our stock more and more and it becomes a safety issue considering it's the target of so many pharmacy robberies.

I recall when Oxycontin first came out, and it was clear that it was heavy stuff. It was no trivial pain med and would probably be mainly for people towards the end of life with intractable pain who would otherwise be in the hospital getting a continuous IV drip. This oral form of the drug might help them remain at home and productive --- a good thing. I went back and reviewed the package insert the other day and was surprised to read it is indicated for "moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period of time."

MODERATE pain ???? Seriously? And how do we define "extended" period of time?
I'm dispensing this drug all the time to young people -- people with migraines, back pain, knee pain, post-op pain --- all things that it clearly wasn't intended for. Again, I know medicine isn't black and white and every situation's different. But knowing the med history of many of my customers I am often stunned when they present the first Oxycontin script. I want to ask them if they really want to go down that road. What's the long-term plan here?

The other thing that disturbed me that day was walking into the pharmacy and seeing a pad of $60 coupons for Oxycontin! Wow, coupons for a C-2. I honestly don't recall ever seeing that before. Cripes, that's all we need.

And still another thing occurred the day before where (due to a lack of diligence) we allowed someone to pay cash for their Oxycontin script. The whole thing was fishy from the beginning and to make a long story short, we realized we got scammed.....

I'm kind of tired of it, as all pharmacists get tired of being the police. But the damn drug is so out there, and we're ordering bottles and bottles and bottles...............

And please, no coupons.

Sunday, July 19, 2009

I Prefer My Doughnuts with Sprinkles

Customers are always asking us why their copay is what it is. Some people are downright snotty about it and those are the ones I like to give the 'right-back-atcha' answer -- "well gosh, it's YOUR insurance plan that sets the copay" -- which, also happens to be the only correct answer. But when someone claims their copays are hugely different from last time, I'll try to go to the trouble of looking up what they paid last time, because we all know that someone who claims their copays are totally different probably paid exactly the same amount last month, and I figure if I'm lucky I can confirm that, shut them up and move on to the next person.

I was a little slow this week in realizing that a couple of our customers whose copays went through the roof have hit the doughnut hole (or "coverage gap" in the proper terminology of Medicare Part D). One guy even TOLD me he was in the doughnut hole, but only after I had spent precious time looking up his old prices and making sure we hadn't submitted the claims wrong. So he KNEW he was there but didn't seem to know what that meant ----totally wide-eyed and flabbergasted at his new prices (total: hundreds of dollars, which I know he does not have). The guy just stood there for several minutes and literally didn't know what to do. We have another customer who I noticed has a small bag of meds to pick up and a price tag of over $1000 smacked on the front. I really hope I don't have to ring that one up.

Well, now I will clue in a little faster when this comes up again. It's wicked, though. One more example of how your pharmacist gets to deliver the bad news.

Monday, July 13, 2009

Memories of Drug Reps Gone By

I guess I've been around long enough to remember when the same drug reps used to drop in at least once a month. Some years ago I even remember the Tylenol (!) guy dropping in regularly with a satchel full of samples for us (ah, those were the days....) not to mention other stuff, edible and otherwise. Some of these drug reps were real characters. A visit from them broke up the tedium of the day.

What I miss more is the information these hardy veterans could provide. They knew their products inside and out. Especially the devices like the inhalers, sprays, patches, self-injecting devices, test kits, etc. They could give you really practical information to show the customers and help them trouble-shoot problems. And if they couldn't answer a question they would actually make an attempt to get back to you. Don't get me wrong, I know their main goal was to sell stuff, but some of them actually seemed like they wanted to help.

We don't see too many drup reps these days. I guess it's kind of a dying profession, since (a) their access is being cut off, and (b) the companies they work for aren't really coming out with anything 'new' anymore. We saw one a few weeks ago who promised to get back to us on a question we had, and never did. I e-mailed the address on the business card --- no response. That just kind of bugs me. You don't know who to call anymore and if you leave a message no one returns it. They'll throw a bunch of coupons at you for some hideously expensive product, and pump you for information about your doctors' prescribing habits, but they don't seem to know much about their products in any sort of practical sense.

Anyway, I'll keep trying to find out why the package says not to use your Ventolin HFA inhaler for longer than 6 months after taking it out of the pouch. Or whether you can use the 4mg Imitrex injection cartridges with the same auto-injector device as the 6mg. Or how I can replace my broken Diskus demonstrator so I can attempt to show people how to use their Advair and Serevent.

Just feeling nostalgic today.....

Sunday, July 5, 2009

WORK with me here !!

Trying to close the pharmacy before a holiday is always a daunting task. About 10 minutes before closing a woman calls up and tells me she's trying to make it in to pick up her refills but the traffic is terrible and there's road construction along the way. She tells me where she is, and I know she's at least 20 minutes away on a good day. She launches into a fairly long whine about how our hours make it hard for her to get there and why were the hours changed (especially when there's so much road work this summer)?
I tell her I am sorry, but the hours had to be changed for financial reasons and in fact some people lost their jobs entirely. She is thoroughly wound up and all I can think of is the accident that's waiting to happen with this woman on her cell phone racing through construction on the interstate.

So I launch into the list of possible alternatives here.

1. We'll be open again at 8am tomorrow.
Answer: No, I can't get back there tomorrow and I need to pick it up tonight.

2. I can transfer the prescriptions to (chain pharmacy) that has later hours so you can
pick it up there.
Answer: No, I don't like them. I'd rather keep it with your pharmacy.

3. I can transfer the prescriptions to another one of our pharmacies that's closer to the area where you work so you don't have to race over here.
Answer: No, I don't like going there, it's too hard to park and the traffic's even busier.

4. I can mail you the prescriptions -- no mailing fee.
Answer: How do I pay for them then? Give you my credit card number? NO, I don't want to do that, it's not secure.

At this point, I really think she thought if she could just keep me on the phone long enough, she would force me to stay open till she got there. What am I supposed to do for you, lady ??? I feel for you, I really do, but I've been here for 9+ hours and I want to go home and sit down. Do you do this type of thing to other businesses too? Do they even give you the time of day? I feel like I'm trying to negotiate with a 2 year old!

Tuesday, June 30, 2009

Michael Jackson and Respiratory Depression

Darn, those tapes of the Jackson 5 are cute, and I really liked "Off the Wall" and "Thriller." The guy really was talented, especially when you look at him in his pre-surgical prime and put him next to the fake pop stars of today.

But as soon as you heard that he was found 'not breathing' you knew, right? Prescription painkillers, narcotics --- how many times can you say "side effects include respiratory depression?" You take too much, your breathing slows down and then it stops. Unless someone's standing by with a syringe of Narcan or a respirator, you're in big trouble. It happened to Heath Ledger, Anna Nicole Smith (and probably her son), Elvis, Marilyn Monroe, Lenny Bruce, etc. ---- it's a loooong list. It happened to a kid in my neighborhood. There are lots of celebrities who have died as a result of illegal drug use, but the 'prescription' drug deaths always catch my interest, cause I want to hear what did it.

I have customers who I worry aren't going to wake up one day. And these are people who, as far as I can tell, are playing by the rules. They don't have multiple doctors or an entourage of enablers. So I can only imagine the precarious position of those that do.
There is speculation that Michael Jackson was on Oxycontin. I see prescriptions for Oxycontin all the time and wonder, as I look at the customer, what the HELL do you need this for? I know for a fact you don't have terminal cancer pain. So.....????? We had a surgeon who had pre-printed postop knee replacement orders for Vicodin, Celebrex (which was never covered) and OXYCONTIN!!! It's a bunch of crap. I see the FDA is getting all wound up about acetaminophen overdose right now. Maybe all these prescription narcotics that we shovel out the door every day could get some attention too.

Don't get me wrong; I'm not trying to take it away from the people who need it. It's just so maddening to see these (young) celebrities who have punished their bodies go out and find a Dr. Feelgood to prescribe something that's so frikkin' dangerous, and end up dead. There will be another one soon, no doubt.

On a lighter note, I got to vacation in California last week (land of the celebrity?). Just let me say, I have learned that there is no swimsuit on God's green earth that should be advertised as 'slimming.' This is the most unforgiving garment in existence. I have been schooled.

Wednesday, June 17, 2009

Go Ahead, Ask Me Why

Did you ever fill prescriptions for a customer who WORKS for the very insurance company you are billing, and argues with you about the copay? This guy today is telling me how the copays are wrong and proceeds to explain some complicated formula of how they are supposed to come out. I also had a guy get mad because the insurance company (that his wife works for) didn't cover his Golytely. Of course both these individuals decided to launch into their little discourse right at closing time.

....... the hell???? You guys know darn well that the prescription is billed online and your company's computer tells us how much to charge you. Why is it such-and-such a copay? ----

I dunno, YOU tell ME !!!

Monday, June 15, 2009

Care for a Sample?

A family friend (already on metformin) recently visited his doctor for high blood sugars and got put on an expensive, brand name medication (Janumet) which I view as being completely inappropriate at this stage in his initial treatment. To my simple mind, the prescriber seems to have leapfrogged over several other steps in the algorithm for Type 2 diabetes treatment.

I was curious and asked him if he'd filled the prescription yet, and how much it had cost. "Oh, I didn't fill it yet" he said, "the doctor gave me a whole bunch of samples, so I'm good for a while."

Damn, that irritates me. Does the doctor (who I know is kind of an old-timer) just pick this drug because he's got a bunch of samples to unload? Makes him look like a nice guy to give free drugs to this elderly patient? And what happens when the samples run out and the patient goes to fill the prescription? Yep, you got it ---- the duty falls to a pharmacist like you or me to break the bad news ---- either it's not covered at all, or the copay is astronomical.

This friend lives in a different part of the country than I do. The clinic system I work in, with very few exceptions, no longer accepts samples. I can remember a few times in the past where physician samples occasionally came in handy --- like, for someone who couldn't pay for a prescription, or lost it, or spilled it, etc. --- kind of a one-time deal. And I can honestly see where a physician might want to give a patient something to 'try', without committing them to a full month's supply of a medication. But it became too much of a hassle to document the dispensing of samples and of course the accepting of gifts and samples from drug companies is now being reined in. I can remember sifting through PILES of samples in an out-patient clinic where I used to work, checking for outdates and looking at drugs I'd never even heard of !

Now we're not supposed to have ANYTHING, even behind the pharmacy counter, with a drug company logo on it. But I don't have a sense if there are certain areas or independent practitioners out there who still readily accept these.

I actually don't think that these things affect the prescribing habits of a doctor who really knows his/her stuff. Any more than having a beautiful "Airborne" travel thermos would ever make me recommend the stuff to anyone.

But this incident with my friend's diabetes treatment was, shall we say, disappointing.

Monday, June 8, 2009

Crazy Talkin' with Oprah

I was pleasantly surprised to read this week's Newsweek article entitled "Crazy Talk: Oprah, Wacky Cures and You". The article discusses how Oprah, wielding considerable influence with her talk show, often features health, beauty and medical topics; unfortunately she doesn't always feature credible people to discuss these topics (for example, the actress Suzanne Somers, who apparently takes 60 supplements daily including 'bioidentical hormones" and does some pretty crazy stuff ). The gist of the article as Newsweek suggests, is that "some experts offer useful information. Others gush nonsense. Oprah can't seem to tell the difference." And for the many daily viewers of Oprah, this can be hazardous to their health.

I'm no medical genius, but I have a little more background than the average person. I love the arts, but my training was in the sciences. I have a really low tolerance for 'experts' on TV who babble stuff that is totally nonsensical from a scientific standpoint. I truly believe our country will be left in the dust if we don't start doing more than paying lip service to the need for more math and science training. I wish that shows like Oprah (or the science and health segments of cable news) would really spend a little more time with the actual doctors, researchers and scientists who study these subjects. But of course the problem is those people aren't the pretty people. They don't do sound bites. They would need time to explain the background information to viewers. And that's boooo--riiing -- we'd rather listen to the pop culture folks who entice us with suggestions we can cure our psoriasis by thinking positively. Sure, a good attitude helps and a good overall state of health helps, but what people really need is to be educated about their illness with solid scientific information.

And I love how these people call themselves "Dr." Whatever. Dr. Phil is NOT a doctor.
Dr. Drew is NOT a doctor. Which is not to say you can still be an actual doctor and not be a little loopy (sorry Dr. Grumpy, I don't mean you.) Check out this tidbit from the website of one of Oprah's frequent guests, Christiane Northrup, M.D. , as mentioned in Newsweek:

"In many women thyroid dysfunction develops because of an energy blockage in the throat region, the result of a lifetime of "swallowing" words one is aching to say. In the name of preserving harmony, or because these women have learned to live as relatively helpless members of their families or social groups, they have learned to stifle their self-expression."

WTF ??????? How do you think your professor would have graded that answer on your endocrinology unit? Energy blockage?

No, I'm sorry. That is NOT what causes thyroid dysfunction.

But Oprah's got a big platform, and if she's got no one there to challenge that then we've got a long way to go. I was glad to see a news magazine shine a light on this subject.

Thursday, June 4, 2009

More Fun with Electronic Prescribing

We send a refill request to Dr. XYZ for a patient's medication and get back a faxed note which reads, "NEVER seen by Dr. XYZ'--- please send to primary care doctor."
We retrieve the hard copy which unmistakably shows "Electronically signed by Dr. XYZ".
We send BACK the refill request and attach a copy of the previous prescription, highlighting the 'Dr. XYZ' part on it, almost like you'd do for someone who has trouble reading. We have NO time for this, but we must do it anyway.

Later in the day we get a new prescripton from Dr. XYZ for the medication we requested.

This happened not once today, but three times.

Something is not working here. It's not like Dr. XYZ pulled a prescription pad out of his pocket, scribbled it out and slipped it to the patient. The thing is computer-generated, saved, archived --- there's a TRAIL here. It's in the electronic medical record, isn't it?

Just another reminder that the system is only as good as the humans using it. And today they weren't paying attention.

Saturday, May 30, 2009

Being Tired

After our organization went through some reorganizing and layoffs, I have this sense of dread as we move into the 'implementation' phase, which basically means doing the same with less. Less staff, less hours -- only thing is, I haven't detected less workload or customer traffic. Urgent Care Pharmacy on Memorial Day was totally insane. And we're still trying to figure out why certain people were cut back or let go and others (perhaps more deserving of the axe) were kept on or absorbed elsewhere in the system. Most definitely there were people who were eliminated not because their jobs were non-essential but because they could be replaced with 'cheaper' employees. In some cases one person has been replaced by two or three newer but less expensive replacements. I know that's the cold reality but it doesn't make it any easier to swallow.

So man, was I tired this week for some reason. You know the kind of tired where you feel like you are underwater? You can't even think straight? Your eyeballs are suspended somewhere on top of your head? You get home and it's a chore to remain standing at the stove while you make something to eat? Then you go to bed and you can't sleep while you replay some silly thing that happened that day.

I know that customers will expect everything to work the same as it always has, and we'll probably get complaints. Unfortunately, the people who made those staffing cuts won't be around to hear those. I'm hoping for the best but fearing the worst...

I was in my local Wal-Mart today and they recently remodelled the store and the pharmacy. Over the new pharmacy hangs this HUGE sign:

1. Call it in.
2. Use our website.

I mean, it was a really big sign. I don't have any special feelings for Wal-Mart, but I must admit I like that. CALL IT IN. CALL IT IN. CALL IT IN. Oh Lord, if we could only get them to CALL IT IN.

I wonder if they would make me a sign, too.

Sunday, May 24, 2009

This Made Me Want to Cross my Arms

Yesterday I had a woman come in with a question about breastfeeding while she was on an antibiotic. As I was trying to focus on her question I was also trying to keep an eye on a wild 2-ish year old kid who was in the process of tearing up my OTC shelves. As the woman eventually nodded toward this same child during her questioning I came to the realization that the kid she was breastfeeding was this wild 2-ish year old kid who was in the process of tearing up my OTC shelves. She didn't seem to believe my answer to her question (that breastfeeding in this antibiotic situation was OK). Gosh, I wanted to say, maybe you should think about calling it quits with the breastfeeding.

This kid was 2 years old. Wild. With teeth.
People sure are......funny....

PS: Mom. I find it neither cute nor funny when your little kid stands there with a big smile on his/her face while they pick up and shake the crap out of every bottle of tablets out there. The eventual buyer will find the tablets broken and crumbled and they will return them and I will throw them out. Thanks for that. I am not running a playroom.

Thursday, May 21, 2009

Would Someone Tell Me What Just Happened?

Wait a minute, weather's getting nice, everythings greening up -- we're sliding into the lazy, laid back summer days. Why was today so frikkin' chaotic? What's going on?

We were shovelling out grocery bags full of prescriptions. People were throwing empty bottles at us like it was a shooting gallery. They were coming in asking to refill prescriptions with us because their insurance was telling them 'too soon' somewhere else (and they just didn't GET why we couldn't fill it either.) Issue after issue after issue.

The printers went down. The fax machine was acting up. The computer system went down (when it wasn't freezing up, that is).

Somebody tried to call in a fake clonazepam script. Twice. They were so inept I actually enjoyed it. Just for fun I asked for the doctor's DEA number and the person covered the receiver with his hand and hollered to someone in the next room ! Oh. Mah. God.

Everyone else must have been having the same kind of day because all the pharmacists I gave copies to were kind of crabby. I totally understand, but when I ask you where I'm transferring the script to, the answer "Walgreens" followed by stony silence isn't quite enough info. You know the drill.

It was just a cast of crazies today. I didn't even check how many prescriptions we did, but I'm sure it felt like double whatever it was....

Sunday, May 17, 2009

Pet Peeves (Contd.), or Silence Can Be Golden

I think I'm pretty good at multi-tasking. You have to be, to survive in a retail pharmacy setting. However, when I'm up to my neck in prescriptions to check or just buried under a list of things to do or people to get back to, the one thing I cannot do is keep up a steady stream of chit-chat. I have some great conversations at work with people, but they have to take place in a relatively 'down' time. I've been in pharmacy long enough to know that when I am distracted by someone talking continuously to me I will make a mistake or miss something.
I know this about myself from experience --- I'll check something or go through a process with someone yapping at me, finish it, but something nags at me and I'll go look at it again, and dammit, I did miss something. And it makes me really mad at myself.

So at the risk of being considered somewhat 'quiet' or not a lot of 'fun', this is the way I have to work. When there's nothing going on, I'm glad to chat. But when things are chaotic I get really irritated by people who just won't shut up for a few minutes, put their heads down and get it DONE. I swear there are times when I wish I had one of those air-horns to stop the din. And then there's always the person who insists on talking or laughing really loudly right next to you when you're on the phone. I clamp my hand over my ear and duck down and they still don't get the message.

I don't think customers necessarily want to see the pharmacy staff all talking at once and yukking it up behind the counter, especially about stuff that obviously isn't work related.
There's plenty of time for that when people are out of earshot.

Thank God we don't have the Muzak -- I'd probably go completely crazy.

Friday, May 15, 2009

Riding the Roller Coaster

Haven't been able to pull together a blog post for a few days because I'm just beat up and tired. Not for the usual reasons (relentless phones, customers and problems in the relentless world of pharmacy) but because with only a few days' warning we went through some staff reductions and other cuts to improve our organization's financial outlook. Suffice it to say that rumors flew, tears were shed, some overdue decisions were made, and some head-scratchingly puzzling decisions were made. I've never been through anything exactly like that before -- the secrecy is intimidating and kind of weird (like what do they think we're going to do, set the place on fire?) Yes, there was some dead weight that was shed, and there were also some good people who won't have health insurance for much longer. I survived, but I can sure identify more with what's going on all around the country now.

There was so much uncertainty that I was playing out all the scenarios in my head. Right now the Classifieds aren't full of the usual pharmacy jobs, not because there isn't a need but because many companies have hiring freezes. Where would I go? I don't want to work in hospital again, and all of the pharmacists I work with who've come from the big chains say "Stay far, FAR away", unless you luck out with one good store and a really good staff.
It was an interesting exercise for me but I'm glad I didn't have to follow through on it.
Not yet, at least. But having the same workload with fewer people is going to be... interesting.

I do know that some of my co-workers were terrified of losing health coverage for themselves or their kids. That is something we've GOT to change -- health care shouldn't be a matter of being 'lucky' to have a job. That roller coaster's gotta stop...... I felt that way before and I'm sure of it now!

Friday, May 8, 2009

Dentists Do the Funniest Things

Several prescriptions from a dentist "post-procedure". One is for 10 capsules of Celebrex (!).
Patient is on state assistance, and Celebrex is not covered. We call the dental office and they tell us they would be glad to switch it to something else, but the patient actually requested Celebrex because it worked well in the past.

The age of the patient: 17.

God, that's so ADORABLE !!

Full moon tomorrow !!!

Saturday, May 2, 2009

Dress Rehearsal at the Purell Theater

Thankfully I've never had the need for Prozac, but I have heard people describe its effects as little 'electrical zaps' bouncing around your brain. That's how I have felt lately -- maybe it's the long winter and the Spring that just won't quite spring (cold and rainy then warm and windy then back again). My body doesn't seem to know where to set the thermostat. I seem to wake up at night with my mind racing with worry, but of course in the morning everything seems fine. I had a couple of days off when the whole swine flu thing broke and didn't know quite what I would walk into at work.

So I went in, splashed alcohol on every available public surface and scraped up one bottle of Purell hand sanitizer to buy for myself. (My nearest Walgreens had not one on the shelf.) I pulled the first e-prescription off the printer:

Tobradex ophthalmic ointment, 5-10 applications three times daily as needed.

Well, thank God for normalcy.

Surprisingly, I had only one man ask about buying Tamiflu. The news outlets reporting that there's a 'run' on it seem to convey the impression you just walk into the pharmacy and buy it. My community newspaper reported that the 'deadly' virus had been found in our state. Huh? --- I'm not sure we can call it 'deadly' just yet, at least no more than the regular flu virus which does result in deaths every year and always has.

Hopefully this thing won't turn out to be as serious as we feared, but I guess this has been a good dress rehearsal for what is bound to be a repeat performance. It's kind of sobering to see how those well-stocked store shelves we all take for granted can become bare at the first sign of an emergency, or a perceived one. Once this thing passes I hope people will think about their emergency preparedness and put aside a box of masks, disinfectants and other items that they would need should normal 'public' life be interrupted for awhile. I hope it never happens, but it does make sense.

OK, now back to the Tobradex guy.......

Friday, April 24, 2009

E-Prescriptions: Great Advance or Big Ol' Crutch?

Computer-generated, flawlessly legible prescription for a topical steroid lotion ----
Rinse mouth twice daily.
Entered, prepared by my technician and presented to me for the final check. Of course, there's something wrong here. The doctor is called and seems flabbergasted: "But the directions just popped up like that! Can you get someone to fix that?"

Oh, no problem then... if the directions just "pop up" (which I seriously doubt) then that completely absolves you of any responsibility to actually READ what is on this prescription you are sending to the pharmacy.

Later, another e-prescription for Cefzil. Helpfully listed on one corner of the prescription are the patient's drug allergies/"adverse drug reactions": CEPHALOSPORINS.
Patient confirms this was an honest-to-goodness allergy, producing hives.
Again, the doctor wails, "Why didn't it (ie., a warning) pop up when I entered it?"

So apparently this prescriber's practice is governed by the "pop-up." I cannot convey my irritation at having to sit on the phone and track down someone, anyone, to clarify these prescriptions. COMPLETE waste of my time. I still wonder if these electronic prescriptions are worth it when prescribers don't check it for accuracy and don't know how to customize it or alter the directions so they make some kind of sense. Please, PLEASE read the thing. Just because it comes out of a computer doesn't mean it's perfect.

I really don't want to bring back those horrific hand-written prescriptions, but some days I just have to wonder.

Saturday, April 18, 2009

The Most Excellent Doctor's Appointment

In my work setting, a lot of the patients we see are coming right out of their doctor's appointment -- as in, across the hall right into the pharmacy, with their prescription in hand or having been transmitted to us electronically. As I am handing the prescriptions over and giving the appropriate spiel, I can tell immediately whether I can rate that doctor's appointment as a SUCCESS or as a FAILURE.

SUCCESS: The patient has a basic idea of what they are getting and why. They can confirm that what I am telling them matches what their doctor said. They know how long to take it for and when (or if) they need to see the doctor again. They may have a handwritten note from the doctor with some of these things jotted down. If the prescription is a device (like an inhaler or Epi-Pen) they may have even been shown how to use it or watched a video. Beautiful.

FAILURE: "What did he give me?" Total deer-in-the-headlights look. "Why did he give me X when I thought he was giving me Y?" "No, I don't know which of those 3 creams goes where." (and the prescriptions don't say either)... "No, they didn't say how long to keep using it." "What am I supposed to do if I don't feel better after 3 (7,10) days?"
"Am I supposed to keep taking my other blood pressure medicine with this one?" "Am I only supposed to use it if I need it, or all the time?" "He told me to get some Vitamin B52.... do you have that?" And so on.

I might be able to take a stab at some of these questions, but I really cannot answer (legally or practically) for the prescriber. What I would really like to do is tell the person to march back over to the office and have a 're-do' of the whole thing. But more often I am obligated to get on the phone and pull the doctor or nurse out and ask them what this person is supposed to DO who was just sitting in their office ACROSS from the doctor, not FIVE MINUTES AGO. Annoys the crap out of me when I am up to my eyeballs in prescriptions.

Now I know there are lots of people who are given perfectly good instructions who just don't listen. It goes in one ear and out the other -- they're nervous, preoccupied, whatever.
But I also think that some people do get the bum's rush out of the doctor's office and just aren't given clear instructions, and I have experienced it myself even though I know what questions to ask. And the doctor may be really nice and all, but sometimes they are TOO casual -- I mean, you really gotta spell it out. We pharmacists have to tell people the same things over and over and it's tedious and routine, but part of being a 'professional' is just doing it. It's like doing the same Broadway play for 9 performances a week.

My "Good Doctor" will:
1. Tell you what he thinks is wrong with you.
2. Tell you what he plans to do about it.
3. Tell you what will happen if it doesn't work and exactly when to come back.
4. Write it down if necessary.

That way I can concentrate on doing my part of the job. Excellent......!!

Tuesday, April 14, 2009

Sorry, but Appearance Matters

In pharmacy you have to be very detail-oriented. You've got to notice the small things. You've got to catch the one little out-of-whack thing that sticks out in a huge pile of repetitive, routine and otherwise unremarkable tasks. Anyone who works in a dispensing pharmacy has to accept this and be prepared for it -- there's no way around it.

How do you get someone to 'care' about their work?

By 'work', I don't mean correctness of the actual prescription - that's my responsibility to sign off on. But along the road to a finished prescription I sometimes get frustrated by the lack of attention to details that may not affect the final product but still indicate someone who just doesn't care enough to pay attention.

Like, for instance, the label that is slapped on cockeyed on the bottle. Okay, it won't kill anybody -- but it looks crappy and some of the more observant customers might wonder if the person preparing it took the right amount of time with everything else. Appearances matter -- to me anyway. Same if the customer's name is mispelled or their address is incomplete. I've checked prescriptions that are to be mailed out where the address labels have been mixed up between patients, or where the address is mis-typed and doesn't make sense -- but it's already passed through several pairs of eyes that just didn't look at that part. Misspelled words on labels bug me too --- I know, we're lucky if the patient even reads the label and there's probably a lot of them that wouldn't notice anyway -- but darn it, I just don't like letting that go (although I am forced to when things are really crashing around me).

Patient drug information sheets that are crumpled up and stuck inside the bag like trash. Bags that have been ripped open and re-stapled shut so they look like crap. Patients who are supposed to get easy-open caps and don't because nobody sees the indicator on the label. I don't ask the technicians to fix these things for me -- I usually do it myself. Should I feel embarassed at my pickiness? I don't think so. I think prescriptions should look professional even if the $4 crowd is determined to de-value them.

Another little pet peeve ---bad handwriting is not restricted to doctors. People will jot down catalog numbers of things we need to order and I can't READ it!! Okay, do we owe that person 106 tablets or 166? And you can be sure that the person who wrote the illegible note is long gone. Just a few extra seconds on their part would have saved me a whole lot of time.

I don't go complaining or chasing after the people who do these little things -- I think some people just 'care' and some don't and I'm not interested in nagging anyone. Some people do a job so mechanically that they forget other people will be looking at the results of that work in a different way. But it does bug me when the person doing the sloppy work doesn't have to deal with the consequences of their sloppy work.

I'm anal retentive, I guess, but that's what I get paid for.

Wednesday, April 8, 2009

The Full Moon Phenomenon

People acting weird, asking weird questions, coming up with weird problems. They seem restless, impatient and just goofy. At some point, someone on the pharmacy staff asks
(1) Did the Looney Tunes Bus just pull up?
and (2) Is it a full moon?

Pharmacists, ER workers, police -- they all swear by the full moon phenomenon even though there's no real science behind it. Some have said it's the tides, the gravitational pull, or even the ancient human instinct of preparing for the 'hunt'.

The full moon is tomorrow. When I told a customer his prescription would take about 15 minutes, he looked at me strangely and said, "My dog is in the car."

Must be getting ready for the hunt. Happy Full Moon!

Sunday, April 5, 2009


I, as a consumer (and just about everyone I've asked) really hate the process of "up-selling" --- when you are standing at the cash register, wallet open, credit card out, and the cashier or sales person attempts to sell you just one more thing by pointing out some discount, upgrade or add-on that you might just impulsively buy. Basically it's the "would you like fries with that?" question. "You can upgrade to the large size for only 50 cents." " Did you notice our scented candles are buy one, get one free today?" etc. etc. It's really irritating -- I'm standing here, ready to make my purchase, ready to leave. Don't put me on the spot by forcing me to say no over and over again. I'm DONE! I don't want to be on the e-mail list. I don't want to buy anything else. And why do you need my zip code/phone number? I guess there must be data somewhere showing that up-selling increases sales, but I don't think the customer alienation is worth it.

Our organization wants us to start this practice. They have literally given us a script to recite at the point of purchase, and all I can say to them is good luck with all that. If someone wants to try their hand at salesmanship, fine with me. But after explaining prescription medication to a customer and ringing up their (sometimes) substantial co-pays, I am NOT going to go down a checklist of annoying questions and make the obvious ploy to sell them just ONE more thing.
I think it is disrespectful. I am more than happy to answer questions initiated by the customer, and I'll point out items we stock that may fit their needs. The other day I searched the Web for coupons for prescription products for an uninsured customer. I'll gladly do that if necessary. But I figure if they want fries, they will ORDER the damn fries....!

Monday, March 30, 2009

Road Trip!

This year's March break took the form of a road trip -- a pretty long one at that -- about 1200 miles passing through the Midwest and into the Southeast. I've done this drive before, but usually when it's hot and the cornfields are planted and well on their way.
Looking out the car window, there are a few things I noted:

1. Burger, burger, burger. Every exit off the interstate has a McDonald's, Wendy's and Burger King. There are some pizza places and Subways, but I'd give anything to avoid consuming 800-1000 calories in 5 minutes and then return to sitting on my butt for another 4 hours.

2. A lot of people across this land live in mobile homes or small modular houses -- we are a wealthy nation, but most of us aren't wealthy. The number of RV's sitting outside is striking too. A lot of them look like they haven't moved in a long while. But for many people, an RV is how they vacation -- they don't jet off to some distant land and stay in a hotel.

3. The truckers and truck stops. As the slogan goes, trucking really DOES move the nation. There are countless numbers of them, and late at night I think it must be a gritty, lonely job.

4. The number of places that are open 24 hours. Pharmacies, restaurants, drive-thru's, grocery stores. truck stops, gas stations --- always someone working late into the night hours.

5. Getting the farm fields ready for spring. Seeing two Amish men out in a field with a horse and plow. The young Amish woman sitting reading a book when we went into her store to buy some jam.

It's a very diverse country we live in. I just find it interesting to observe, whether you're standing in the middle of Times Square or driving through West Virginia coal country.

Now, back to work --- and no more burgers for awhile!!

Wednesday, March 18, 2009

Puh-leeze Read the Signs

The car wash I use has an automated pay station located slightly around the corner from the entrance to the car wash itself. You pay, and then a large green arrow lights up when the car wash is ready for you to drive in. There is a large, clear sign on the pay station: WAIT HERE UNTIL GREEN ARROW LIGHTS UP. So I watched with amusement as every car ahead of me paid, then plowed ahead and waited inches from the closed door to the wash. Of course eventually the sequence of payments got totally screwed up and the wash wouldn't open at all until the cashier came over the intercom and got things re-aligned, reminding everyone of what the sign said. Sigh.

Why don't people read the signs? We've all had the customer who spots you in the pharmacy and pounds on the window "ARE YOU OPEN??" when their pounding fist is literally inches away from the sign that states the pharmacy hours of operation. Public places, including medical clinics and pharmacies, are full of signs that are gleefully ignored:

Pick Up
Drop Off
Please present insurance card with prescription
For the privacy of the person ahead, please remain behind this sign
Please check in with pharmacy staff if your prescription has been sent by your doctor
Leave lab slip here, ring bell once, have a seat

.. and so on

Someone I know who works in a museum always stresses the importance of signage.
Its purpose is to give people direction in an unfamiliar place and to improve the success of that place by keeping people moving efficiently through it. But you've got to stop for just a minute and READ -- you've got to take just a second and OBSERVE, and that's the problem.

We deal with lots of people who are distracted and in a rush. There are lots of non-English speakers too (although many of our signs are in multiple languages.) I think there is a subset of people who just outright refuse to 'follow' the signs, though. You can spot them a mile away. One good example is the alpha male type who isn't going to be told what to do and certainly isn't going to be part of the 'herd.' It's ME first, and I don't have time to read your silly signs so you will have to give ME your personal attention. These are the ones I dislike the most. Nobody's trying to boss you around, your Royal Highness, we're just trying to make things run a little smoother. Just take a second and read the sign.

Sunday, March 15, 2009

Random Things that Made Me Go Hmmm.....

A parent who rushes in to pick up a brand new prescription for a bed-wetting child who's going on a school field trip (like, leaving in a half hour). We don't have the strength they need, we call around to find it, get the Dr.'s office to re-send the script to the other pharmacy, and she rushes off. Hmmmm. You mean she's going to send this kid off on an overnighter with a brand new prescription he's never taken before and hope everything goes fine?

A female patient being checked out with a new prescription for a psychiatric drug. Paid up, ready to go, and then mentions that she and her husband are actively trying to get pregnant, and that she didn't mention this to the doctor. Hmmm. That definitely would have been a good thing to mention somewhere during the discussion -- this isn't M & M's we're taking here. In fact, we check the literature and find you don't want to be taking this drug during pregnancy, especially the early stages. We pony up with a refund and she decides to call her doctor tomorrow.

It's chaotic, and we're having the usual back-and-forth-question-and-answer discussion with a customer to try and determine the insurance plan to which we bill their prescription. Phone calls, trial and error, a few more questions, doctor NPI search, several interruptions, customer hovering and waiting expectantly and being told it's gonna be a few more minutes and we'll call you when it's ready and finally we are ready with the prescriptions and applicable co-pays. Customer looks wide-eyed and then informs us he didn't bring any money with him. Hmmm. I want to pound my forehead on the counter.

A customer who squawks about a 3.00 copay comes in for an antibiotic which, she informs us, is for an infection she contracted from a pedicure. Hmmmm. I've never had a pedicure. How much are they?

We always double-count controlled meds that are dispensed by the Scriptpro (automatic 'counting' robot machine). I decide to randomly double-count some other meds too. Every single damn one seems like it's off by one or has broken tablets or fragments in it. Hmmm. I wouldn't blame a customer at all for getting mad about that -- they're paying for it, after all. But we don't have time to double-count all of them, so I hold my breath and hope.

I LUV my great technicians, but I worked with one this week who I don't see that often. Every time she prepared an antibiotic suspension or tube of cream she covered up every pertinent part of the manufacturers label (that I obviously want to see in order to check the thing) with our store prescription label and wrapped it in enough tape to seal a mummy. I don't mean to be picky here, but when I check something I like to see the original label, NDC number and bottle size. Hmmm. I can't see through your label and I sure as heck can't peel it off through all those layers of tape. Maybe I could dig through the garbage to find the box? Whaddya think I'm doin' over here anyway? I'm checking! I REALLY AM!

Saturday, March 7, 2009

New Drugs, Old Drugs and Borrowed Drugs

I usually try to be nice to drug reps, unless they are really obnoxious, condescending, or try to tie me up when I'm obviously really busy. They're just people trying to do a job (one that I would not want). Some of them are nice and even thank me for my time, and jeez, how often does someone do that? I guess I'm just a sucker for anyone who even fakes respect for me.

I got a visit from the Kapidex rep last week. I mean, I felt bad for the guy even having to TRY and sell this stuff. This is the new R-isomer of Prevacid -- another example of the many 'new' drugs which take an existing drug and tweak it a little to make it sound brand new and different.
You take that existing drug and you market the isomer, prodrug or active metabolite and promote it as the next best thing, especially when the original drug is soon to go generic. And the company offers a discount card for $55 off on Kapidex -- so you know if they are knocking $55 OFF it already costs too much. You look at all the glossy literature and you think, this is an especially unfortunate waste of resources in these tough times. I mean, seriously? I can't wait to see the TV commercials.

The other one out there in the TV commercials now is Oracea, a "unique" formulation (ie. lower dose) of doxycyline, another drug that's been around since the Stone Age. They were even running an ad on my TIVO service. I don't see too much hope for a market share for either of these drugs -- insurances will give them the cold shoulder --- but we'll be forced to stock some eventually and then allow it to expire.

Speaking of old drugs, I'm interested to see if the FDA will pull Darvon and Darvocet-N products. I remember being told in pharmacy school that propoxyphene was a pretty mediocre analgesic with more risks than benefits and I've never been real excited to dispense it to anyone. We've already had a customer panicking on this one.....

Saturday, February 28, 2009

Customer Service or Not?

This is sort of an extension of a topic I've written about before, but it continues to be an issue in my workplace (which is a string of clinic/medical office building pharmacies, not a big corporate chain.) The organization is feeling the economic pinch and loss of revenues, just like many others. Our business is still quite steady, but cost-saving measures and ways to maintain our business are always at the forefront.

Some of the staff don't give a rat's ass and continue to do their job as they always have. But some of the 'good' technicians are conflicted as to how far they have to go to cater to people who don't present adequate insurance information, and they get varying directions from the pharmacist managers they work for. Some technicians feel they are now expected to get on the phone and track down insurance information for everyone who claims to have it --- they just don't have a card or don't know why our information is rejecting. Otherwise, the customer is either expected to pay cash price or (more often) walks out the door. It's slowly creeping into the realm of "customer service."

I'm conflicted about this. Don't get me wrong, I know that pharmacies are not obligated to verify insurance, period. That information has to be supplied by the customer. We don't expect the Target cashier to call our bank to get our credit card number. And the big chain pharmacies doing 800+ scripts a day have absolutely no capacity to do this -- the wait time on a prescription would be about a week! I get really annoyed when someone expects me to bill an insurance they can't produce. Being in a clinic environment, we do sometimes have access to more information than an outside pharmacy would, but I have actually told technicians on the phone with insurance, "look, we're just getting too bogged down here -- just give the customer their options. We can't solve this for them." But the technicians will tell me some pharmacists expect it of them, especially the managers in some of the smaller stores who are worried about their prescription volumes.

So I guess I'm not sure where to draw the line between being helpful and facing reality. I'll call an insurance provider if I believe it's something I can solve relatively quickly. Some of the insurance companies have websites, but the first thing they want is the patient's ID number and that's usually what you don't have. If it's a regular customer who's well known to me, and all of a sudden their insurance doesn't work, I'll try to help them. But I do NOT want people to expect this, and many of them now seem to.

Oh yeah, and if that prescription is $4 you can be darn sure the Insurance Detective Service will NOT be offered....

Tuesday, February 24, 2009

The Obesity Epidemic

There are some days when I am really taken aback by the number of our pharmacy customers who are seriously, morbidly overweight. They are young and old, male and female alike. I have to wonder what it's like for them at their doctor visits --- is the doctor laying it on the line? --as in saying, "Most of your health problems and the majority of your prescriptions could be eliminated if you JUST LOST WEIGHT." I know it's easier said than done, and doctors probably repeat it over and over (perhaps at some point they have to give up), but it is so true.

You look at the meds these people are on. A serious weight loss (and for some, we are talking 80-100 pounds that needs to go) would mean they could probably cut back or eliminate meds for blood pressure, blood sugar, joint pain, depression, breathing & wheezing, fungal skin conditions and many more. Next to quitting smoking, weight loss has to be the #1 best thing you can do for your overall state of health (that you have control over.) It seems so simple, but of course it isn't....

Most of us would love to drop 5-10 pounds anytime, but the folks I'm talking about are way past that. And you know the sad part is that exercise is out of the question -- they can barely MOVE. Where the heck do you go from there, other than into surgery? Way easier to just not let it get to that point. This kind of weight gain doesn't happen overnight and you wish these people would have looked in the mirror honestly a few years ago and said, I gotta change this.
It is a uniquely American predicament. I've been lucky enough to travel to some other parts of the world and I am struck by the fact that looking around you, you just don't see the fat like you do here.