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!