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.