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??