Monday, November 29, 2010

Turkey Talk

I worked Thanksgiving in close proximity to a "Quick-Check-Urgent Care" walk-in clinic type of place ---- surprisingly, most of the patients pretty much needed to be there. Lots of antibiotics were flowing. Not too many people wandered in on Thanksgiving Day to have that rash checked that they've had for 3 weeks, or to get a handle on that blood sugar that's been out of control since last Thanksgiving. So that was a pleasant surprise.

I did get several people who wanted me to 'guarantee' that their prescription would work.
Like, the person getting a Z-Pack (I know, who doesn't get a Z-Pack?) who said in reference to their ailment, "And this will TAKE CARE OF IT, RIGHT?" Or the woman who demanded to know if the phenazopyridine would work IMMEDIATELY for her UTI. As I opened my mouth to answer, she said NO, I MEAN IMMEDIATELY !!!

I can't guarantee that prescriptions are going to work. Prescribing is as much an art as a science. Every so often someone tries to return something because it "didn't work" or they just didn't like it and we have to explain that legally we can't take the medication back and re-sell it again. I had to explain to a customer once that "you wouldn't want me to dispense medication to you that had already been taken home by someone else, right?"

On Black Friday afternoon a customer brought in a prescription for an anti-nausea med for pre-treatment of chemo. The (naturally) expensive medication wasn't covered. We asked when the chemo treatment was scheduled.... "Monday morning." Date of the prescription: 1 week ago. Doctor's phone goes to voice mail. Possibility of getting a prior authorization on Friday afternoon? Slim to none. Moral of the story: bring those prescriptions into the pharmacy ahead of time. I sure hope they figured something out on Monday.....

Monday, November 22, 2010

The Drink

We have a customer, a relatively young individual, who's been through a succession of reflux medications and got rather agitated when his new PPI prescription wasn't covered.
I spoke directly to the prescriber, a younger female physician who actually sounded kind of scared of the guy. "What he really needs to do is put away the vodka," she informed me.

Obviously many of our pharmacy customers have conditions that they have no control over, but others can attribute a lot of their medical problems to things like obesity, smoking, and alcohol. I recently read a small news item in Newsweek magazine that stated,

British researchers find that alcohol is more destructive to individuals
and society than any other drug, including heroin and crack.

Pretty eye-catching statement, but I think it's true. I'm thankful that my parents were only social drinkers -- it was an occasional thing, holidays and special occasions, and no one ever got drunk. I am the same way. I wasn't aware of it as a kid, but I realize now that I have numerous extended family members who are approaching middle age looking back at a legacy of broken relationships, estranged children, shaky financial status and general poor health as a result of the erratic and unpredictable behavior that comes with alcohol dependence.

I work with people who talk about 'going to the bar' like it's a destination in itself. That's their weekend activity. They leave their kids in the care of others so they can hit the bars.
Their kids eventually catch on to this and recycle the behavior later themselves. People describe something to me that happens at home with their (haha) 'plastered' spouse and I think to myself, YOUR HUSBAND IS AN ALCOHOLIC. Why can't you see that? I'm not talking about college students here; these are full-grown adults.

Think about the percentage of police calls that are related in some way to alcohol. (Watch an episode of "Cops".) It's phenomenal. I once heard someone say that beer is the most underrated drug in America.

Unfortunately, smarter people than me don't know what can be done about it. Alcohol is never going to be illegal. Humans are social animals and alcohol is associated with that. We've created a stressful society where people are looking for ways to take the edge off. I believe some people are genetically predisposed to 'addictions' while others will never come close to any kind of problem. But the impact of alcohol on our society really is very dramatic, when you think about it.

Just another observation from behind the counter.....

Monday, November 8, 2010

The Incredible Missing Prescriptions

I know some folks out there who work for big chains perhaps aren't directly involved in the mailing-out of prescriptions. Everybody has to do it now (for free) to remain competitive. But what is your company's policy when the patient tells you they didn't receive it (and it's documented as being mailed, the address is correct, etc.?) People seem to feel it's our responsibility to simply replace it, at no cost to them, and that is regardless of whether we can bill insurance again. We are getting burned on this big-time. I'm curious to know how it's handled elsewhere.... Thanks!

Tuesday, November 2, 2010

Theater of the Absurd

Prescription medication for customer is being increased from 40mg per day to 60mg per day. Thus, the prescription is written as 40mg tabs, take 1 and 1/2 daily, because there is no 60 mg tablet. Easy -- peezy !!!

Insurance company says no, we will only pay for one 40mg tablet daily. We advise the customer that this medication is inexpensive, and he can buy a month's supply for cash at under $14.00.

Customer says NO WAY and wants it covered under his insurance. Since we're all about the customer service, we send it off to the doctor's office for a Prior Authorization.

A few days pass. A nurse actually calls (!) and says the prior auth is approved. I run the prescription again -- it rejects. I call the insurance company and sit on hold for about 10 minutes. Finally the person on the other end tells me it is approved, but the customer must take three 20mg tablets instead of 1 and 1/2 of the 40mg strength.

OK. I run that through, and the copay is MORE than if the customer had just paid cash for the month's supply of the DAMN 40mg.

Customer comes in later, and when given the two options elects to pay cash price for the 40mg. Customer also is pissy and registers his unhappiness that the insurance company is telling him 'what to do.'

I wish I could total up the salaried time that everyone involved spent on this. Sometimes you just have to laugh in this job. And again, I am reminded of (a) why healthcare is so expensive in this country, and (b) why your prescriptions take so long to fill.

On another note........ we all hate it when management dictates we have to give a spiel to the customer at checkout, whether it be upselling or telling them about a special or asking for a donation to something. I was reminded how much I hate this myself when I attempted to buy a cheap paperback book the other day at Barnes and Noble.

Check out lady: Are you a member with us?
Me: No.
C-O-L: Do you know about the program?
Me: Yes, and no thanks.
C-O-L: Would you like to donate a book to our book drive?
Me: Not at this time, thanks.
C-O-L (now typing into the computer): What is your e-mail address?
Me (out loud): I don't use e-mail.

By the way, I TOTALLY lied cause I do use e-mail!!

Can't wait for the Christmas shopping season.