Monday, May 7, 2012

O, Omeprazole!

The talk about establishing a third class of medications -- not requiring a prescription but being sold only after pharmacist consultation --- is (I feel) a worthwhile attempt to bring down some of the costs of health care in the United States.  Canada and many European countries already do this.  We already have a multitude of prescriptions written by non-M.D. prescribers, and to be honest, I think I am at least as qualified as some of them to offer someone an ounce of triamcinolone cream or some 600mg ibuprofen tablets.  No, I am not trained in diagnostics or physical exams and would never attempt to do anything I'm not qualified for.  But at this point in my pharmacy career I've probably seen hundred of thousands of prescriptions and inpatient orders --- and I HAVE been paying attention.

I think about this as I am checking my 70-millionth prescription for omeprazole, which is a product that is freely available over-the-counter but is still covered on many prescription plans. I think about the salaries of the technician who processes it, counts, labels and bottles it, and the pharmacist who checks it.  I think about the overhead of the pharmacy that stocks it.  I think about the salaries of the person who receives the patient's request for a refill, enters it into a computer, and the nurse (or sometimes pharmacist) who reviews it -- then if it doesn't fit the criteria for them to approve, bumps it up the ladder to the prescriber.  He/she approves it, hands it off to the nurse/secretary/whatever who generates a prescription or prints or faxes it or calls the pharmacy and the cycle is repeated.  In this case, all the people involved in this cost way more than the medication itself.

So many of our customers visit their doctors for minor, uncomplicated issues. Obviously, everyone has to know when to draw the line and realize when something is more than 'minor', but it seems to me that many of the prescriptions we process over and over again do not warrant the involvement of our vast, hugely expensive health care system.

When a perfectly healthy person wakes up with red, itchy, burning eyes one day -- well guess what, it's probably pink eye, probably viral, and probably will go away on its own in a few days.  Most people will still go to the doctor for this, or at least some kind of walk-in clinic type of place. How about if they could come to the pharmacy, get a 3-day supply of antibiotic drops (useless for a virus, but at least they feel like they are doing something) with instructions to see their doctor if it's not better after that.  The vast majority would be just fine and never come back.  Done.  Lots of money saved!

The time involved in processing, filling and refilling prescriptions for things like prenatal vitamins, the aformentioned prescription strengths of ibuprofen and naproxen , even things like Flonase nasal spray -- seems to me to involve too many people, all of whom are expensive.   Don't get me wrong, there are plenty of sick people out there -- doctors and hospitals aren't going out of business any time soon. But I think there should be some intelligent assessment of many of the routine prescriptions that occupy so many people's time all the way up the chain.  Time, paperwork, overhead, equipment, bottles, labels, insurance claims, personnel, physical plant -- it all adds up in that tiny li'l bottle of Polytrim eye drops.

And by the way, ENOUGH omeprazole!!


Jenn said...

Not even antibiotic, for a viral. Just something to ease off the symptoms. Who wouldn't get in line for that?

Pandy said...

I would! I would!

Dominic Molise said...

I totally agree that pharmacists should be able to do this. I knew that they were technically able to write prescriptions already, but I have always wondered how they are able to utilize that ability. I have also wondered why patients with illnesses requiring life-long medication still require new prescriptions to refill their meds. My father has thyroid disease and can die if he doesn't take his levoxyl, but for a long time he simply could not afford to go to the doctor every month for bloodwork just to get a prescription for the exact same strength he had been on for years. He ended up having to take his medicine every other day so that he could stretch it out as long as possible before going back to the doctor, and of course this caused a lot of problems for him.

As far as whether this will ever change, one of the reasons that this hasn't been done already is the legal liability, which is also one of the main reasons that healthcare in general is so expensive. There are just too many medical lawsuits. Of course there are many cases of malicious negligence that warrant lawsuits, but accidents can happen to anyone, especially hospital docs that are obscenely overworked. Even though the laws changed to limit hospital hours after the Libby Zion case, many hospitals still push the limit to shave a few measly bucks off the bottom line. I don't think that this is a risk that pharmacies are prepared to handle. The laws are much different in other countries, and until our laws change, not much else can.

Anonymous said...

Australian pharmacy tech here - the antibiotic drops to treat conjunctivitis went Pharmacist Only (OTC but requiring pharmacist input) about two years back for us. I have had so many parents look grateful and relieved to find out they don't need to take their 6-year-old for a doctor's appointment. The other big one is Ventolin and generic Ventolin. Patients can still get these things on scripts if they're cheaper under their level of government health cover, but for the most part we sell them OTC. I definitely think it's useful and necessary for people to be able to come to us and get something without needing to a) find time to make a doctor appointment and b) find the money.

Kinda funny that omeprazole is OTC over there, though, as it's still Rx-only for us. Just an aside.

Frantic Pharmacist said...

Australian pharmacy tech -- that is interesting -- I'm always curious to hear how others do things. Ventolin inhalers take up a lot of time too, although I don't see those going OTC here anytime soon. Although it sometimes seems they are available from docs just for the asking.....

Anonymous said...

"When a perfectly healthy person wakes up with red, itchy, burning eyes one day -- well guess what, it's probably pink eye, probably viral, and probably will go away on its own in a few days."

This statement is exactly why pharmacist must be trained in dianostic patient care before prescribing medication. Viral infections like pick eye will not "just go away" They must be treated with antibiotics to completely cure the condition.

Anonymous said...

Like the asthma medications that I've been taking for more than twenty years: Albuterol inhaler, 4 mg albuterol pills (so that I can split them in half if necessary,) and the new additions, Advair and Singulair. I know the dosages, the pharmacist knows the dosages...everyone who has asthma knows these medications and the dosages.

So why can't the pharmacist change the prescription when the PA who saw me for 5 minutes wrote down the incorrect med? When she wrote me for a Ventolin inhaler (brand only,) when I specifically asked for ProAir HFA?
That would be useful! And then I wouldn't have to come back later, because the meds were sent in electronically, so I couldn't even check the written prescriptions to make sure that they were correct.

Frantic Pharmacist said...

Anonymous above: I totally hear that. Things like that are a waste of everyone's time (especially yours). Some pharmacists might go ahead and change the prescription, especially if they know the prescriber well... but others just won't accept any liability.