Ohh, where did the time go? Thanksgiving, Christmas, and now January (normally "hell month" because of insurance changes and most people's neglect of carrying that new insurance card and general cluelessness about their own insurance coverage.) Yeah... remember that "high-deductible" plan you signed up for? Yeah, that is why your prescriptions are not SIX DOLLARS anymore. I know they USED to be, but they are NOT NOW. And apparently it's me, the sweaty, wild-eyed, hungry, tired and full-bladdered pharmacist that has to explain that to you. And by the way, please don't cough on me.
I was attempting to read some sort of Medication Safety Newsletter the other day, full of breathless phrases like, "learners attend sessions on patient safety, pharmacy processes, human factors, and identifying potential hazards in a patient’s environment of care. They gain hands-on experience by following a medication from order entry to administration and identifying vulnerable points and possible solutions." and......."The 90-member team is a network of physicians, nurses, respiratory therapists, and other healthcare professionals who serve as ‘lifeguards’ for providers traumatized by an unanticipated event or error. " It had been a particularly hellacious day at my job as a retail pharmacist, and it just struck me whether the people writing these things have any idea at all about the working conditions that most pharmacists on the front lines (ie, community) endure. Um, yeah, I think we could all identify a few of those 'vulnerable points' --- as in, well..... (see any pharmacy blog).
I saw my first pre-stamped prescription for Vicodin 5/300. This is the new lower-strength- acetaminophen Vicodin which is not interchangeable with the generic 5/325, which is the only thing anybody stocks. So time was wasted calling the dentist's office in question, where someone (probably the receptionist) brightly assured me that the generic would be fine! I can only hope that after the 500th pharmacy call that this dentist's office will get rid of those pre-stamped prescriptions.
I waited on a customer whose main complaint appeared to be a stuffy nose. She had 5, count-em, FIVE prescriptions, including saline spray, Flonase spray, Sudafed, Mucinex and of course, amoxicillin. All covered. Seemed like a bit of overkill to me. (See previous blog post about excess time spent screwing around with OTC prescriptions.)
Spent a lot of time with an elderly lady who had initially been given samples of a very expensive patch, found they worked well, got a prescription, and was now discovering they were not covered by her insurance. Oh, the hazards of samples... and somehow it's up to me to fix it.
Does anyone out there show up at grocery store 5 minutes before closing with a 2-page shopping list and dozens and dozens of questions for the staff who are trying to go home? I wish people wouldn't do that at the pharmacy. It's just inconsiderate and not right, especially when it's something that could and should have been dealt with earlier, or called in ahead of time.
New Year's resolution -- find more time for blog posts.... it's therapeutic!
Monday, January 14, 2013
Saturday, November 3, 2012
Boogie on Down
I love scanning the chain-store ads for new OTC products -- not only because I get asked about them, but because it's always interesting to see what's "NEW!" -- that is, same ingredients in a different form. One of
my favorite marketing devices is when they take an external product and put it in the form of a 'wipe.'
So we have eye-makeup remover wipes, facial cleansing wipes, bum-cleansing wipes, disinfectant wipes, furniture polish wipes, and so on. But "Boogie Wipes" really has to be my favorite one so far. Forget the Kleenex, ladies and gentlemen!! This is the wave of the future!
Monday, October 8, 2012
Keep it Real !!
We have a regular customer, elderly, always nice, who cares for his elderly wife and seems somewhat overwhelmed most of the time. Shells out big money for a variety of prescriptions. The other day a prescription for nystatin powder was called in for his wife. We ran through the quantity that was prescribed and it was ridiculously expensive (yeah, nystatin powder -- WTF?) He shows up to get it, and we jointly decide on a lesser quantity to start with, so it's not so expensive.
I asked him how large an area he was using it on. He said he had a couple of other creams he was using for his wife's pressure sores, and he had been instructed to 'mix' the nystatin powder with those creams. He seemed a little hazy on the details, and as I say, overwhelmed. Why would someone instruct this 80-something couple to be mixing creams and powders? Do we really need to complicate their lives like that? There are other things they could use --- heck, tell me the proportions and I'll mix it for them (unfortunately not an option today, a Friday afternoon at 5pm, much to my frustration.)
I shake my head at the impracticality of prescriptions sometimes. I think part of 'treating' someone is stopping to think whether they are capable of carrying out the instructions. Everybody's got good intentions but it is wasted time and MONEY to send people out the door with instructions that are difficult for them to perform or a course of treatment that's unlikely to be completed. I admire the prescribers who think outside the box and who can come up with something simple as an alternative, even if it's not by-the-book treatment.
Speaking of practicality, I had an encounter with a bunch of prescriptions the other day for a patient who was fresh from an MTM session. Good intentions all around, but practicality --- zero. All sorts of medications were added -- vitamins, combinations, other items meant to address some perceived need.
No thought was given to how much they cost, whether they were covered, or how much more complex they made this patient's life. The meds have never been picked up. Don't get me wrong, I understand the philosophy behind Medication Therapy Management and I'm not trying to sound grumpy about it. But this is a total failure unless somebody takes into account whether it's practical. There's more to it than what looks 'good on paper. '
I asked him how large an area he was using it on. He said he had a couple of other creams he was using for his wife's pressure sores, and he had been instructed to 'mix' the nystatin powder with those creams. He seemed a little hazy on the details, and as I say, overwhelmed. Why would someone instruct this 80-something couple to be mixing creams and powders? Do we really need to complicate their lives like that? There are other things they could use --- heck, tell me the proportions and I'll mix it for them (unfortunately not an option today, a Friday afternoon at 5pm, much to my frustration.)
I shake my head at the impracticality of prescriptions sometimes. I think part of 'treating' someone is stopping to think whether they are capable of carrying out the instructions. Everybody's got good intentions but it is wasted time and MONEY to send people out the door with instructions that are difficult for them to perform or a course of treatment that's unlikely to be completed. I admire the prescribers who think outside the box and who can come up with something simple as an alternative, even if it's not by-the-book treatment.
Speaking of practicality, I had an encounter with a bunch of prescriptions the other day for a patient who was fresh from an MTM session. Good intentions all around, but practicality --- zero. All sorts of medications were added -- vitamins, combinations, other items meant to address some perceived need.
No thought was given to how much they cost, whether they were covered, or how much more complex they made this patient's life. The meds have never been picked up. Don't get me wrong, I understand the philosophy behind Medication Therapy Management and I'm not trying to sound grumpy about it. But this is a total failure unless somebody takes into account whether it's practical. There's more to it than what looks 'good on paper. '
Sunday, September 9, 2012
Co-Pays and No-Pays
I guess because it's an election year people are thinking about the 'health care' debate and peripherally paying attention, although in their own typical way --- "hearing about" stuff, and rumors, and watching the cable news channel that they agree with most -- without actually doing any hard reading or research. I'm no expert either, but from my perch as a pharmacist I detect certain trends. It hit me the other day when I had a customer grumble about his $59 copay for a 3-month supply of 4 prescriptions. It's my feeling that during the time I've been a retail pharmacist, copays have been trending down. Most of the drugs we dispense are generics -- the big expensive brand-name drug with the big copay is becoming less common. Maybe that's why people's expectations are that everything's eventually going to be 'free.' But of course nothing is 'free.' I don't have any problem with a reasonable co-payment for prescription medications. I don't think that the $59 tab was unreasonable at all. The future legislation is called the "Affordable Health Care Act", not the "Free Healthcare Act." People are flabbergasted at how expensive something like, say, Seroquel is; well, yeah, it's a drug that alters your brain chemistry and which took years of research, testing and know-how to develop and put into a little tablet that you can swallow and fix your 'mood disorder.' It might even change someone's life? What's the price on that? And yet people can also take a dirt-cheap drug that keeps their blood pressure under control and prevents them from having a heart attack or stroke. That's pretty significant. I don't think people get this.
It's the same old story -- the cheaper something is, the less value it's perceived to have and therefore all the professional services behind it are cheapened too.
People used to treat a doctor's prescription like gold. They would fold it and put it in a safe place (their wallet) and bring it to the pharmacy almost immediately. Now they are treated like grocery store coupons-- collect 'em, trade 'em, transfer 'em, and (my favorite), lose 'em. And what they represent also seems to have declined in value, where $59 is apparently outrageous for those multiple 90-day prescriptions. I guess I just remember a different era..... or something.....
Now on the flip side, I would like to address my workplace. If you're going to complain that customers don't treat you as a professional, then for God's sake, ACT PROFESSIONAL.
1. Wear some decent clothes. Wear your identification badge like you're supposed to.
2. Stop cooking your lunch in the pharmacy microwave so the entire place reeks. It smells like a damn Burger King in here.
3. Stop EATING, snacking and drinking all day in the pharmacy. IT LOOKS TERRIBLE.
4. If someone talks to you from out at the counter, get out there and talk to them. Don't holler across the room. Respect people's privacy, even if they are oblivious.
Can you tell what's been bugging me this week?
It's the same old story -- the cheaper something is, the less value it's perceived to have and therefore all the professional services behind it are cheapened too.
People used to treat a doctor's prescription like gold. They would fold it and put it in a safe place (their wallet) and bring it to the pharmacy almost immediately. Now they are treated like grocery store coupons-- collect 'em, trade 'em, transfer 'em, and (my favorite), lose 'em. And what they represent also seems to have declined in value, where $59 is apparently outrageous for those multiple 90-day prescriptions. I guess I just remember a different era..... or something.....
Now on the flip side, I would like to address my workplace. If you're going to complain that customers don't treat you as a professional, then for God's sake, ACT PROFESSIONAL.
1. Wear some decent clothes. Wear your identification badge like you're supposed to.
2. Stop cooking your lunch in the pharmacy microwave so the entire place reeks. It smells like a damn Burger King in here.
3. Stop EATING, snacking and drinking all day in the pharmacy. IT LOOKS TERRIBLE.
4. If someone talks to you from out at the counter, get out there and talk to them. Don't holler across the room. Respect people's privacy, even if they are oblivious.
Can you tell what's been bugging me this week?
Monday, August 13, 2012
Subject: Miscellaneous
I've got a few things running around my head to vent about.
1. E-scripts. It's official, I HATE them. I have never seen such a run of errors, ambiguities, lazy and nonsensical stuff coming through on these things. Yeah, they're great if the prescription is "Amoxicillin 500mg, one TID." But for anything that requires any degree of thought, forget it. So we have the situation where doctors are sending us one set of directions because they are pre-loaded into the system, but telling their patients something completely different, because they don't know how to change it. They don't know how to add special directions, like where exactly to apply each of those 3 ointments they just prescribed. So, when it comes time for my little counseling session with the patient (who hasn't listened or has forgotten everything the doctor said), we're both clueless. I actually had a doctor (attempting to prescribe nystatin cream) select an entry for a multi-ingredient compounded ointment because it 'contained' nystatin, which I guess was good enough for him, and stick the words 'nystatin cream' in the comment section of the prescription entry which was his way of saying...... I don't know what the hell I'm doing. I mean seriously?
2. I got a big drug order from my wholesaler but was missing some of the paperwork. I call the wholesaler, give them my customer number and all that --- she types it into a computer and says, "I don't show any order sent to that customer," followed by....... total silence. That was the SUM TOTAL of the amount of 'customer service' that she was prepared to offer me. God, I hate that. OK, I guess this stack of totes from your company is just a hallucination, then. Bye.
3. I get calls at work from drug companies wanting to tell me about some new product. Why do they insist on doing this? I really hate to be rude, I know the person on the other end is just doing their job, but I simply cannot stand there and listen to any spiels with the place going crazy around me and customers staring me down. I've got enough crazy customers wanting to keep me on the phone for twenty minutes because (and this is true) they want to discuss a pharmacy charge on a bank statement from TWO THOUSAND AND TEN. That's 2010. Twenty-frikkin-ten.
There is an article in the current New Yorker magazine by a surgeon named Atul Gawande called "Big Med."
It's very interesting and I recommend it . This author has written many articles and at least one book that I know of, and I think he's an example of one of the smart people that we should listen to in the whole health care debate ---instead of these idiot politicians, I mean. I come home after a particularly trying day and I think a lot about how we do things. One day I'm working in a well-oiled machine with everyone at the top of their game, and the next day it's a different staff who can't even stick a label on straight. But more on that later.
1. E-scripts. It's official, I HATE them. I have never seen such a run of errors, ambiguities, lazy and nonsensical stuff coming through on these things. Yeah, they're great if the prescription is "Amoxicillin 500mg, one TID." But for anything that requires any degree of thought, forget it. So we have the situation where doctors are sending us one set of directions because they are pre-loaded into the system, but telling their patients something completely different, because they don't know how to change it. They don't know how to add special directions, like where exactly to apply each of those 3 ointments they just prescribed. So, when it comes time for my little counseling session with the patient (who hasn't listened or has forgotten everything the doctor said), we're both clueless. I actually had a doctor (attempting to prescribe nystatin cream) select an entry for a multi-ingredient compounded ointment because it 'contained' nystatin, which I guess was good enough for him, and stick the words 'nystatin cream' in the comment section of the prescription entry which was his way of saying...... I don't know what the hell I'm doing. I mean seriously?
2. I got a big drug order from my wholesaler but was missing some of the paperwork. I call the wholesaler, give them my customer number and all that --- she types it into a computer and says, "I don't show any order sent to that customer," followed by....... total silence. That was the SUM TOTAL of the amount of 'customer service' that she was prepared to offer me. God, I hate that. OK, I guess this stack of totes from your company is just a hallucination, then. Bye.
3. I get calls at work from drug companies wanting to tell me about some new product. Why do they insist on doing this? I really hate to be rude, I know the person on the other end is just doing their job, but I simply cannot stand there and listen to any spiels with the place going crazy around me and customers staring me down. I've got enough crazy customers wanting to keep me on the phone for twenty minutes because (and this is true) they want to discuss a pharmacy charge on a bank statement from TWO THOUSAND AND TEN. That's 2010. Twenty-frikkin-ten.
There is an article in the current New Yorker magazine by a surgeon named Atul Gawande called "Big Med."
It's very interesting and I recommend it . This author has written many articles and at least one book that I know of, and I think he's an example of one of the smart people that we should listen to in the whole health care debate ---instead of these idiot politicians, I mean. I come home after a particularly trying day and I think a lot about how we do things. One day I'm working in a well-oiled machine with everyone at the top of their game, and the next day it's a different staff who can't even stick a label on straight. But more on that later.
Monday, July 16, 2012
Health Care Blues
The scenario: A young woman, a member of a large immigrant population in our city and on state assistance, brings a prescription to the counter. It is from a prescriber who staffs what is commonly known as "urgent care" or "quick clinic" or by many other names -- a walk-in, no-appointment- needed type of area which is intended to address problems that are acute, or can't wait for a regular doctor's appointment. Her prescription: Differin Gel (its generic form) -- a topical acne medication. It costs over $200 for a 1- 1/2 ounce tube. Her out of pocket copayment: Zero. She collected the medication, picked her smartphone up off the counter, and was on her way.
Now, I know this is a sensitive topic. I'm not suggesting that immigrant populations, or those on state assistance, don't deserve quality medical care. Of course they do. But does this qualify?
This nagged at me in so many ways. Why is an "urgent care" provider seeing people for acne? (Don't get me wrong, half the stuff coming out of Urgent Care is not urgent). Do they know that they have selected a $200 medication? Should it be covered under a state plan when many private insurance plans don't, or at least require prior authorization?
The fact that health care legislation is always in the news now makes me more aware of this stuff. I don't pretend to be an expert on all of it, but I can look at the prescription side of things and see a lot of things that don't make sense. People sound alarm bells about the 'rationing' of health care. We all know that it's already rationed. Maybe there are some situations where even more "rational" rationing is not a bad thing at all.
Incidentally, I do know that the huge amount of time we spend processing, labeling and verifying over-the-counter medications for state plans is ridiculous. Forget the computer entry, the labeling, the piles of stuff to check, the impatient insistence and shouts of "Is it READY YET???" Let me hand the customer a bottle of Tylenol, tell them how many to take, and bill the state for one "over-the-counter" charge or some such thing.
No waiting, no labeling, no screwing around.
Lately I am seriously questioning how long we can sustain this.
Now, I know this is a sensitive topic. I'm not suggesting that immigrant populations, or those on state assistance, don't deserve quality medical care. Of course they do. But does this qualify?
This nagged at me in so many ways. Why is an "urgent care" provider seeing people for acne? (Don't get me wrong, half the stuff coming out of Urgent Care is not urgent). Do they know that they have selected a $200 medication? Should it be covered under a state plan when many private insurance plans don't, or at least require prior authorization?
The fact that health care legislation is always in the news now makes me more aware of this stuff. I don't pretend to be an expert on all of it, but I can look at the prescription side of things and see a lot of things that don't make sense. People sound alarm bells about the 'rationing' of health care. We all know that it's already rationed. Maybe there are some situations where even more "rational" rationing is not a bad thing at all.
Incidentally, I do know that the huge amount of time we spend processing, labeling and verifying over-the-counter medications for state plans is ridiculous. Forget the computer entry, the labeling, the piles of stuff to check, the impatient insistence and shouts of "Is it READY YET???" Let me hand the customer a bottle of Tylenol, tell them how many to take, and bill the state for one "over-the-counter" charge or some such thing.
No waiting, no labeling, no screwing around.
Lately I am seriously questioning how long we can sustain this.
Monday, June 18, 2012
And I remain........
"I don't have my card, and I don't know the number!" chirped the young lady as she checked in
to pick up her electronically-prescribed prescription (thank God she wasn't responsible for bringing
us that piece of paper, either). Why doesn't this situation EVER get better? It's becoming more and
more expected that part of our 'customer service' is figuring out people's insurance for them. What other
business that relies on 3rd-party payers is run that way? And if your prescriptions are completely covered
by the state? Well, if I had a little card that allowed me to walk away from the pharmacy counter with
hundreds of dollars of medications at no cost to me, you can be damn sure I would bring that card
with me. And if I got a new card in the mail, you can be damn sure I'd bring the new one too.
I remain glad to see the abuse/overuse of narcotic prescriptions getting some attention. The amount
of time I spend every day on C-II drugs (double-counting, inventorying, logging, re-ordering) is
getting SO out of hand. I'm forced to keep huge inventories of these medications and I still can't keep
up. I remain mystified as to the ultimate plan for my customers gobbling up OxyContin for back pain.
We had a customer cheerily remark the other day "Yah, some a' these pharmacies are gettin' in trouble
with all these drugs, eh???" Yeah, dude, we pharmacies are the troublemakers.
And what was this customer picking up? OxyContin. Never did figure that one out.
I remain convinced that one of the solutions to our health care costs has to be the outsourcing
of 'minor' ailments --- to 'quick clinics', non-M.D. practitioners, and to pharmacies (by way of
a third class of drugs that pharmacists can prescribe or dispense on their own.)
I think many of the doctor visits that Americans engage in (in my world, anyway)
are unnecessary and wasteful. People don't understand the costs. If they did, I hope they
would think twice about rushing to the doctor with every little sniffle or skin rash -- that way,
there would be more money to include the uninsured people who don't go to the doctor at all.
And finally, with the statins we've made great strides in cholesterol management and cardiovascular
disease. The next great frontier ---- sugar. Any pharmacist can tell you how buried they are with
blood sugar medications, diabetes meters, testing strips, lancets ---- the time and money that goes
into diabetic and pre-diabetic teaching and monitoring; doctor visits, labs, insurance hassles (don't you
love it when they all of a sudden decide to stop covering one type of meter and you have to switch
people to a totally different system --- just because? And their old supplies -- well, I guess they go into the
trash). It is staggering. So if the mayor of New York says restaurants can't sell 20oz. sodas anymore --
it's OK by me. Baby steps.
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