I Think if I See One More Prescription for Tylenol, I'm Gonna Lose it

More and more, I feel like I am spending a TON of time filling prescriptions for over-the-counter medications. (For the non-pharmacist reader, many of these are covered under medical assistance plans -- and as such, need to be processed just like a prescription medication, with all the same procedures, record-keeping, etc.)    Now, this is not going to be a swipe against the "moochers" -- and believe me, I struggle with this, because I believe that the majority of people on assistance do NOT abuse it.   But even fellow pharmacists who've been doing this a long time are beginning to wonder how long we can keep it up.  Additionally, many of our customers on state assistance are immigrants (some might even say refugees) from other countries.   Now, if a child enters this country and immediately comes down with leukemia, I'd like to think we're not going to stand there and let him die.  We are better than that.  But how obligated are we are to cover prescriptions for (and to stock people's medicine cabinets with) things like Tylenol?   And hydrocortisone cream,  and every form of vitamin, Miralax, Compound W, Colace, saline nasal spray, simethicone,  Sudafed, Claritin, Eucerin, ibuprofen, calcium, iron, aspirin, Benadryl, Maalox, Milk of Magnesia,  Lotrimin cream,  Robitussin, artificial tears,  and many MANY others -- all things that most of us purchase on our own.

Inexpensive products..... BIG EXPENSIVE HEALTH CARE machinery behind them.  I think about it now every time I wade through those quality-assurance double checks of my saline nasal spray prescriptions.

We routinely have people bring us prescriptions for OTC's from a hospital emergency room.  We all know the cost of an emergency room visit,  and this is utter INSANITY.    There needs to be a way for people to get advice on minor health issues, (ask your pharmacist, maybe?)  and then be given a recommendation on what to go out and BUY for it.  To be sure, there are lots of very expensive drugs and medical procedures out there that the average person cannot afford on their own.   Tums is not one of them.

The Prescription Abuse Game

I've only worked about half my career in retail pharmacy (started in hospital) so I always thought of myself as a neophyte when it came to fake prescriptions, phony call-ins and other forms of drug diversion.  I'm sure I've been fooled more than once.  I'm not sure how many occurrences most pharmacists would say they have in a typical week, but I seem to have encountered a cluster.

We had one guy come in -- never filled with us before and wanted to pay cash for his Percocet prescription ( I wasn't too familiar with the doctor, either.)  Of course even for me this was a red flag
and a check of the state's monitoring website revealed a long string of Percocet prescriptions, some filled literally right on top of each other.  The most recent was 4 days earlier for an even larger quantity.
Sent him away and he was not a happy camper.  I don't really care what he's doing with it,  probably selling it, but it's irritating as hell and a waste of my time.  I contacted the doctor's office, sent them a copy of the State information, and never heard anything back.

I've also encountered a string of 'lost' prescriptions claims -- 'lost' on vacation, 'accidentally' threw it away, lost my purse, etc. etc. etc.   I wish every prescriber would make it clear from the outset that they will not replace lost or stolen prescriptions without a police report.  I can't believe how accommodating some of these doctors are.

Also recently became aware of someone calling in her own prescriptions -- she was pretty good but it never sounded completely right to me and I am mad at myself and the rest of our staff that no one thought to take the time to verify it.

I guess it's just irritating to be played for a fool.  We're hammered with the principles of customer service and being nice to everyone and I feel like these drug seekers are probably laughing all the way out the door.  I know this isn't news to any experienced retail pharmacist out there, but just had to get it off my chest.

Pharmacy PRO

There's a commercial on TV for National Car Rental that features the "Business Pro" -- the frequent and experienced business traveler who can breeze through the airport -- going "shoeless and metal-free in seconds."  In the endless procession of people we wait on at the pharmacy every day, I have come to truly appreciate the Pharmacy Pro.  I'll give people a pass for their first couple of visits (maybe) but after that, well ----  these are the true marks of you,  the Pharmacy Pro:

1. You hand me your prescription insurance card with the prescription, or in the case of an e-prescription, when you check in.  Each and every time.  Even if you've been to the pharmacy 40,000 times before.  It's the newest and most current card. It's not your dental or medical card.  If the prescription's for a family member, you give me their card, not yours. I already love you for that.

2. You are acutely aware of your surroundings.  If the place is going crazy and there are lots of people waiting, you say "I'll stop back later."  If you know you have multiple prescriptions, you do the same regardless.  I love you for that.

3.  You are aware, at least generally, of what your doctor has sent us.  If there are things you don't need filled, but just kept on file, you tell me up front.  I love you for that.

4.  If you want a refill of something, as well as having your new prescription filled, you tell me immediately.  You do not wait until we are ringing up the prescription before saying, "Oh, and I also need some test strips" and expect to just stand there and wait.

5.  While waiting for your prescription, if you are paying by check, you have your checkbook out and you have already filled out the entire check except for the amount.  I love you for that.

6.  You are an active participant in this process.  You look over what you are receiving and verify that what is there is what you're after.  Not when you get to your car, not when you get home, not 3 days later when you tell me you 'never got' something.


Here's to you, Pharmacy Pro.

Random Stuff I've been jotting down

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!

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!

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. '

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?