Mom's boyfriend.

Followers of the NFL heard about Minnesota Vikings' running back Adrian Peterson losing his 2 year old son last week.  The child was beaten to death by his mother's boyfriend.  There isn't a lot of detail about how involved the multi-millionaire football player was with this child -- obviously he wasn't married to the mother and somehow this child became another sad statistic;  losing his tiny, young life at the hands of "mom's boyfriend." How many times do we hear that phrase?   Indeed, there's a lot to be debated about wealthy pro athletes spawning kids all over the place and then apparently having little to do with their well-being.  Of course, lots of people who aren't pro athletes are guilty of the same thing.

It goes without saying that we all feel physically ill at the idea of child abuse. I once worked in an in-patient pediatric health care setting and I couldn't imagine being a physician or a nurse who had to treat those patients and somehow keep it together.    I REALLY want to see a big-name professional athlete (or several of them)  come out and blanket the airwaves with public-service announcements on child abuse prevention.  I want to see those ads run during NFL and NBA and NHL games.   The only pro athlete I'm aware of who has done these types of ads is Mark McGwire, and that's because I saw him on a poster in a doctor's office once.  Think anyone else will step up to the plate?

I'll keep at it if you meet me halfway

I'm not computer-savvy enough to link to YouTube videos but if you get a chance, go to YouTube and search for "Louis C.K. hates cell phones". Then watch the video of the comedian Louis C.K. on Conan explaining why he doesn't want to get cell phones for his kids.  It's great -- funny, sad, and true.  As someone who watches people all day with their nose in their cell phones, I realize that the loss of eye contact caused by technology (and other kinds of personal contact) has really been a bad thing for our society.  It also makes it increasingly hard for anyone in the service industry to do their job.  I lament this and I refuse to give in to the zombie-like behavior of those I am supposed to be helping.  And it's not just the customers.  I work with pharmacists who see themselves as paragons of professionalism but apparently have no problem whatsoever being distracted by stupid texts and stupid Facebook crap on their personal cell phones. All day long.  While they are checking your prescriptions.   I don't accept that.  I love my iPhone, but it has no place in my workspace when I am doing my job.

I understand that the airlines are contemplating allowing people to use their devices all the time, including during takeoff and landing.  I am totally against this. Make people turn the goddamn things off for 10 minutes and listen to what's going on around them.  No, your iPad cannot be used as a flotation device.

I didn't participate in the recent Pharmacist Tweet-A-Thon.  I just wasn't in the mood.  My first customer of the day handed me a letter that said his $300 prescription had received prior approval from the insurance company.  He spoke not one word of English.  When the prescription was filled and I prepared to collect a $3.00 copay, he looked at me quizzically and shrugged in the universal "no money" gesture.  Another person haughtily informed me that she did not have $1.00 for her copay. When I indicated I was not going to just hand it over, she reached into her purse and pulled out a dollar.
Someone else told me I was "full of shit" when I tried to explain the rules regarding quantities of diabetic test strips when covered by Medicare.

I have a few tips for everyone who is entering the health care market under the new legislation (and I'm truly glad you are getting health care, by the way):

1.  READ.YOUR. POLICY. You, and only you, are responsible for understanding it.

2. Understand that everything is not going to be free. Being 'covered' by insurance also means that you might have to pay $3 ( or $100) out of a $300 prescription.  This is nothing new.  Even my long time customers with good jobs and good insurance have trouble grasping this.  The payer makes the rules.

3. You have to be able to communicate. Please learn the language or bring someone who speaks it.

4.  Be patient.  Be courteous and respectful of people in health care.  We are human too. I will move heaven and earth for someone who gives me an ounce of respect and practices common courtesy.
And please don't walk up to me with your face in your cell phone.

And how will you be paying for that?

CrazyRx Man recently posted "Why it takes TIME to get your Rx filled" and it was a great summary of all the potential obstacles, safety steps and other assorted procedures your pharmacist must perform before handing you those pills in a bottle.   It made me want to elaborate a little more on the step which involves submitting the claim electronically to your insurance, because people sometimes just don't get it that this is the PAYMENT step.  And just like any other retail transaction, we can't let you walk out with the goods until they are paid for.

Most people pay for stuff nowadays with a credit or debit card.  As long as you swipe your card and it is not 'declined' you are on your way.  Now imagine if there were conditions put on that card (like an insurance plan would do) which involved more than just having money on it.   To use my favorite analogy, let's say you are buying a new couch at a furniture store.  You swipe your card at the sales desk and any one of these messages pops up on the screen:

1. Too soon!  You bought another similar piece of furniture 3 months ago. There's no way that could be worn out yet.  You're gonna have to call us and explain yourself.

2. Prior authorization required!  That is a very expensive leather sofa.  We need to know why you can't get something cheaper.

3. Plan limitations exceeded! We'll only let you buy one with 2 cushions, not 3.

4.  Plan limitations exceeded! We prefer you to buy Sofa World brands, not Sofas 'R Us.

5.  Invalid days' supply!  You need to estimate how long this couch will last you.  We think it should be 12 years, not whatever you put in.

6.  Step therapy required! We need you to try a loveseat before you can move up to the full-fledged couch.

7.  (And if none of those get you...)  Card number not found! The number on your card is NOT the same number that we need to process this purchase.  You need some other numbers which we're not going to tell you until you have been on hold with us for at least 10 minutes.


No wonder I need some couch time when I get home from work.

Wait, Wait.... I know the Answer

A physician called the other day with a question and I drew a complete blank.  To be honest, it wasn't a question that was strictly in my area, but certainly something we covered back in pharmacy school.
The caller I spoke with before that was someone who had an e-prescription sent to our pharmacy, but wanted to pick it up at a different store in our system.  She wanted it transferred to the "24 hour pharmacy" at the hospital where she 'went before.'   I debated back and forth with her for several minutes, explaining that that was the HOSPITAL pharmacy and they would not fill an regular outpatient prescription (she wasn't buyin' it.)  I gave her a nearby alternate pharmacy and she wanted specific instructions on how to get there.  Then she decided she'd fill it at a chain pharmacy and wanted me to look up their phone number for her.  Then she hung up on me.

Which brings me back to the physician question.  I hate feeling like my pharmacy knowledge is slipping away.  Some days it really hits home how much of my time is spent screwing around with e-prescription problems and trying to figure out people's insurance coverage.  I am awash in prescriptions for over-the-counter products, trying to put them through insurance, trying to explain to people that they're not covered, or if they are covered, why there's a copay and why it is what it is.   Attempting to generate an e-prescription for any medication that requires ANY personalized directions is like putting a square peg in a round hole.   And arguing with people about WHERE their prescription should be filled....  I've said it before, I kind of miss the days when people brought you a piece of paper and that was that.

So Doctor, I'm sorry I had to put you on hold and scramble to find that information for you.   My life is full of argumentative customers and prescriptions for insulin syringes that say "Take one 3 times a day."
Have mercy on me.

Sum-Sum-Summertime

Well, most of the allergies are taking a break till fall, the hacking coughs seem to be at a minimum, and the ADHD prescriptions await the start of school.  Things are perhaps a little slower right now for some of us.  Our regulars, the core patients, continue to visit us though.  When I hear statistics describing how a small percentage of people account for a disproportionately large percentage of health care expenditures --- well, I sure believe it.   Don't get me wrong, I know most of them would rather not be in that group, but there's always the few who are demanding, entitled and have no concept of how much money is being spent every time they walk in the door.  I wish they knew.

My other summer observations, in no particular order:

If your insurance won't pay for your dose of gonorrhea medication because you've exceeded the maximum of once every 30 days -- maybe it's time to change your lifestyle.

I hate to harp on this, but I really am sick and tired of Vitamin D prescriptions. We could save billions of health care dollars by putting a big barrel of the stuff at the pharmacy entrance with one of those scoops in it, like the bulk section of the grocery store.  Help yourself.  All ages.

People are STILL stunned by this whole prescription coverage thing.  Again, just because your doctor writes the prescription, doesn't mean your INSURANCE has to cover it.  It also doesn't mean they have to cover it at little or no cost to YOU.   This is nothing new.  People still have a hard time getting this.

I get it, it's summer -- you're going out of town tomorrow, and need everything refilled NOW.  You wouldn't have thought of taking care of this yesterday, or the day before.  The insurance company is not going to pay for it early, so I'll drop everything and call them for you while you stand there with a quizzical look on your face.  What do you say we take this little task away from the pharmacist and give it back to the vacationer?

I don't lecture people on good eating habits or unhealthy lifestyles -- I get rather bored with that stuff myself.  But I would swear that some of my co-workers eat a fast food meal EVERY day.  Guys, that's not good for you.   I guess I get discouraged when I see people making bad lifestyle choices of all different descriptions, and it never seems to get better.

I guess I'll see you at the pharmacy in about 20 years..... every week or two, regular as clockwork....

The Public, the Providers, and the Plodding

As the routine daily tasks of pharmacy continue on these days,  I find myself thinking about the general state of our health care system and how uncertain/hopeful/apprehensive I can feel all in one day.  I'm thinking of three components..........

The "Public" Factor:

I just returned from a trip to a large, very busy city -- surrounded by people jammed in the streets, mostly looking at their cell phones, lost in that cell-phone world of whatever the heck they are looking at that can't wait until they have fully crossed the street.  Additionally,  I'm always stunned by the inability of large numbers of people to follow simple directions ("Turn off all electronic devices now."
"Order here."  "Pick up here."  "No parking." "Retain your ticket stub."  etc. etc.)    I always think it does not bode well for something like health-care reform, which is going to require people to 'do the reading', comprehend, and apply what they've learned.   People who have health insurance right now generally do a poor job of understanding it and reading the fine print.   It's only gonna get worse, and they are going to blame everyone but themselves. And they're still going to make a full-out $150 doctor's appointment and come out of it with a tube of $3 hydrocortisone cream.   I'm not hopeful at all.

The Providers:

 A physician is retiring from a medical office nearby, and I asked his nurse one day if they were going to replace him.  She said they hoped to, but  "it is very difficult to find a male M.D."   I found that interesting, and worrisome.   We have seen the trend of alternate prescribers (physican's assistants, nurse practitioners) take hold in the last few years,  and in many cases they are a great alternative for those minor ailments.  But they are probably going to be asked to do more and more that is outside the scope of their practice.  I have gotten phone calls from these folks asking me some prescribing questions that I would consider pretty 'basic,' and that's a little scary.  I had a nurse-midwife send a prescription for Seroquel the other day.  We needed some clarification on the dose and after calling her she realized that she didn't mean to write Seroquel at all, but something else.  Yikes.   And when you've got Americans consuming 80% of the world's prescription painkillers, you know that there are not enough M.D.'s (male or female)  anywhere to keep up with those scripts.

The Plodding:

On my recent trip I was surrounded by technology.  Buy something, and they e-mail you the receipt in seconds.  Wave a card in front of your hotel room door and it opens.  Your airline boarding pass is sent to your smartphone.  iPads are everywhere, for crying out loud......  I feel like the airport lounge has better technology than my pharmacy.  We are so FAR behind.  We are still fumbling with insurance cards (when we're lucky enough to be presented with one.)  We're still running out of drugs because our damn inventory system doesn't work properly.   I'm still getting electronic prescriptions that say "Take 1 tablet daily  Take 2 tablets daily."  (yes, an actual script from last week, that resulted in about a 48-hour delay and many phone calls until someone called us back. )  And of course, I'm still spending 15 minutes on the phone to find and retrieve a prescription, e-scripted to the wrong pharmacy, for frikkin' over-the-counter VITAMIN D.  And the customer is screeching "How LONG IS IT GONNA TAKE?"

Yup, this is gonna be interesting.

Advancements in Pharmaceuticals for the Good of Humankind

Hey, there's a "new" drug out for morning sickness! It's called "Diclegis" and it costs about $570 per 100 tablets.  Each tablet is a combination of 10mg pyridoxine (Vitamin B6) and 10 mg doxylamine.
The cost of these two medications, if purchased over-the-counter separately -- a few DOLLARS. (Doxylamine is "Unisom", in a 25mg tablet --- hint: break it in half!)

The DrugMonkey has covered this kind of stuff thoroughly in his newest book, "The Pharmacy Rip Off List", but wow, this one took my breath away.  Maybe because even the Pharmacists Letter felt that it deserved a mention (although they did put the quotation marks around the word "new.")

We waste so much money and resources on this kind of silliness.  I can't believe we're still seeing it.