The Supply Chain, Adderall, and Flying by the seat of your Pants

There are so many drug products on back-order or limited supply right now that working in a pharmacy can feel like a scavenger hunt, especially when we're asked to keep inventories down and don't have a lot of 'cushion' to work with. I hate having to bounce people around on different generic manufacturers of the same drug because the one they got before is unavailable. If all forms of the drug are totally unavailable we have to track down the prescriber for an alternate --- but if the person doesn't want an alternate ("Midrin generic is the ONLY thing that works for my headaches -- would anyone else have it?") --- well, I'll make a couple of calls but after the second or third "no" I've got to give the prescription back and send them out to continue the search on their own. I swear I'm spending so much time trying to find a solution to these problems -- calling other stores, scouring the wholesaler's listings for SOMETHING --- it almost requires a full-time person right now. And it's not just prescription drugs; a lot of OTC's are affected too (PanOxyl soap?? -- really??).

We can't get the 5mg tablets ---- but hey, I can instruct the customer to split the 10mg tablets, right? Problem solved. Uhhhh..... not so fast. Customer calls the next day and swears that those half-tablets made her deathly ill. Every fiber of my being wants to protest --- "but, there's NO reason in the WORLD why that should happen !! It's the same thing !!! It's the............." ------------- oh, never mind. As Charlie Brown would say, AAUUUUGHHH.
I've got enough problems without this.

One that has hit us hard is the generic Adderall shortage --- unfortunately this medication is HUGE in one area where I work. The XR capsules have been unavailable for awhile and now the regular generic tablets are starting to go too. We can get brand name Adderall XR but of course people are charged the brand name copay (which they love) if we can get it to go through at all. Or, the insurance lets us fill the brand name but doesn't reimburse us for it.

Just as an aside here, the stuff is way overprescribed. There, I said it. I know there are kids who have seen their school and reading performance greatly improve because of it, and that is good, but I cannot believe that all the kids and adults we have on this drug truly have attention deficit disorder. Apparently it's quite popular amongst the college set if you need to pull an all-nighter. People become so casual about it. Parents call in because their kid has run out, knowing full well the prescription is not technically refillable, and the doctor needs to write and sign a new one each time. I am of the opinion that Adderall is not an emergency. I even had one parent say "yeah, I know it's a controlled substance and blah-blah-blah." (YES, she actually SAID "blah-blah-blah"). Sorry to inconvenience you with these pesky DEA rules, ma'am.

But I digress. I know we shouldn't whine too much, because here in the USA we are lucky to have access to pharmaceuticals, and if we can't get one there are usually plenty of suitable alternates. If you come down with pneumonia, or kidney stones, or a migraine, or gout --- well, in many other parts of the world you're just SOL.

But damn, I hope that generic Adderall is back soon... so I can concentrate (!?) on the more relevant parts of my job again.

Caller, Identify Thyself

Even though most people have caller I.D. these days, when I call a customer's home from the pharmacy the FIRST thing I do when they answer is identify myself -- who I am, and where I'm calling from. THEN, I ask if I can speak to the person I'm looking for. I figure this is common phone etiquette and they know up front that I am not a telemarketer or some other nuisance call. I got a phone call the other day at home that went:

Me (not recognizing the number but answering anyway): Hello?
Caller: Is Mrs. McGillicuddy there?
Me (pretty sure this is no one I wish to speak to but still don't know who it is): No, she's not.
Can I take a message?
Caller: Well...uh... is Mr. McGillicuddy there?

Okay, at this point I feel under no obligation to answer any more questions till the caller identifies THEMSELF. I find this really obnoxious. People will call the pharmacy and ask for a certain person. When told they are not there, they'll ask for another person. When they are not there either, they'll say "Well, who is there today?" I STILL have no idea who I'm talking to and now I have to give them a rundown of the entire staff? Nuh-uh.

Or sometimes it will go:

Me: Frantic Pharmacy, this is Lucy speaking.
Caller: "WHAT IS YOUR FAX NUMBER?" (or, "DO YOU CARRY OXYCONTIN 60MG?" or, "DID YOU GET A PRESCRIPTION FOR ETHEL MERTZ TODAY?")

Am I not justified in asking ...... WHO ARE YOU ????


(..... sorry about all the CAPITALS.)

90-Day Nonsensical

In my Sunday paper's Walgreens flyer there was a little boxed-off section which read:

Get your 3-FILL; 3 months supply
.. it's 3 refills in one
..and for 3 months, you're done.
Ask your pharmacist about a 90-day prescription today.

That was it. That's all it said. NO disclaimers whatsoever!!! Easy as pie, right?

Now I do not work for Walgreens, but if I did this kind of stuff would drive me CRAZY. What a totally misleading ad, and what a headache it must create for their pharmacies. I'm sure they have people coming in 'asking their pharmacist' why they can't get a 3-month prescription of Percocet or Oxycontin. I'm sure they have people coming in asking why they can't get a 3-month prescription and pay the same as they do for 1 month. And of course the big thing they left out here is that your ability to get a 3-month prescription of anything (even if your doctor wrote it that way) is dictated by your INSURANCE plan, and unless you are on a dirt cheap generic you're going to need a plan that covers 3 months (with the appropriate increased copay), otherwise you'll be sticking with the one-month, thank you very much. Or, if your plan does cover 3 months they'll likely require you to use mail-order, which has nothing to do with Walgreens anyway. But strangely, the ad didn't mention any of that.

They would prefer you come in and 'ask' your pharmacist for the details on this, and God knows they've got all kinds of time to explain it.

For 3 months, you're done!!!

I Don't Get It

1. When there's a huge computer, phone, or other technology screw-up that impacts our customer service and puts us a half-day behind, why is there never any accountability? If I messed up so royally in my job on such a regular basis, I'd be in serious trouble. But all we get from these fiascos is, "sorry for the inconvenience, thanks for being patient." These people want us to believe that these glitches are unexplainable, and we just have to hang in there. I'm NOT BUYING that CRAP anymore.

2. When someone is fully aware that their prescription needs a doctor approval, or a prior authorization, or some other Act of God before it can be filled, and simply shows up without calling first and watches in amusement as I frantically search for something that just ain't gonna be there, no way, no how.

3. When I e-mail someone in management with a legitimate question or concern, why can't they simply hit the 'reply' button and send me a one-line, simple response?.... even if it's only to say, "I got your message and I'll get back to you."

4. When a customer sends me on a long, time-consuming wild goose chase to get their cheap prescription changed to something that will be covered without a copay, because they inexplicably came to the pharmacy with no money. However, said customer is adorned with piercings, tattoos, jewelry, exotic nails and a smart phone.

5. In these days of high unemployment, when a pharmacy employee can't condescend to do their freakin' job. Show up on time, not 15 minutes later. And get up and go wait on that customer who, whether you like it or not, provides the revenue to keep you employed here.

6. Cameron Diaz. She's apparently one of Hollywood's highest paid actresses. When was the last time she was in a movie that anyone wanted to see?

It's An Error

There's another prescription error in the news -- in Colorado, a woman was given someone else's prescription (the person had a "similar sounding" name) and she took it home and took a dose. She realized soon after that a different name was on the bottle. Unfortunately the drug was methotrexate and the woman is in her first trimester of pregnancy, so now she must await the possibility of miscarriage or birth defects.

This is awful of course, and according to one news report, the woman said the pharmacist (and we'll assume it actually was the pharmacist and not other support staff) knew that the drug was methotrexate and even helped her pick out some prenatal vitamins.

Obviously there was a breakdown here --- the pharmacy says their policy is to double-check the name and address when handing out a prescription. In addition, the offer of counseling or at least the quick 'show and tell' wasn't done. I'm sure the pharmacist couldn't feel worse. Reading about this kind of thing is a good wake-up call for all of us not to let ourselves slide into any shortcuts because of the pressure of doing things 'fast.' (Yeah, I know.... all the forces are still against us on that...... See: every pharmacist's chief complaint..)

Believe me I'm not blaming the patient for any of this, but it's also a good reminder to folks who are picking up prescriptions--
1. Please don't get visibly irritated when we ask (again!) to verify your name, date of birth or address.
2. Look carefully at your medication bottle and receipt before you take any of it.
3. Look at the patient information leaflet that is provided with your prescription. If this patient had done so, she would have immediately realized this medication was NOT for her.

Another reminder of the human factor today. For all the venting we do on our pharmacy blogs, none of us wants to see this happen.

First of the Month -- Schedule 2 Count Time!

For the non-pharmacy folk: Schedule 2 drugs are the heavy hitters (Oxycontin, Percocet, Ritalin and many others with high abuse potential) that pharmacies are required to keep an exact count of. Every month we are required to count our inventory and make sure it reconciles exactly with the record of prescriptions dispensed, which are individually logged throughout the month.) Other bloggers have lamented how a Schedule 2 prescription used to be a rarity --- now, we shovel them out in buckets.

One of the pharmacies I cover occasionally has constant trouble with these counts. Some are over the expected amount and some are under. There's no real pattern to either the amounts or the drugs affected. Now, ordinarily this is how many a pharmacy employee has been caught stealing, but this is a small staff --- no turnover, long-term capable employees and honestly there's really no suspicion of diversion here (I know it sounds naive, but trust me on this.) In addition, most of these discrepancies are solved and found to be the result of error --- miscounts, addition or subtraction errors in the log, brand-name/generic mix-ups, prescriptions dispensed but not logged, new inventory received but not logged in correctly, etc. The mistakes appear to caused primarily by people in a hurry, as is the usual state of pharmacy.

There are a few that are never solved, though. It takes so much time, effort and teeth-gnashing to figure out the discrepancies -- there's always a little nervousness and finger-pointing and frustration involved, because it is a big deal and no one wants any cloud of suspicion hanging over them.

And then it came to me to ask out in the blogosphere if anyone out there has a good system going that keeps those Schedule 2 counts pristine? Other than counting the damn things on a daily basis?

Complaint Dept.

I don't know what it is, but the last couple of weeks at work I feel like I could jump out of my skin. The same obstacles keep popping up every day and easy stuff finds a way to be difficult. It'll get better, but for now I would like to blow off steam about a few things.

1. Managers who give permission for technicians to leave early on days that the manager is NOT working, and I AM. I think it would be common courtesy for the manager or technician to ask ME if it's OK beforehand, since I am the one who is going to cover for the absence by being a highly-paid cashier for the rest of the day. I am sick and tired of seeing people walk out the door early because someone who's not there told them it was OK.

2. I understand it is sometimes necessary to use your lunch break to run errands. But that is still your lunch break. Don't come back to the pharmacy, plop yourself down and proceed to take another half hour to actually eat. You had your lunch break. It is now over.

3. Please, for the love of God, cut back the personal phone calls. Ignoring customers while you talk loudly on the phone to your 'whoever' is --- well, I shouldn't even have to get into it.
What makes people think that personal conversations take priority over doing their damn job?

4. OK, insurance companies --- you've sent me a letter advising me that all generics of a certain drug are back-ordered and will be for many weeks. Only the brand name is available. So how about giving people a little break on that jacked-up brand name copay, since it's really not their fault that they can't get the generic, huh? And you know they can't get it --- you just told me, right?

5. I really don't like telling people that the advice they've been given is baloney. I try to be nice about it and not undermine anyone too much, no matter how stupid it is. My customer was told by a dietitian to take "super-potent" Vitamin C supplements to help his back heal after surgery. I told him to save his money. He agreed with me.

And that concludes my pissing and moaning for now.