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.
Monday, September 2, 2013
Wednesday, August 14, 2013
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.
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.
Monday, August 12, 2013
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....
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....
Wednesday, July 17, 2013
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.
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.
Monday, June 10, 2013
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.
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.
Wednesday, May 22, 2013
DON"T !!
I generally stay out of the personal lives of my co-workers. Over the course of a long work day in an enclosed space like a pharmacy, the conversation can drift many different ways. I'll listen, I'll offer benign advice, but I don't lecture or impose any of my viewpoints on anyone else. Sometimes I am listening to two other people talk, but staying out of the conversation myself. However, I REALLY hate to see people making stupid decisions, and it's hard to keep my mouth shut sometimes.
A short list of my advice, if I were to offer it:
1. Thinking of lending your boyfriend of 2 months a bunch of money so he can buy a car? DON'T.
2. Thinking of making a personal style statement by getting a big ugly-ass tattoo that creeps down your arm and you will look at for the rest of your natural life? DON'T.
3. Thinking of continuing your visits to the tanning booth when you've already had two cancerous lesions removed because you just 'feel better' when you tan? DON'T.
4. Thinking of taking on a ridiculous amount of debt because you've just gotta have that gi-normous
pick up truck to drive yourself to work every day? DON'T.
5. Thinking of having another child even though you are in no way financially stable and your husband/boyfriend seems to spend most of his time drinking? DON'T.
6. Thinking of quitting your job (with nothing else lined up) because someone pissed you off and you want to make a statement, even though you know damn well that no one is irreplaceable? DON'T.
I'm still not gonna say anything, though. I don't think it would matter anyway.
A short list of my advice, if I were to offer it:
1. Thinking of lending your boyfriend of 2 months a bunch of money so he can buy a car? DON'T.
2. Thinking of making a personal style statement by getting a big ugly-ass tattoo that creeps down your arm and you will look at for the rest of your natural life? DON'T.
3. Thinking of continuing your visits to the tanning booth when you've already had two cancerous lesions removed because you just 'feel better' when you tan? DON'T.
4. Thinking of taking on a ridiculous amount of debt because you've just gotta have that gi-normous
pick up truck to drive yourself to work every day? DON'T.
5. Thinking of having another child even though you are in no way financially stable and your husband/boyfriend seems to spend most of his time drinking? DON'T.
6. Thinking of quitting your job (with nothing else lined up) because someone pissed you off and you want to make a statement, even though you know damn well that no one is irreplaceable? DON'T.
I'm still not gonna say anything, though. I don't think it would matter anyway.
Wednesday, May 8, 2013
Let the Games....Continue
I had a prescription ready at the counter and called the customer's name. She walked up to the counter with her nose in her phone. Of course, that's not unusual. She reached the counter and still didn't look up. I waited a few seconds.... still no eye contact. Normally I would walk away, but I decided to play a little game and see how long it would take her to look up while I stood there waiting. I waited, and waited, and with only about 3 feet between us it probably took her a good 45 seconds to allow me a moment of her time -- and only a moment. Yes, we've got a sign asking people to turn off their cell phones. What a joke that is. It often occurs to me that there is a whole generation of toddlers and pre-schoolers who, when they think of their parents, will picture them staring at their cell phone. Until the kids get old enough for their own phone, that is.
Every once in a while you get an elderly customer who is a breath of fresh air. They are polite and respectful. They don't have cell phones. When you talk to them they listen, and are appreciative. They come from a generation who didn't run to the doctor with every minor ailment. A trip to the doctor's office was a responsibility they took on to maintain a good state of health, or it was because they had a medical concern or condition that they felt required a doctor's attention -- in which case it was probably pretty significant to them. A prescription is a big deal and they look at a pharmacist as someone providing a professional service. I love those folks, and I will spend ANY amount of time with them, no matter how busy it is.
What is it about standing in line that makes people behave like first-graders? When we have a bunch of people lined up, some picking up refills and some waiting for new prescriptions, we've got to be fair.
The people who have been waiting for new prescriptions for 20 minutes may get called up ahead of someone who just walked in to pick up a refill. We'll get to everyone, people. I can't count the number of times I've felt as though I'm in a schoolyard.... and by the way, just because you're a regular customer who comes in ALL the time does not put you at the head of the line.
I feel vaguely guilty selling people Mucinex. Expensive placebo? I always tell them to drink lots of water with it. In fact, just drink the water, skip the Mucinex.
I still do a slow burn when someone walks up, slaps down 2 or 3 prescriptions, and the FIRST words they speak are "how long will it take to fill these?" I always wonder if the first thing they say to the doctor when he/she walks into the examining room is, "How long will this take?" Or when they check into the lab, or X-ray, or lay down on the gurney in pre-op --- are they asking this same question?
I wish I knew of a response that might convey a reminder that this a professional service, and not a sub shop. Or at least a response that wouldn't get me fired.
Every once in a while you get an elderly customer who is a breath of fresh air. They are polite and respectful. They don't have cell phones. When you talk to them they listen, and are appreciative. They come from a generation who didn't run to the doctor with every minor ailment. A trip to the doctor's office was a responsibility they took on to maintain a good state of health, or it was because they had a medical concern or condition that they felt required a doctor's attention -- in which case it was probably pretty significant to them. A prescription is a big deal and they look at a pharmacist as someone providing a professional service. I love those folks, and I will spend ANY amount of time with them, no matter how busy it is.
What is it about standing in line that makes people behave like first-graders? When we have a bunch of people lined up, some picking up refills and some waiting for new prescriptions, we've got to be fair.
The people who have been waiting for new prescriptions for 20 minutes may get called up ahead of someone who just walked in to pick up a refill. We'll get to everyone, people. I can't count the number of times I've felt as though I'm in a schoolyard.... and by the way, just because you're a regular customer who comes in ALL the time does not put you at the head of the line.
I feel vaguely guilty selling people Mucinex. Expensive placebo? I always tell them to drink lots of water with it. In fact, just drink the water, skip the Mucinex.
I still do a slow burn when someone walks up, slaps down 2 or 3 prescriptions, and the FIRST words they speak are "how long will it take to fill these?" I always wonder if the first thing they say to the doctor when he/she walks into the examining room is, "How long will this take?" Or when they check into the lab, or X-ray, or lay down on the gurney in pre-op --- are they asking this same question?
I wish I knew of a response that might convey a reminder that this a professional service, and not a sub shop. Or at least a response that wouldn't get me fired.
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