The Ball Drops......

It's the last (week)day of 2011. Things are chugging along fairly smoothly in the ol' pharmacy, until about 4:20 pm. And at that point things go completely, totally to hell. The phone starts ringing nonstop, because the whole world has discovered that:

a) they still have money in their flex spending accounts that needs to be used up before the new year, or

b) having met their deductible and having no copays, they really really want to squeeze in one more refill of their medications before the copays kick in again on January 1st.

Now, I'm not blaming anyone for wanting to save some money, but I do blame them for waiting until the VERY LAST minute to cheerily advise me that they'll be stopping by in 15 minutes. God, it's frustrating. And if they have no refills remaining (as is often the case) then they're stunned that I can't snap my fingers and make it happen. True, perhaps they haven't filled that prescription since 2009, but what's the big deal "I'm sure my doctor will OK it." And damned if some of them don't get on the horn to the doctor's office (apparently), because I start getting calls from exasperated nurses telling me to go ahead and fill so-and-so's acne medication one more time. The doctor's offices must be as sick of this as I am.

Also had one customer, getting on an overseas flight that afternoon, plop down a bunch of empty bottles and then proceed to get restless once 10 minutes had passed and we weren't finished. Only had a few tablets of one of his meds in stock -- it was a 'nonessential' so had no problems telling him he was SOL. In fact, even if it was an essential medication, I guess he would have been SOL.

The end result was standing-room-only in the pharmacy well past closing time. The Overtime Gods will not be happy.

HAPPY NEW YEAR.....!

Holy Crap, It's December?

I haven't been keeping up too well on blog posts lately, not because I've lost interest but I just can't freakin' believe where the time goes. Amazing how this leaving home at 7:30am and coming back at 7:00 pm cuts into one's free time.

I can't really get into Christmas this year. Each year I find myself less and less enthusiastic. The stores are full of the same crap and every sad news story reminds me that it's really just another day for a lot of people. Forgive me, but I don't really look forward to Christmas 'get-togethers' with co-workers either. Nothing against them at all, I just associate work with a different mind-set and it's hard for me to put it away when I'm looking at the same faces outside of work. When that gate comes down, I just want to get out of there. I suspect a lot of people feel the same way but are good sports about it anyway.

Seems like December 1st brought about some formulary changes for a lot of customers. I get the impression a lot of people are changing insurance plans in the new year and there's going to be a lot of confusion -- more than usual, maybe? People have been asking about generic Lipitor for weeks now, even delaying their refills till it came out. They thought the price was going to plunge immediately and wanted to know what their insurance would charge them for it. (Completely unknown to us!) We've had to caution them that they may or may not see a difference right away, and that has been borne out.

I've struggled mightily with more and more customers who speak little or no English. In fact I've become quite discouraged at what I see is a waste of money and resources in the polypharmacy for these folks. How much of a chance is there that they're going to use the
Pulmicort Turbuhaler or the Medrol Dose-pak correctly, and therefore benefit from it? I'm not saying they don't deserve the appropriate treatments, but they can't read the label (I can see them trying to 'memorize' the directions for each bottle) and I have no idea how well they understand my game of 'charades' as I try to demonstrate with hand gestures, because that's all I can do. (Plus, I've got these ridiculous SureScripts prescriptions that print directions even I can't decipher half the time.) I've watched people go out the door with bags of very expensive medications that I have no real hope are going to be used correctly. I don't know what the solution is, if the person doesn't bring someone along who can translate. We can't keep written materials in every language and for every question. I also suspect that it's a cultural thing for some folks to decline to ask questions, particularly of a female pharmacist.

I dunno, man.... it's just been on my mind. Hey, I'm gonna watch "National Lampoon's Christmas Vacation" -- that will get me in the spirit!

Ours is not to question why..... but why?

--- I put together a multi-prescription order for someone a couple of weeks ago -- several refills (had to order one thing specially), a transfer from another pharmacy, and two prescriptions that needed doctor approval. I remember the guy dumped it all on me over the phone and wanted to know how long it would take. We called him as soon as it was all ready. Then WHY, two weeks later, is it still sitting in the pickup bin --- UN-picked up?

--- a guy brings in several bottles, and complains that the generic brand of Ambien we filled for him does not work nearly as well as the one he got from Big Box down the street (he has that bottle too.) We do the usual back-and-forth until my technician notices that the Big Box bottle has his wife's name on it. We ask him, um --- is that prescription supposed to be for your wife? He seems completely mystified as to why we would question that, and continues to be confrontational about the brand that he got. Well, I'm still not sure how that conversation was supposed to end. WHY would anyone EVER take someone else's prescription medication? .....ha ha, I know, I know ... dumb question. But the whole thing was still our fault.

--- a customer gasps at the 10 dollar copay on her sedative prescription and tells me she does not have the money, nor does she have a credit card. While telling me this, she sets her tablet computer on the counter. She says accusingly, "Well I guess I won't be sleeping tonight." WHY..... don't I feel very bad about this?

--- I keep having customers telling me their medications were 'stolen.' It's almost always the controlled substances. Enough already. OK, even if it's halfway true.... if you don't have enough brains to safeguard your prescription medications from the neighbors, or your kid's friends, or your kids, the painters, the movers, your brother-in-law, the landlord, or any one of dozens of people who apparently go through your possessions and sift out the prescription for which they recognize the generic name as something they might enjoy.... then I can't
help you. And as far as leaving your entire prescription in your purse, or car........ WHY?

Pharmacy Gets A Mention?

Billy Crystal is going to be hosting the upcoming Oscars. I like him on the show and I think he's funny (although I hear he's a raging egomaniac -- but who isn't in show biz.) I couldn't help but notice this in the news article:

Crystal, who has hosted the widely-watched Hollywood telecast eight times previously, announced his new job on Twitter with a post: "Am doing the Oscars so the young woman in the pharmacy will stop asking my name when I pick up prescriptions. Looking forward to the show."

It's a funny line, but I would like to personally congratulate that 'young woman in the pharmacy' for doing her job. People don't understand the catastrophes that have resulted when names aren't verified in the pharmacy -- even if we're supposed to know who you are. Give us a break, Billy --- but I'm looking forward to the show too.

Talking About Waste (Again)

"The Drug Enforcement Administration says people turned in more than 188.5 tons of unwanted or expired prescription medications in the agency’s third National Prescription Drug Take-Back Day on Oct. 29."

This kind of bothers me. What a waste! There are a lot people around the world who have little or no access to quality pharmaceuticals and you wonder how much of this stuff might have helped someone.

Sure, there are a lot of reasons why prescriptions are wasted or not completed. A patient starts a new medication and can't tolerate it; they start an antibiotic and it has to be changed later because of lab results; a patient is prescribed 30 tablets of pain medication for a minor procedure and needs only one or two. But there are a lot of situations where I feel like I'm looking waste right in the face, like:

-- a person starting a brand new medication, and is prescribed a 90-day supply right off the bat...

-- a tiny little baby prescribed voluminous quantities of a topical product (the jar of ointment is almost bigger than the kid)...

-- OTC products that are prescribed in multiple packages at a time (this is especially unsettling when the recipient of the prescription seems completely clueless on what they're supposed to do with it)

-- a gigantic bottle of some horrific-tasting liquid medication, for a kid who I can tell you right now ain't having none of it after that first dose....

-- boxes and boxes and boxes of expensive nebulized medications, inhalers, aerochambers going out the door ---especially for anyone who can't look up from their cell phone long enough to even answer me, when I ask if they know how to use the stuff.

When someone complains that they can't get more than a 30-day supply with their insurance, or that they can't get an 'early' refill, I'm kind of sympathetic but I understand what the point of that is --- it's to try and keep the waste to a minimum. I don't feel like a lot of people have the respect for prescription medication that it warrants. And sorry, but I see NO reason why any prescription should be 'lost.' Things happen, but I really grit my teeth when someone airily tells me they misplaced their $200 inhaler like it was a bag of M & Ms.

And of course, don't even try to figure out why you fill all those prescriptions that never get picked up----

That's my little rant for today.

What Up, Walgreens?

Why has this happened to me more than once? A patient calls and says they need to transfer their prescription from me TO a Walgreens. They have contacted the Walgreens, as they should, but the Walgreens tells them I have to call THEM (Walgreens) to give them the prescriptions. (For the non-pharmacy folk, this is not the way it's done. The pharmacy that will be filling the prescriptions calls the other pharmacy for the information). I hate to put the patient in the middle of this, but they are adamant that the Walgreens refuses to call me, as they are supposed to. Sure I could call them and happily give away my business, but it's the principle of the thing.

When this happened the other day, I held my ground and told the customer to call the Walgreens back. They know better, I told him. I know it wasn't the patient's fault, but why does this keep happening?

E-Prescribing can be E-vil

The prevalence of electronic prescribing and faxing of prescription orders has generally made things more convenient for customers and probably decreases wait time as well, but as all pharmacists know it is a mixed blessing. The attempts to plug in a 'personalized' prescription into a computer program can lead to some pretty interesting prescriptions, like "Apply 9999 applications topically ", or my personal favorite from this week, a prescription for Plan B, quantity 60 tablets, with 11 refills. Customer then arrives and is totally taken aback that it's not 'ready yet,' either because we have received no prescription or the one we did receive is completely nonsensical. Heaven help me, there are days when I really miss the old fashioned exercise of someone visiting their doctor, being handed a prescription, and then being responsible for choosing a pharmacy and bringing that prescription TO IT. Y'know, kind of like having a little responsibility all their very own self.

So now we not only have the responsibility to fill your prescription correctly, with all the usual challenges associated with that, but we seem to be charged with hunting down that prescription and obtaining it for you as well. If we didn't get it, then it's up to us to seek it out, right? Clear the decks, folks, I'm about to spend 20 minutes on the phone trying to track down one prescription from Giganto Orthopedic Surgery Group and by the way, it's lunch time and please leave a message.

The problem is even worse when, like me, you work in a medical building/clinic when we seem to be held accountable for any prescription written by any doctor in the building whether the patient fills it with us or not. It doesn't matter how many times you tell me "THEY TOLD ME THEY SENT YOU MY PRESCRIPTION" --- I can't fill a prescription that I don't freakkin HAVE. Really, I wouldn't lie to you. We actually had a customer claim her doctor had faxed us
her prescription, watched us tear apart the pharmacy looking for it, acted like a complete bitch and finally rolled her eyes and said, "Well, I've got it out in my car -- do you want me to go get it?" I said, yeah that would be swell. Then I went in back and looked for a sharp object to do myself in with.

And then there are the people who want to 'read' you their prescription over the phone because they didn't want to be bothered stopping at the pharmacy, nor do they want to wait while it's being filled. Sigh.

When it comes to electronic prescribing I know there's no going back, but some days I feel there are just as many errors, just as many problems to clarify, AND the added bonus of leaving people with the notion that everything's going to be done for them. It's the fast-food, drive-through-ability of everything. We'll find the prescription, we'll figure out what your insurance is, we'll wrap it up and tie a bow on it and do it in 10 minutes. Dang, it's frustrating.