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Tuesday, April 30, 2013

Pharmacy Patient Rights

As A Pharmacy Customer, You Have The Right To...
-have your prescription filled at any pharmacy you choose.
-have your prescription sent to my pharmacy.
-have your prescription filled in a timely manner.
-have your prescription filled correctly.
-speak to a pharmacist.
-be counseled on your medication.
-have your pharmacist check for drug interactions.
-have your pharmacist review your allergy history.
-have your pharmacist ensure accuracy of your prescriptions.
-have your pharmacist double check the doctor's orders for errors.
-privacy.
-pay cash for your prescription. (meaning we can skip your insurance altogether, and early narcotics are exempted from this right.)
-ask questions about your Rx and OTC medications and have them answered by a pharmacist.
-expect professionalism.
-come back later.

These are your rights as a patient. Read them. Understand them. Most importantly, Exercise them. Remember, as a patient, your most basic rights include professionalism and accuracy.

Your Rights DO NOT include the following.

You DO NOT Have the Right To...
-complain to me about your copay.
-argue with me about your copay.
-have your prescription filled as fast as possible.
-throw a temper tantrum and act like a 2 year old (unless you are a 2yo).
-throw anything at me or my staff.
-yell or scream or swear at me or my staff.
-park in my drive-thru lane.
-invade others' privacy rights by crowding my counter.
-expect preferential treatment.
-have your insurance billed for you (it is a professional courtesy).
-be lazy about your healthcare (you don't care? I don't care).
-demand anything.
-command me to bill multiple discount cards and manufacturer coupons.
  (again, it is a courtesy-so ask politely and who knows?)
-expect me to do everything for you (call your doctor for refills, call to remind you to fill something, call to remind you to pick it up, call to remind you to take it--Again, all Courtesy).
-complain about some perceived slight to a store manager and expect a reward.
-complain about the wait.

I'm taking my profession back. If you don't like this list, please read your list of actual rights again. Number one is "you have the right to have your prescription filled at any pharmacy you choose".

Friday, April 26, 2013

Returns Not Accepted

Let me make this clear: We are not allowed to accept prescription medication returns. This is why we belabor these points at checkout...
Average Customer: I am picking up my prescriptions today.
CP: How many, kind customer?
AC: Three
CP: That will cost $240
AC: I see. And why so much?
CP: The one is a non-preferred brand so your insurance is charging you $200 for it.
AC: Ok.
CP: You are welcome to leave it here and check with your insurance to make sure that what I am telling you is correct. (It is...) But if you take it home, I am not allowed to return it should you decide paying me $200 was ill-advised.
AC: That's okay. I shall take it now.
CP: Are you sure? Again, let me remind you I am not allowed to accept returns.
AC: Gotcha.

<15 minutes later>
Any Customer's Spouse: Why did you charge my Significant Other $200?
CP: That's your copay.
ACS: We can't afford that. We have food to buy.
CP: And I expressly forewarned AC that it could be left here at the pharmacy. AC decided that you needed the medication more than food which is why it is now at your house and not at my pharmacy.
ACS: You're taking this back.
CP: Nope.
ACS: Yes you are.
CP: No. I most certainly am not. Once it leaves my pharmacy, once it crosses the invisible wall that is your side of my counter, I am not able to accept it as a return. I have this annoying little thing that governs me in these cases. It's called the law. The State Boards like that we strictly adhere to the laws they establish.
ACS: You should have mentioned that when we picked it up.
CP: I did.
ACS: Significant other says you did not.
CP: Of course SO said that. SO is afraid of you. In fact, you scare me a little bit and I'm on the phone with you. SO has to live with you and face your ire for spending your food money. Too bad you give SO no credit for thinking about your health. About how much of a concern that was before deciding to pay for the medication. Apparently SO cares more about your health than you do. So take the medication and thank SO for being so dear to you and live long and prosper...

Thursday, April 25, 2013

Medicare patients and Coupons

Don't you know we, as a society and as pharmacists, hate old people? Yep. That's what they tell me. Repeatedly. We're always out to screw the elderly.
Rare was the nasty curmudgeon who met every sincerity with nasty remarks. Today, it is rarer to find an older customer who isn't mean or complaining and directing his ire at us. It essentially boils down to them not being able to receive the discounts available to the rest of the population. But is it really that big of a savings that we should be treated as poorly as we are, simply because a manufacturer coupon cannot be combined with a Medicare plan? Oh. And stores that offer rewards programs for gas or groceries or sets of fine China cannot offer them on government-funded plans. Yep. Screw the elderly. Well, the welfare people too. We obviously discriminate against them as well. It's not enough that Medicare D plans give decent copays. It's not enough that welfare has copays of nothing (some States have copays, but they're usually $3 or less and it's not for all drugs everywhere).
Average Old Guy: Why can't I use this coupon?
CP: It says on the card "cannot be combined with Government-funded plans".
AOG: The government isn't funding me anything.
CP: In fact they are sir. You have a $6.60 copay for a 3-month supply of your medication.
AOG: Right. And I should be able to use this coupon to make it free. Or at least $4.
CP: No sir. The only way we could use that is to charge you the cash price.
AOG: Fine so do that.
CP: But sir, it would cost you $257.78 to pay me cash for it.
AOG: Then use the coupon so it'll be $4.
CP: The coupon maxes out at a $50 discount. You'll still be responsible for $207.78.
AOG: Then why did my doctor give this to me?
CP: Because the lovely drug rep who visited his office told him to do it. And he listened. Your doctor is not smart enough to read the coupon. Your doctor does not work in my pharmacy. In fact, he really doesn't do any work in his office. Watch him. He pops into your room, chats you up a bit, types some notes, then walks out. He may dictate some more notes, but he passes off the work to a nurse or assistant. She, if he didn't already do it, will send your prescription electronically. When you check out, another girl collects your copay, if you have one, and she bills your insurance for the office. Your doctor is really only there for the easy part-to find out what's wrong with you and to tell someone else what to prescribe electronically. He doesn't even need to sign anything anymore.
AOG: Can I at least get my store rewards for this?
CP: Only if you pay the cash price sir.
AOG: Why?
CP: Again, the government says you are already receiving perks. Also, we are not allowed to use these special perks to incentivize you to do business with us. They call it leveling the playing field.
AOG: I'm going to level someone. This is discrimination against old people.
CP: Absolutely sir. You take your lawsuit to Capitol Hill. I couldn't agree more. The government is giving you prescription drug insurance which you may not otherwise have and that is not enough.

Wednesday, April 24, 2013

Entitlement

How do you pick your doctor? Is it a general practitioner? Is it a specialist? Do you ask for a referral? Do you do research online or get recommendations from friends?
How do you choose your pharmacy? Do you put as much effort and thought into the professionals providing your medication as you do your doctor? 
You should. While it is true any pharmacy can fill your prescription, not every one can develop the personal relationship needed for quality healthcare. 
Which brings me to...

Entitled Customer: My doctor gave me a prescription and I've never used your pharmacy before.
CP: Fantastic. Thanks for calling. How may I help you? (Since that was a statement and not a question.)
EC: I wish for you to fill it. 
CP: Superb. Since we are a pharmacy, we do that sort of thing here. 
EC: I do have a question for you first. 
CP: Absolutely. I am an amazing pharmacist. As you can plainly see, I have a wonderful rapport with my patients and will often go out of my way to help them. Ask away.
EC: What are you going to give me?
CP: Sorry? Give you? I shall fill your prescription and give you what was prescribed. 
EC: No. I mean, what incentive do I have to come to your pharmacy?
CP: My supreme awesomeness is not enough?
EC: No, quite frankly, it is not. I want gifts lavished upon me. I want to feel like a queen. In order to gain my business, you should bow before me. Offer me coffee, a mani-pedi, gift cards, free gas, some chickens, and a FastPass to the front of your line every time I come here.
CP: I think not.
EC: I think so. Your company prides itself on customer service. If you don't give me everything I ask, I shall complain. Then you'll get in trouble and I'll get everything I wish, and more, anyway. So make it happen, post haste!
CP: How about NO? I pride myself on professionalism. I pride myself on being the best pharmacist around. Patients love me. My techs love me. I don't care if you are offended that I won't hand you the keys to my pharmacy and do a little dance on the counter for you. It's not my job to kiss your ass. Do you shop for doctors this way? See who'll give you a free colonoscopy? Or maybe a breast augmentation? I think not. Feel free to keep shopping around. I know plenty of pharmacies crawling all over each other to gain your business. Try them. Maybe you could conference them in on a 3-way call and take bids for the opportunity to fill your Diflucan and Valtrex. It's not going to happen here. Unlike the rest of my whore profession, I still respect myself and demand you do too. Away with you.  

Wednesday, April 17, 2013

It's my Job...

I know lots of stuff. Usually useless stuff, but often important stuff. I know words and stuff and math and stuff and like, drugs and stuff. Yep. Drugs. Pretty much my day job is dealing (with) drugs. I'm always amused/bemused/astonished when someone questions me on drugs. Drugs are my bailiwick. Perhaps I've overdone it with this conversation, but these interactions always make me giddy. I reflect upon them when I am visited by the Dark Side. I attempt to put right, what once went wrong....

Overconfident Guy: Which ones are these?
CP: Your Gabapentin, sir.
OC: I know that. But which ones?
CP: The shiny capsules? Or perhaps you meant to ask "which strength?"
OC: But of course. Allow me to rephrase..."With what strength are you filling my prescription, kind pharmacist?"
CP: Very nice! We have filled your prescription with the 300mg capsules. You are to take 3 of them at a time, 4 times a day.
OC: These are not the 900mg tablets?
CP: No sir. They are not. They do not come in such a strength.
OC: Oh but they do.
CP: Oh, but they do not.
OC: Surely they do. I know that is the highest strength manufactured. It is the highest strength allowed. It is the last strength I can try as it is the maximum dose.
CP: They do not. And don't call me Shirley. While you are indeed at the maximum of 3600mg per day, there is no such strength as 900mg. To achieve this, you must take 3 of the 300mg capsules.

OC: My doctor say it does.
CP: Well my doctor says I'm paranoid. But I think he's just out to get me.

OC: Yes, they make it. Of this I am quite certain.
CP: You dare to question me? THE CP? How did you come across this knowledge? I can tell you it is available as 100, 300, 400, 600, and 800mg formulations. However, no 900mg exists. Of this, I am quite certain.
OC: I have tried the 300mg before. The effects wore off and they had to increase my dose.
CP: And now you are taking 3 of them. At a time.
OC: Yes. And they won't work because the 300mg didn't work before.
CP: When you were taking just 1 at a time?
OC: Yes.
CP: Um. I think you're the first person to argue that taking more of the exact same medication will NOT have an increased effect. Usually people will say "if 1 works well, 2 will work better!"
OC: I already take some other medications. This is too many to take if I have to take 4 more tablets at a time? Are you sure?
CP: <Double checking the math here...3 pills at a time does not equal 4. It's 4 for the day, but>
Yep. I'm sure
OC: Certainly sure you're sure?
CP: Yes. It's drugs. They're kinda my thing...



Tuesday, April 16, 2013

Give Me an A!

I've mentioned before how much our profession has become a carnival. We are circus performers behind a counter. I often feel as though juggling bottles a la Tom Cruise in Cocktail isn't enough of a show anymore for my patients. We need something new; something edgier to excite the public into knowing we have the best pharmacy in town. It's not about fast service or accuracy or low prices anymore. Pharmacy is all about the gimmicks. I want to introduce...the Drugstore Cheerleaders. 

First, we'd have a Carnival Barker standing in front of the counter. He'd be dressed in Rod Roddy's jackets and wearing the smile of the Cheshire Cat. 
CB: "Step right up. Step right up! What can we do for you today? Ah! A Manufacturer discount card! 
<Starts playing the limbo song and slowly building a rising chant with "how low can you go? how low can you go? How Low Can You GO?!">
The cheerleaders will come up behind you and join in the chorus. Then they'll start shaking their pompoms and cheering "take it off! take it off! take it off!"
You, as the customer, will get so caught up in the excitement you'll forget all about how much work is involved on our part. But that's okay. It's called distraction. Throw some loud, obnoxious, sequin-clad people in your face along with a theme song, (I'm thinking Eye of the Tiger) and you'll forget all about the wait and the hassle. People will look forward to coming to my pharmacy. 
After the card is run through, the CB will announce the savings over the store's paging system and to the patient and confetti will drop from the ceiling while the cheerleaders carry the customer on their shoulders to the cash register to pay. 

"How will we pick our pharmacy now?"
"We used to go wherever there was a coupon."
"But CP has Cheerleaders! and an announcer!"
"They are so entertaining there. And it's so much fun, I forget it takes them an hour to rebill my prescription. But that's ok. It's so much fun! If only they added a craps table..."

A craps table? Hmmm....


Monday, April 15, 2013

Change of Mind?

Announcement: "Attention all Pharmacy customers, the time is now 10:30. Thank you for shopping."

Blissful Couple approaches the counter for an encounter...
Blissful Lady: We are here to pick up my husband's prescription.
CP: And his name would be?
BL: Obedient Husband
CP: I don't see anything ready. Ah. The computer tells me he gave us a pickup time of 11:45.
BL: Correct.
CP: It is now only 10:30 as the announcement made clear.
BL: I changed his mind.
CP: You did?
OH: She did.
BL: I did.
CP: You do realize, of course, that someone has to tell me? Since I am the person actually preparing prescriptions, please pass on your plan changes to me.
BL: So it's not ready?
CP: No. Do you go out to dinner much?
BL: Yes. All the time, but I fail to see...
CP: Do you make reservations?
BL: Yes.
CP: This would be similar to you calling the restaurant and making reservations for 4 people at 7pm on Friday night. You then would arrive on Tuesday, with 6 people, at 5pm and expect them to have your reservation ready.

And she was quite serious that "I changed his mind" was a good enough expectation that we should have it ready.

Thursday, April 11, 2013

Waiter!

Refill requests get placed in different ways every day. Yesterday was different. 
Fine dining establishment or pharmacy? This is a new one, even for me...
...and I'd like a side of HCTZ with some fresh ground Metformin...

Lady Customer: I'd like to place an order for my husband's refills. 
CP: Ok. Do you have the numbers?
LC: I do. He needs #123, #234, #345, and #456. 
CP: Fine, madam. Anything else for you today?
LC: Oh. He also needs #567. 
CP: Ok...
LC: And I'll have the same.
CP: Ok...I'm sorry?
LC: And I'll have the same. 
CP: The same...what?
LC: The last prescription numbers I gave you.
CP: I'm sorry. But what?
LC: I take the same medications too. I need them filled for myself. 
CP: OooooKay. Do you have those numbers, by chance?
LC: No. I just always order it that way. 
CP: You are aware this is not a restaurant, right? 

Tuesday, April 9, 2013

More Doctor Bashing...

As if we needed a reminder that doctors still don't respect Pharmacists or our profession, along comes this story...(yes, the story is true...)
Another Stupid Scriber: (He is a specialist, foreign, but still supposedly trained in his discipline...) I see you have some medications listed you no can take. 
Awesome Patient: That is correct.
ASS: I see Cipro and Levaquin. (pronounced "Cee-pwo" and Wee-vuh-kwin") 
AP: Yes. I cannot take them. Drug Interaction with my heart medication. 
ASS: And where did you hear that? Bet it was a pharmacist who told you that, huh? These pharmacists...all they do is read package insert and tell you few things to scare you. If they had their way no one would take any medications. Everyone should try it before they know they can't take it. Did you try them?
AP: I did, actually.
ASS: Ahhh, and what happened? A widdle rash? A widdle itchy? Pharmacists are stupid. You can take this. What happened?
AP: My heart stopped.
ASS: Oh. 
AP: And I happen to be a pharmacist. So I know the seriousness of the reaction with my Amiodarone, Dr. Assbag...
ASS: Who prescribed these for you?
AP: My cardiologist, Dr.....
ASS: Oh. He's a well-respected fellow. Um...
AP: And you're a douche. Perhaps, had you bothered to get a personality while getting your degree and spent your time learning the value of my profession, you wouldn't hold us in such disregard. Remember, I will save your ass more times than you will save mine. Unfortunately, I know you have given this narrow-minded spiel to too many of your patients who don't know better. I also know you are incapable of changing your opinion and will continue to belittle a fellow professional. But that's ok. Lucky for you I know you're an ass. Lucky for you I am a pharmacist. Lucky for you I saved my own life. What kind of a professional just tells people "try it first to see what happens"? Well, of course DEATH may be a side effect, but the only real way to know is to try it? That's your professional opinion? You went to school to do that to people? Do you really have a license? Seriously? Please let me see it...

Monday, April 8, 2013

It's New to Me

Doctors get in a rut. They tend to prescribe the same things they always have. When doctors cover for other doctors' patients, it can make life a little interesting at the pharmacy. If you have never prescribed something before, why are you writing for it now? If you are covering for someone and their patient needs a refill, why are you not just prescribing it as it was written previously? And why are you mad at me for inquiring?
1. I ask thanks to this conversation...
Office Person: Why are you calling?
CP: To question the doctor's directions. He wrote insulin for a sliding scale based on the patient's carbs. But he did the calculation wrong. The conversion is not correct based on what the patient used last time.
OP: Well, this doctor doesn't usually write for that. We're just covering for someone so the patient has enough to get her through.
CP: Um. "Just Covering?" Sorry. That's not an excuse. That's like a pharmacist filling in at a store and giving a patient the wrong medication and then answering "Sorry. I'm just a floater." So that makes it A-O-Flipping-K? How about striving to always prescribe it correctly? How about learning about what you're prescribing? How about not getting mad at me for doing my job? A job which not only may save a patient's life, but your doctor's job and your job? How about that?

2. Strength? Bueller?
CP: I am calling to get the strength of a medication. The doctor omitted it when she wrote it today.
OP: Let me check with her.
CP: Fine. I shall hold patiently and anticipate my next comment. It will either be "that's what I thought" or "how can she not know this?"
OP: She said it's for the normal strength.
CP: Great, mystery option #3...It comes in all of these strengths. Each one is abnormal. Please check with her again. Or might it be possible for me to speak with her directly?
OP: Oh no. She is with a patient right now.
CP: Well you go and interrupt her again because I'd like to be the patient in the room where the doctor is continuously bothered because she doesn't know how to prescribe something. That'll instill confidence in me that she has my diagnosis correct.
OP: She want this one. She said she didn't know it came in multiple strengths.
CP: Seriously? That's your answer? You mean to tell me she prescribed a drug she knows nothing about? Why is she prescribing this? Did the drug rep hand her a nice shiny pen? Did she get her prescribing information from the skeleton picture the rep taped to the wall? I bet she gets her prescribing habits like Keyser Soze from The Usual Suspects: She just looks around at the walls and writes whatever she happens to see. Maybe she diagnoses that way too. If she doesn't know about the drug she is writing, what else doesn't she know?
I bet she gave them a coupon too...

Friday, April 5, 2013

End of Humanity

1. A customer complained that the Metformin he was purchasing today for his diabetes was too expensive. A normal dose is taking one tablet twice a day. His doctor prescribed two tablets twice a day. He was mad when he had to pay twice the normal 90-day cost because it was twice the normal 90-day amount. (He is paying cash, no insurance, because it is cheaper.) He threatened discrimination because he was "sicker than other people". He threatened "false advertising" because it only says "90-day supply" and his dose is normal for him.
At no point did he say "Thank You" for the two years where his medication was provided for free as a marketing gimmick. Perhaps I should have reminded him.
It would be like me getting pissed at my car company. I traded in my car last month for a new, larger vehicle. My gas tank nearly doubled in size as a result which means I need to purchase more gas to fill it. Thanks to this guy, I think I'm going to try to sue for discrimination. The manufacturer and gas companies are charging me more to fill up because my tank is bigger.
Although this did give me an idea for another post...But another time.

2. A (loyal) customer approacheth...
LC: I say. Would you be so kind as to renew this prescription?
CP: It would be an honor kind sir, thou art our most (loyal) customer and...oh, bother.
LC: Problem?
CP: Yes. See, it appears as though the refills are no more. They have quite expired.
LC: Ah, yes. Was afraid of that.
CP: May I suggest a call to your friendly prescriber?
LC: No. May I suggest you just refill it now and give me my damn pills?
CP: Ooh. Testy are we? Let's try "You need your doctor to write more. No doctor, no refill." Follow?
LC: My doctor won't refill it without seeing me. I don't have the money for an office visit. You need to just give them to me.
CP: Haha. How about, NO?
LC: Listen up. I've been coming here for years. You need to just shut up and refill my bottle now or I'm never patronizing this establishment again.
CP: Is that a promise?
LC: Most definitely.
CP: Then may I bid you fond adieu. Parting is such sweet sorrow. Good day.

3. I have no idea...
CP: Hi.
Missed the Boat: I'd like to have this here prescription filled.
CP: Delightful. We do that here.
MTB: It's an antibiotic, right?
CP: That it is.
MTB: And it's free, right?
CP: I am sorry, but it is not.
MTB: I thought all antibiotics (and everything in life) were free at pharmacies.
CP: At some, they were. Some pharmacies used them as a marketing gimmick to drive sales. All it really did was give people unrealistic expectations about the cost of our services and shorten the temper of lots of really sick, irritable people who now have a deep-rooted hatred for our once revered profession. But I digress...
MTB: When did that stop?
CP: A few months ago.
MTB: Well I want it for free, now!
CP: I am sorry, but we cannot do that. Some places have this for $4 now. You could simply pay me with a $5 bill and I would even give you change.
MTB: NO! That's not right! That's not fair! I wasn't sick when they were free so I couldn't take advantage of free antibiotics then. I want them now! You need to give them to me now!
CP: Wow. Slow down Veruca Salt. I wasn't driving when gas was less than a dollar and I don't think anyone is going to sell it to me for that now simply because "I couldn't take advantage of it then" is my excuse. Similarly, I don't think Apple will let me buy stock today for its $22 IPO from 1980 simply because I was too young to invest at that time.
MTB: You're trying to screw me over. This is bullshit. Give me back my prescription. I'm going somewhere else...
CP: ...Where you'll pay more than $4. Have a lovely afternoon.

Wednesday, April 3, 2013

All Refills Must be Faxed!

I am all for living for your convictions. I also believe there should be a little common sense sprinkled in to everyone's day, just to spice it up a bit.
True Story...
Dedicated Customer: I need you to fax my office for my refill.
CP: Ok. It appears we already did.
DC: My doctor, alas, say you did not.
CP: My computer, in fact, says I did. Here is the timestamp.
DC: Ok. That's what I told them. I'll call you back.
<A few minutes later>
DC: I called my doctor. They gave me the fax number, again, to make sure you get it right.
CP: Hmmm. That is the one we have. It is correct.
DC: Well they say they still have yet to receive it.
CP: After I spoke with you, I actually printed a copy and fed it manually into the fax machine.
DC: Hold on for me, please.
<listening to Aenima in my head as hold music>
DC: CP?
CP: Yes?
DC: I have the doctor's office on conference call with us.
CP: Sweet! Party line!
Fax Us: We haven't received it. Here's another fax number.
CP: You have two?
FU: Yes. A regular fax and the one for electronic prescriptions.
CP: I have sent this three times now. All outlets have been faxed.
FU: Well we don't have it.
CP: So how's your day?
FU: Fine.
CP: What's new?
FU: Nothing.
CP: Do you have any paper at your office?
FU: Yes.
CP: Do you possess any writing implements?
FU: Of course.
CP: Can you take a note for me?
FU: I suppose.
CP: Patient wants a refill. On her medication. Send it to her pharmacy via fax, e-rx, and phone. See which one arrives the fastest.
FU: But we need a fax.
CP: But why? You do realize that because you are so stuck on getting a fax from the pharmacy, which has tried valiantly over the last day to accede to your demands, this patient is stuck in the middle? Wasting her time to fight with you? Wasting my time? All you had to do, when she first called, was take a note. You already told me you have paper and a pen. Perhaps no one there knows how to transcribe, taking a message from ear to pen? Regardless, there comes a time when doing what's right is more important than sticking to your principles. Take care of the patient. Then, while you have your favourite CP on the phone, ask about the fax/e-scribe issue. But we have all just lost 27 minutes of our day for one single prescription. And the best part is, you STILL had to write it down because you swear the fax didn't arrive AND you still have to have the doctor approve the Rx which means this patient is still without medication.
FU: Um.