NuvaGlo--Part 2

You may remember a couple months back a post I did about the NuvaGlo; a lighted version of the Nuvaring. It would come in different colours. As technology improves, so does the ability to improve the original product and get a new patent. All great manufacturers are great at patent extensions. They market the crap out of their products and, with a little twist, can continue raking in profits hand-over-fist for decades. With that in mind, I propose an extension to the lighted Nuvarings (NuvaGlo).

Today we will introduce The NuvaShine, NuvaVibe and NuvaSavers.

NuvaShine: It's like the Flashlight app for your phone. Super bright. Wear a skirt and it's easy to find your seats walking down the aisle of a darkened movie theater.

NuvaVibe: It will be a vibrating vaginal ring. Keep it in for 3 weeks, then take a week off. For those of you who like to skip periods altogether, put another one in after the 3 weeks. The convenience here is it stops vibrating after 3 weeks so you know when it's time to change. (Perhaps a remote control upgrade in the future? I'm thinking Katherine Heigl in "The Ugly Truth".)

NuvaSavers: (Inspired by LifeSavers) these rings will come in a variety of flavours to meet your tastes.
Luscious Lemon, Tangy Tangerine, Sweet Berry, and of course Regular and Black Cherry...
...or Rainbow Sherbet (pictured below).

\

One Month Supply

Doctors don't like math. It's okay, they're not really that great at it anyway. Their e-scribing software usually does the hard work, but for those who like the old ink-and-paper method, they still have to use their brains a little.
That's where we as pharmacists come in. Historically, it has pretty much always been our job to be the math gurus. We need to double-check the doctors' calculations; on dosing, quantities, and day supplies, etc. It is a surprisingly not-so-infrequent occurrence that the supply and directions do not match (take 1 tablet 2 times a day for 10 days--dispense 14 tablets). Do we call? Nope. We get to exercise Professional Judgement. By the powers vested in me by the State License under which I practice, I can make that change all on my own. Do we double-check antibiotic dosing for children? Yep. The maximum amount of acetaminophen per day? Sure do. Let's not even get in to the amount of calculations my brethren in the hospital world have to do.

Doctors frequently take the easy way out and write to dispense a "One Month Supply".
As Pharmacists, we always take that to mean 30 days. (For once a day dosing we'd dispense 30 tablets. For twice a day, 60 tablets, and so forth...)
But why do we always pick 30 days?
Is it because it works out to an even 360 tablets in a year?

As a Cynical Pharmacist, I obviously see things differently. The next time the doctor actually writes "month supply" or "1 month" or something similar, I am going to say "February". That's the month supply I am going to use. February. (Side question: How many months have 28 days?  All of them have 28 days, the rest all have 30 days, and 7 of them have 31...But I digress...)

What's really funny is, if we use the 28-day method, patients can fill prescriptions 13 times which equates to a 364 day supply. It is actually a better way to fill. However, as with all things new, two groups would not go for it:
1. Doctors. They'd never be able to figure out how to prescribe 1 month plus 12 refills.
2. Patients: They'd never be able to figure out how we gave them 13 months of medication in a 12 month period. AND they'd complain about the extra one copay per year and extra trips to the pharmacy.

Besides, what else is good about February? It should be the new standard month...

Fire!

Our pharmacy had the fire alarm go off in the back room around 7pm a while back. Most people, most normal, rational people, would see and smell smoke and opt for the closest exit. Neigh, Neigh! I say. For we are dealing with the "Retail Pharmacy Patient". It played out like this...

Hyper Manager: The sky is falling! The sky is falling!

CP: Pull yourself together. It's only the fire alarm. We heard it, but figured it was a drill. 

HM: It isn't. We have to evacuate now! Get everyone out of the store. 

Put Out Patient #1: But I need my medication. I've been waiting in this pick up line for an hour and a half. 

Put Out Patient #2: Yeah. It's just a fire. I can't even see the flames. I have to be somewhere in 5 minutes. I can't go outside and come back. 

HM: It is my job to ensure the safety of our employees and customers. For that reason you have to close the pharmacy and evacuate. Now!

POP#1: I'm going to sue you for not giving me my medication. 

POP#2: I'm going to call your corporate office and file a complaint about how inconvenienced I was by all this and score some free gift cards. It's all your fault I'm missing my son's soccer game that started 15 minutes ago, even though I just got here as the alarms started sounding. 

I realize it's a little being next in line when the movie sells out. Or when the roller coaster breaks down. Or when the bathroom gets the "closed for cleaning" sign put up right in front of you. But It's A Fire! I really wish these people were in line when my pharmacy was robbed. Couldn't you just see them bitching to the death the guy with the gun? 

POP#1: Oh no you don't. I was here first. They closed this place down for a fire last week and I couldn't get my medication for a whole 3 hours!

POP#2. I'm going to complain that this robbery was all your pharmacy's fault and score me some gift cards. This always happens when I come here...

Dick and Jane

See Jane. She is a pharmacist.
See Dick. Dick is a patient.

Jane: How can I help you today?
Dick: I need a refill.
Jane: Do you have the prescription number?
Dick: No. But it's in your computer.

Don't be a Dick.
------------------------------

See Jane. She is a pharmacist.
See Dick. Dick is a patient.

Jane: How may I help you today?
Dick: Can you tell me the price of this before I have it filled?
Jane: Do you have insurance?
Dick: I do.
Jane: Then I cannot tell you. I can give you a cash copay, but I must process the prescription to your insurance so they can tell me what I am to charge you.
Dick: But every other pharmacy I ever used can always do that.
Jane: Alas, they cannot. Do you know if you have set copays for brands and generics?
Dick: No. That's not my job.
Jane: Actually it is, for it is your insurance.

Don't be a Dick.
------------------------------

See Jane. She is a pharmacist.
See Dick. He is a patient.

Jane: How may I help you today?
Dick: I need a refill.
Jane: I am sorry sir, you are out of refills. As it's been over a year since this was written you need to call your doctor to have it refilled.
Dick: I ain't got time for that. You do it!
Jane: As I cannot do that, since your doctor requires an annual visit and does not like us to fax him, it appears we are at an impasse.
Dick: I'll just die then.
Jane: Or you could go to the doctor...

Don't be a Dick.
------------------------------
See Jane: She is a pharmacist.
See Dick: He is a patient.

Jane: How may I help you today?
Dick: This was run through as cash. Why didn't you tell me? I have insurance! Shouldn't you pay attention?
Jane: Some people have 1 insurance. Some have 2. Some prefer to pay cash and submit for reimbursement. Some use discount cards. Had you filled with us before, we may have had your information on file. Shouldn't you pay attention to what you are buying BEFORE you fork over the credit card?

Don't be a Dick.
------------------------------

See Jane: She is a pharmacist.
See Dick: He is a non-pharmacist District Manager.
Jane: Good to see you today, sir!
Dick: Thanks. How are things going? Lots of shots administered? Script counts up?
Jane: Of course. We are the best store in the district.
Dick: Oh. I see you have a customer.
Jane: You mean a patient? Here in pharmacy-land, we have patients.
Dick: Patient. Customer. Whatever. As long as they spend money, right?

Don't be a Dick.

I Have the Power!

I was not blessed with the benefit of foresight. I, unfortunately, was only given hindsight. Prescience is not one of my skills. This does not stop people from thinking I have this magical power. With the number of predictions I am routinely asked to make, you would think otherwise.

What time will my doctor call you?
What will my insurance copay be?
When will the prior authorization go through?
How long will I have to wait...if I come in after 6 tonight?
Who will win the EPL this year?

I decided to take a sublime approach to answering these questions. I am going to get a sound effects board for my computer. The next time someone asks this question I will announce "Sublime Time" and the whole pharmacy, a la Coyote Ugly, will jump up on the counter, join arms, do a kick line and sing:

"I don't practice Santeria. I ain't got no crystal ball."

Pharmacy Analogies II

Calling the store from the drive-thru when you can clearly see 9 cars in front of you is like calling Disney World from the back of the line and asking why the wait for Toy Story or Space Mountain is so long...except there you have big signs telling you the wait time before you get in line.

Asking if any of your prescriptions (i.e. METHylprednisolone or METHotrexate) have METH in them is like asking if POTatotes have POT in them. (Spelling-wise oui! Drug-wise non...)

YOU calling ME to ask if YOUR insurance will cover a certain prescription is like ME calling YOU to ask if MY insurance will cover MY prescription.

Asking if we will be busy when you come in "in a few hours" is like jumping into the monkey cage at the zoo...not sure what's going to happen then, but it'll be fun to watch.

Complaining to me that the front of the store is out of an advertised sale item is like complaining that every retailer is out of this year's "IT" Christmas item...on Christmas Eve. (Everybody else wants the deal too...)

Whining that you are out of medication, out of refills, and have to make an appointment to get more is like complaining you have to stop for a red light and wait for a green light. (That's the way the system is supposed to work.)

Doctors telling patients how much their prescriptions will cost at my pharmacy is like me guessing the winning lottery numbers.

Asking your doctor how much a prescription will be at my pharmacy is like calling me from your doctor's waiting room and asking when he will see you.

Telling me to call your insurance for your ID number is like telling Starbucks to call the bank to look up your debit card number.

For Hire...

"I wish I was a neutron bomb, for once I could go off."
And I wish we could be allowed a HIPAA exemption a day. Here is why...

CP: <at drop-off window> How may I help you today?
Know-It-All: Obviously I'd like to fill a prescription.
CP: Thank you, but my name is not obviously. I see you have papers there, and I understand you are at "drop-off" but many people come to ask questions with shopping lists in their hands. Not so obvious...
KIT: Fine. How long will it take to fill these?
CP: Have we filled prescriptions for you before?
KIT: Obviously, that's why I come here.
CP: There you go with calling me obviously again. I expect it to take between 17 and 23 minutes.
KIT: What? Why so long? All you do is (pick one: 1. put pills in a bottle, 2. slap a label on it, 3. grab it off the shelf from right behind you there.)

<And this is where the exemption comes into play.>

CP: Oh! You're experienced! Why didn't you say so? I happen to have an application right here. Just fill this out while you wait. Better yet. Come on back. I will let you fill your own prescriptions today. I sure am glad you came along when you did. We are short-staffed this week, what with budget cuts and the addition of flu shot quotas and all. I actually have to go give a shot right now so let me let you in to get started on your prescriptions. I'll only be about 3 minutes so I expect you'll have everything ready for me to check upon my return. Again, I can't tell you how excited I am that you happened to walk in just as I was crying in the corner, praying that the Gods would send me someone to ease my suffering during these long pharmacy winter days. Pharmacy Gods be praised! They like me. They really like me!

KIT: <to Super-tech> What just happened?
ST: CP happened. CP owned you. Now go have a seat in the waiting area. We shall call you in about 27-33 minutes.
KIT: It was just 20 minutes like a minute ago.
ST: First, you spent so long arguing with CP that more prescriptions got in front of you. Second, it's a time penalty for arguing with the pharmacist. Any more questions?
KIT: No.
ST: Don't forget your application...

Trump!

It has always been my policy to have my employees verify the copay price with patients BEFORE actually ringing the sale. I hear there are some companies that mandate this as well. That makes me pretty smart. My reasons were always to make sure the patient was AWARE of the price so we would not have to reverse a sale. This ensured that a really high-priced item would trigger the obligatory "but I have insurance!" or "didn't my insurance cover it?" or "WHAT?!" exclamations from patients. These were usually handled delicately with a quick explanation that their high-priced insurance actually did cover it and we'd quote some lofty Usual and Customary (U&C) price to them to prove how expensive this could have been.
However, this would not be funny, or cynical, without an outlier, a nonconformer, a person that just doesn't quite get it. They laugh in the face of, well, themselves in the mirror probably. They are smarter than you and I. They own us. They have us played. It is a chess game to them. They are card playing professionals.
At the penultimate moment before the sale, as the wick is about to be snuffed by its own waxy cocoon, the player tries to trump us...

Awesomest Tech At Things: How may I help you today?
Bret Maverick: I am here to pick up a prescription.
AT-AT: Lovely. We do those here. Name, date of birth, next of kin, blood type, and the first 314 digits of pi?
BM: <cooly complying> Anything else?
AT-AT: No sir. Are you aware of the price of this medication?
BM: I am. I have purchased this before, many times.
AT-AT: Wonderful, then if you'd like to hand me payment we can be all....

<as if in slow motion, and played like the titular character's final hand (FYI that's Maverick)
A card is slowly removed from its hand, then slowly, carefully flung upon the counter, where it rattles,  clacking around, until coming to rest, face-up, to be revealed as the Ace of Spades! Straight Flush! Winner!>

AT-AT: Yes?
BM: Bam!
AT-AT: Bam what sir?
BM: That's my card. My insurance.
AT-AT: It is indeed yours sir. But nonchalantly flicking it upon my counter like you just won a WSP event is rather overdramatic and ineffectual.
BM: So this doesn't help?
AT-AT: It already helped sir. Of this you were most certainly aware, as you stated earlier. However, the theatrics were quite nice. I can't quite figure out how you managed the whole slow-motion video of your deal to me, but it looked really impressive. Now I just need a credit card. And this time, you can just hand it to me, thank you.