But I'm a Prescriber

There are no more powerful words in the English Language than these.

It is the fix-it-all answer for any situation. 

CP: There's a problem with this prescription you wrote. 

Good Ole Doctor: But I'm a prescriber. 

CP: Your car ran out of gas. 

GOD: But I'm a prescriber. 

CP: You have a small penis. 

GOD: But I'm a prescriber. 

CP: I'm trying to explain why you're wrong. 

GOD: But I'm a prescriber. 

You get the picture. This would not be so bad if the following events had not taken place. 

CP: You can only get one inhaler. 

GOD: But I'm a prescriber. I write it like this all the time. 

CP: Good. So you understand that just because you write it like that does not mean they actually get it filled like that. 

GOD: But we need one for home and one for school. 

CP: And the insurance only allows one at a time. Picture this. Let's pretend that you're a prescriber...

GOD: But I'm a Prescriber. 

CP: Good. So stay with me. As a prescriber you know that you can write for whatever you want, let's say 90 days of HCTZ 25mg. The insurance...

GOD: But I'm a prescriber. I know what you're trying to say and I get it. 

CP: I don't think you do because you keep interrupting me. As I was saying...

GOD: But I'm a prescriber and we need one for home and one for school. 

CP: Okay. Let's try this. Let's pretend it's NOT the first day of school. Your insurance only pays for one inhaler because, per the directions, this one inhaler is a 25 day supply. This means you can only get one filled per month...You can refill it...

GOD: But I'm a prescriber. I know this. Just tell me when I can get another one. 

CP: As I was saying...most likely, you can get it in 17 days. 

GOD: And it will be free, right? 

CP: Wait what? Why free? 

GOD: Because it's the rest of what was written. I shouldn't have to pay another copay because you can't fill the whole thing today. 

CP: How does that even begin to make sense? 

GOD: But I'm a prescriber. I know these things. 

CP: Obviously not a good one and obviously you don't. Back to the 90 day thing. You can write for whatever you want. It does not mean the insurance has to pay for it. If they limit you to 30 days, you don't come back and get the next 2 months for free. 

GOD: But I'm a prescriber. Of course what you are saying makes no sense to me. You are the fool. Just tell me what I need to do to get my child's inhalers filled. 

CP: I tried but you kept interrupting me. 

GOD: I'll just call my coworker and have her send a new one for two inhalers. 

CP: Fine. As long as it meets the criteria for payment from the insurance or we will be back to the top of this dialogue and I don't think you want to try this again. It will end poorly for you. 

GOD: But I'm a prescriber. 

Open at the Close

Signs are only helpful if two requirements are met:
1. You must be looking for them.
2. You must read them.
There are other factors that enter into it of course but without these two, the rest of them are moot.
(You must be able to interpret them. You must pay attention to them. You must heed them...etc.)

We have our hours conspicuously posted:
a. on the front doors
b. on the pharmacy counters
c. on the wall of the pharmacy
d. in the waiting area
e. drive-thru windows

The problem with arriving early to work is people can see you. Even if you have shutters instead of a gate, people see the lights on and know someone is home. They'll just bang on the shutters shouting "I know you're in there. I just have a question!" until your blood boils.

Here is last week's verbal sparring joust:
<We are early. It's a Saturday. Unpacking the crew's donuts and coffee. Sunny. 78 degrees...inside and out...>

Early Ass Talker Making Exclamations: What time do you open?
CP: We open at 9am, kind sir. About 20 minutes.
EATME: It's 14 minutes.
CP: What?
EATME: It's 14 minutes.
CP: Well my clock says it is 8:43 so that's 17 minutes. (Which is also "ABOUT 20 minutes".)
EATME: Mine says 14 minutes.
CP: Glad I don't use your clock to open, then, huh? Perhaps you should sync your watch with my clock. This way you will always know when we are open and never be too early.
EATME: Smart Ass.
CP: Smart Ass who fills your prescriptions when we open at 9am. Which is now 16 minutes away. Provided I open on time. Sometimes people talk to me and keep me from getting my work done and I lose track of time. Glad you're here though so I won't forget.
EATME: I'll be back.
CP: In 15 minutes...give or take.
EATME: Can you take my prescriptions now?
CP: Are we open?
EATME: You're in there.
CP: And you're out there. What conversation would you be having right now were I not in here? Had I not decided to arrive early? What if I had been that pharmacist who believes in only working the exact 10 hours, 600 minutes since you're counting, and not a second more than scheduled?
EATME: Piss off.
CP: I don't get to do that in a 10 hour shift. See you in, hey! look! it's now 14 minutes.

Disney's 3:00 Parade Question

Little Old Lady: My doctor gave me these patches. Which side do I use?
CP: The sticky one.

Every business should work to discover what their "What time is the 3:00 Parade?" question is. From this, they should teach their employees to learn what the inquirer meant to ask instead of giving them the straightforward, "you're an idiot" answer. For the Disney example, the takeaway is that people are actually asking "What time will the parade pass by here?" or "When will it enter Frontierland?" since that is where they are heading next.

I thought of this as my intern dutifully told me about LOL's question and I was about to answer her call.
What was she trying to ask?
She obviously had never used transdermal patches before.
What did the patches look like?
Was she going to ask where to put them?
Was she concerned about side effects?
Did she read the package insert?
Why, when she was at the counter and offered counseling, did she not ask then and there so I could open the box and show her?
How do I answer this over the phone?

LOL: Which side do I use?
CP: Which side is sticky?
LOL: There isn't one. There is a silver side and a clear plastic side. There's also this tape cover thingy in case I think it won't stick. Do I tape it on with that?
CP: No. Since I can't look at one right now, let me ask you: Does the clear side look as if it peels off?
LOL: It does.
CP: Good. Lay the patch flat on the counter, slowly peel the backing from one corner to keep it from curling, then once it's removed, place it in the desired location on your body. Press the patch into place starting in the center then working out to the edges to make sure it is completely stuck in place. If you're worried about showers or swimming with the patch in place, you may use the cover. Always remember to remove the old patch before placing another patch anywhere on your body.
LOL: That makes more sense now. I read all the directions but they didn't say which side to use.
CP: That's why we are here. To help. Remember, there are no stupid questions, only stupid directions.

Cost

No one knows the value of a prescription medicine. If we want to improve healthcare, we need to revisit our approach to pricing.
Everyone knows how much a gallon of milk is worth. And a gallon of gas. The harder something is to produce, or the harder to find, the more expensive it becomes. Think lobster (outside of Maine), caviar, truffles, Kobe Beef, Lamborghinis, etc.
Thanks to insurances, no one can appreciate the true value of a prescription medication. Let's develop a chart and pricing scheme for illnesses. The more common your disease and the easier to treat, the cheaper your medication.
We could introduce tiers to each classification.
Infections: A. General, B. Complicated, C. Lethal
Heart Disease: A. Basic, B. Complicated, C: Imminent Death
Diabetes: A. Madonna (Borderline), B. Illegal Immigrant (Over the borderline)

I think we need to publish a list of costs...Acquisition Costs (AC).
American Healthcare (weigh in if your country is different) needs to use a better pricing scheme than Average Wholesaler Price (AWP) when looking at costs of medications.
Why do some companies consider Generic Zofran (Ondansetron) to be a specialty drug? Cost.
AWP is listed around $700.00 while AC (the cost the pharmacy paid for it) is closer to $4.00 for a bottle of 30 tablets.
Insurances require prior authorizations on this due to cost.
Make healthcare more affordable. Charge $20.00. That's $10.00 for the basic cost to fill a prescription with NO drug in it, plus the price you paid, plus a $6.00 dispensing fee.

Better to Give Than to Receive

...or so the saying goes. In the pharmacy world, this is often accurate.
Sometimes it is for insurance reasons.
Sometimes it's a relocation.
Sometimes it's because I'm an asshole.
Sometimes it's because the patient is an asshole.
Either way, the initial optimism and joy and thinking to yourself "boom! script growth, baby!" is quickly met with the harsh reality of the pain those scripts will cause you.

Just Another Cynical Pharmacist Openly Thrilled: This is the pharmacist. May I help you?
CP: CP calling for some transfers. You really busy?
JACPOT: Time is relative, my friend. Sounds like more than a few.
CP: I have 8 for you. All for one person.
JACPOT: Any chance you were given numbers?
CP: Any chance Sunderland win the EPL this season?
JACPOT: Right. Who we got?
CP: Last name Baggins. First name Douche.
JACPOT: What? Really?
CP: Um. Yes.
JACPOT: (loudly announcing to rest of staff, rather muffled) ...seriously! she's transferring. Yeah, no shit! Oh this is news most welcome. Hooray!
CP: So I take it...
JACPOT: ...Phew. Hey everyone. I'm buying tonight!
CP: Well she sounds like an old sailor, port to port. How long did it take you to get rid of her?
JACPOT: About 3 months of pure hell.
CP: Well once I have these 8 copies, you can start the clock on me.
JACPOT: Good luck! (and somewhere in the background, I could swear I heard Munchkins singing...ding dong the witch is dead.)

Anniversaries

Something about the celebratory nature of an anniversary that makes one reminisce about the good ole days. There are gifts to buy, cards to send, hugs and kisses to be shared by all.
Somehow, the annual expiration of one's prescription does not qualify for this sort of fete.

Why, then, do people complain we did not call them when their prescriptions expired?
Should we have an obituary section in the local paper, or perhaps on our website mourning the passing of these refills into the land of insignificance? Should they appear on the eve of their demise?
We already know people do not pay attention to...anything really.
Silence your cell phone alerts during movies? They're talking to YOU. Yes, you on the phone right now, oh never mind.
Medication Pickup Reminders? Patients complain they never got the 7 calls we made in the last week.
Refill Reminders? Patients complain they didn't listen to the message or they weren't out when we called the first 4 times.
Text alerts? Patients ignore them.
Email Reminders? Must have been lost in their spam folders.

It's not as if we don't put an expiration date on the bottle itself. You know, the bottle the patient has to physically touch each time they wish to take a dose of said medication. (oh wait, what? we do do that? never mind.)
Remember, you can give a person an education, you just can't make him take it.

It Matters Not

Cat, dog, beaver, monkey, rat, snake. It does not matter to me. I have filled prescriptions for these and many more animals. People love their pets. They are quite passionate about their non-human friends. This tends to make some of them a little more out of touch than one might expect, say, a normal parent to be. Bear with me.

I had this conversation multiple times my last weekend so it's not an isolated occurrence, as most of you will be able to attest. (...and I had another last night.)

Fiercely Enraged Learning It's Now Expensive: I am here to pick up the prescription for My Precious. 

CP: Peachy. That'll be $46.99

FELINE: (Incredulously) WHAT? IT'S FOR A CAT!
CP: And?
FELINE: It's for a cat!
CP: You keep saying that as if you think you are a JEDI. I am a retail pharmacist. Mind tricks don't work on me.
FELINE: (More indignantly now) But it's for a CAT!

CP: I don't care. 

FELINE: What do you mean? 

CP: Should it cost less because it's for a cat? You are at a human pharmacy picking up a human medication that will be used on a cat. Its use does not dictate its price. If that were the case, different indications for different medications would warrant a pricing flow chart. 

FELINE: So I have to pay the same? 

CP: If you were taking this medication and, like your unemployed cat had no insurance, I would charge you the same price to take it as well. The medication does not know who or what is taking it. I don't get charged less to purchase chicken wire because I'm using it to make little prisons for my mini-voodoo doll collection of pharmacy CEOs instead of making chicken coops.

Deal(er) With It

I wonder if people treat their Street Dealers with the same courtesies as they do their professional, legal dealers.

1. Did you make this batch of Meth in an old Mt. Dew bottle? I can't take the batches made in Coke or RC bottles.
2. What brand of baby powder did you use to cut my coke? It better not be that store-brand stuff. I want the real Johnson's.
3. My marijuana buds had little hairs on them last time. Can I get the ones without the little hairs? They creep me out. I think I'm smoking little furry spiders.
4. My crack rocks are different sizes this time. Are you sure you gave me crack and not crystal meth?
5. Can I get the Ecstasy with the pictures of leprechauns on them? The ones with Hello Kitty made me too thirsty.
6. Is this one of those bad batches of heroin that's going around? I had that the last time and it damn near killed. It must be generic. I think I'm allergic to it.
7. Where were these drugs made? I don't want any from Colombia. I heard they use drug mules and my last batch tasted like shit. I only want drugs that are made in America!
SD: Technically, they are Made in America. Colombia is in America, albeit SOUTH America. If you want to show 'Murican Pride, perhaps you should insist on "Made in the USA".