That's Not How It Works - Never Has

ME: Are we doing another PSA series? 

MICE ELF: I hope not. 

CP: Just a refresher course. 

ME & MICE ELF: Oh dear. What is it?

CP: <clears throat> ahem. Let it be known that today, I am announcing, again, for those who may be caught unawares, the following about the Patient-Prescriber-Pharmacist Healthcare Triangle:

Doctors and all Prescribers, it is not necessary for the pharmacy to contact you or your office to request refills or any prescriptions for our patients. 

ME: But. . . 

CP: You do not need to hear from the pharmacy to send a new prescription. 

Do not tell your patients it is our responsibility; it is not. 

MICE ELF: But. . . 

CP: You say you didn't receive our request? You. Don't. Need. It. 

You are fully capable of submitting a new Rx without our intervention. 

ME & MICE ELF: But why do they keep telling people that?

CP: <shrugs> I have no idea. They'll reject the refill request anyway before submitting a new Rx in its place which causes more work than me being able to match the Rx's together and fill the new one. 

ME: But what about the ones who claim it's "their policy"?

CP: My policy is to not accept this as reality. Will I send a request? Yes. Once. After that, if you have had your office on the line and they insist they need to hear from me, politely explain how this is a lie. Here's how it has always worked: Patient becomes unwell, goes to their provider. Provider performs magical dances and spells and diagnoses a problem that the medication I govern can treat. Said provider then provides a prescription indicating which of these you need and which I am to dispense. Prescription arrives at my pharmacy, whether by land, sea, or air and, after performing my due diligence, it is filled properly, patient retrieves it and, presumably, begins to get better. No steps are to be skipped. At the end of the initial treatment, their provider will indicate if they need more. If none indicated, treatment is complete and you shall go on your merry way. However, a follow up visit may also be indicated. Notice how none of this involves the pharmacy?

ME: Yeah, not the initial visit, the follow up visit, the diagnosis, whether the patient still needs it. 

MICE ELF: Yeah, we really don't need to be tracking down the refills of all thousand of our patients. 

CP: When they have only their own to worry about. Last week, a patient called and reminded us of his provider's "policy" and I reminded him of mine. It had been 11 days since we first contacted the office. I went back and pulled the successful confirmations, all four of them, circled them, and sent them along with yet another request; a request which also contained the following note, written with "Dr. Zoffis Sharpie", that said: If it is your policy to have the pharmacy request refills, then do not ignore and stop telling your patients you didn't receive them. As you can clearly see, we faxed this successfully four times. I shall remind you of this one more time: YOU. DO. NOT. NEED. THE. PHARMACY. TO. REQUEST. REFILLS. Stop telling patients this when you have them on the phone."

ME: Did it work?

CP: Three days later we received the refills. 

MICE ELF: Unbelievable. 

CP: From now on, I tell patients I will send it once. Here endeth my obligation. If your office can't figure out a way to refill your prescription without my intervention, then again, even WITH my intervention, there is nothing for me to do. But I have way too many patients to play this game. Find a new Dr. Zoffis or track it down yourself. 

ME and MICE ELF: Amen. 

 

It's Not Rocket Surgery

CPP: <aside> why are you using me as the setup person in this?

CP: <whispers> because I need a cold intro since no one else has heard of this. 

CPP: you're saying we are old?

CP: -er, old-er. 

CPP: Phine. What is the best migraine relief medication you have used that you can't get anymore?

CP: Wow. That's really out of left field. Let me think. Sprix. 

CPP: That was a good one. Why did you have me ask you about it?

CP: It's gone rogue, off the grid, escaped the tethers of reality. 

CPP: Do tell. 

CP: We were able to order it, briefly, over a decade ago. Then it became a special order from the manufacturer. 

CPP: And now?

CP: Now the prescriber has to order it online through the company. 

CPP: And the story phor today involves this, somehow?

CP: It does. 

UT: What the hell is this?

CP: Sprix! I haven't seen a prescription for this since Moby Dick was a minnow. 

UT: You're old. 

CP: Only in pharmacy years. I didn't think you could find this anymore. 

UT: You can't. I checked all suppliers. 

CP: Let's ask da google. hmmm, curious. 

UT: What have you found?

CP: It is only available online, through the manufacturer. I''ll call the office and let them know. 

Little Office Lady: What is your question?

CP: The doctor prescribed Sprix nasal spray. If they want the patient to have this, they have to go online and have the prescription sent to the company. 

LOL: Ok. Well I'll send them a message and see what he wants to do and call you back. 

CP: No. No "see". They have no other option. If he wants the patient to have it, they send it online. You don't need to involve me in this matter any further. I shall even ring the patient myself and provide them the same information. You two can hash it out between yourselves. 

LOL: Okay. Someone will get back to you. 

CP: I often wonder if we speak the same language. 

UT: People would be so much better if they weren't so people-y. 

#IfYouDontKnowHowToPrescribeItPerhapsYouShouldnt

Not On Me

Pick A Pharmacy That Executes Special Tasks: Did my doctor call in my prescription?

CP: Yes. It's ready to pick up. 

PAPTEST: Is it ready?

CP: Asked and answered. Next question. 

PAPTEST: Do you deliver?

CP: Alas, we do not. 

PAPTEST: Now how am I supposed to get my medication?

CP: <shrugs>  Not my problem. That's not up to me. 

PAPTEST: I really need it. 

CP: I don't doubt that. Needing it is not the issue here. What you really needED to do, was choose a pharmacy that offers the services you so desperately require. If you cannot pick up your prescriptions between 8-6 M-F, then skip the independent that is closed nights and weekends. You choose a restaurant based on what they DO offer, not what they don't. Besides, McDonald's doesn't tell you how to eat your food if you're NPO or can't chew and you just ordered a Filet-O-Fish and fries.

PAPTEST: I just live down the street. 

CP: That's not going to change my inability to deliver. 

PAPTEST: Can you walk it to the curb?

CP: I am by myself and cannot leave the pharmacy. How do you get other things? Groceries and other sundries?

PAPTEST: Someone picks them up for me. 

CP: So. . . ?

PAPTEST: I guess I'll call them. 

ME: But they've been here before. 

MICE ELF: And they know we have neither a drive-thru nor delivery on our menu of options. 

CP: Apparently we need to change how we operate our business for one put-out patient. 

ME: Yeah, like Chik-Fil-A will open on Sundays for me. 

MICE ELF: I do miss the days when most businesses were closed every holiday and Sundays. 

CP: Somehow we all managed to survive the cold, cruel world of the 70's. 

ME: Imagine if it had been the 40's and there was rationing with a war. 

MICE ELF: It's too difficult. 

CP: Now I'm hungry. 

ME: Door Dash us some Chik-Fil-A. 

#KnowTheRulesBeforeYouPlay 

#BecauseINeedItDoesNotMeanICanChangeMyAnswer 

#TheAnswerIsStillNo 

#WhyYourPharmacistHatesYou 

Insurance Stupidity Knows No Bounds

UT: You'll never believe this one. 

CP: Oooh. That's a challenge I'll accept. Proceed. 

<UT on phone with long-time patient>

UT: Your insurance won't pay for your NP Throid; it requires a prior authorisation.

Patient On Phone: I know. And I can't afford over $100 per month for it. 

UT: They want you to try and fail both BRAND Synthroid AND BRAND Levoxyl before they will cover the NP Throid. 

POP: Can you tell me what the cost of those will be?

UT: Sure. Well that's interesting. 

POP: I assume that is "not interesting"?

UT: If I run through Brand Synthroid, the insurance requires a prior authorisation. Same with Brand Levoxyl. Unless. . . 

POP: What?

UT: Unless the doctor writes DAW1 on the prescription, the insurance requires prior auth. 

CP: Wait. So the insurance requires these brands be tried and failed. 

UT: Yes. 

CP: But they won't pay for them unless it's with a DAW1?

UT: Yes. 

CP: So we now have to call the office and have them send another Rx to prevent prior auth?

UT: Yes. 

CP: That's not THAT surprising. 

UT: But they set the rules and changed them midgame, it seems. 

CP: You mean "why couldn't they just say that in the first place?' instead of sending us a prior auth request for brand Synthroid and Levoxyl when it was their idea? 

UT: Right. Why do they need a p/a on what they prefer? It seems stupid to require brand only to THEN require it be DAW1. Brand is Brand. It shouldn't matter. 

CP: And they're delaying for months therapy that has worked for this patient for years. 

UT: Insurance rules don't matter. It's like they're playing a different game than we are and when we discover the playbook, they change the game. 

CP: Monopoly versus Australian Rules Football. 

UT: Well said. 

Can't Catch Up

CPP: <sarcastically> Anything exciting happen this week?

CP: <sarcastically> When doesn't anything exciting happen?

CPP: Care to share?

CP: I present you the following, compiled from two, eerily similar interactions. 

CPP: Terrifying!

CP: Welcome to Vials and Victuals. Pills or fills, today?

Most Always Exact Verbatim Exchanges: Um, I'm here to pick up my refill. 

CP: I love your confidence. Name?

MAEVE: Maeve. 

CP: I see you called in a refill, but it was too soon so I couldn't fill it. We last filled this 30 days supply for you only 14 days ago. 

MAEVE: "So even though I waited more than 30 days last time, I can't fill this early?"

CP: No. Nope. Not how it works. 

MAEVE: But why?

CP: Maths. You can't make up for something you missed. If you forgot to eat breakfast yesterday, you can't make up for it by having second breakfast today. 

CPP: Elevenses!

MAEVE: I don't understand. 

CP: I. . . 

CPP: Allow me. <ahem> In the immortal words of CP: "I can explain it to you; I can't understand it for you". 

CP: Thanks. Now can you help me out with this one?

CPP: Sure. 

CP: Next!

Another Arithmetic Remeberer Of Nothing: What about mine, then?

CP: Sorry?

AARON: I called in my refill as well and you just said it was too soon. 

CP: Ok. Let's check for . . . 

AARON: "I'm behind on taking my medications so can't you just fill two months for me this time?"

CP: Again. Not how this works. 

AARON: But I didn't fill it last month, or the month before. I want those fills too. 

CP: <shhhh> You can't make up for lost sleep any more than you can make up for not filling on time, A-A-Ron. If you missed the sale at Penney's last week, you can't save on those items this week. Just because I wasn't driving when gas was $0.79/gal doesn't mean I can go back and take advantage of that deal now. And Aaron, how are you going to play catch up? 

AARON: But they're my refills. 

CP: You can pay cash for them, but the part of the deal where your insurance pays for their part has expired. 

AARON: I don't understand. 

CP: Again, maths. CPP?
CPP: I can explain it to you. . . 

But I NEED It

CP: How often do you wonder is people's' elevators go all the way up?

CPP: With every human interaction. 

CP: OMG! Samesies. 

CPP: Don't do that. Why do you inquire?

CP: One of our irregulars over the weekend. 

CPP: Do tell. 

CP: Are you dropping off? <they intone>

Compliance Usually Not This Hard: <standing under drop off sign> I think so. I just need a refill on something. 

CP: <cringes> I see your refill expired 2 days ago.

CUNTH: "I can't go without it!" <she ejaculated> "I NEED it."

CP: The evidence says otherwise. We last filled this for a 30 days supply on 5/19. I challenge that you CAN live without it.

CUNTH: It should have 6 or 7 refills left. <she exasperated> 

CP: It did. They expired. Two days ago. You filled this a total of 5 times. For 5 months. Out of the last 12 months you've had this prescription. Apparently you can and have done without it. 

CUNTH: "I'll have to have a talk with her at my appointment Friday!"<she exhorted sternly>

CP: Why? <they asked inquisitively>  She's not the one you need to talk to about this. 

CPP: Oh that's rich. 

CP: At least she didn't say "but I'll DIE"!

CPP: True. That's melodramatic in its triteness. 

CP: She really acted all stern and matronly when she said she was going to have to have a talk with her provider. It sounded like a mother saying "just wait till your father gets home". 

CPP: Not sure how she thinks that's going to go. 

CP: It's like the ending of "A Few Good Men" where Downey says "what did we do wrong? we did nothing wrong". 

CPP: In that 5 months of compliance is better than none? 

CP: <shrugs> 

#HowManyPeopleWillCheckTheDefinitionOfEjaculate 

#WhyTheRandomAFewGoodMenQuote  

#Verbatim 

#IDontWantItIJustNeedItToBreatheToFeelToKnowImALive 

Blood Pressure Two-Pher

CP: Picking up today?

HBP Lady: No. I just have a question. 

CP: Go phor it. 

HBPL: What can I take for sinuses? Another pharmacist sold me Advil Cold and Sinus and I'm not any better. 

CP: Sinuses are a physical cavity in your skull; we all have them. What are your symptoms you wish to alleviate?

HBPL: They're stuffy and congested. 

CP: What medications do you take? Rx-wise. 

HBPL: I take medications for my HBP. 

CP: Perfect. Well Advil Cold and Sinus should be a no-no. Plus I dislike combo products like that since most people have ibuprofen or acetaminophen at home. 

HBPL: Why is Advil Cold and Sinus a no-no?

CP: The sudafed in it can increase your BP. 

HBPL: But I don't have it any more. It's under control. 

CP: Because you take medications to keep it that way. Outside phorces can act upon it to elevate it. My cruise control in my car keeps a set speed until I punch the gas to pass someone. Sudafed is a punch to the gas on your blood pressure. 

CP: You're past due for a refill on your HBP medications. 

HBPL2: I know. 

CP: Okay. Do you want me to get them ready phor you?

HBPL2: I guess. My BP was really under control for a long time so I stopped taking my medication. 

CP: Your medication which was keeping your BP under control?

HBPL2: Yes. 

CP: It was under control because you took the medication. It doesn't cure you of HBP. You still have the condition but it may not show up on BP readings. 

HBPL2: Oh. Yeah. I get that now. 

CP: My electricity works as long as I pay the bill. My car runs until I stop putting gas in it. They're both "under control" until they're not.  

Negotiations Were Short

CPP: What was the silliest thing asked of you last week?

CP: I'll answer first then everyone else can have a turn. 

CPP: It's your page. 

CP: This off-the-wall conversation:

Persistently Interrupting Staff Seeking Offers For Fills: <on a walkabout passing the pharmacy windows> Do you carry Percocet?

CP: <doesn't look up, whispers to UT> did you hear something?

UT: yes. trying to not make eye contact

PISSOFF: Hello?

CP: Rude much?

PISSOFF: Huh?

CP: You didn't bother to get the attention of either of us prior to shouting a random question into the ether about a narcotic product. Care to try again now that you have disturbed us and have gained some of our attention? 

PISSOFF: Yeah. Do you have Percocet?

CP: Mayhap I do. Strength?

PISSOFF: 5ng

CP: I have some in stock. 

PISSOFF: My current pharmacy is out of it and I'm looking for more. 

UT: <whispering> no red flags on you, sir. nope, none at all. 

CP: <snickers> You don't say. It is on backorder so there are known supply issues. 

PISSOFF: How much will it be?

CP: Probably what you have been paying. Based on the less-than-the-minimum-required-to-answer-that-question, I'd say more than a nickel, less than a share of Pfizer stock. 

UT: Why does "nickel" sound so weird?

CP: <shrugs> right?

PISSOFF: Well I take 15 medications. If I transfer them all here, how much of a discount will you give me on the Percocet?

CP: Less than nothing. 

PISSOFF: But that's a lot of prescriptions; anyone would love to have them. Can't you offer me a deal?

CP: Hard no. That's a pass phrom me. This isn't a bundle business. We are not Progressive or Spectrum or a Streaming service. There's no discount for getting them all together. I have a sneaky feeling you'd also not be compliant on the other 14 medications and would cause me a ton of problems. I can afford to be selective in the headaches I take on and yours is not one I wish to undertake. 

PISSOFF: <still wandering aimlessly in front of the Rx counters> Huh? No deal?

CP: As sad as it has become, this is still a profession. I have some integrity and dignity left and, while your offer of 15 prescriptions sounds enticing, the baggage included is a lot to unpack and my back hurts phrom carrying this profession as it is so that's a no. 

PISSOFF: <still meandering distractedly as if standing in one place will result in him being hit by space debris> I'll check around and see what I can find. 

CP: You do that. And piss off. 

CPP: Wow. Monty Hall Redux, huh?

UT: No one under 40 will get that. 

CP: <shrugs> They have the internet. They'll find some cool videos of better times.