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Thursday, March 17, 2011

Patient Responsibility

I have long believed that a lawyer would sue Mother Nature, if he could get Her into court, for every day She didn't make the sun shine on his rear end.  I started off this year telling people that I believed my New Year's resolution was to act like the general public and lay blame on everyone I could, absolving myself of any in the process.  The media is full of stories of stupid people trying to get compensated by big companies for the dumb things they do: (hot coffee from McD's is actually HOT, pickles on the burger were too hot, I'm too fat because I ate all my meals through drive throughs).  It is also responsible for some of the dumbest warning labels we have on products today: WARNING- Remove baby before collapsing stroller.  Seriously.  It is this type of sue-first, admit no culpability attitude that leads me to the conversations I have every day that I am no longer in the mood to have.

INSURANCE-Look, you get an explanation of benefits (EOB) at the beginning of every year, just as I do.  By definition, this Explains YOUR Benefits to YOU.  Read it.  Commit it to memory.  Use this knowledge to advance yourself in human society.  Now you may ask "But O Wise One, how can I use this information in my daily life?"  Allow me to answer, my friend.  When you bring a prescription to my pharmacy you will not have to ask "what will this cost?" for it will be known to you.  If you need to know if it is brand or available as a generic, with this I can help.  No longer will this conversation take place: You-"how much will this cost?" Me-"I don't know" You-"Why not? Isn't that your job?" Me-"No, my job is to know what MY insurance copays are so I don't act like an idiot when I go to my doctor or pharmacy, not to know YOUR copays.  Do you know what my copays are?"
You will also know that with set copays, the price will be the same whether you are filling your Rx at Wal-Mart in Tuscaloosa or Yukon Cornelius's Discount Drugs in Anchorage.  Please do not try to tell me you paid $5 for 90 days of Lipitor at Walgreen's and I am fleecing you by asking for $30 for the same thing here.  If you have not filled something since last year, and this is a new year, and you have read your EOB, you will know that deductibles have restarted (usually $100 per member or family up to thousands of dollars) and that your first copays will be higher.  You will also be aware of increases in your copays since your employer is paying less for your benefits and you are responsible for more of it.  As I tell my customers every January, all bets are off once the first of the year arrives.  Do not assume everything will be as it was.  

PRESCRIPTIONS-Let us examine the initial process that brought you to me, the first time we ever met. You were unwell, scheduled an appointment with your doctor, visited said doctor, gave him your list of complaints, he diagnosed your condition, wrote your prescription(s), then either handed them to you to bring to me, faxed them to me or sent them electronically (much-preferred).  At the end of this process, you found yourself in my pharmacy waiting to pick up your medication(s).  Understand the process so far?  Good.  Now let's jump forward a few months to when your refills have run out and you need more.
Here is what actually happens and is expected: You call my refill line with your RX#, punch it in on my phone or through our website, you are alerted there are no refills and that we will contact your doctor for you, our computer then faxes or e-requests your doctor for the refill or we may phone them for you, then we wait.  We wait for the doctor, YOUR doctor to call US back.  We have done our part, met our promise.  Now it's a few days later and you are out of medication so you call US and ask "where are my refills?" and we kindly explain that we faxed, called, Pony Expressed a request to Herr Doctor and he has not called us back.  Then you always ask "well when will he do it?  I have been out of my medication for 3 days now and it's all your fault!"  Okay, well let's examine this for you, shall we.  First, in case you didn't notice, I am your pharmacist.  I do not work in your doctor's office, nor would I ever.  He does not pay me to put up with you, though I think he needs to adjust your meds right about now.  Second, please read the first 3 sentences of this paragraph again.  These are YOUR prescriptions from YOUR doctor that you brought to me.  The process starts with you talking to your doctor and ends with you bringing the RX to me.  If your doctor is one of those who only takes refill requests from the pharmacy and I have done my job, you still need to call him to find out what is going on over there because, say it with me "I do NOT work there!".  I cannot control what goes on over there any more than I can stop people talking on cell phones while driving.
I understand it is all about convenience, but keep in mind, I will fill thousands of prescriptions just like yours every month.  There are doctors who refill only through pharmacy requests, doctors who refill only through patient requests, and doctors who charge per request made outside of an office visit.  Not only am I expected to keep these straight, but I have to make follow-up calls every day for refills and for prior authorizations for drugs you need but your insurance doesn't want to pay for you to have.  If I had nothing else to do but call doctors all day, I could get you your refills.  However, I work 12 hour days at my job filling everyone's expectations that are the same as yours.  What are you doing that you can't do some of the legwork yourself?  Which leads me to:

WEEKEND OUT OF PILLS-This could also be known as "Going on Vacation".  Most prescriptions are taken once a day, every day.  As I peer into my bottle every day, I notice a dwindling supply.  As it approaches single digits, I start to say to myself "self, better think about calling in your refill".  My question becomes, how the hell do people not notice their bottles are empty until the weekend?  It never fails that my weekend starts at 5:01pm Friday and lasts through Sunday.  During this time, I will be inundated with the following requests either separately or some combination thereof: "I ran out last week and I really need this or I'm going to die.  Can you just give me a few pills til I can see my doctor Monday?", "My doctor never called so now I need them", "it's your fault I don't have any so you owe them to me", "I'm going out of town and need a few to last til I get back.  I have an appointment next week, honest", "I lost them?".  Now the burden falls on me to be the bad guy.  How did you NOT know your bottle fell empty on Monday?  Did your planned vacation to Texas just sneak up on you?  You didn't know you stopped your mail, packed your bags, got your tickets and needed pills?
Please make it stop!  Please accept some responsibility for your own healthcare.  Please don't make me be the bad guy.  I have long been served well by the following quote and have issued on rare occasions when customers have not asked but demanded something that is not urgent:
"Lack of planning on your part does not constitute an emergency on mine."

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