Refill Too Soon

People do not understand copay issues.  The don't read their explanations of benefits that answer all the questions they could have.  The only issue more elusive for them is the Refill Too Soon concept.  On the surface it seems pretty self-explanatory.  Your refill is too soon.  It is too soon to be filled.  It is too early.  It is not yet due.  It is not ready to be filled.  Not today.  Customer customer go away, come again another day.

However, like anything else, we must assume stupidity trumps common sense and investigate further.  Why is this such an enigmatic problem?  What piece of the equation are they missing?   

Most of these conversations begin the same way with "I am sorry, but your refill is too soon by 1 day".  Believe me, the 1-day early is worse than telling them it's a week or 10 days early.  I will always get asked "well if it's only 1 day can't you just fill it?"  Um, No.  If it was due today, we would not be having this intellectual back-and-forth, this witty tete-a-tete.  Instead, I get to explain what you have yet to wrap your head around.  The insurance (easier to explain) will not pay for it yet because it is 1 day too soon according to their records.  What this means is that you actually should have 8 days worth of medication at your house, so in other words, plenty.  As in you do not need it urgently, or today.  See you tomorrow.  

Most insurances require a percentage-complete to be met before they will pay for you to have more.  On a 30-day supply, an 80% complete requirement translates to you having taken 24 days of medication, leaving you with 6 days.  This means that 1 day early means you have 7 days.  Get it?  You have medication.  You are not out yet.  Perhaps you like to stockpile, you're a hoarder.  Awesome.  What you need to understand here is that someone else is paying for your stash.  They don't mind being a mild enabler, but they will not help you get on a reality show with your mass accumulation of medication.  

Cash customers are another issue.  Personally, I'd be happy if you wanted to buy all 365 tablets of your Hydrochlorothiazide 25mg today so I don't have to see you for a year.  As long as it's not a controlled substance you can pay cash for whatever you want.  If your doctor writes on your prescription "Do Not Fill Until...." then expect me to obey that.  Again, not my fault, not my problem, nothing I can do.  No. I will not call to override it.  If you're going on vacation, tell me before I process everything.  I have to call your insurance for an override.  Please do not wait until you are in my drive-thru to pick up your stuff as you are heading to the airport.  There is more work involved.  You have been planning this for a while.  I am sure this vacation did not come about last minute and surprise you.  Don't surprise me.  

No Waiting

I hate waiting.  Customers really hate waiting.  Anymore, we can't help but wonder why everything isn't instant.  Social media, on-demand movies from Netflix, coffee, burgers, prescriptions? are all immediate.  It's our instant gratification society.  I believe I have a few solutions to alter the mindset that prescriptions should be included on this instant list.
Personally, I know when to avoid patronizing certain businesses.  Do not go to banks at 5 pm on Fridays, grocery stores on Saturday mornings, movies on opening nights, or buffets on the first of the month.  The three ways to convince people to avoid peak times in my pharmacy are simple:

1.  Post a sign that says: "WARNING-Peak Times are 11-2 and 4-7, Mondays all day, First of the Month, Days Preceding and Following Holidays.  Wait Times will be longer.  Expect Delays."

2.  We should take a cue from the Department of Transportation and major theme parks.  We could post digital boards outside the store, throughout the store, and at drop-off giving estimated wait times for your order so no one is surprised (yeah, right) when they get to our counter and we tell them "30 minutes".

3.  My last suggestion is to post a "NO WAITING" sign.  When people ask how long? we will tell them "tomorrow".  When they ask about the sign we can calmly and politely inform them "You won't be waiting, you will be home".  We could even go so far as to ask them to reread the sign, explaining it is not an advertisement, but a statement--like "No Loitering".

I like the "No Shirt, No Shoes, No Service, No Waiting" idea.

Favourite Stupid People We Face in Retail

There are always stereotypes.  There are always people who do their best to reinforce them.  There are people trying to break the mold and start brand new classes of stupid.

An older lady brought us a prescription she had obviously stashed in her purse some time ago.  We explained we could not fill it because it was too old.  With her years of wisdom and maturity forgotten, she tore up the prescription and threw it in the air to land all over my floor.  First, it was for an antibiotic.  Second, it was over 1 year old and she complained her doctor wanted her to have it because she "had something".  How about NO.  You just wanted the gift card for a new prescription and are mad at your own stupidity and inability to use a coupon.

A man approacheth.  I say-Hi sir.  What is her date of birth?  He says "It's my daughter.  I don't know."  Okay then.  Well don't get mad at me because you're an idiot.  It's called projecting.  You know you're a blithering idiot and feel insecure because your daughter hates that you never give her a card or present and you're taking it out on me because I called you on it.  Mature.

"How long will this take to fill?"  It will be about 20 minutes.  "Oh, well I can't come back until after 6pm tonight."  Jolly good for you sir.  Have a fine day.  But, then why the hell did you ask?  Just tell me you'll be back for it after 6pm and don't come back before then.  Were you just gathering data?  Are you really nosy?  Come on, stop wasting my time.  I need to get to work immediately on your scripts.

Do you have any questions for the pharmacist?  "No, I've taken them before."  Good. Not what I asked, but thanks for playing.

When did you say you'd be back for these?  "I told that girl, Oh, around 2 or 3."  Fine, sir.  You do realize it is now only 12:54?

Irrational Price Expectations

Nothing makes me giggle like a schoolgirl more than the thought of having to discuss pricing issues with patients.  I get so excited I almost wet myself in anticipation.  My rather cynical approach to most pricing questions is "why are people so irrational when it comes to medications and prices?"  Here are a few of my ??? moments from my past to set the stage.

1.  Crabs--A guy came to me asking for an OTC remedy.  I showed him our Nix and Rid products and he balked at the $10 price.  Seriously?  You Have Crabs!  He asked for something cheaper and I asked if he owned hair clippers and he gave me a funny look.  I patiently explained that a bear can't hide in the forest if there ain't no trees, nudge nudge, wink, wink.  He caught my drift, but again balked at the thought of something sharp nestling near his twig and berries.  As he walked away he said "I guess I'll just go home and get a match and lighter fluid".  Seriously.  I shit you not.  I wonder if he won a Darwin Award?

2.  STD--A guy came in asking for our price on Flagyl.  Not to assume anything, but one look and I guessed his diagnosis (he was hunched over holding his junk with one hand and offering the Rx with the other).  The hospital discharge sheet confirmed it.  I quoted him $10 and he started swearing up a storm at my counter.  "WTF? $10 f-ing dollars?  That's some bullsh!t right there."  Okay, really?  Apparently his limit is under $10 which explains why he didn't buy the condoms in the first place.

3.  Brand-Names--A woman asked for an OTC steroid cream for itching/hives/bags under her eyes.  I put the House-Brand Hydrocortisone in her hand.  She picked up the Brand-Name product, looked at who made it and said "well I want this one because I own stock in that company and it will help them".  Not really one bit.  The extra two dollars you could have saved would have been better spent on a lottery ticket; better odds.

4.  Copays--A guy complained about the $30 he had to pay for the 5 medications he was about to receive saying he didn't have any money.  He stormed out, only to return 10 minutes later with cash.  He said he put $20 in the lottery machine and won $50.  He was actually bragging that he "hit the jackpot".  Wow, so where did the $20 come from in the first place?  Apparently his priorities are 1. gambling, 2. medications?  Go away, now!

5.  Dumb Price Dialogue #1--"How much will this cost?" I don't know.  I have to process it on your insurance first.  "Well how do I know I want it here?" Well, correct me if I'm wrong, but you are standing here, right?

6.  Dumb Dialogue #2--"Hi, I'd like a price on my blood pressure and Parkinson's medications because I would like to transfer them here from my other pharmacy."  Okay, what are they called?  "I don't know."  Well I cannot give you a price unless I know what I am to price.  He got angry and left.  It's like asking AAA for directions from Point A to Point B, not knowing either Point, then getting mad at me and storming out like a bratty 3 year old.  Yes, he really was pissed that I would not help him, said this is why he never comes to us, and actually left in a huff.

All of this and people still amaze me that they readily buy drugs from Canada, continue to pay for expensive brands, yet without any hesitation will buy drugs over the internet.  If brand is so important, how do you know what you're getting online?

It's Our Fault

I cannot simply compile these into one giant heading because it would read like a Steven King novel, very long chapters.  I prefer the James Patterson approach where you can read a post in the length of a long pee. So now we're back with more stupid pharmacy stuff and one cynic's take:

I believe we all need to post a big sign in our stores admitting "It's Our Fault..." with the following list:
a.  ...your doctor did not call/fax/e-scribe/Pony Express your medications yet.  Sorry.
b.  ...we did not fill the refill on the prescription you have filled at another competing pharmacy.  Sorry.
c.  ...we did not anticipate you'd be in today and did not get everything we didn't know you needed ready for you ahead of time.  Really sorry.
d.  ...we are out of stock on this medication that has been on backorder by the manufacturer for the last 3 months.

The last is another favourite of mine because I cannot help myself from wanting to shake the crap out of the people who listen to me talk, but apparently have a disconnect where the words get jumbled on their way to the brain and the people think I'm lip-syncing to our overhead music.  Inevitably, I will get to have this conversation:  "Why do pharmacies not carry this?"  Well ma'am, as I just explained at great length, so there would be no confusion, it is a manufacturer supply issue;  they were recalled, on backorder, quit making, can't make, plant exploded, whatever.  So why the hell are you asking me why we don't carry it.  "Okay, can you call another pharmacy to see if they have it?"  Or, better yet "Your manager should be fired because he doesn't know how to order inventory that people need."  Aaaagghhh!

Stupidity and Stupid Expectations II

In the immortal words of Ron White, "You can't fix stupid".  If you could, someone would be making a ton of money.  (Un)fortunately, stupidity is NOT a clinical diagnosis, nor a valid legal excuse.  Someone once asked me, rhetorically, "how stupid can people be?"  I replied "don't ask, because it's a competition and everyone is trying to outdo each other".
For example, the dosing for a medication established by the manufacturer and FDA is merely a guideline or suggestion, not an actual set-in-stone dose.  Someone called for a refill on their codeine cough syrup and when we informed them it was way too early they said "I didn't have a spoon so we just took swigs out of the bottle.  Now we're out and we need more".  Wow.  No spoons, huh?  I guess you're limited to only forkable foods in your house then?
This idea led me to a list of more WTF??? moments.
1.  A woman on Medicare D was getting her script filled and wanted to use a transfer coupon to get a gift card.  When we informed her that government-funded scripts were excluded she whined that "they're always after the old people"!  Really?  Now how the hell did you arrive at that?  Your $1.10 copay apparently isn't enough for you?  The government is not allowing you to get an EXTRA benefit on top of their assistance.  It's not as if they're personally taking the gift card away from you.  The only thing worse than this heinous crime is not allowing people on Medicaid to get gift cards I guess.

2.  Sense of urgency--This is open to interpretation.
  A doctor calls us and says the patient is on his way and 15 minutes later we're expected to have it done because you called?  It's 5 pm!  WTF did you do all day that you NEED your antibiotics NOW?

3.  "Your bottle is out of refills, sir."  "but I have a new prescription at home."  Wow, a lot of good that does me here now, huh?  I bet it's lonely.

4.  My favorite conversation always starts with "but my bottle still says 2 refills!!!"  Yes sir it does.  If you bury it in a time capsule or a landfill and your grandkids unearth it in 50 years, it will still say 2 refills.  Our labels do not have the magical power to erase refills as you fill them.  This is why you are expected to throw away the old bottles and why prescriptions expire after one year.

5.  Outdated medications--Now I can understand hanging on to something for purely sentimental reasons, like your first hemorrhoidal cream script.  However, if it is life-saving, I may want to have the most current, freshest stuff I got.  A woman brought in a bottle of Nitroglycerin for a refill in April, 2011.    The bottle inside had an expiration date of December, 2007!  I offered her a new bottle for free and she said "No.  I don't want to waste them".  As I tried to explain about its potency, she hurriedly walked off saying "no thanks" and giving me the big brush off sign.