How to Make Money in Pharmacy Without Really Trying

I like making money.  For the last decade at least this has not been a problem.  With an over-saturated market of licensed pharmacists and lower reimbursement rates from PBM's and state and local governments, retail pharmacy needs to find ways to make more money.


I realized that a lot of people take credit for things they already do.  They also have figured out how to charge for these things that they used to do for free.  For example, airlines used to fly your bags for free.  The space was empty anyway and you were seated just above them headed, most of the time, to the same destination.  When they realized they needed more money, they started charging for the bags to tag along.  


How can this translate to the world of retail pharmacy you ask?  It's called " a la carte pricing".  It sounds better than fee-for-service but hear me out on this.  If doctors require us to fax them for refills and look up prescription information even though they have a chart in their office, I am going to charge them for these services.  I know.  This was in the last few blog entries but this is where it gets good.  The examples will look something like this:


     Patient is Responsible for:

•      Handwritten Rx's--------------------$2.00 each
•      Rx Too Old---------------------------$1.00

     Offices Responsible for:


     If we have to call your doctor because information in missing or incomplete:

•           Wrong/Missing patient name----------------$3.00
•           Missing drug or strength---------------------$3.00
•           Illegible/Missing Directions----------------$5.00
•           Quantity missing----------------------------$2.00
•           Refills Unclear-----------------------------$0.50
•           Not Signed--------------------------------$25.00
•           Forgot to select anything on a preprinted Rx where all he has to do is check a box----------------------------------------------------$15.00
•           All Refill Requests you Require me to fax---$1.77
•           Looking up Refills you are Calling in to me-$8.23

     Computer-Generated or Faxed Prescriptions--Flat fee of $11.38 per occurrence

•           Wrong patient
•           Quantity (N/A)
•           Drug/Directions Mismatch (take 5 mg tab intravenously)

All prescriptions are required to be completed electronically and either sent electronically or faxed according to state and federal laws.  They may be issued to a patient directly, but please do not forget to sign them as per your state law.  Phone-in prescriptions will be free, for now.  The exception to this is offices that employ nurses who have an ADD-type disorder and omit information regularly in which case the above prices will go into effect.  Also, if your nurse does double-duty as a Micro Machines pitchman or commercial legal representative on TV or radio ads and I can't understand a damn word she says, please read the pricing chart above.  


Since we are already performing this task, we might as well get our piece of the pie too, right?  Insurances can't complain about this since it doesn't affect their bottom lines.  What are doctors going to say?  Let's think about this.  
     1. I don't like you charging me for forgetting to sign my name.  I'm a doctor!
     2. I don't like you charging me for always entering N/A on the quantity line when it should auto-compute.  I'm a doctor you know!
     3. It's not my fault you can't read the Prednisone taper I clearly wrote, even though it doesn't say for how many days and the quantity is "QS". I always write it that way.
     4. It's not my fault the computer put Oxybutynin ER first and I wanted the regular.  You should just know that because it's cheaper.  


It may seem petty, but how long have we given away our professional services?  We have automatic refill systems, auto-faxing to doctors for refills (which used to be a courtesy), and reminder calls to fill and pick up your prescriptions.  How much else are we willing to give away for free?  
This is not anything more than an attempt to be compensated for our time and energy.  This is time and energy that have to be redirected to fix something that never should have left your office in its current condition.  
    

Pharmacist vs. Doctors, the 3rd

And another thing...If you, Dr. Zoffis, are calling me, Herr Pharmacynic, to authorize refills, confirm prior authroization approval, give new prescriptions, or do any other professional work, please be prepared.  Let us remember the healthcare cycle: patient goes to doctor, doctor writes prescription, patient brings Rx to pharmacy, pharmacist fills Rx.  When refills are done, we go back to the beginning.  This means everything starts with you.  The doctor.  Lather, rinse, repeat.  


I implore you, as a former Scout, Be prepared!  Again, I do not work in your office but if you expect me to do your work I am going to have to charge you every time I have to have this conversation:


     Nurse: Calling in to refill a patient's prescription.
     ME: OK
     Nurse: They didn't give me their prescription number but it's for HCTZ.
     ME: OK. What strength?
     Nurse: Can't you just look it up?
     ME: Yes.  But can't you just look it up?
     Nurse: I don't have the chart but it's the same as before.
     ME: Correct me if I am wrong (and I rarely am) but did you not originally prescribe this medication?  And did you not put it in a chart? And if you knew you were going to call me (because I didn't know you were going to make me do your job too before you dialed my numbers) how did you not know I would need all of this information?  If you knew to call me for his refill then you knew you were going to do this to me.  Therefore, I am going to send you a bill for looking up each piece of information you don't have.  How do you know he even (still?) takes HCTZ?  How do you know the doctor didn't change it since the last visit?  Does he get 30 days or 90 days?  Is this even the right pharmacy?  What's his date of birth?  Help me!  Then pay me!
     

Pharmacist vs. Doctor II

Pharmacist.  Magician.  Receptionist.  Thinker.  I can do it all.  Just ask every customer who tried in vain (allegedly) to reach their doctor.  Why does everyone think we can work through to their doctor faster?  


     Patient: "You need to call my doctor because I can't get through."
     Pharmacynic: "Wow.  Neither can I.  I have to call the same phone number you do.  Did you hear the magic 'pharmacists press now to have all your questions answered' prompt?"
     (Im)patient: "Well what am I supposed to do now?  You need to help me!"
     Pharmacynic: "Okay. Revolutionary thought here but bear with me.  Drive. To. Your. Doctor.  Ta-da!


I think all offices should have a dedicated Pharmacist option on their phone lines.  We have an option for doctors to leave voicemails but the most we usually get in return is a refill line.  That doesn't help if I couldn't read a prescription for someone who just left your office and is here now.  It doesn't help with any questions about interactions or answer any questions I have about the voicemail your nurse left just seconds ago.  She is apparently charged for each second she spends on the phone and can't afford to enunciate or spell anything and now I can't get her back on the phone to answer my question.  


Most doctors' lines include options for other doctors or hospitals, for making or canceling appointments, for lab work, for billing questions, a refill line (if they don't require us to fax them), a worker's compensation option, and an option to give hours, services and directions.  Why don't we rank?  If we are expected communicate frequently with these offices, we need a pharmacist-only line.  I have asked some offices if they have back lines and have occasionally been granted these numbers, but only after swearing to not share it with anyone.  Right.  There's a whole black market looking to exploit doctor's private office numbers.  


Make it easier for me to get my job done and your life will be easier as well.  Since you are already expecting me to fax all refill requests and look up the refills you are calling in to me when you have their chart, it's the least you could do.  

Pharmacist vs. Doctor

In the beginning there was a doctor.  He wrote prescriptions.  There was also a pharmacist. He filled prescriptions.  And the world was good.  I am not a doctor, nor do I play one at work.  However, it seems that we as pharmacists have let the lines blur a little too much in what is each person's role in the whole healthcare dynamic.  One of my favourite quotes to customers is "I don't work in your doctor's office and he doesn't work in my pharmacy".  I often use this to great effect after a customer is sent directly over from his doctor after being told any or all of the following: "your prescription will be ready by the time you get there", or "it's on their $4 list", or "Augmentin is only a few dollars, don't worry".  Well, I can't tell you the last time I saw your doctor here, let alone actually spoke directly with him, so don't believe everything he tells you.  


Today I realized it has gotten so out of hand that we pharmacists haven't even noticed we are now employed by every doctor in town.  While waiting interminably on hold (pharmacy hold times aren't always better, I concede), to clarify a poorly written prescription, I heard this message: "We are requesting that all refills be faxed.  Please contact your pharmacy and they will fax us for you".  Another office used the similar "please notify your pharmacy to send a fax to us".  


Excuse me?  What?  When did we allow other people to tell us what our job is? (Oh yeah, when we sold out to mail order and PBM's over the last 10-15 years.  But this is different.) 


Anyway, I have decided that I need paid.  If the doctor requires I fax your refills to her, I am going to send her a bill at the end of each month for every one that I send.   Yes, most faxes are generated electronically but I still have to answer your phone call after you have already talked to the office.  Since the doctors would like to place the onus on us if a refill is not authorized, I would like to be compensated for this responsibility.  We all know that faxes do not get received, doctors ignore them, lose them, forget to sign them, etc.  As I have mentioned before, I cannot fill prescriptions I do not have.  The patients know we are the only ones they can yell at directly and therefore, since the doctor requires we fax them, we must be the most culpable if the process breaks down somewhere.  If the fax number is incorrect or missing or a doctor enters or leaves the practice, I have to track this down for you.  A precedent has already been set in other similar situations.  Doctors requiring pharmacists do NOT send faxes will charge the pharmacy for each one they receive.  Doctors also charge patients a full copay for any refills they require outside of an office visit.  


To further support this, my second resolution is to post on my hold message the following script: "Our pharmacy requires that all new, paper prescriptions be sent electronically or faxed.  Please contact your doctor and ask her to invest in this new technology and to stop hand writing prescriptions as we will no longer accept these."    Perhaps we should charge to fill illegible scratch.  I may be on to something here.  But that's another story.