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Tuesday, April 26, 2016

Pharmacist Policy

As we all know, corporate pharmacies are filled with policies. Policies telling you to read new policies. Policies stipulating how often they will make and you are to read policies. Policies stating how to sign policies. But does your pharmacy have a policy regarding pharmacists? 

In our Random Discussion of the Week (RDW), we explored the subject of the Pharmacist dropping dead, or at least comatose, to the floor. Without being able to locate a corporate policy on the subject, we took it upon ourselves to fill in the blanks and write one ourselves. 

1. Check for pulse. 
2. Check for breathing. 
3. Is pharmacist's body in view of public? 
4. If yes, roll body under counter. Keep working.
5. If no, keep working. 
6. If fingerprint or retina scan are required and no pulse has been found, carefully remove the pharmacist's finger or eyeball and keep it on ice to be used accordingly. (See Policies on Proper Knife Usage and How to Make Your Spatula into a Mini-Katana)
7. If breathing, roll pharmacist under counter closest to workstation. Distract patients with sleight-of-hand tricks when placing fingerprint or retinal scanner near pharmacist's body. 
8. Do not be afraid to step on pharmacist's body to appear taller. Where possible, it may help to place the anti-fatigue mats on top of him/her. 
9. When time allows, call for a replacement pharmacist and one will be sent over some time before closing to lock the doors. 
10. Under no circumstances are you to call 911 until a replacement pharmacist has been sent. We cannot afford to close the pharmacy for any inconveniences, however minor. 

Remember, laws require that a licensed pharmacist be IN the pharmacy. Technically she and her license are IN the pharmacy. 

Friday, April 22, 2016

The Human Mind is Amazing...

...ly stupid. 
Where do people get their expectations of entitlement? 

CP: Sir? Dr. Zoffis called today to renew your inhaler. I am sorry to report we used our last one this morning and have to order another for tomorrow. 
Weird Thinking Frantic Dude: That's okay. 
CP: We shall see you then. 
WTFD: One question. 
WTFD: Did my doctor order more than one at a time? 
CP: He did not. He prescribed one with 5 refills. 
WTFD: I wanted him to write for more. "I'm overdue for it, so shouldn't I be able to get more this time?" (yep. he said that.)
CP: Nope. How does that work exactly? Because you are noncompliant, you now expect what is essentially backpay for work you never did? On top of that, you are now expecting to be compliant going forward? 
WTFD: I just thought I was owed them. I should have been taking them and my insurance pays for one a month. Since I didn't get any the last few months, I wanted to get all of the ones they owe me. 
CP: You are a sad, strange little man. Remember when that one pharmacy was advertising "free antibiotics"?
WTFD: Yes. 
CP: Did you get sick during that time period and require any of the antibiotics they offered? 
WTFD: No. 
CP: Since the promotion ended some time ago, would you believe you are entitled to free antibiotics today? 
WTFD: I don't know. Why? 
CP: By your logic, you were not sick at the time so you could not take advantage of their incredible marketing practices. Since you were not conveniently sick during their promotion, were you to get sick now, I'd expect you to march up to their counter and ask for, nay demand, that they honour their expired promotion. 
WTFD: Why not? 
CP: Because, #ThatsNotHowItWorks
Try this, when your car is low on fuel, you refill it, right? (Preferably, BEFORE you run out.) If you don't fill it in the morning while the price is low and the price jumps $0.40 by evening, you cannot go back and ask for a full tank at the morning's price. See you on the morrow. 

Thursday, April 21, 2016

Vaginal Tissues

A prescription instructed the patient to apply the cream to her "vaginal tissues". Out of context, vaginal tissues sounds like a product for post-coital cleanup.

Tuesday, April 19, 2016

Pharmacy Analogies

Patients call in their own refills. Since people have so many resources readily available to them for initiating prescriptions, they are taking ownership by using them. There are many ways for them to accomplish this - via text, company app, online, email, or, according to some, telepathy. Either way, people, to some extent, are ultimately responsible for their own prescriptions. I know, I know...hard to imagine in this day and age that anyone is responsible for their own actions but we try to remind them of this from time to time.

Getting mad at the pharmacy for filling your prescription that you requested online is like getting mad at Amazon for delivering a Hutzler Banana Slicer 571 that you ordered online after reading really creative reviews on Amazon.com.

Better yet, remember that scene in Austin Powers after Austin is thawed and he is receiving all his valuables?
"One Swedish made penis enlarger... One credit card receipt for Swedish made penis enlarger, signed by Austin Powers...One warranty card filled for Swedish made penis enlarger pump filled out by Austin Powers..."

You ordered it. Now take it!


I needed to make a compound at work. Went to allrecipes.com. No Magic Mouthwash. No Progesterone Suppositories. Lying Bastards!

Friday, April 15, 2016

More Phun With Dick and Jane

Dick is a Patient.
Jane is a Pharmacist

Jane: Hello, sir. What is your Birth Date? 
Dick: Dick. 
Jane: No. Your Birth Date. 
Dick: Dick. 
Jane: Okay. What's your Date of Birth? 
Dick: Day the 5th...
Jane: <starts writing May 5th>
Dick: Day the 5th, of the 10th Month, in the Year of Our Lord Nineteen Hundred and Seventy-Nine. 
Jane: So...10/5/79?
Dick: Yes. 

Don't be a Dick.

Dick: I'm here to pick up my prescriptions.
Jane: Okay. How many do you have?
Dick: I'm not sure.
Jane: We have two prescriptions ready for you.
Dick: What? Where's the other one?
Jane: Which other one?
Dick: The third one.
Jane: You didn't know how many and now you know it's three?
Dick: Yes. Which one is missing?
Jane: <deadpans> The third one.

Know what you take. Don't be a Dick.

Misheard at the Pharmacy

Pt: Can I put this on layaway?
This got me thinking, maybe that's what we should call it. When we put prescriptions on hold, they are on layaway for up to 6 months. Now if we could just get people to pay on them while they are unfilled...
CP: Would you care for us to put this on layaway for you in our computer? This way, all you have to do is contact us and ask us to prepare it for you. No dropping off, no waiting, all convenience.
Pt: Yes. That'd be lovely.
CP: There's a charge for this. You have to pay the cost of our restocking fee now for us to hold it. This way, if you choose not to pick it up within the 6 month limit, we retain the processing fee for our effort. Once filled, the deposit will be applied to your co-pay.
Pt: And if I don't have it filled or the prescriber changes my medication?
CP: It happens. But those are risks we are willing to take for you. You don't have to worry about losing the prescription.
Pt: What if I move?
CP: Good question. We can transfer your prescription to any pharmacy you choose. The fee would then cover the relocation costs associated with your prescription. Prescribers often charge for copying their files. Thinking about it, shouldn't we follow this lead and charge for Profile Requests? 

First Sign of the Apocalypse

Spring. Life itself is reborn and along with life, hope.
Hope will sustain us when we've lost our way and have nothing upon which to cling. 
Hope gets us through each minute, each hour, each day. 
Hope keeps the darkness at bay.

How is it that this Spring should dawn any differently than the last? I fear that all hope has been lost and I am succumbing to the darkness, pushing and pulling and dragging me down. That upon which I could always rely has been wrenched from my grasp, tenuous as it was. 

The Apocalypse is nigh. There can be no more rational explanation for the events of this week. As with all signs, this came as a triple. Once is an isolated occurrence. Twice is a coincidence. Thrice? 

It was there on the voicemail. The dulcet tones of Piper the speed-talker/legalese reciter's voice alighted upon my ears with their softness, almost tickling. I was prepared for an aural onslaught the likes of which cannot easily be matched. She is in rarefied company when it comes to her messages. I braced my left hand for speedwriting with a few quick calisthenics and prepared my right to quickly pause and rewind the machine. What happened next was nothing short of a miracle. Piper spoke not in her clipped cadence but in a soft, melodious, enunciative voice. I was able to match her pace quite easily and still read my own writing. At the end of the prescription, as I prepared to replay for a double check, Piper repeated herself! Slowly, deliberately, she proceeded to reread the entire prescription for me. I was lost, confused, numb from shock. This was Piper the I-don't-need-to-breathe-to-leave-4-prescriptions-in-10-seconds, from Dr. Zoffis. She never slows, never enunciates, never repeats. What happened? 

As I said, once is an isolated occurrence. Twice? 

The next day, a person who can only be referred to as Piper's Scription Slingin' Sister called from Dr. Baggins's office. The result? Same as described above. Different office. Different caller. Same expectation going in, same unlikely result. Weird. 

Twice is a coincidence, right? But thrice? 

Late the next day, my partner had left me a voicemail to retrieve when I arrived. His mood was shaken, the look dour. "Play it", CPP said. This time I was greeted by a warm, pleasing voice. I looked at my partner who nodded gravely as he knew what I had just realised. The only person worse than Piper and Piper's SSS, Phoebe, was Paige. Paige has won the awards for fastest time to complete a voicemail, most voicemails completed in shortest time, most prescriptions given in one voicemail, and countless others. She is in our County's Voicemail Hall of Fame for all the records. As a look of recognition struck my face I was alarmed that I could understand this voicemail. CPP could sense this and gave me the slightest arch of an eyebrow, shrug of a shoulder, and upraising of the hands as if to signify "I know. What does this mean?" 

After taking a moment to sit and collect my thoughts, and wipe away the tears from the final voicemail that solidified our beliefs in the Apocalypse, CPP and I hugged each other and started saying our goodbyes. It was Friday. This had to be the end. So shaken were we by this trauma that we thought about closing the pharmacy to collect ourselves. Instead, we opted to seek solace in the place where this all started: the offices. 

We called to speak to Piper, to Piper's SSS Phoebe, and to Paige with one question on our minds: Are you okay? We followed this with: Were your messages code for "I need help"? Do you need us to call 911 because you are being held hostage? Kidnapped? Is it Demons?

Piper said she went to pick up a prescription for her child at her pharmacy and spoke in her "office voice" and the pharmacy had to ask her repeatedly for the information. She then realised the error of her ways and vowed to be mindful of the need to slow down and be more careful. 

Double, double toil and trouble; fire burn, and cauldron bubble. 

Wednesday, April 13, 2016

You Know You're in the Medical Field When...

... someone calls you "A Vile Human Being" and you hear it as a compliment and think, "Gee, a Pharmacist really is a VIAL person. I'm going to use that."

Restocking Fee

I've written about this subject before but recent posts have let me know it's time to revisit. I was discussing with a friend how when we started in pharmacy, our will call section was two little baskets under the counter. Today it's a full wall or 30 linear feet of filing cabinets. Why? Are we that much busier? Or are people more lax in picking up their prescriptions?

Is now the time to charge restocking fees in the pharmacy?
Insurances charge us for the privilege of submitting claims to them. They also charge us fees to reverse claims from them. They typically pay us a dispensing fee of $0.25-$2.00 per prescription. Going to make a great living on that! We lose that with each claim we lose. How do we recover these costs of doing business?

What amount is viable? I'd say a minimum of $25.00 for all prescriptions, regardless of the cost of the medication. Products that the store had to special order or that cost more that $1000.00 (acquisition cost to the pharmacy or what they actually spent to receive it) would be priced at a percentage not to exceed 15% with the minimum $25.00 still in effect. Many of these items cannot be returned from the pharmacy to the wholesaler which means there is a significant chance the product will go outdated on the store's shelves and the pharmacy will eat the loss.

I know what you're thinking: "But, CP, how will we charge the patients for this? If they don't come in for their prescriptions, how can we assess this fee?"
Good point. There are many ways to accomplish this. First, we could add a credit card to the patient's profile in order to conduct business with us. Think of hotels that keep a card on file for "incidentals". In the days of yore, mostly independent pharmacies called these store charges. Second, we could ask for a down payment (the penalty amount) BEFORE we order the item. If they do not return to pick it up, we assess the fee to the card. Third, we keep a record on file of the amounts a patient owes for all Returned To Stock (RTS) items. The next time they come in to pick up prescriptions, they first have to pay the accumulated restocking fees before they can receive their medication. Think of it as a lien.

I know. "It's not fair. It's their medication. Some people can't pay their copays and you want to add another fee making it more difficult on them. You're an asshole, CP!"
Yep. I know. Let's take a look at this issue, shall we?

The cost to fill a prescription with NO medication in the bottle, is $10.00. This means that to do my job, without even "just putting pills in a bottle", the "label slapping" part, costs me $10.00. We have the technology to call you when your prescription is ready. It calls you on day 3, day 6, twice on day 9, and texts you on the days in between. Basically, unless we have the wrong number, there is absolutely no excuse for a patient to claim they didn't know anything was ready.
Okay, so you have chosen to ignore the 5 automated phone calls, 7 texts, and messages left by 3 human beings. What now? We have to return everything we did to fill your prescription. This involves essentially the same amount of work. However, state guidelines dictate how we handle the medications' return to the shelf. This extra step is not part of the initial filling process. It's the restocking part. If we ask for the $10.00 we did not receive for filling your prescription, PLUS the $10.00 it cost us to undo all our work, we are breaking even at $20.00. But what about that extra step? I'd say $5.00 is sufficient.

"But you get paid regardless of how many prescriptions you fill. You get paid to be there. You get paid to do a job."
Correct. Why does your prescription take so long to fill? I know you have oft wondered this.
If I filled no prescriptions, I wouldn't have a job. I fill prescriptions and do all the work associated with them. It's like an assembly line. Prescriptions come in, they get entered, then billed, then counted, then checked, then sold. Picture a really complicated Subway restaurant line. Anyway, when a patient comes in, or does not want something, all the work we did needs reversed. The people on the assembly line have to change what they are doing. This interrupts the flow. The guy in line at Subway gets to the end and decides to restart his sandwich order. It can't go backwards but it creates a logjam on the line. You now have to wait for your sandwich and your prescription while other matters are resolved. (Yes, we often delegate one person to restocking in the mornings. But what if he/she could fill prescriptions instead of spending an hour canceling them.)

What happens at Domino's when a pizza is not picked up? They have to eat the loss. (Too Punny.) It was ordered with the intent of being salivated over and contributing to someone's waistline but alas, it shall remain uneaten. A golden, saucy reminder of unfulfilled satiety. What about those lonely prescriptions? People don't call in another pizza the next day after forgetting the one ordered last night. They do, however, return to the pharmacy expecting a prescription to be ready when it had been filled 3 weeks prior. Now we are going to repeat the process. This time, we will receive our $10.00 because she is going to wait, irritatedly, at my counter for it.

I am not suggesting this fee for any situation other than when we have exhausted all resources to contact the patient and we are obligated to return it to stock after 13 days due to insurance regulations. Did we fill something today that your doctor ordered and you don't yet need? Sure. I can return that with no charge. I'm not a mega-asshole.

Obviously this is a much larger issue and there are many many examples and exclusions people will proffer, but I don't have the time or space to devote to each one. Pharmacy is phluid, especially in retail. Exceptions can be made to every rule. You just have to have rules before you can offer exceptions.

Tuesday, April 12, 2016

Sometimes You Have to go Back

CP: Welcome to the Thunderdome. How may I help you? 
Frumpy Little Oaf: I require the filling of this prescription. 
CP: I see. Ah, yes. The ever popular 10/300. I apologise but I do not stock these. 
FLO: I had this problem last time I was here. 
CP: I see that was ... 6 months ago. They haven't gained in popularity since then, I am afraid. 
FLO: What am I to do? 
CP: I, being ever so gracious, shall check another store for you. 
FLO: Delightful. 
CP: Yes. I was able to locate this medication for you. They have it at the store on West Main St. about 10 minutes away. 
FLO: But I just came from there. 
CP: Splendid. So you are familiar. 
FLO: I am. I don't want to have to go back that way. 
CP: I could call another store that is further away if you'd like. 
FLO: What? Why? That doesn't make any sense. 
CP: You did complain you just came from there. I thought, perhaps, you wished to travel in another direction. Since I did not know your intended vector, I chose proximity over the desire to not retrace your route. 
FLO: I just need my medication. 
CP: This does present quite the quandary. 
FLO: You're damn right it does. 
CP: You can either stand here and stare at me, and argue with me, and continue to lose, and still not get any medication until my order arrives in 48 hours or ... you can go back from whence you came and retrieve said medication today. 
FLO: But I just came from there. I drove right past that store.
CP: I guess you should have stopped...

Thursday, April 7, 2016


Remember the post I wrote about the word "JUST"? It's a word people use to trivialise that which they deem insignificant or inferior.
"It's just a refill".
"It's just a flesh wound".

Sometimes, all it takes is one quote to jumpstart my warped little mind.

CP: That'll be $128.67.
Lady: For what? "It's just an antibiotic!"
CP: It is. You also have a deductible to meet so there's that.
Lady: What? I'm not taking this. "It's just an antibiotic."
CP: You keep saying that as if it will make the price change.
Lady: I'm not paying that. There are cheaper antibiotics. It's ridiculous that they should be so expensive. "It's just an antibiotic!"
CP: You, my dear, are racist. Or at least, majorly prejudiced.
Lady: <scoffs, fumbling for words> I. AM. NOT!
CP: You are. These poor little antibiotics have a job to do. They have to work as hard as every other medication. You are a Drug Class Racist. Sure, they may not have the sexy job of inphlating phalluses or kickboxing kancer, but they have a job to do and they do it well. It's too often people don't treat antibiotics the right way and stop taking them when they feel better. You would probably be one of those people. All antibiotics just want to be loved and treated the same as heart and diabetes medications. But you <sniff>, you, <sniff>, you Drug Class Racist people just have to ruin it for them. They're trying to make it in the pharmacy world. Sure, no one is designing new friends for them but dammit, we owe them. Thanks to one moldy orange, you're not like to die from syphilis. Think about that!
Lady: What does syphilis have to do with...
CP: Stop! I'm on a roll. I don't believe all my medications gather round and tell stories in the pharmacy but we don't have them segregated on the shelves for a reason. We don't want them thinking one class is better than the other. Okay, the eye drops are in their own section, but we don't want them to get lost. They're really small, like preschoolers. From now on remember that all medications are "just" as important. Any one of them could be called upon to save your life at some point.
Lady: I never thought of it like that.
CP: Fortunately, most people don't think like I do.