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Wednesday, April 13, 2016

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cannot be returned from the pharmacy to the wholesaler which means there is a significant chance the product will go outdated on the store's shelves and the pharmacy will eat the loss.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.

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