Damned If You Do ...

... Damned If You Don't.

Let's face it, you're not going to make everyone happy.
Correction. In pharmacy, you're not going to make anyone happy.

That's better. As we all know, pharmacies make too many phone calls to patients; so many in fact, that patients can't keep them straight and decide to just call us for clarification. It's not their phault, but that of the "helpful compliance systems" developed by pharmacies. However, for every person complaining we call too often, there is someone equally sore we do not call enough. For this reason I say we are damned if we do and damned if we don't.

<Day 1>
Understandably Wants It Now: <at the counter> I need to have this filled.
CP: First, this prescription will require prior authorization. Second, we do not have it in stock as it is quite expensive. Third, we will not order it until the prior auth has been approved. Do you agree to these terms and conditions as I have explained them to you?
UWIN: I wholeheartedly understand and agree.

<Day 2>
CP: We are calling to inform you that your prior auth has been approved.
UWIN: Hooray. I'll be right down.
CP: We have to order it.
UWIN: But I brought it in yesterday.
CP: And the prior auth went through today. Now we will order it. It was all in the agreement you agreed to agree with when you left your prescription with us. (Besides, I could have waited until tomorrow to call you and tell you it was approved at which time my order would have arrived and you'd've been none the wiser. Just sayin'.)
UWIN: This is ridiculous.
CP: No. Here is what is ridiculous.

If I order it, your prior auth won't go through and I'm stuck with it.
If I don't order it, you get mad because I don't have it for 1 more day.
If I order it AND the prior auth goes through, the co-pay is too high and now you don't want it.
If I don't order it and the prior auth is rejected, you get mad because you want to pay cash for it now.
If I order it, you decide to transfer it to a store closer to home because they have it in stock.
If I don't order it, you complain that we never have anything in stock even though this is new.
If I order it, you decide to call the prescriber and have her change the medication to something in stock, cheaper, or preferred on your insurance.

Whatever we do, it is wrong in someone's eyes. While just my appearance at work is often enough to make angels and technicians sing, for some, the pitchforks and flaming torches appear.

Tickets! Get Your Tickets!

I already did a post on adapting Disney's FastPass to the pharmacy for prioritization during normal hours. After navigating the Rings of Hell known as Ticketmaster to procure my TOOL tickets the other week, I had a new thought: Preferred line treatment.

We can sell passes to be the first in line on your narcotic due date. They will be VIP passes good for one date at a time. We can also hold a lottery to distribute a limited number of tickets for each day. I suggest an auction for the most prized day, Friday! Instead of being told to come back the next day after 10am or 11am, we will guarantee your prescription will be ready by 8:05 or 9:05am (5 minutes after the Rising of The Gates in your store) on the promised date. We will number the chairs in the waiting room 1-5 and you will claim your prized seat that morning. Busier stores may adapt this idea to accommodate the number of chairs in their waiting area, or greediness of their staff.

CP: Your prescription cannot be filled until next Tuesday.
Pt: What time will it be ready?
CP: Since we do not open until 8am, we need everyone to give us until 10am to finish the morning's work that awaits us upon entry to the Hallowed Halls of Hygeia.
Pt: Can I not get it any quicker?
CP: Your prescription, as well as the others we promised for that day and the ones entered into our system overnight, all get the same treatment and take equally as long. Let's not forget about all of the new prescriptions people will be bringing to us they also need that morning.
Pt: Isn't there anything you can do?
CP: We did just start a new pilot program. We are selling seats in our waiting area. The first 5 patients to purchase seats will have their prescription guaranteed to be ready for pickup by 5 minutes after we open.
Pt: Go on.
CP: However, patients must remain in their seats until their names are called. If they are found to be lurking, standing, malingering, or otherwise impatiently hovering, their ticket becomes void and non-refundable and their prescription enters the general queue. Might this interest you?
Pt: Yes. How much does it cost?
CP: Each seat license is $25.00 for priority seating if purchased before closing the night before your fill is due. Any remaining seats that have not been purchased go on sale on a first-come, first-serve basis or a lottery the morning of filling. There is no discount for waiting until Filling Day.
Pt: Any other restrictions?
CP: As of right now, Fridays are the most popular days for narcotic pickups. For this reason, tickets will be auctioned off every Wednesday at 9pm.

This will check many of corporate's boxes: great customer service and guaranteed repeat business along with a little extra cash flow.

Are We Speaking The Same Language?

CP: Good Day Madam I'm Adam.

What The What: You're a palindrome? 

CP: Something like that. 

WTW: Why are you calling me? 

CP: We processed your refill and the insurance will not pay for it. 

WTW: I called my insurance last week and they told me they do pay for it. 

CP: As of today, they do not. 

WTW: Yes they do. 

CP: It needs a prior authorization. 

WTW: No it doesn't. I called them. 

CP: They may pay for it AFTER the prescriber submits the prior auth. 

WTW: No. I called them and they told me it's covered. You must be doing something wrong. 

CP: Of course. I shall bear the blame for this. If I could take on any more burden I'll need 80's shoulder pads under my clothes. Here's how the "you must be doing something wrong" part of your argument crumbles: I enter your insurance information. I enter your prescription information. I hit "enter" on my keyboard. I wait. Your insurance responds with "paid" or "denied". The only thing I could be "doing wrong" is hitting "enter" incorrectly. Unless...

WTW: Unless what? 

CP: Nah. It couldn't be that. 

WTW: Be what? 

CP: The only thing that could be wrong would be if you provided me with incorrect information. But that wouldn't happen, would it? 

WTW: No! I called my insurance before I brought you that prescription. 

CP: Okay. Just for phun, I have to ask. Whom? 

WTW: What? 

CP: Whom did you call? 

WTW: My new insurance. 

CP: What new insurance? 

WTW: The one that starts the first of next month. 

CP: You do realise this is March, right? 

WTW: Yes. 

CP: And that April is still 2 weeks away? 

WTW: Yes. 

CP: And the new insurance starts in April...in 2 weeks...which is not today? 

WTW: Yes. 

CP: So when I explained to you it wasn't working and you told me I must be "doing something wrong", you know now that it was YOU "doing something wrong"? I cannot process prescriptions for phuture dates if the insurance is not in effect. 

WTW: Oh. I didn't think about that. 

CP: Obviously. See you next month. 

No. No It Is Not

People will believe what they want to believe no matter the evidence in front of them or what learned professionals may tell them.

[The Earth is round. (Why is this even a thing?)]

CP: How may I help you today? 

Ordinary Citizen Raging And Pestering: I have a question about this product. 

CP: Go for it. I shall have an answer for you. 

OCRAP: Is this the same as Rexall? 

CP: Say again? 

OCRAP: Is this the same as Rexall? 

CP: Rexall? 

OCRAP: Yes. 

CP: Rexall is a pharmacy. Not a product. 

OCRAP: Well my wife has a bottle of Rexall and wants this to replace it. 

CP: Rexall is a pharmacy. It's also a line of products. They make all kinds of items. 

OCRAP: So is this the same thing as Rexall? 

CP: As Rexall what? That's like going to CVS and asking simply for "Equate".
OCRAP: I don't know. She has a bottle that says "Rexall" on it. I just want to know is this the same thing?
CP: Okay. Sorry for my less-than-valiant attempt at answering your question. Please allow me one last go. Hold the bottle closer to me. Closer ... Closer ... Right there. <I touch the bottle> Now, close your eyes. Listen to the mellifluous tone of my voice speaking these words. Picture the bottle your wife has. Focus on it. Are you focusing?
OCRAP: Yes.
CP: Where is it?
OCRAP: On her dresser.
CP: Focus harder. Concentrate. See only the bottle. Wait. I got it. I see it.
OCRAP: You do?
CP: Yes. This is most definitely the same thing as Rexall.
OCRAP: How'd you do that?
CP: Part of my skill set as a pharmacist.
OCRAP: You are amazing!
CP: I know.
OCRAP: Thank you so much.
CP: No worries. It's what I do. Before you go?
OCRAP: Yes?
CP: She needs a refill on her KY too. Your vision was unfocused at the beginning and I saw it there too.
OCRAP: She's not supposed to be home. 

Help Equals Assistance ...

... It Is Not The Same As Me Doing Everything For You.

(A real conversation from a real pharmacy.)

The Oxford English Dictionary defines Assistance as: noun - "the action of helping someone by sharing work".

Every day we bemoan the issue of patients no longer helping themselves. My interest in their health is directly proportionate to the amount of interest they have in it.

CP: How may I help you today?
Where's My Mommy: I called in for my refill?
CP: That's a question.
WMM: I need to pick it up?
CP: Still a question. But let's roll with it. What's the name?
WMM: My name?
CP: You just can't help yourself, can you? Yes. Your name. If the prescription is for you.
WMM: WMM.
CP: Finally, a statement! I do not have anything here ready for pickup.
WMM: Um. I called it in the other day.
CP: Allow me to research. I see here that you did phone on Thursday last at which time we told you there were no refills. We faxed and rang the prescriber that day, Monday, and Wednesday. So far she has not responded to our requests for refills. As of this morning we deleted the requests after leaving you a message that you should attempt to call her yourself.
WMM: What should I do now?
CP: Perrrrrrrrhaps you should call her yourself.
WMM: Would it help if you sent it again?
CP: Back to questions again. No. It would not help. We contact the office every other day for a total of 3 attempts. If those are unsuccessful, we put the ball back in your court. After a week of trying to reach her ourselves, I can say that no, it would not be helpful for us to contact them. It would, however, help if you called them.
WMM: Okay. Can you resend it?
CP: I can. I won't, but I can. Someone needs a swift kick out of the nest.
WMM: Oh. Ok.
CP: You fly back to school now little Starling. Fly, fly, fly. Fly, fly, fly.