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Monday, July 29, 2019

Return To Stock

ME: What is bothering you today?
CP: Bothering me today? Or what am I choosing to post about today? 
MYSELF: Right. Everything bothers your brain every day. It's just a matter of how long it has to ruminate for your post to fully develop. 
ME: Okay. What is it? 
CP: Return to stocks. 
MYSELF: Big issue. 
CP: Why do patients get mad when they come in to pick up their prescription only to discover we put it back in stock that morning or the day before? 
ME: Good question. Because they made a special trip down here expecting it be ready only to discover it is not and now they need it and are inconvenienced by having to make another trip? 
MYSELF: Well there's that. But there has to be more to it. 
CP: Let's look at the process. For some reason, courtesy fill, patient request, prescriber submission, whatever, we filled the prescription. The patient then receives a text/call alerting them to its presence in our will call section as soon as it gets bagged. Then another text follows every 3 days until the ultimate text which tells the patient "you have until tomorrow to pick it up or it will self-destruct in our baggage claim section". 
ME: You're telling me the patient receives multiple alerts, including a final notice, yet they still come in AFTER you return them to stock and have the gall to yell and scream and complain on the 1-800 number how nothing is ever ready when we tell them it is? 
CP: Yes. So again I ask, why do people get mad? Did we fill your 90 days supply at OUR convenience? Probably. It's the benefit to us to having you enrolled in our automatic/courtesy fill program. Did you need it yet? Not likely. That's the drawback to having you enrolled in this program. However, you had 13 days to make a decision. Should I stay or should I go now? Do I pick it up? Do I tell them to return it until I need it? 
MYSELF: What would fix this issue? 
CP: Most insurances allow for a "percent completion early fill date". This means that a patient could fill her prescription with 30 days remaining if she is allowed for a 67% completion early fill on a 90 days supply. If we fill it this early, it will sit for 2 weeks, be returned to stock, then she will still have 2 more weeks until she needs it; provided, of course, she is entirely compliant. 
ME: I see. Basically, you're saying it's our fault. 
MYSELF: It appears to be. 
CP: If we ignore what the computer tells us is the next available fill date, even the one provided by the insurance, and fill it only 7 days early based on when they last picked it up, not the date we last filled it, the return to stock situation would be much less traumatic on everyone. If we stuck to 7 days early, the patients should, in theory, be more likely to run out before it hits the return report. It will result in much less work and less repetition of the same work over and over. 
ME: That's redundant. 
MYSELF: Like our work. But I repeat myself. 
CP: Imagine filling prescriptions when patients actually need them as opposed to trying to prove compliance to the STAR ratings by showing on time pickups and sneaking in that one extra fill per year to the insurance. 
ME: Basically, if I understand you, you're telling me this valuable service we provide is only self-serving to the pharmacy so it can brag about its patients being super compliant, always taking their medications, and billing the insurance for one extra prescription per year thanks to the early cumulative refills? 
MYSELF: That's what I heard. 
CP: Don't get me wrong. There are plenty of patients who benefit from the reminders. There are many who consider these services invaluable. As with all great ideas, when taken from a small context and applied to a greater percentage, the values tend to disappear. 
ME: What do you suggest? 
CP: In my own little world, patients will follow up the texts with a call, asking what is ready, telling us if they need it now and retrieving it from our baggage claim section before it explodes. Or they tell us to return it as they do not need it and will call us back to fill it when needed. 
ME: You're so cute when you mythologise. 
MYSELF: Yeah. You're really going to upset those in charge of metrics. 
CP: But it keeps medications from getting filled that shouldn't be. Patients have medications changed all the time - new directions, new strengths, new combinations, etc. This would prevent them picking up duplicate or discontinued therapies and allow us more time to talk with them as opposed to a quick chat.
ME: Back to your original point, why do people get mad at us when they had 2 weeks and multiple notifications and opportunities to pick up their medications? 
CP: It is easier to blame someone else for your own mistakes and shortcomings than it is to own up to your personal responsibilities. The more we try to do for people, to facilitate easier healthcare management, the more they expect us to do for them and when the rate limiting factor in the process fails, the patient, it is easier to blame the experiment rather than that one step. 
MYSELF: Yet corporate continues to run the same experiments. 
CP: Precisely. 
ME: And we get yelled at. 
CP: Some things never change. . . 

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