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Wednesday, October 23, 2019

Another Damned If You Do, Damned If You Don't

ME: What's you Topic Of The Week, CP?
CP: Days supply. 
MICE ELF: Sounds zzzzzzzz
ME: Specifically?
CP: 30 versus 90. 
MICE ELF: zzzzzzzz
ME: I'm sure others are on the edges of their seats with anticipation. Please continue. 
CP: Some insurance plans only allow us to bill for 90 days supplies; some for only 30 days. 
Some patients only want 30 days at a time; some for 90 days. 
Some patients want certain of their prescriptions to always be filled for 90 days; some for 30 days. 
MICE ELF: zzzzzzzz
ME: Why is this important? 
CP: If the prescription is written for 30 days, and has enough refills, I can fill it for a 90 days supply. Honestly I'd rather all prescriptions be written for 90 days at a time. That way I can fill for any quantity the patient wants. 
ME: OK. Not getting any less boring.
CP: Here is the problem. Regardless of how many prescriptions we fill each week, it is impossible for any pharmacy to manage the needs of not only each individual patient, but his or her specific needs as it regards to each individual prescription in their profile. Add to that the fluidity of copays as they change over the course of the year (deductibles start/end, tier changes, new insurance plans, etc.) and no amount of notes in the profile will enable the pharmacy to make each person happy on each prescription. 
MICE ELF: <sleepily opines> make them responsible for their own prescriptions <zzzzzzzz>
ME: Yes. Thanks for that. Is that your goal here? 
CP: Simply put, Yes. As a patient, you have the obligation to ensure your prescription is filled to your satisfaction. 
If you want your HCTZ 25mg filled as cash for 180 days at a time, ask when you place the refill order. 
If you want the Eliquis filled only for 30 days, ask. 
If you want the Januvia filled on a discount card, make sure I do, by asking. 
If you want everything filled for 90 days, even when you hit the Medicare Gap, don't be surprised when I explain the $500-$1000 copay totals. 
ME: Seems simple enough. Why is this an issue again?
CP: People will complain that we should just know how they want everything filled each time. I once had a patient who paid cash for a week of medication every Friday. Simple. Yet if he forgot a dose, he wanted one fewer tablet that week. Or if he wanted an extra for a vacation day, he added a dose or two. Now consider the patient whose insurance charges him $15.00 for a 30 days supply of one of his medications but $75.00 for a 90 days supply of that one medication. His prescriber always writes for 90 days supplies which he gets on some of his other prescriptions. How am I supposed to remember this one patient and his individual needs among the other thousands I will fill each week? 
ME: I'm guessing he's the one you have in mind for this post. 
MICE ELF: <yawns>
CP: Not wholly. It does exemplify the point however. Both of these men have unique filling needs. One is nice, the former, and one is simply an ass, the latter. Unfortunately there are more of the latter than the former. If you have unique filling needs for each of your medications, it is up to you to ensure it is correct. While I may fill 2000 to 4000 prescriptions per week, the last thing on my mind is "how does Little Old Lady want this particular Rx filled?". 
ME: Any words of advice for the prescription phillers out there? 
CP: Yes. 
Ask before you come to retrieve it. It is easier to fix BEFORE you get in my pickup line than being the wrench in my gears that slows down the whole system. 
Ask before you pay for it. Note the word "ASK". 
Just ask instead of yelling at me that I should know how you want it filled each time. It's like yelling at the pizza place because you changed your mind AFTER you placed the order and, now that it's ready, you want a new pizza, made the way you like, to be already cooked and waiting. 
MICE ELF: Pizza? 


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