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Friday, April 30, 2021

We're In This Together

ME: What are some things that haven't changed that should have by now?
MICE ELF: Women getting the respect they deserve as professionals? 
ME: Good one. 
CP: Doctors still claiming the throne as the omniscient providers they believe themselves to be?
ME: Nice. But they're not "providers", they're "physicians"!
MICE ELF: Don't conflate the two issues. Let's stick with Holier-than-thou prescribers. 
CP: Good choice. 
ME: I take it you have a story?
CP: Always. Random thoughts and musings as we talk to ourselves at work. 
MICE ELF: To wit?
CP: We have always had a corresponding liability on all prescriptions we fill, yes?
ME: Yes. 
MICE ELF: Of course. 
CP: Follow my rabbit on this. . . 

He's a Doctor! I Think: Your job is to fill what I write. 
CP: No it isn't. 
HAD IT: Yes it is. 
CP: No it isn't. 
HAD IT: Yes. Yes it is. 
CP: Ok. Let's try this. 

<ring ring>
HAD IT: I'm being sued. 
CP: Why?
HAD IT: Because you filled something wrong. 
CP: No I didn't. 
HAD IT: Yes you did. 
CP: No. I filled it exactly as you wrote it. As you have previously lectured me, my job is, quote "to fill what I write", unquote. Sound familiar?
HAD IT: You should have known it was wrong. 
CP: But how could I know it was wrong? I only fill it as it's written. Your words. You can't have it both ways. You can't tell me to fill what you write and NOT understand the relevance and importance of my job. You then cannot hold me accountable for performing my job the way you think it should be done. Either I do my job, which means catching, calling out, then fixing your mistakes, OR I can do your interpretation of my job. But you don't get to blame me for your mistakes. Unfortunately for you, I documented our last conversation where you told me to "fill what I wrote". I counseled the patient. I explained it to her. I documented my consultation. Apparently someone in the family called to verify with your office and the staff member said "Yep, that's what he wrote" and overrode my work. You have bigger things to worry about than whether someone calls you "doctor" or "provider" because prison is in your future. I can't wait for your cellmate to say "what's up, doc?".
ME: Basically you took us on a tour of how little many providers think of us?
MICE ELF: Mostly doctors. Must be something that happens their first day at Med School. Here's your lab coat, your ego, and your official, notarized letter stating you are better than all other medical professions. It's a get out of jail free card to abuse other professions, both in person and on social media without repercussions. 
CP: Remember, we are in this together. When pharmacists say they are "saving lives" every day it's not just those of patients, but of the prescribers having a bad day at the office.  
ME: In summary, your point is that doctors can't tell you how to do your job then excoriate you for either doing it too well, or not doing it at all if they are the ones getting in trouble. 
CP: Precisely. We're just people needing people. 
ME: <singing> People. People who need people, Are the luckiest people in the world. 
CP: Yes. But why are "those" doctors the ones who always forget about that part? 
MICE ELF: Well, don't forget about that one CNP. 
CP: Oh yeah. Or the one who wrote last week's Lorazepam script. 

Thursday, April 29, 2021


UT: CP's Pill Palace. How may I help you?
Lady Unusually Calling And Being Rather A Sullen Ignoramus: I need to authorise an early refill on a control we wrote. 
UT: Hold phor CP, please. 
CP: CP here. How may I help you?
LUCA BRASI: Can you take a verbal order to change a fill date on a prescription we wrote?
CP: It depends. Did you send it to us electronically? If so, I CAN take a verbal okay if it's urgent or the provider is unable to correct the problem today. It is only 1:33pm so it's really not an emergency. 
LUCA BRASI: No. We did not send it electronically. 
CP: Did the patient bring it to us? I can pull the hard copy and document the change in fill date. 
CP: Okay. Then where is the prescription?
LUCA BRASI: We have it here in the office. 
CP: Say what? 
LUCA BRASI: The patient had a televisit a few weeks ago and came in today to retrieve the prescriptions for the next 3 months and we noticed the one for today was dated incorrectly; it was dated for next month. 
CP: Wait. You are physically touching the hard copy right now?
CP: And you want ME to agree to change the first allowable fill date and document our conversation with a date and time stamp and handwritten note of said conversation? When the patient swings by later?
CP: So you don't have to do it yourself?
LUCA BRASI: Essentially. 
CP: Have the provider cross out the date, write the new date, then initial it. Or print a new one with the corrected date. 
LUCA BRASI: The provider already left and I didn't want to have to print a new one. 
CP: Is it just me or does this approach not sound a lot more labor intensive than either reprinting or initialing a change in the office?
LUCA BRASI: So can you fix it?
CP: No. First, I am not in possession of the actual hard copy currently. Second, you are the office that wrote it and you are literally holding that which needs fixed. I understand the patient is there wishing to pick up the prescription two weeks after the appointment but I am not going to bail you out for this mistake. 
LUCA BRASI: So you're not going to help?
CP: It's rather ballsy for you to assume I would, or could. But you have the prescription! Reprint it!
LUCA BRASI: <whispers to patient "they won't do it">
CP: Wrong. I CAN'T do it when I don't have the prescription. You know you messed up so do not blame me for your mistake. Nice try. I bet I can give the patient a better, more convincing explanation of the law than you can muster. You're a pain clinic. You should know better. That's just plain lazy. In phact, phor being so lazy, I sentence you to sleep with the phishes.  
LUCA BRASI: Well I guess I can see what we can do. 
CP: You got two choices of what you can do. Sign a new prescription and reprint it too.

#Laws? #WeDontNeedNoStinkingLaws

Wednesday, April 28, 2021

Random Midweek Thoughts

ME: Have you ever noticed how people will scratch their heads when they hear mention of lice?
MICE ELF: Or when we see, receive, or fill prescriptions for said condition?
CP: Yes. But why do people not have a similar reaction to hearing about other conditions and filling other medications?
ME and MICE ELF: Like what? 
CP: Sympathy erections upon filling Viagra?  
ME: Like guys feeling a sudden Penile Pulse Pounding?
CP: Sure. Or women with a sudden, sympathetic itch and burn when filling Diflucan?
MICE ELF: Twin Twat Twinge!
ME: Say that 3 times fast!
CP: Seriously though. Why can everyone describe having a reflex reaction to the mere mention of lice or seeing a script for Nix/Rid/Natroba but nothing else elicits such a physiological response?
MICE ELF: They're bugs?
ME: Yeah. Bugs are creepy. 
CP: They're insects. 
ME: Phine. But I still think pubic lice should be called Crotch Spiders.  
MICE ELF: How is that better than Crabs?
CP: Try it out. First, announce that you have pubic lice. Then say "I have crabs". Then tell someone you are afflicted with Crotch Spiders. 
ME: First, lice are not arachnids. Second, I'm pretty sure no one ever wants to hear anyone ever bragging about Crotch Spiders. 
CP: I thought it might make them sound less awful. 
MICE ELF: Let ME finish.
ME: Third, I really have a horrible image of a spider egg sac with thousands of spiderlings just erupting around someone's naughty bits. How can that be less awful? You really need to get outside and let your brain walk around a bit. 
MICE ELF: Yeah, these long hours inside are rotting your mind. 
CP: Seriously though? Why does the topic of lice elicit this and nothing else? Hello?  Some days I feel as if I'm talking to myself. 



Monday, April 26, 2021

It's The Circle of Pharmacy Life Or. . . The Fax of Life

Provider: Dear Pharmacy, please fill this medication for my patient. 
Pharmacy: Dear Insurance, please pay for this for my patient. 
Insurance: Dear Pharmacy, this needs a prior authorisation. 
Pharmacy: Dear Provider,  this needs a prior authorisation. 
Provider: Dear Insurance, please approve this medication for my patient. 
Insurance: Dear Provider, this medication does NOT require a prior authorisation. 
Provider: Dear Pharmacy, this medication does NOT need a prior authorisation. 
Pharmacy: Dear Insurance, provider said you told them this does NOT need a p/a.
Insurance: Dear Pharmacy, this does, in fact, require a p/a. 
Pharmacy: Dear Provider, insurance says it does, in fact, require a p/a. 
Provider: Dear Insurance, WTF? 
Insurance: Dear Provider, it does not need a p/a. 
Provider: Dear Pharmacy, they said it needs no p/a. 
Pharmacy: Dear Insurance, WTAF?
Insurance: Dear Pharmacy, it needs a p/a. 
Pharmacy: Dear Insurance, is it a specific manufacturer? Specific NDC?, Specific form or size?
Insurance: Dear Pharmacy, no. It just needs a p/a. 
Pharmacy: Dear Insurance, do you have a list of alternatives?
Insurance: Dear Pharmacy, yes. (lists alternatives)
Pharmacy: Dear Insurance, you do realise that the medication I am submitting is on your preferred list, right?
Insurance: Dear Pharmacy, meh. With a p/a, it is.
Pharmacy: Dear Insurance, Where do we go from here? 
Insurance: Dear Pharmacy. You give up. 
Pharmacy: But how does that help my patient?
Insurance. It doesn't. 
Pharmacy: What's your endgame?
Insurance: You give up. Or the patient gives up and pays cash. Or the provider gives up and prescribes something else. In the end, you will be blamed by all parties. We won't have paid for something more expensive, and we will audit you for not documenting all of this to our satisfaction and take back any money you received from us for this claim and a select few others. We're basically trying to put you out of business. 
Pharmacy: Dear Insurance, thanks for the honesty. 
Insurance: No problem. Anything else I may assist you with?
Pharmacy: Well, since you haven't helped me with anything yet,  I suppose that's a rhetorical question. 
Insurance: It is. <click>


Monday, April 12, 2021

Prior Auths In Two Parts

A: The Self-Fulfilling Prophecy
CP: In prison, I learned that everything in this world, including prescriptions, operates not on reality. . . 
CPP: . . . but the perception of reality. 
CP: Posit. New insurance requires prior auth. Previous one did not. 
CPP: Consequence. Patient is mad and blames you. . .
CP: . . . Not understanding the process itself or her insurance. 
CPP: We fax/call her provider for the prior auth for her medication. 
CP: Result: Patient goes to another pharmacy only to discover. . . 
CPP: . . . They don't require a prior auth because we already took care of it. 
CP: Thereby making us look like the inept fools. 
CPP: Conclusion: The patient believes the failure of the system is caused by our pharmacy. 
CP: Precisely. 

B: Motivation
CPP: How do you get a prior auth? 
CP: The most efficient way?
CPP: Natch. 
CP: Step one. Tell the patient her new insurance requires a prior auth. 
Step Two. Make sure the Rx is for a pain medication. 
Step Three. Wait. 
Step Four. Field the phone calls from the patient, the provider, and the insurance over the next hour until prior auth goes through. 
Step Five. Celebrate having to do practically nothing while the motivated patient did all the work for you. 
CPP: Awesome. I mean it IS her prescription after all. It should work this way all the time.
CP: Witnessed it myself last week. Amazing sight. 
CPP: We should coordinate a "buddy system" for prior auths. 
CP: Like Big Brother Big Sister?
CPP: Yes. Partner a seasoned professional prior auth go-getter as described above with a neophyte, "that's-your-job" slacker. The slacker gets her prior auth and the pain med patient gets her copay covered. 
CP: Terms to be decided/negotiated as the deal is struck, specific to each pairing.
CPP: Never underestimate a motivated patient. 
CP: I just wish it weren't this difficult. Whether for a procedure or a medication, it really shouldn't be this difficult. 
CPP: People need to understand we can only do so much from the pharmacy and the providers' offices. 
CP: THEIR lives and the fate of THEIR prescriptions are in THEIR hands. 


Thursday, April 1, 2021

I Want Half!

CPP: What are some things that bother you that shouldn't?
CP: Directions that should change but don't. 
CPP: That's rather basic. 
CP: Here are the two annoyances that came to mind this morning:
Option 1: 
Sig: Take 1/2 tablet by mouth once a day for 30 days. 
Notes: pt states she has been taking 1 tablet a day since May, 2019.

CPP: Yeah. It would be nice if they would fix that. 
CP: Not only is it confusing (is she really still taking one tablet?) but why are you letting the patient determine her therapy on Lasix? When you ask me which providers are on my "never go there" list, lack of attention to detail or not reviewing my therapies with me is right on top. It's been two years! Phix it!
CPP: Of course you called the office, instructed them to fix it then resend it while subsequently deleting this Rx. 
CP: Natch. 

Option 2: 
Sig: Take 1/2 tablet by mouth once a day for 7 days, then increase to 1 tab daily thereafter. 
#30 with 11 refills. 

CPP: I love this one for so many reasons. 
a. what do they do with the extra 1/2 tablet? when do they take it?
2. since there are refills, do they restart this taper each month? 
z. will the office continue this Rx year after year as in Option 1? 
CP: Don't be daft. It's obvious. Since the directions will remain the same on each bottle, the provider wants them to taper it each month and year after year. That extra half tab is the start of the following month's taper.
CPP: You know this will reignite the "professional judgement" vs "I'm afraid. I must call the office" debate. 
CP: Yep. As planned. Should we bring up Chantix Starting vs Continuing Packs refills? 
CPP: Nope. I'm still bothered by the leftover tablet though. Why can't they just write the directions for an even number of days?
CP: Prescribers are sent to school to learn what to think, not how. Simple math and basic handwriting are electives and the rooms sit empty during those lectures. 
CPP: Especially since they have e-scripts to calculate everything. 
CP: Which they still manage to phuck up. "Okay. I want 60 tablets for a 30 days supply and if I write 'bid' that will fix it". <writes directions as "2 bid" instead>
CPP: Right?
CP: But, as with everything else, the pharmacist will phix it. This always reminds me of my favourite John Grisham quote: "If it wasn't for lawyers, we wouldn't need lawyers."
CPP: You mean: "If it wasn't for prescribers, we wouldn't need pharmacists"? 
CP: Something like that.


ME: I see that vein popping on your head again. 
CP: Is it really that noticeable?  
MICE ELF: It is. What's got your knickers in a twist?
CP: Chronic Vaginal Secretions. 
ME: Yeah. I never know what I'm going to find in there. 
CP: Their inventory management is atrocious. If I dispense a medication, I need to replenish it so I have more for next time, right?
ME: Normally. You can't sell what you don't have. 
MICE ELF: Remember we used to hate it when <other company> had a 90% rule?
ME: Yeah. As long as we had 90% of the needed inventory for the next refill, they didn't send us more. 
MICE ELF: That really sucked when we had 27 caps in a Nexium bottle and the patients always received 30. 
CP: But at least we could tweak it. You can't quick order anything for Chronic Vaginal Secretions. 
ME: Why not? 
CP: They don't allow it. 
MICE ELF: How do they get more inventory? Especially if it's needed for the next day?
CP: They have to place it out of stock. That way, the computer sees the store has a need for it and, hopefully, it arrives the next day. 
ME: Which I'm guessing doesn't happen?
CP: Not unless you cycle count it to zero first. Then you have to check the order that prints at night to make sure what you need is on it. Otherwise, it won't be there and you'll have pissed off patients. 
ME: I'm guessing this happens. A lot. 
CP: Why do they tell their patients "I'm sorry but it's out of stock. It will be here tomorrow" when they know full well it won't? Then the patient comes back two days later, expecting the medication and is told "we ordered it but it didn't come in and I don't know why but it should be here tomorrow.".
CP: How do you "not know"? Either it was ordered or it wasn't. Either it's available, or it isn't. "When it comes in" isn't an answer either. Find out!
MICE ELF: Sounds like you observed this personally?
CP: Yeah, when family members start calling me to complain about Chronic Vaginal Secretions, all I can do is shrug, listen to their stories, and confirm them with my phriends who work there. 
ME: Maybe it's on backorder?
CP: Nice try. Except I use Cardinal where I work, same as them. I looked up the medication. It was in stock. Readily available. I could order (and did) for the next day. I mailed it. If I can order it and have it the next day, why can't they? Why do they make their ordering so complicated? 
ME: You sound like a disgruntled employee. 
CP: Not at all. I am perfectly gruntled. All of my stores (multiple pharmacies and stores-it's an average) have had ~$300,000 in inventory and dispensed over 2000 Rx's/week. I never had as many out of stocks as my phriends' stores that are working for Chronic Vaginal Secretions. Their stores often have over $1.5M in inventory. 
MICE ELF: That is a lot of inventory. 
CP: A lot of wrong inventory. 
ME: They claim it's because they saved $0.11 per 1000-ct bottle of Metformin by buying it in bulk and, over 10k stores, it adds up so they force it into the stores. 
MICE ELF: Yet they won't let, or don't trust, the pharmacists to order what they NEED when they need it. 
CP: Exactly. Which is why I get calls asking why, if an order was placed on Monday, and the drug is readily available, my family and friends don't have their medication(s) or any clue as to when they will get it as of Friday. This is not the patient's fault for ordering too late. This is a testament to how slippery Chronic Vaginal Secretions can be when it comes to inventory. They are setting up their staff to fail with this horrible inventory management system. They are the only company I know that doesn't have Inventory as a bonus category or a controllable expense by their pharmacist in charge. 
ME: Feel better?
MICE ELF: Nope. Vein is still there, just-a-poppin'. 
CP: Simply put: If I can get it, and neighbouring stores/competitors can get it, Why. Can't. YOU? Again, I realise this is mostly beyond the control of the staff, for the most part, but not being able to simply quick order a needed product for the next day is irritating. I could never work under these conditions. 
ME: You just really wanted to complain about your family member's recent experiences while also coining the phrase "Chronic Vaginal Secretions" to represent "that chain", didn't you?
CP: Yes. And to work in gruntled. 
ME: You are quite the cunning linguist.