The Pharmacy Chick

I have a long time customer, I’ll call Ms Brand.  She has always been a really nice lady, but she made it clear from the start of time, that she likes brand name products, regardless.  I learned a long time ago that it was generally fruitless to argue with people about this.  Its a no win situation.  They are convinced generics don’t work and even if you showed them a tome worth of evidence to the contrary, they would certainly be the exception to the rule and your credibility would be shot.   In fact even if you used the generic MADE by the innovator (same product, same tab, same bottle, just different printing on the tab), it still wouldn’t work.  Therefore, I just never went “there” with her. Occasionally she would accept the generic for some antibiotic I didnt’ stock…like Keflex or Cipro. 

This was easy for her because she had great insurance at the time.  Same copay for everything brand even if generic was available, $25. No problem, and I didn’t feel the need to intervene or interfere.

 Well, as all things do, her insurance changed.  She had to pay $50 for brand names and had to pay the difference between brand and generic when she took brands.   She started to make more and more noise at the cash register about the price of things.  Still she was not open to changing to generic meds.

One day I decided to go out a limb.  I prepared a statement for her.  She spends on average $2400 per year on copays.  I printed out what she would save if she went for generic theraputic substitutes for her meds: simvastatin for Lipitor, Citalopram for Lexapro,  Albuterol for Proventil HFA, etc.

Once finished, I had taken that $2400 down to $900 per year.  I presented these facts to her. When faced with the $1500 savings, she was amazed.  She said she would think about it.  I figured it was a polite way to blow me off.

Well, about a week later, I got 3 pages of faxes from her dr.  Every suggestion I made, she took.  She came in later to pick up the drugs and said it was worth $1500 to consider trying generics.  If “they didn’t work” then she could always go back to her brands, but saving over $150 per month on meds really spoke to her.

Go Me!  So far so good, she has been refilling her generic meds and saving her cash.

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Fred came to the counter clutching a pharmacy bag.  He had been in a few hours ago picking up a prescription for his wife.  I was at the other end filling a prescription and our poor tech got the brunt of his tirade.  “You shorted me 3 pills”.  He was waving his bag, going on and on about who is going to take care of this,  what kind of business we run around here, ripping off old people, etc.  I let him rant for while.  He was going to have his say, and I was going to let him.  After all, Pharmacy Chick knew exactly where this conversation was going to end up. After the cork holding in his steaming brain blew off, I walked over with an overly big smile and said ” Hi Fred, Do you you remember when you came in on Friday and wanted a refill on this and we had to call the Dr?” He nodded ” And do you remember you told me you were OUT and I loaned you 3 tablets AT NO CHARGE (my emphasis added)?  The blood began to drain out of his face. “well, 30 minus the 3 we gave you is 27, so  your bottle had 27 tablets in it, and was marked as such, if you look at your receipt” .  “oh, yes, so it was” he mumbled “never mind” and he slinked away.  No apologies offered, and no apologies accepted. Marvelous tech said “He didn’t even say he was sorry?”  I guess embarassment trumped traditional social graces.

Another day, Another issue:  Eileen comes to the drop off window with her bag from moments ago.  She was literally shaking with irritation. “This rx is $121.00?  I only paid $5 for it last month.”  We had had this discussion at the register on an different rx, different day day but apparently it went completely over her head.  “you are in the Donut Hole remember?”   “Yes, but I only paid $5 for this last month” She paid $5 for everything last month… Could it actually be she thinks this eye drop  only costs $5??  I tried to explain that she wasn’t in the donut hole last month and that her $5 copay was only a very small part of the cost.  “You mean I am the one who has to pay for it while I am in the donut hole?”  Uh, hello, who else would you expect would be paying for it?…. yes that is exactly what it means…the unwelcome reality of the Donut Hole. 

Had she asked SOMEBODY, we might have been able to keep her out of the dreaded Hole.  Dump the Lipitor the Cozaar, try the Simvastatin and the ACE or Beta-blocker first.   Accept my recommendation to not get the Vanos with the $35 manufacturer loyalty card, ”But its FREE!” and use the Fluocinonide cream. 

The donut hole has a purpose.  It’s a reverse incentive to not waste the drugs you take, and be ever watchful about what these things cost.  If you play your cards right, many people can get thru the entire year before reaching the donut hole.  $2500 ads up right quick when your profile is full of single source brand products like the Lipitor Cozaar, Advair,  Januvia, Nexium,  Alphagan, and Effexor.  Toss in a few infections treated with Levaquin and TaDa, YOU are in the hole.

I offered to take back her unopened box of eye drops.  “but I have to have them!” She kept them but said she would get samples for the rest of the year. 

Hey, I tried.

Tags: behavior, customers, insurance, pharmacy life | |

Pharmacy Chick decided to do Mr Chick a favor and barbecue dinner. He was slaving away digging up a root from a bush we chopped down a few weeks ago. AND since the Chick family doesn’t have a kitchen at the moment due to a major renovation (think sub floors and wall studs all that remain), we have moved into the garage and cook outdoors.  I thought I should share my recipe!  so, here it is.

Buy 2 packages of chicken and some fancy schmancy marinade, and marinade for 30 minutes. Leave skin on because the barbecue book you ‘borrowed’ while working says it tastes better with skin on. Figure now that you are the barbecue queen. Gently season chicken with secret stuff.

Start Barbecue…flame goes out.  Start barbecue again… and again. Flame finally stays lit.

Carefully position chicken on heated BBQ, Turn temp to what appears to be LOW and begin cooking.

FIRE!  Grab water bottle and spray BBQ.  Remember that water doesnt put out grease fire. SH!T.

Move chicken around to minimize fire.  Put out another fire.  Put out yet another fire. Turn temperature down, Flame goes out.  Re light barbecue for 5th time.

Question the wisdom of barbecue book-Chicken is black on the outside and raw on inside and everything is on fire. Blame the skin.

Whine to Mr Chick about the condition of chicken.  Mr Chick asks why the temp so high. Tell Mr Chick haughtily that if its turned down the flame goes out.  Mr Chick gently shows PC that “low” is under the control handle and, in fact, she was turning OFF the barbecue every time she turned it “down”. Oh. 

Realize that instead of “low”, chicken was cooking at a temperature someplace between Blast Furnace and Volcano.

Rename “Sesame Orange chicken” “Blackened unidentifiable meat” . Figure that the microwave can cook the inside of chicken.

Serve on paper plate.  Sit up straight and pretend you intended it to look that way.

Happy cooking!

Tags: personal life | |

I had a customer come in one day, who also happens to be the Chick’s family friend.  He had a prescription filled, we had a few friendly words a the counter, I sent my well wishes and off he went.

A few days later I saw this man and as our conversation wound around, he learned that Mr Chick had no idea that he had been in to see me..

“You can’t tell him that?”   “nope, unless you say something like, :say Hi to Mr Chick for me:, I don’t say anthing”.

“Its THAT confidential?..even me?”

Yes, even you.  And for that you might be very grateful someday.

Tags: customers, ethics, pharmacy life | |

I was ringing up a sale at the register when a long time customer asked me Do you like being a pharmacist? It seems like a fun job.  After I checked to see if she had alcohol on her breath I took a moment to respond. I didn’t want to lie and tell her I had the coolest job on the planet, but I also didn’t want to make it sound like my job was akin to mucking out port-a-potties either.  Since she had asked a sincere question, I decided that a sincere, honest and to-the-point answer was in order: I said “Depends on the day”.

I told her the truth.  The business has been good to me financially. I have made a good living in a field that to date, has been largely immune from the trials and tribulations of economic instability.  For 20+ years we have weathered pharmacist shortages that has virtually guaranteed that I will not have to stand in the bread line anytime soon.  I could walk off my job tomorrow and by the middle of next week I could have my pick of any number of jobs.  Granted, they may not be GREAT jobs, but they would put food on the table.  For a lot of people, that is a lofty aspiration and one that I do not take for granted.  Neither do I consider myself indispensable (forgive the pun).  Everybody is replaceable even if it DOES take a while. 

I told her that the job however is rarely “fun”.  The cost of this good income is long hours, working in a retail setting that is open 363 days a year, and dealing with the public who comes to me largely because they HAVE to and not because they WANT to.  My hours are decided by somebody else, not myself.  I cannot choose to close early because I am tired or sick. For the priviledge of being a retail pharmacist, I also forfeit uninterrupted lunches and working in a quiet unhurried environment.  I cannot choose my workload.  The wearer of the white coat lives under a microscope most of the time,  micromanaged by the company she works for, and pressured all day by the demands from whomever is the most persistent. 

“Line 1,  Guess who?”  Like I’d have to guess.  For the 6th time today Harold has called to see if his Doctor has ok’d his Vicodin.  AND, despite my promises that I will call him the very moment its authorized, Harold calls about every hour….and demands to talk to me.

“Line 2,  Guess who also?”  Harold just hung up so it has to be Dina, who just picked up her prescription.  We play 20 questions every time she comes in.  No human on the planet has called our store more often than Dina.  While I like her, I wish she would go away.  “Can I take Aspirin when I am using Patanol?”, “Can my son take Ibuprofen with his Amoxicillin?” “If I have an allergic reaction to Claritin, can I take Benadryl?”  “What happens If I have a reaction to Benadryl?” “Can I take Benadryl and Tylenol at the same time?”  “Will I overdose if I take Claritin and Patanol?”   There will be, in fact, at least 2 followup phone calls for every single rx she picks up, whether it be new or refills. She has even called us while she is on vacation.

When you are a pharmacist, there is no closed door to retreat behind (but the potty) when you’ve had enough.  Go ahead, try… somebody will demand your attention before the aforementioned door closes…and you will again be at somebody elses beckon call. Thats what its like to be a retail pharmacist.  I should have a mantle full of Oscars for the performances of a lifetime I have played out in the white coat. 

This customer  then asked me if they took it all away, would I go to pharmacy school again?   Tougher question:  Its a good thing that I was an uninformed college student when I chose Pharmacy as my major.  I worked thru each quarter, one at a time, always amazed that I survived to pass on to the next one.  It was harder than I had imagined…and its even harder now with the Pharm D as the entry degree.  Ignorance is bliss I think.  There are a lot of things that I have done in my life that were harder than I had thought when I started them.  I have completed a lot of things that if I had the opportunity to repeat, I probably wouldn’t simply because I would remember the effort involved.  “Glad I did it once, don’t want to do it again” might be a good motto for the things in THAT category. 

I guess I didn’t have an answer for her. I dont remember exactly what I said, but in retrospect, if I was 20 years old and had my life before me, yes I’d probably do it again.  If I was 45 and starting over with a new career,  not so sure. 

What made me write about this was the following conversation:

A nurse called me the other day on a refill auth to inform us that at the end of the month, the Dr was closing her practice.  I casually asked “Having a baby?”.  No, the nurse replied, she is giving up medicine to go to Law School.  WHOA.  Pharmacy school was one thing, that took 6 years.  But Medicine?  This physician likely had a dozen years or more in school and residency before she hung her shingle…and she is giving it all up. I wish I knew her well enough to ask her why.

I know the nurses name and when I go back to work next week, I am gonna call her and ask her. I’ll let you know.

For now I put the same question to you–Would YOU do it all over again? or better yet,  If you were going to start over, what WOULD you do?

Thats an easier question for Pharmacy Chick–I am passionate about animals, I’d be a vet. 

Tags: , drivel, general junk, letting you in to my life, pharmacy life, rambling endlessly | |

I was reading some of my old posts and I thought to myself: PC, you complain a lot.  Well, yes I do, because there isn’t much of this job that is fun and uplifting to write about anymore.  I actually used to like my job and used to look forward to going to work.  I also used to do about 500 less rx’s per week and was allocated the same labor hours that I work with now. That means that I do almost twice the work with the same labor.  No wonder I am stressed and grouchy about my job.  There must be a direct correlation, ya think?

So, to reverse that trend I decided to share with you some of my favorite things today.  Note, none of them will have anything to do with the pharmacy!  I may go back to my bitch-fest tomorrow but for today, its happy-post day.

My favorite food:  Pizza, especially pepperoni and sausage.  Barbecued Ribs! Lay it on thick with some spicy sauce and I’m in heaven.  I am not a sissy salad chick.  Pharmacy Chick is a carnivore. I also love my mothers fried chicken.  I can’t make it exactly like her, but Mr Chick says its a close second.

My favorite sound:  The sound of the wind thru a stand of ponderosa pine.  Nothing says ‘peace’ more than that.  Its compeletely unique and different and any other wind thru trees.  I hope you all can hear it someday.

My favorite smell:  chocolate chip cookies cooking,  bacon, and new-car-smell.  I get the cookies and bacon enough but not the new-car smell….

My favorite TV: Watching baseball, Red Sox, thanks, on my HiDef Plasma TV, and anything on HGTV

My favorite person: Jesus Christ, even though I fall pretty short, he’s always there to pick me up, dust me off and send me trundling on my way.

Favorite beverages: Coke (original),  Red Gatorade,  Chocolate milk, Egg Nog and Grapefruit juice.  Just not at the same time.

Favorite Holiday: none–I declare my own.  Sometimes I will declare a day “Vacation day” and spend the day doing whatever I want, regardless of the dishes/laundry/chores whatever.  Its very theraputic, try it sometimes.

Favorite Movie: White Christmas. The Chick family doesn’t do movies or network TV unless its sports.

Favorite outfit:  Jeans, a cotton turtleneck and a sweatshirt for winter and  just about anything for hot weather!

Favorite season: Summer–hands down.  I hate the cold.

Favorite book:  Harry Potter, was a late bloomer, read all 7 in succession.

Favorite snack:  Potato chips and onion dip,  Freshly made spicy Guacamole.

Favorite Team:  Red Sox, even when they stunk.

Favorite place: I love the mountains, except the mosquitoes tho, REALLY dislike the mosquitoes.  They however seem to like me. If I could live in the mountains I would, but my home ended up in the city.   I also like any place where my dog can sleep with her head on my lap.

Favorite car: Lexus SC 430 Sport Coupe, my never-gonna-own dream car.

Favorite colors: Bright Red and Dusty Blue.

Favorite thing about work: Locking the doors and going home! heh heh…

All in Fun,

Pharmacy Chick

Ps, Does anybody miss Pharmacy God posting like I do?

Tags: letting you in to my life | |

One of the things that makes or breaks a day  for Pharmacy Chick is the general smoothness of the day, in other words,  how many petty annoyances I have had to deal with.  You all know what I mean, its all those little straws that add up and finally break this camel’s back.  What bugs me may not bug another pharmacist, and vis-a-versa. Here are a few “straws” that start adding up after a while.  Best stay away from PC when they do.

1. Visitors: when some guy from the corporate office comes by and pretends to be interested in talking to me when actually all he is doing is keeping me from getting my own work done. Giving me a firm handshake as he leaves, I have no doubt he had forgotten my name before he hit the door.  Meanwhile I am 15 minutes behind from this 5 minute encounter….Any Rep who wants my time to extol the virtues of his new $400 a bottle me too antidepressant/PPI/antihistamine enantiomer.

2.  The pointless cash register questions:  why is it that some people cannot take one prescription from the counter without having to have it taken back to the computer for SOMETHING?  “How much would this cost without my insurance?”  Why? are you losing your insurance? “Just curious.” Well, I am sure the 6 people behind you are more curious as to why you are holding up the line than you are about the price of this rx. OR  “I only paid $25 for this last month…why is it $35?”  (trudge to computer and find that she has paid $35 every month since Jan and tell customer..to which she replies) “Are you sure?” NO, I AM A COMPULSIVE LIAR!”

3. Out of everything: Some days we get RX’s for every weird item under the sun, none of which I have and have to special order.  Must be the moon. 

4.  The price checker who wants to know BEFORE she fills her 4 prescriptions what her copays are…right now…while she stands there….Come back in 15 minutes. If you dont want them fine, but go away for now.

5. The refill auths that have to go back because something is different and no notes are added. We ask for Fiorinal, they fax back Fioricet.  We ask for Levoxyl 112, they fax back 125.  We ask for TAC 0.1% cream, they fax back ointment. We ask for 90 +3 and they fax back 30+11 refills. Geez, dont they even READ the refill requests?

6. I have a transfer max.  Give me more than 2 copies a day and you are pushing the Annoyance Quotient dangerously high.  Same for price match requests.  (an aside:  Pharmacy Chick is of the firm belief that when you put the control of price in the hands of the customer, you have lost control of your business) …probably a entire other blog post on that one statement.

7. No time for food.  Pharmacy chick needs to eat something between 2 and 3 pm. Thats when her body speaks to her and says “feed me or I will become surly”.  I get testy when people annoy me and keep me from eating my food…especially for piddly, pointless, petty questions like “My dr told me to take Advil–should I take tablets or caplets?” 

8.  The normally brilliant Tech who left her brain at home.  “How do I ring up this WIC?”  Its on the wall, follow the procedure..” Where on the wall?”.  Look up! ” I dont see it” (walk over and almost hit her nose taking it off the wall) “Oh, thanks”  Then she still F’s it up despite the fact its written so clear a 6 year old could follow the directions.  AND “Do you want me to ring up this insurance check?”  We do it every day. why would this day any different?..  “Do we carry Harry’s Hair Potion?”  I am apparently the all knowing psychic because I am assumed to know if we carry everything without having to check.

9. Any more than 2 calls per day from any customer wanting to know if a prescription is ready when they have called it in only 2 hours ago…on a friday afternoon… 

10.  Any more than 2 conversations that begins with ” I know you are busy, but….”

11. my Annoyance Quotient gets into the red zone when too many people come back to pick up their prescriptions BEFORE they are done.  I tell them 20 minutes, they come back in 10 and hover over the counter.  I dont lie folks,  20 minutes means 20 minutes.  I get testier when I hear  a tech say “yea, its ready, all the pharmacist has to do is check it”, like its no big thing.  Sometime I have to remind my techs that THE PRESCRIPTION ISN’T READY UNTIL ITS CHECKED, SO DON’T TELL THE CUSTOMER IT IS. THATS THE FINAL CHECK, AND ITS NOT TO BE RUSHED OR TAKEN LIGHTLY. I have caught a fair number of mistakes on this final check.

12. anybody who orders a refill at the checkstand…and wants to wait…right there..and the clerk lets them…  They come in bunches, they do.

Some days I skate thru a day with few of these annoyances, other days they make me ready for the loony bin. I find that its rarely the big things that make me crazy but the little ones that bring me to the brink. I dont mind the challenge of a big project, but when you tap on my shoulder every 15 seconds, the breaking point comes into view.

 ….I’m just sayin’

More to come. I have decisions to make.

Tags: behavior, customers, employees, pharmacy life | |

Pharmacy Chick is one unhappy pharmacist this evening.  The relief pharmacist scheduled for tomorrow cancelled and I have to work. That means 52 hours this week.  I dont work because I like to. I dont work because I want to.  I work to make a living and I only maintain my sanity by sticking to 40 hours.  I REALLY dont like to add another 11+ hour shift.   We all know this isn’t a cake job, and the last thing I want is 11+  more hours of high stress in my week.   I know they tried to find coverage. It didn’t happen, so they expect me to be there.  Sucks to be me today.

So what would happen if I really wasn’t available?  Close the store?   Its not the first time, I doubt it will be the last time.  I’m sick of this shortage nonsense.  I can’t be sick, and its a pain to get a vacation. 

Don’t tell me to be grateful I have a job.  I AM grateful to have a job. I purposely picked this field because it was a good long time job prospect.  Little did I know that 22 years later we’d STILL have a critical shortage of pharmacists.  Little did I know I’d have to ask for vacations a year in advance and still only hope I get it. Little did I know that you could completely suck as a pharmacist but if your liscence is intact and you are willing to work, you are hired.

My family doesn’t understand that I cannot “just come” to a wedding when I get the invite 30 days ahead of time; and that if you want the Chick’s to come to your event/reunion/whatever, you better let us know at least 6 months ahead of time, especially if its in the summer….and then hope. 

The job pays well, but this aspect really stinks.  The tech said “at least you get extra money”….You know what? I’d take my planned day at the lake over the cash anyday.  They tax the crap out it anyway.

I’m having my own pity party tonight–attendance: one.

Tags: personal life, pharmacy life, ranting, vacation | |

Sometimes conversations defy explainations:  we had 3 today… 

Number 1.

Customer craining her neck over the pharmacy counter to Tech: “Can you tell me which window I drop off a prescription?”

Tech-pointing “At that window where by the sign that  says ‘drop off prescriptions here’.

Customer:  “Sorry, I’m from Seattle.”

Me thinking to myself ..what? last time I was there, they read and speak English in Washington state….but then again, all that rain might mold the mind…who knows?

Then, later in the day a woman approaches the counter and asks: ” Can you tell me where the room fresheners are? I looked by the toilet paper and its not there”

Me, again thinking to myself I suppose there could be some rationale to that reasoning..you need toilet paper while you are stinking up a room, hence the need for room freshening..

Then lastly,  this lady’s daughter asks for a vaccination for her mother.  Mother doesn’t have her insurance card but she says she has Medicare-D, but doesn’t know which plan.  She wants to know how much. I tell her the cash price and the nightmare begins.  “But she has insurance.” Bring me the card and I can tell you exactly what it will be.  “Can you estimate it for us?” No, every plan is different and will depend on deductibles and copays” Can you look up somebody who has a similar plan and tell us THEIR price?” what!? um no, that would be impossible on several levels including the fact that your mother doesnt’ know what plan she has.  “She has Medicare D” Medicare D is a generic term for a thousand different plans.  “So you have no idea what she has to pay?” That is correct.

I have to admit that in 22 years of practice I have never had  anybody ask me to look up somebody “similar” before!

I am glad I have the next two days off…

Tags: customers, pharmacy life | |

My friend has little money. Jim has been coming to my store for a long time, and has job that would be considered “unskilled” because he works in a retail department store.  He is always pleasant and its always pained me that as an insulin dependent diabetic, he has to make some difficult choices when it comes to paying for his meds. 

DM spares no economic groups, poor and rich alike get afflicted with this disease and anybody who has it (or knows somebody who does) knows that its expensive to be a diabetic, especially when insulin is involved.  Newer and cooler insulin and delivery devices have come out to make it “easier” on the diabetic  and everyone of them costs a lot of money. 

For a while, Jim was covered under his parent’s policy. Then he grew up and lost  that insurance.  He had a few jobs before this one, but none of them offered insurance.  He uses Lantus and Novolin/Humulin.  It is hard enough to make ends meet on minimum wage.  Throw in a chronic disease for which you MUST take expensive meds to survive and things become way more complicated.  Jim was excited when he gave me his new insurance card for this new job he took. 

I processed his Novolin/Humulin and it came back $35…not much over the retail price of it.  His Lantus came back with a $50.00 copay.   $85.00 per month in insulin for a kid making not much more than minimum wage?  This insurance isn’t helping too much.  Its not like he is doing anything fancy.  He is just using bottled insulin and syringes he loads himself, not the pre-loaded pens.  He got is machine for free but the strips cost him $35 copay for the box of 100.  He has to pay for his syringes.

It bugs me a bit that we have a patient who isn’t making a lot of money, but his insurance isn’t helping much. I dont have a gripe when an insurance puts a tier 3 price on a pricey drug when there are a lot of less expensive alternatives to choose from.  But everything that Jim has to choose from is tier 2 or 3.  Where are the generics when it comes to Insulin?   Will there ever be any? It seems a clever ploy to charge a lot of money in premiums and not have to help the insured much.

At what point does the copay for a drug become too high for the insured to pay?  I remember many years ago a major corporation had a 50 cent  (yes one-half dollar) copay on every drug prescribed.  A big shake down occurred and the copays went to $5.oo, which was actually more standard at the time.  It was a big union with a lot of clout.  Somehow they lost somewhere.  You should have heard the whining and complaining.  

 Fast forward to 2008.  Unless you are on state aid or Medicare-D, good luck in finding plans with copays under $10.  We have plans with 50 PERCENT copays on brand meds (tell that to a Temodar or Zyvox patient).  Having insurance used to be the safety net.  It doesn’t seem to be that way anymore.  More and more things aren’t covered, and many that are have copays that make them cost prohibitive.  Not EVERYTHING has a generic, and Insulin seems to be that glaring example.  For some, its not fair.

Just ask Jim. 

Tags: customers, insurance, prices | |