The Pharmacy Chick

Flying the Coop in Retail

Doing the right thing, even when its the hard thing.

Filed under: Uncategorized — pharmacychick at 9:34 pm on Saturday, March 8, 2008

We have a urgent care clinic fairly near our pharmacy. For the most part, they write for the Blue-Plate special: antibiotics, pain meds and cough syrups. Its been open for less than a year. As every pharmacist knows, urgent care clinics can attract some seriously sketchy folks looking for a new ears to hear their sorry lies. Since its a pretty small operation, we can usually call and get the dr on the line if we need to “confer”. Today was such a day.

Mr. Clean-cut-nicely-dressed handed me a one of the clinic’s rx’s. Now, I can’t speak for all pharmacists but most of us have a pretty strong 6th sense when something doesn’t seem right. A dead giveaway for me was when he quickly (a little to quickly) announced “I’ve been here before and I am paying cash for these”. He had scripts for an NSAID and a C-II narcotic. I looked at his profile and the same pair of rx ’s has appeared from same clinic 3 additional times. We had insurance on file for him.

I decided to diss his request to “pay cash” and thought I’d run his insurance to see if my intuition was right on. The NSAID went thru fine….the C-II rejected: filled yesterday, someplace else. Intuition:1 Customer:0

Hmmmm Pharmacy Chick wondered if the Dr at the urgent care clinic was in on that bit of information, so we rung him up. Dr didn’t know (duh) and cancelled the C-II, which left me with the rather dicey duty of telling this guy that all he was going to get was the NSAID.

I decided to play it cool and called Mr Nicely dressed back over. My hands were a little shaky and it wasn’t the caffeine from my coffee. I told him that I saw we had insurance on file for him and wanted to save him money. I was hoping that he wouldn’t get pissy if he knew he was busted, but was spared embarassment. I explained that when the pain med rejected, we had to call the doctor for further advice, and in doing so, the Dr. cancelled the prescription. I could see his jaw tighten when I asked him if he had this drug filled yesterday, but he admitted to me that he had. (I wish I had a blood pressure and heart rate monitor on him–or me for that matter– right then).

He took the NSAID, and I highly doubt that neither Mrs Chick or the Dr. will be seeing him anytime soon.

You know, I didn’t take a lot of pleasure in doing this. In fact, there was a moment when I truly considered doing the easy thing and just filling it, knowing full well what he did yesterday. But I also know that I would be feeding a multi-headed monster, one head being his drug problem, and one head being my apathy at not doing the right thing. It would have been easy to rationalize: it was just 15 tabs, it WAS a legit script (until I called the office to confer), it would have been a decent profit on about $.50 cents worth of inventory, and I wouldn’t have to worry about getting my head ripped off. However, I would also be compromising my ethics, something I have always felt was was important in my practice. If I lose my ethical practice of pharmacy, I lose my credibility in my own mind. I would have sold out. I am not ready to sell out. I may not be popular with those “sketchy folks” ,and I might risk an unruly customer, but I will go to bed at night with a clean conscience.

So if you read this and nod your head and think “yea, I’ve been there”, I’d love to hear about it.

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5 Comments »

55

Comment by Pharmacy Mike

March 9, 2008 @ 9:38 am

That was absolutely the right thing to do. In fact, I really don’t even know why you’re questioning your decision at all. Our job isn’t to hand out pain meds for people to get high or sell them. I actually take great pleasure in busting someone like this. It lets them know that they can’t get away with that kind of shit on my watch.

58

Comment by pharmacychick

March 9, 2008 @ 5:06 pm

Mike, I questioned my decision only because I knew what was going to happen next–an confrontation. I get enough of those without stirring them up myself, if you know what I mean. I dont take particular pleasure in this kind of thing, maybe its because I have been doing this thing so long that facing angry people doesn’t excite my inner being. But the reason I keep doing it is because I dont want to EVER been known as a haven for drug seekers. Until I was forced to by my company, I refused to sell needles by the bag. Box only. Now what do I find? needles in the toilet, the parking lot, and the garbage.. I get some FINE looking humanoids coming in for needles now. sounds like good fodder for another blog…hmmmm

59

Comment by CPhT

March 9, 2008 @ 6:23 pm

I take pleasure in this type of thing still. We have had some sketchy, sketchy people come in, and the last thing I want these people to think is that this can be their “safe haven” to get their CII’s with no problem. I want them to know I am going to be breathing down their neck, because we are in a pretty affluent area, and sure, you have the money to toss at me to pay cash, but I don’t have the tolerance for your drug problems. Quite honestly, neither I nor my three store pharmacists want to take our days off heading downtown to help prosecute these people, too.

I’m grateful that my state doesn’t allow needles to be sold OTC. I’m also more than happy that they don’t tell me I have to be 100% honest when checking my CII book for new customers I’ve found in the database with just controls, some billed to cash, some billed to insurance, and not surprisingly, running a claim and it rejecting for a refill too soon. I just tell them with a smile on my face that we’re out, and our order won’t be in for (insert absurd date a week and a half later), but if they’d like to wait for it to come in, I’d be more than happy to fill it, and them dragging their druggie asses to another pharmacy.

60

Comment by Lois, RPH

March 10, 2008 @ 1:18 pm

Of course you did the right thing. I’m sure we catch only a small fraction of the people who pull this kind of stuff. When I was still fairly new to retail pharmacy I filled an Oxycontin script & later discovered the woman had the same thing filled 2 days before. She paid cash (and I’m sure turned a nice profit when she sold them) and the scripts were written by some old doctor who took people at their word when they ‘lost’ their prescriptions (his nurse knew exactly why I was calling when I let them know what had just happened.) And this customer was the nicest (!!) woman — she even gave a few bucks to the customer behind her who couldn’t afford her kid’s Tylenol. I felt pretty stupid, but you live and learn. By the way, the computer-generated prescriptions are nice, but way too easy to forge.
A few weeks back: Cash customer, Phenergan with Codeine script stating “must be signed in non-black ink” — signature was black - probably a photocopy –
duh. One point for me. But I don’t want to be a policeman either.

73

Comment by Shalom (R.Ph.)

March 11, 2008 @ 5:49 pm

We are a relatively new store, and it seems the junkies are starting to find us. Every so often we see a script for Percocet, for cash. These all get twice as much scrutiny as the rest, and I’ve discovered something interesting: the latest technique around here is to go to the ER and talk the doctor into giving them scripts for Percocet and Motrin. They fill the Percocet in one store for cash, then alter the other script so it also says Percocet. Then they try to fill that in another store, also for cash. At first glance they look really good, and if you call the ER and ask, they verify that they did indeed write for Percocet for this guy… but the quantity and sig match the Motrin script, not what they wrote for the Percocet. If you look edge-on at the script, you can see where the erasure wore off the upper layer of the paper on the official state blank, giving the lettering a white background rather than the official blue. I see one of these, I’ll make up some BS excuse to call the hospital (e.g. missing NPI number, state license or some other unnecessary datum) and verify it. Generally the second they see me pick up the phone, they’re out the door.

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