The Pharmacy Chick

I am grateful that I don’t see too many phony prescriptions. I see way more drug seekers than actual phony prescriptions. I can’t even remember the last time I had a phone-in phony. The tech filled this one and presented it before me to sign off. I took one look at it and said “Nope, this one is a phony.” Man, you’d think that this guy would get a little more creative–he’s been using the same photocopied prescription for 3 years. We even had the Dr flagged as “call on every narc”. I mapquested the address he gave (didn’t exist) and called the phone number he gave us (sorry, wrong number). And of course, he came in at 6 pm on a Friday night. I couldn’t make the final verification of its phony-ness by calling dr (no answering service) but the conspicuous absence of anger when I refused to fill without verification it gave him away. I wrote on the hardcopy “pharmacy–verify with office before filling” but I am sure he had 10 more pristine copies at home to try passing. Unless I confirmed it was phony, I had to give it back when he asked, but I kept a copy for myself.

It gave the tech’s some excitement on this rather slow day.

I’ll find out its status for sure on monday–I faxed a copy to the real office. Boy won’t I be eating crow if its real..but I don’t think I will, because I don’t think it is!

Tags: customers, druggies, law | |

Over the years, I have gotten used to our wholesaler being out of things. Sometimes it feels like we live in a third world country by the sheer amount of “shorts” I see on my invoices every day. What is it with (blame manufacturers or wholesalers, you pick) the fact that I have to change generics every other month because the one I had in July, I cannot get in August. It just goes on and on. Every night when my reports print and I see what I will NOT get, I head to the computer to get alternates. One thing that is not on that list is my supplies.

Today I got my invoices and noted that my wholesaler was out of BOTH safety caps for my 8 dram and my 13 dram vials. Are you kidding me!!!! Granted, we dont wait til we have used our last cap to order, but we dont keep 50 bags of each on hand either. I also found out that some other stores were calling us to see if we had any extra to spare (over my dead body). As with all things that constitute a problem, it was handed to me.

First, lets backtrack a bit. Many years ago, you might remember if you are old enough, when you bought a box of vials, you got the safety caps included in the box. They would also include a few non-safety caps. To me, this make sense, what good are the vials without a lid? But for some inexplicable reason, they (being the manufacturer) decided to split the combo and make us purchase the caps separately.

Pharmacy Chick isn’t allowed to buy the kind of vials she likes. I love those vials with the reversible caps. They are perfect! Safety when you want them, non safety when you dont. And, the lid doubles as a cup if you are desparate (haha). And since the lids COME with the vials, I wouldn’t have to buy them separately.

So anyway, I am given the pharmacist specific task of procuring more caps. RING RING–called the wholesaler and ascertain that yes indeed they are out of caps still. They do not know when they will get more in. I tell them they need to do better than that…every pharmacy in the nation needs caps. This should be a “never out” item. I finally hit on a better option. I ask (because they don’t offer) “can you check a different distribution center (DC) to find these items?” He puts me on hold (sit and wait, sit and wait) til he comes back on and tells me he ordered 2 bags of 8 dram caps from a different DC. I guess I had to ask “How about 13 dram?” (back on hold again). Eventually he returns and tells me I also get 2 bags of 13 dram caps. To arrive on monday. Today is thursday.

I might be dispensing 30 lanoxin in a 20 dram vial by then, but we will survive. Wonder what everybody else is doing?

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The Pharmacy Chick loves old things; well not ALL old things, but since she is half way to “old” herself, she has an appreciation for things now commonly called “vintage”. Actually..many may think I am vintage already, and some days I feel that way. Since Mr. Chick does not share my love for vintage things however, I rarely get to fulfill my cravings. He doesn’t understand, and if we happen upon a junk shop together, (and I happen to get to go inside), I seldom buy anything because he sees it as garbage. And no, my house does not look like an old farm house with antiques hanging off of nails everywhere…as I said, Mr Chick does not love old things.

I love the smell of antique shops. I love to look at history, and really to me, it IS history. It just happens to be ordinary, everyday, run-of-the-mill, average joe, bottom-of-the-closet history. Records, old pens, kitchen stuff, furniture, books, clothes, you name it. I love to look at it all. I gravitate towards old Pyrex, and I have several pieces. I love to cook in my old Pyrex. Who knows how many meals were whipped up in those old bowls and casserole dishes I have. I have no doubt I paid more for my antique Pyrex than I would for a new piece, but nobody makes those old designs and colors that I grew up with and I just get the warm fuzzies when I see them in my cupboards. Who gets warm fuzzies from new stuff anyway?

I also love pharmacy antiques. If I didn’t exercise some restraint, I would buy every pill bottle and piece of pharmacy glassware I came upon. I would also be broke, because apparently pharmacy antiques has fans other than myself based on the price some of these pieces fetch. I do however have quite a nice collection in a lovely glass case of pieces I “couldn’t live without”. Some of them were gifts, others were great finds. Years ago I used to work in a small store that had something called an antique mall next to it. Really it was a building where you could rent a few square feet and display your wares to sell. Every monday I would walk over on my lunch hour and gaze at all the wonders therein. I bought some great Pyrex there…(remember my pyrex fetish? what Mr Chick does not ask about, Mr Chick doesn’t need to KNOW about) . I also found a few lovely pharmacy antiques. I also found these places to be sad too–I often wondered about the previous owners of all these things. I wonder what they would think if they saw hundreds of people rooting thru their belongings. Will my things be in a place like this someday? Ok, THAT makes me sad.

When I buy my pharmacy antiques, I do have some requirements. They have to be interesting, and they have to have their original products in them. Once I happened upon a vendor who had emptied all of her bottles of their contents, and spiffed them up all nice and clean. I can’t imagine she had been in the business very long– I told her she had ruined the value of every piece. Her argument was that the contents could be dangerous. I told her anybody crazy enough to ingest the contents of a bottle 100 years old deserves whatever he gets.

Here are some of my favorite finds:

McCormicks Insecticide powder for Body Crawling Insects– came in a shaker tin like spices do. Ewww–I’m thinking regular bathing would have gone a long way back then to alleviate the Body-Crawling-Insect problem and this powder might not have been necessary.

Chamberlains Pills for Constipation: active ingredient? Mercury. It also said keep out of reach of children. I’d say keep out of reach of everybody and call the Hazmat team. Thankfully whoever purchased these pink gems never opened it.

Chamberlains Tonic for Flatulent Wind Colic: Chamberlain had issues with his GI tract apparently.. Ative ingredients: Chloroform, ether, camphor and ginger. I am guessing that “flatulent wind colic” is a rather creative name for “burp”, and again, I am not sure how using these two anesthetics would help, but maybe the ginger.

Yohimone: Active ingredients: Yohimbine, Pituitary hormone, thyroid hormone and supradrenal gland hormone (desicated). Althought it didn’t specifically SAY it was for men, I would guess that this was to help the male humanoid in his oat-sowing department.

Prescription number 15 by Red Star: never lists ingredients but apparently was good for sore throats! Personally I would love to have 1-14 also.

Litharge: Lead monoxide. yes, LEAD. This was in a pharmacy, it was open and it weighs a ton for such a small bottle. nuff said.

Darn, now I am in the mood to buy more….must….supress…urge….to….shop…..

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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.

Tags: customers, ethics, law, pharmacy life | |

Pharmacy chick was 5 minutes away from freedom. 300 ticks on the clock, 1/12th of an hour, then 48 hours of bliss away from the pharmacy. Dinner was already on the stove by Mr Chick, and the fire was burning in the fireplace, a DVD in place for a relaxing evening.

Then, they showed up. Always-A-Problem AAP for short. This couple couldn’t ask for directions to the toilet without finding some fault in your answer. I knew I was in trouble because we were on Day 3 in trying to extract a refill authorization for MR AAP. Beg, borrow, or steal, I couldn’t get this Dr to cough up one single refill. Mrs. AAP asked for his prescription and I said very nicely, “I wish I had a prescription for you–I have been trying very hard but they haven’t called me back yet.”. At this point the fire under Mr AAP’s butt flared and he decided that I was personally responsible for his angst. (Note to mr.AAP: chewing my a** is not going to endear me unto you and make me want to help you anymore…understand that?)

“Well, they called ME to tell me they were going to call you!” he bellowed.. (we are past closing time and Mrs PC’s attitude gets really crummy after closing time).

Holding my bubbling anger I said “well, unfortunately it doesn’t matter much what they tell YOU, it matters very much what they tell me..and at this point, they haven’t said anything”.

“WELL THEY CALLED ME!” and he walked off, leaving me with Mrs AAP. She suggests I call a nearby competitor because she “uses them too” (yea I bet she does). I spent almost 10 minutes on hold to find out that they too have NO rx for them. It’s now about 15 minutes after closing time and Chick is not pleased or patient anymore. Mrs AAP leaves with 2 tabs for the next day and explicit instructions to not come down until I call her tomorrow.

I spend the next 15 minutes cooling off in my car as I drive home and a brilliant idea comes to my head!

I propose we initiate a new way for drug authorizations. Have the Dr. call the patient and the patient can call the pharmacy! Brilliant! I wish I would have thought of it earlier–we wouldn’t need a call box anymore, we wouldn’t even need a fax anymore. Think of all the paper we would save. The patient would be the one doing the waiting. Once the dr called the patient, he/she would relay the message to us and woo-hoo! Prescription authorized and filled.

I can’t imagine any problems with this system, can you? heh heh

RING RING “hello, Pharmacy Chick’s pharmacy and food emporium, how can I help you?”

“yes, I would like to refill my Vicodin ES”

“Um, its 15 days early”
“Yes I know, but I checked with the doctor and he said it was ok to refill”

“Oh, well OK then, since you checked, we will get it ready”

“By the way, the Dr said I could have a few more refills too”

“Okie Dokie” “see you soon!”

click.

(ok, maybe its not such a brilliant idea after all)

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I love my techs, I really do so I must qualify this particular rant that I couldn’t do my job without them. They do a great job and I am grateful for every one of them. So if any of my readers are techs, I love you all, just don’t do this to your pharmacist!

Mine do, however, all have this one annoying habit that will, if continued, put Pharmacy chick in Shady Hills Sanitarium if they don’t stop. I suspect they have learned it from each other and they all find it pretty clever. I beg to differ. It presents itself in one of two scenarios:

Scenario one: A customer comes up to the counter and asks Tech Extraordinare #1 “I just saw an ad for Dr Diddlysquat’s Foot and Face cream…do you carry it?” Fair enough question. My tech who up until now has been freely able to move about the pharmacy apparently now has her feet firmly screwed to the floor. Without batting an eyelash or moving one leg muscle towards the aisle that Dr Diddlysquat’s cream might be, she turns to me and asks the same question of ME that she was asked not 5 seconds ago. To which I often blankly answer ” I don’t know, did you LOOK?” This often is followed by my receipt of an evil eye by Ms tech whose feet have miraculously been freed from the floor and who not-so-nicely stomps by me to search out the cream. To me, this is called “BUCK PASSING” and I personally despise it.

I have a zillion things I have to do every day, jobs that only a humanoid with an RPH after her name can legally do. Searching out items for customers is not even on the list, and in my opinion, stays pretty high on my Tech and Clerk list, and yet this pathetic vignette repeats itself several times throughout the day.

Scenario #2 is even worse: Customer comes to the counter and says to Tech ” I have a question” AND before the next words are out of his/her mouth Tech interrupts and says ” I will get a pharmacist for you”. Never mind you that the question could be where the bathroom is, or do we carry such and such, or where are your toothbrushes… No, No, No. Its just too easy. Just have the pharmacist answer every question. Lets not do any sort of triage to separate the important from the rest! Sometimes I think they do this just to piss me off, and see that little vein in my head pop.

I used to have lots of time for all tasks from monitoring drug interactions to vacuuming. I just don’t have that kind of time anymore. Too much of it has been eaten up by pharmacist specific stuff now. I don’t even have much time to talk baseball/football/tennis and golf with my favorite customers. (yes, Pharmacy Chick loves sports!) I have to find a way to maximize my time to do the things I must, and being a personal shopper is not one of them. It makes me nutso when an employee thinks they can avoid a customer request by passing it off to me. We all have worked here for several years. My white coat doesn’t give me any special gift to know where stuff is.

Its not that I don’t want to be a team player. Running a pharmacy is like performing an intricate dance anyway, so we all have to work together. If I am not busy, I do every chore including cleaning the sink. PC just feels she doesn’t need to be the point guard for fellow “team players” trying to get out of helping a customer.

Aaahhhh. I feel better now. Nothing like a good rant to take the edge off.

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You gotta love these prescriptions: An out of town ER script from some Dr. I have never heard of, not dated so I don’t know if its written yesterday or 3 weeks ago. I need a DEA number to submit the claim to the insurance. Ya’ll know they don’t like the fake ones anymore, its not in my online data base, so trying to be as accurate as possible, we ring up the ER:

I get Nurse #1, who transfers me to what I believe is a phone booth in the mohave desert: 50 rings and no answer and no transfer back. So I hang up and call again.

This time I get nurse #2 who announces that the Dr I want is “here” and she will transfer me to his extension: He picks up the extension (I can hear him breathing), punches a few numbers and transfers me back to nurse #2. Now apparently once was not enough so we do this bizarre exercise 3 more times. Back and forth, no talking just breathing (click click) back to nurse #2 who is probably getting tired of me and this! After the 4th time I get Nurse #3 NWA. I am getting just a tad edgy (Pharmacy Chick ALWAYS starts out nice and peachy…but it CAN decline).

I tell NWA that I have been transferred all over the ER and all I want is a DEA number and do you suppose you can transfer me to somebody who might actually have it (other than the Dr. who apparently has bigger fish to fry). I can just see her face screwing up now as she says ” I am sorry to INCONVENIENCE you, but we are a hospital ER (freakin DUH) and we are busy. This should be handled by the pharmacy”

Eeeeew So sorry, NWA, I am just sitting here eating bon bons in my pharmacy hot tub, and watching soap operas. This is YOUR Dr, writing scripts for YOUR patients so piss off…I think to myself… So I bite my tongue and ask “So, do you suppose you might transfer me there then?”

I am hopeful when somebody in inpatient pharmacy answers the phone. I state my request. She says “oh, you need the OUTpatient pharmacy” Pharmacy chick is starting to lose it. Some poor creature in the outpatient pharmacy picks up the phone ( I should really send her flowers) and I say “Hello, this is pharmacy chick from FarAway pharmacy. I have been to every phone in your ever lovin hospital over the last 20 minutes trying to get a DEA number for a prescription this moron should have filled while she was there (it was a emergency room, right?). I am now HERE. Its Dr Flipmeoff, do you suppose you might have it?”

“Sure, its BF1234567.”

Thank you tech goddes in Outpatient pharmacy.

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Well they came in for the Brand P and didn’t bat an eye at the copay. I guess money burns a hole in their pocket more than it does mine

Be Good!

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Ok, I am working hard when I hear “ahem” at the window. (Its always ahem or cough-cough isn’t it?). So this brilliant mind is waving this bottle of cough syrup at me and asks–and I quote:

“Will this hurt me?” I am tempted to respond “Only if you plan on beating yourself over the head with it I suppose?”, but I restrained and decided to play devoted druggist:

“Are you diabetic?” (contains sugar) Nope.

“Are you allergic to any medications that you know of?” Nope.

“Have you taken this medication before?” I’ve taken X before (same stuff inside)

“Well, I believe that medication will not hurt you in any way”.

And then he asked me this……drumroll please…….

“What is this for?”.

Give ME the bottle so I can beat myself over the head with it.

Tags: customers, pharmacy life, ranting | |

Today Pharmacy Chick got to have a bit of fun doing EXACTLY what the customer wanted.

We got this new customer, a transfer really, from some competitor. She had several drugs, one of which is P. She had some insurance, and when I was getting all her information, she pointed to her P bottle and said “I dont want generic for P–it doesn’t work”. I noted the last date on the bottle–November…before the generic came out…I am seriously doubting she even tried the generic yet, but I wasn’t going to argue. I learned a long time ago that arguing with customers who have their minds made up about generic medication is akin to beating my head against a wall–it feels good only when you stop.

So anyway, as I am currently aware, there are two companies who make generic P, and one of them is the Innovator themselves, infact when you open the bottle, the darn tablets still say P, which I think is the biggest corporate cop out on the planet. If you are going to put a med in one bottle and charge $400 for it and put the same med (not even changing the paint on the tab) and charge $100 less, then somebody ought to fine your butt a bazillion dollars. You’d think they would at least take the name off the stupid tablet before putting in the bottle!

We happen to have that one at the moment, tho it could change at any time due to the fact that we have a corporate buying deal–I get whatever they have on their list of approved products.

So anyway, I collect the transfers and start the filling process. In my infinite wisdom, I obtained what she paid in November..something in the $40 range, a percentage of the brand price. I filled the prescription today with a DAW-2 (remember, its EXACTLY what she wanted) and the price now is $143 ish. Now, not having ALL the history of this woman, she may have a deductible, but I wasn’t finding out, and I didn’t do a test claim of the generic either…I don’t want to know what her copay would be because 90 days from now I will likely not have the same “brand” of generic.

The thought of trying to explain to this lady that “this tablet that SAYS p is actually the generic of p” then changing it later does not appeal to me. And remember THE GENERIC DOESN’T WORK according to her. Pharmacy chick suspects she already had this filled generic at her old pharmacy and wouldn’t accept it so she transferred to me…but thats only a suspicion.

She will get exactly what she wants. I’ll let you know what she decides when she actually has to open the pocketbook. I think I better get a bottle of the other generic, cuz I’m not sure what I would say if the identical pills were in the bottle if she decided to go generic. I think it would be a good idea if the tabs looked different–call it a hunch.

Tags: customers, pharmacy life, prices, ranting | |