The Pharmacy Chick

For those of you old enough to remember the days before prescription insurance, this should be right up your alley. It used to be that if you received a prescription written for Drug X 30+11 refills, that it basically meant you had 360 tabs to play with. AND, provided it wasn’t controlled or you weren’t afraid the patient would hurt themselves, if they asked for 90 instead of 30, no big deal.

Then the insurance industry gathered momentum and power and ripped the spines out of pharmacists everywhere. Next, the govt got involved and politicians (Medicare/Medicaid) rewrote the rules for everything.

Today, to the consternation of pharmacists and patients everywhere, if you get a RX for 30+11, you better fill it for 30+11 or when you get audited, you’ll give that money back. You see, its fully ok, legal and actually encouraged to underpay pharmacies and rip us off, but if you have one clerical error or decide to make things convenient for the customer by saving them trips to the store, you are SO Toast.

You see, by now most Medicare D people have figured out that they can get 90 days on their plan. Pretty much every 90 day rx for a brand name med pays me under cost. However, Pharmacy Chick didn’t sign the contract so if her company is willing to take the loss, so be it. If they dont care, neither will I. I have bigger fish to fry. More and more customers are asking, no–demanding, that they receive 90 days, especially if they have met their deductible.

Problem is that the Drs seem to be a little slow on the uptake and continue to write for 30 days +11 refills (or “prn”). Take this for example: we have this HUGE clinic where 100+ dr’s have a central phone number for all their refills. We fax in our requests and it enters the big Black Hole of their refill service. Time and time again, we send in requests for 90 days and they fax back an automatic Rx written for 30 days +11. Since it takes up to 3 days for these guys to return our refill requests, I don’t have the time to send it back AGAIN. Does anybody even READ the things I fax?

Therefore I fill it as its written…30 days… I try to explain it to customers in preschool verbiage, but it doesn’t always sink in….”but I had 90 days last time…”

Sorry, but to me its the most stupid of rules. Just another way to screw pharmacies over the minutae by the insurance companies.

If Pharmacy Chick was queen of the world, I’d encourage doctors to re-think how they write their rx’s. If they want to give a years worth of refills, then write the prescription for HCTZ 25mg # 365 to be dispensed per pt or insurance requests. I did, in fact, have a dentist that used to write every fluoride prescription for # 365. Brilliant, he was. That way, every option is open for the patient , the Dr would get a lot fewer phone calls to change it, and the insurance auditor……..can go pee up a rope.

Seems like a win win situation from my perspective.

And, hope you all had a happy Independence Day. We spent all day outdoors and all evening INdoors trying to keep my drugged dogs from crawling under the couch. Pup-1 has no fondness for the fireworks….

Tags: customers, insurance, rambling | |

One would think that with the price of fuel these days that people wouldn’t be so aggressive with the heating /cooling of their businesses. Heating never seems to be an issue. I cannot think of anyplace I have ever gone into where I was shedding clothes because it was too warm. However Pharmacy Chick keeps clothes in her trunk because there seems to be an abundance of businesses who run the A/C til frost forms on the windows.

Take today for example. The Chick’s decided to grab a burger before church. It wasn’t very warm today, only about 72 and cloudy all day, so it was not like we had a heat wave going on. We got out of the car and I asked Mr Chick to open the trunk to grab my fleece. He just rolled his eyes and popped the trunk. I had been here before, I knew exactly what it was going to be like and I was right. It was FREEZING in there, in fact there was NOBODY eating inside the restaurant, everybody was outside. We joined them. We positioned ourselves fairly near the door and almost everybody who walked to the outdoor eating area said the same thing: ” Sheesh its cold in there, lets eat out here!”

Now ya gotta know that all that air conditioning is costing somebody money. Even we are fairly careful about turning on the air at the Chick household. We dont like to see our electric bills escalate into the triple digits just because we want to be cool. We save it for when we need it. So what is the purpose of having a room temperature that is in the low 60’s when its only 72 outside?

Even experts suggest you heat your house to 68 in the winter and cool it to 78-80 in the summer. Church wasn’t much better. I remember the days before somebody donated air conditioning to our church sanctuary. Granted there were some days where some fans and ice water would have gone a long way during a sermon, but I’d trade that over needing fleece in July.

Perhaps its just me. I like to be warm. I am not an Eskimo at heart. I’d wear flip flops over boots anyday and my outdoor activities revolve around sun not snow. I am the first to put on pants when it cools down and the last to go sleeveless when the temperature goes up. I am ready for a hot-flash.

Even my store is guilty of this. Until it reaches into the 90’s where even the A/C cannot even keep up, our store is routinely 65 inside. I know this because I have a thermometer in the pharmacy. I wear long sleeves all year long. I’d love to know, if they would raise the temp up to 70, how much money in utitilies would they save.

Maybe enough to give me a raise…its been awhile.

Tags: letting you in to my life | |

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 | |