The Pharmacy Chick

The call of the sun came in the form of 2 plane tickets to a warm southern exposure.   Visions of bathing suits, relaxed evenings on a veranda someplace, and lazy days were too much the the Chick family to pass up.  Weeks and weeks of rain/snow/frost and cold had taken their toll.  Relieved that they didn’t live in Fargo ND, and glad they did live miles away from rivers and streams that could flood and cause worry, they packed their bags and held their boarding passes like they were solid gold bars.  “I can hardly wait to get out of here” Mr Chick said.  “I am with ya” Pharmacy Chick replied.  Their two dogs, left in the diligent care of their neighbor,  PC and Mr C slipped quietly out of town….

See you in a week!

Tags: Vacation time | |

Nobody likes loyalty cards less than the Chick, but they keep coming in and I suppose its better that I get the sale than having the Dr hand out samples by the bag full.

Not only do the reps hand out cards to the doctors, but now they hand them out to me to use with the rx’s I get.  Honestly, I don’t mind the one-timers that I use and pitch.  I am not a big fan, however, of the ones that can be used monthly. I have resorted to telling the customer that if they have a multi month split bill then THEY need to keep track of it and verify its billed. If I remember, great, but if I dont, do not get pissy with me.

What I dont understand is why some PBM’s (including one huge one)  do not allow cards. What difference does it make to them if the customer gets money off their copay.  If the PBM doesn’t want to cover the drug, then don’t cover the drug. What the hell do they care if their member gets the copay marked down?   Likewise, I think is a shame that the Medicare D enrollees cannot use them.  Again, if the plan doesnt’ like the drug, then dont cover it, but I dont see it fair to accept the claim, charge the patient an exhorbitant copay and then deny them a way to get it cheaper. After all, its this group of people who could best benefit from this savings.

To the Chick, it seems rather obvious.  But hey, I dont write the rules. 

I like to eat out, and I like to dine out with coupons.  It seems that more and more restaurants offer dining discounts from a few dollars off all the way to free entrees.  Imagine if I owed $30 for a meal and I put my Visa card and a coupon on the bill-tray and the server comes back and says “You can’t use the coupon if you pay for it with a VISA, Visa has a rule that prohibits it.”  Sounds ridiculous doesn’t it.  Well, thats how it sounds to a patient when I have to explain that their insurance cards prohibits any coupons on their copays.

It makes no sense to the Chick…..

Tags: Ramblings from a restless mind | |

It was a dry day in Chickville today so Pharmacy Chick decided to do something she hadn’t done in over 30 years.  She went for a bike ride: something pretty incredible since she technically doesn’t own a bike. 

You see, I found a bike.

It started in late November. We live in a cul de sac, in a pretty small neighborhood. Its a nice and tidy neighborhood and even tho it has some kids in it, people mostly keep their things in their garage. Therefore it was of some notice when I came home one night after work and saw a bike sitting against the neighbor’s fence.  It was even more noticeable because it was pouring rain out and it appeared to be a nice bike.

Night after night, I drove past that bike on my way to my garage.  Nobody seemed to want to take it inside. Then, it started to snow. After about 3 days in the snow and 3 weeks in the rain, I decided that for no reason other than its preservation, I was going to take the bike inside.  When I plucked it from the snow bank, I noticed the pedal was broken.  Thankfully it was laying on the ground nearby but the bolt was missing.  I was beginning to think it had been stolen, broken and left behind.

I rolled in into the garage, and let it dry out.  It was a nice bike but it hadn’t been given the best care, and spending over a month outside in the rain and snow had not helped it much.   The tires were mostly flat, there was some rust on it and the back tire was out of round, but still, it seemed to have some good bones. I  looked online and found that new, it had been about $300.

It sat in the garage for a month or so but one day I hauled it into a bike shop and asked them if they could tune it up cheaply. After all, if somebody came to claim it, I didn’t want to have much cash into its repair. Amazingly, the tires only needed air, the spokes adjusted to make the tire round, and a grease job. It took all of $70.  Nice. 

Still, I didn’t climb on the bike yet.  I was chicken. I hadn’t ridden for 30 years.  Today, however, I got on that bike.  It was a scary first minute.  Geez, would I fall off? I did NOT fall off.  I was too chicken to ride on the streets with cars so I went to a park path and rode for about 15 minutes. (note to self: riding downwind for 15 minutes means you have to ride into the wind for 15 minutes…and its kinda chilly out)

It was a harder workout than I thought, and after a half-hour, my legs were very tired and I froze my ears off, but I had more fun than I thought.  I think I am going to do it again soon (with my ears covered this time)

I think its time to buy a bike helmet…and oh, maybe a bike for Mr Chick

Tags: personal life | |

Although I can never stay awake long enough to watch him, I have always enjoyed David Letterman’s top 10 lists.  Some are more funny than others.  I think we pharmacists need our own.  I started jotting some thoughts down on paper. 

PC’s top 10 ways you can tell you are no longer welcome at a pharmacy.

10.  You tell them your name is John Smith and they ask you to spell your name…..twice.

9.  Your pharmacy is out of everything you order…every month.

8.  You find your child resistant bottles glued shut

7.  The pharmacy staff seems all to happy to give you a 3 or 6 months supply of medication

6.  Nobody says hello but everybody enthusiastically waves goodbye when you leave

5.  If you special order something and ask when it will arrive, they respond “when Hell freezes over”.

4. When you call the pharmacy they always put you on hold…and never come back.

3.  You’ve been coming to the pharmacy for 20 years and while you recognize everybody, they dont recognize you.

2. You call the pharmacy to ask when they close and they ask you  “when are you coming in?! and they always “close” the hour before you want.

And the number one reason you can tell you are no longer welcome at your pharmacy

1.  When you come to the counter, all the pharmacy staff huddles to draw straws and the one with the short straw has to wait on you. 

Any contributions you have would be welcome! Who needs to stop at TEN?

Tags: my attempt at humor, pharmacy life | |

For those following my blog, Mr Chick has had some health issues involving some sudden headaches, leading us to switch from serving patients to BEING patients.  I have always said that I would never want to be critically ill in this city because health care is more like a cattle drive than a personal experience. MOO.

I came from a smaller town. It had 2 hospitals, one on each end, and because Pharmacy Chick’s mom worked at one of them, many of the employees became part of our extended family. It had the cutting edge technologies in a small package.  It was personal.

We checked in today at 0600.  That’s 6:00am. O’dark thirty.  The only advantage to getting to the hospital this early in the morning is the killer parking spots you get.  As good as the Dr’s parking.  We found admitting who said we were in the wrong place and sent us upstairs to ICVR (interventional cardio vascular recovery), WHO said we were in the wrong place and sent us back to a different admitting, who (after filling out more paperwork, including the do-we-unplug-you-or-not-directive, sent us back to ICVR. The place was like a maze, with different colored elevators that took you to different “pavillions”.  We did a lot of walking before Mr chick finally got  whisked away to be changed from my husband to yet another patient in a paper dress.  To their credit, everybody was very polite and professional.

He had his test, slept off the drugs, ate a banana, and after receiving the ok, we dressed and I took him home. He gets to be waited on hand and foot for one day. I think he is enjoying this part.

To make a short story even shorter, I am pleased to report that the angiogram went fine.  Mr Chick’s brain is mostly normal, with the narrowing he saw on MRA to be “congenital, and not likely to be symptomatic”.  He found one small spot of possible athersclerosis but, again, not pathogenic.  This is a huge relief to us both. No aneurysms, tumors, or blockages.

And while we are still mystified as to why he is getting these sudden headaches, (possible vasospasms), we have eliminated the life threatening ones, and those that may require surgery. 

Praise God!

Tags: Mr Chick, personal life | |

Today was dumb prescription day.  A couple of weeks ago I wrote about the fact that electronically derived Rx’s weren’t necessarily the answer to our problems with errors or misfills.  Trust me, some of these issues are alive and well, even with Rx’s that are handwritten and clearly understood.

Rx number 1:  computer generated:  Peridex Solution  1 bottle, sig:  1 tab po qid x 10d.   This was actually a signed document.  Do you suppose if I slipped a blank check in there, the dentist would have signed it?

Rx number 2.  Handwritten by nurse/cna/or janitor (who knows?) Oxycontin 80mg #120 Sig: 1-2 tabs every 4-6 hours as needed for pain.  You’re kidding right?  One phone calls reveals the truth. 1q12h. Quantity changed to 60. My interview with patient didn’t seem to confirm that he is as opiate tolerant as this kind of dose would call for…but then again, he may not be telling the truth about his opiate usage.

Rx number 3.  Restoril 30mg #30.  1 q am.  This person does NOT work the graveyard shift. This rx was completely handwritten which means the dr wrote this in his own hand….but not brain engaged apparently. Patient interview confirms 1 hs.

Rx. number 4.  Phoned in: Vagifem Tablets #30, “1 po qd 11 refills”.  A phone call confirms what I thought all along. 1 per VAGINA daily for 14 days then twice weekly thereafter.

Here is the thing:  These are 4 prescriptions that went out of a doctors office with a glaring error.  We caught them.  We are just one pharmacy among thousands in the US. We are that last guard before the patient and the drug they are about to ingest, the last degree of separation between the Dr and the patient. 

Something to think about the next time somebody tries to rush you.  We dont have any degrees of separation.  Our mistakes end up in the hands of the patient.

Take your time. Keep your license. 

Tags: pharmacy life | |

Its pretty safe to say that most, if not ALL of us get asked about every single trend in “dietary supplements”.  If its not Oprah’s guests touting the health benefits of some ’system’, its somebody else doing the same. Everybody is looking for the magic bullet: something to make us thinner, younger looking, more virile (if you are a male), protect us from disease, help us sleep better yet provide us with more energy.  I mean really, isn’t that the holy grail of all things in the drug world?  If we could ever truly latch on to some extract that could accomplish even HALF of these things then there would be some serious money made by its founder/inventor/discoverer.

Enter the Acai berry.  I started getting inquiries about it a few months ago.  We didnt’ stock any and our wholesaler didnt list anything under Acai yet.  Since being informed makes the Chick look good, I decided to check out this product and see if it sniffed of scam.

First of all I looked for scientific study and didnt find much.  What I did find was a lot of “free” (but not really) trial offers.  You know the ones:  “try it free for 14 days, and if you dont manage to send it back, we charge you an exhorbitant price and enroll you in automatic shipping for a monthly supply of our junk. AND even if you do send it back, we will somehow LOSE your return and charge you for it anyway and you will spend the next 3 months trying to get a refund.  Ha ha you sucker…”  This does not bode well for my objective investigation into Acai and scored high on my scam-o-meter.  Nevertheless I kep trying.   I never found any bonafide studies, but there was a lot of anectodal/testimonial evidence that would intice one easily influenced to believe its claims.

Lets discuss its claims.  Depending on what website you look at Acai claims it will make you feel less hungry, speed up your metabolism without stimulants, is a powerful antioxidant, cause you to lose weight like you were a cancer patient, make you sleep better, but have more energy during the day.  Of all these claims, the one most believable would be its claims about antioxidants.  It is quite an antioxidant and for that it may be a worthy supplement.  The rest is debatable. 

However, for some inexplicable reason (maybe those 10 lbs of fat around my middle), the Chick decided to test the claims herself. 

First order of business: Pick a vendor who is NOT a rip off.  This is harder than it seems.  I wanted an Acai product that was pure and not something like 10% Acai.  I did NOT want a not-so-free trial.  I wanted to pay for what I was buying and not be roped into some automatic shipping nightmare I’d have to wade thru Hell for to free myself from. I also wanted to purchase from a reputable site and not some vaguely described Malaysian internet pharmacy/warehouse. Lastly, I was looking for somebody who might tout the real benefits of the product and not some hype. After wandering thru most of the  w.w.w  I narrowed in on one site: Amazon Thunder.

Now before you start screaming “Hey Chick, are you endorsing a product?”  the answer is NO, I am not endorsing anything, I am just telling a story. 

I found this site to sell a purified product that I would have to pay for and it didnt promise the fountain of youth, nor did it promise I would be leaving a trail of fat behind me as I walked off my excess pounds. They let their testimonials tout all its benefits, carefully leaving out any specific health promises in its official information.  After 2 weeks of thinking about it, I leaped in.  Being the ever cautious shopper, I made my purchase on Amazon.com instead of its own website and got free shipping (which may be significant because it came in two big glass bottles). I also looked at the reviews and decided on the puree in the bottle instead of its other offerings.  Several reviewers described the concentrated powder as tasting like “dirt”.  Since I am pretty sure I would not enjoy eating scoopfuls of dirt daily, I opted for the liquid.

I am happy to say that the liquid does not taste like dirt, but I am not sure I would describe it as a beverage either. Its a very thick puree that has some grape juice added for flavor as the berry itself isn’t very sweet.  I am grateful that a 1oz serving is standard because nobody would be able to consume very much of it. Its very thick, but pleasant tasting once you get used to it. I drink it down like a shooter, then rinse out the glass with water (lots it left behind) and drink the rest. It is low in calories, something like 15 calories  per ounce so the user isn’t consuming a dessert whilst supplementing his/her health.

But what about its benefits, Chick?  Thats what we are waiting for!

Two weeks into it, I still look 45. I haven’t lost any weight, and that bag of potato chips still calls my name at 10:30 every morning.  I still sleep about the same, and my energy level remains unchanged. The jury is still out on whether it has helped my golf game.  I don’t have any chronic illness for which I am hoping for a cure, so I am not looking to Acai to heal me, tho I must admit I was hoping for the appetite suppression. Maybe it takes a while to kick in.

I still have 1 bottle to go. I may even re-order once to give it the old’college try. Its not a miracle product. I am not cinching up my belt from any dramatic weight loss and nobody is asking the Chick to pose for the next SI swimsuit issue.

However, the stuff’s not bad and who knows, maybe all those antioxidants may  provide some unforeseen benefit down the road.  You are at least getting what they advertise, and nobody is roping anybody into any predatory auto shipments thru sneaky terms of service.

All I can say, is if there ever is any discovery that delivers on all these things without causing painful tumors or boils all over our bodies, the stuff will sell itself and the world will beat a path to its door waving fistfuls of money.

And, oh, could I be that inventor……hope springs eternal.

Tags: pharmacy life, supplements | |

The town of PharmacyChickville has a dermatologist whose sole purpose in life seems to prescribe stupidly expensive drugs with long complicated instructions.  This doctor cannot write for anything cheap and easy. 

For example: this is a typical sig on something he writes:  Wash face with X brand soap, pat dry with white organically grown cotton towel.  Apply a pea sized amount of cream 30 minutes after washing to acne spots only.  Use on Monday, wednesday and Friday only.   (ok, I added the “white organically grown towel” part, but the rest is pretty spot on for accuracy).  Its quite rare to be able to fit ALL of his instructions on a standard pharmacy label.  He is also a sucker for every rep on the planet,  because if there is some obscure (and expensive) dermatological out there, HE will certainly find a way to prescribe it.

So………..I come to work and find 3 prescriptions in the FOA box ( things we need to order). Aczone, EpiDuo and Doryx 150 from this doctor.  They totaled almost $700.  She had the mother of all prescription plans apparently (some stranglehold union maybe?), because her copays were $6 all across the board. I expected to see some chick with a bad case of pizza face.

She came in the next day.  Nice looking gal, but the only zit I could see was one red spot above her left eye brow. 

Either she had been receiving samples and the stuff works spectacularily…or its just another example of wasting valuable health care dollars on the equivalent of zit cosmetics.

You decide.

Tags: health care dollars, pharmacy life | |

It started today at at about 10 am with the phone call. ” I need a refill on my birth control”.  Its friday and SHE has no refills. The Dr’s office is a huge clinic not known for their speedy replies.  I tell her she has no refills AND to call the office to explain her situation if she needs it before Mon/tuesday of next week.  After all, the Dr is accountable to her, not to me.

She apparently did not do this….but showed up around 2 pm wanting to know if it was ready..and of course, it was not. It was then that she decided to call the doctor, at my drop off window.  I could hear her plead her case, and it was falling on deaf ears because her replies were full of “ifs and butts”.  “But I need it today” “If I had known I was out of refills…” “But, can’t you do it now?” Click.

And then the blame shifted to me.  She said it would have been nice if somebody had told her she was out of refills.  Both The Chick and  Tech Extradordinare reminded her that her refill status is printed on every label that goes out on every prescription.  She throws that away.   She just kept at it..yada yada yada…it would be good customer service….not too much to ask….would it be that hard?…I’m a teacher and if I feel my students need special instructions, I give it to them…(did she just compare her mental capacity to a child?)

I was having no part of this.” Not to be disrespectful” I replied “but because we provide clear information on every label about your refill status, we do not feel it is necessary or our responsiblity to specially point it out to you.”   She didnt’ like this very much.  I guess I am supposed to be a combination babysitter and personal assistant. Besides, I don’t think of refill status as ’special instructions’.

I have a pretty thick skin after all these years, but she really ticked the Chick. Not only had I faxed the Dr WITH a note that she wanted it today, but I gave her special instructions on how to improve her chances, something she chose not to do until she was at my counter.  Her failure of personal responsiblity became my fault.

We don’t provide our labels in secret code. The number ”0″ is never confused with any other number that I am aware of.  If you throw it away, well, thats your problem.  Rx labels tell you quite a bit about the past, present and future of your rx–  Past: When you got it and who gave it to you. Present: What it is, what it should look like and how you should take it now. Future: how many times you may continue to get this and when it expires.

She was offensive to me. (see my recent posts on rudeness). I had to stop what I was doing (working on a prescription for a person AHEAD of this lady) and listen to her rant about how awful we were.

 Despite it all,I brushed it off, and took care of business, doing the stuff she will never see, know about or acknowledge: calling the dr at 4pm and 7pm (clinic closes at 8), to check on its status: calling the pharmacy across town (where she wants it now) to alert them what is happening over here: and then finally calling her to keep her updated.

I still did all these things but the motivation for doing so was vastly different.  Instead of trying to move Heaven and Earth because she’s a nice lady and I’m trying to help, I did them to get her out of my face.

How different this scenario might have gone if she had said ‘geez, I sure screwed up, anything you can do to help me sure would be appreciated’. 

Nope, she had to make dr’s office mad, make me mad and still…the refill sits in my box, unfilled.

We were promised a Saturday morning refill since the Dr had friday off.  Between you and me, I think they are holding it on purpose.

Ya know what? I wouldn’t blame them.

Tags: customers, pharmacy life | |

For those of you who have expressed interest and concern about Mr Chick, we have one update.  He saw the mirconeurosurgeon today.  We finally got to see the MRA films.  There are 3 spots of narrowing they wanna look at.  He said that they can actually be artifactual which means nothing may be wrong but cannot tell for sure.  They want to do an actual angiogram to determine if the narrowing is significant.  One looks like a kinked hose on the film and one looks like the vessel disappears completely before it resurfaces…

He’s not thrilled about the process, but has decided to go thru with it…next week.  What has yet to be determined is if these findings are the CAUSE of the headaches or if we simply found these things while we were looking for solutions to the headaches, and they are just congenital, as is often the case. 

What IS good is that the dull ache has reduced.  What is a bummer is that the exertional portion resurfaces upon exertion.  We are still holding hope that its a sinus infection issue.

BTW, the surgeon is young and cute.  I joked with Mr Chick about this.  He said “too bad his nurse isn’t…”  So I told him “If I was his wife, I’d make darn sure the nurse was a horse!”…hahaha.

One must keep one’s sense of humor.

The test is next friday.  They told him to be at the hospital at 6 am for check in.  Mr Chick (also noted for his sense of humor) said “geez, dont you people ever sleep around here?”

We know that God is going before us as we be blaze this trail.  Thanks for your thoughts, and we will let you know more as we learn it!

Tags: personal life | |