The Pharmacy Chick

Remember my post “Character Flaw?”  Well, my flaw reared its ugly head again when the same floater tech sho called in sick 3 times last month, called in again today, leaving me to run the pharmacy alone on a Saturday.  She is so toast.

For 5 hours today there was one staff member running the pharmacy….ME.

I got the call…excuse me…MESSAGE…before we opened.  (insert your favorite expletive here) What am I going to do, we usually do over 100 on saturdays

I called every tech whose last name I knew and could find.  No such luck.  At 9 am I hit the ground running. I was behind the 8 ball from the start and about all I could accomplish was keeping the line moving at the checkstand and occasionally pulling a script from the pile of ‘waiters’.   It was getting deeper and deeper.  Occasionally the line would disappear and I could attack the pile of prescriptions.

Only once did I think I would lose it.  I had at least 6 people in line and one wanted a vaccination.  She was a patient woman thank goodness. This other lady was at the drop off window in a scooter cart.  She handed me 8 refills and 5 new rx’s and wanted to wait.  I told her it was not going to happen and explained why.  She got immediately pissy ” I need everything as soon as possible, I am sick.” I stood over my pile of 30+ rx’s I was behind and prayed “God, you knew this would happen , but I didn’t ,please help me.”

The prescriptions didn’t vanish. The rx’s didn’t fill themselves. I still had just as much work, but the pissy woman went away and inexplicably, the counter went quiet. I worked feverishly to get caught up and then at 1:30 one of the techs I called returned my call.  She said she would be in as soon as she could.

By 2 pm, Tech Extraordinare arrived.  It took most of the next hour to catch up, but we did it.  I am extremely angry  at the tech who flaked out on me again, but very grateful for the provision that God provided in getting me thru this day.

But I am not in any hurry to repeat it.

Tags: difficult days, pharmacy life | |

It was a hot day in Chickville and the upstairs was feeling the impact of its western exposure.  As the pleasant temps of the evening set in,  we opened all the windows and let the breezes blow thru.  Nice.

We decided to sleep with all our windows open.  Other than the occasional dog barking that would wake up our own two barking machines, we had a pleasant night…until 4:42 am.

Tweet, Tweet, Screech Squawk!  Every bird in the neighborhood had awakened, and was heralding the new day. Half asleep I scrambled around and shut all the windows to get a couple more precious hours of sleep!

It is said that the early bird gets the worm…

I say “who wants worms?”

Tags: personal life | |

I am fully aware that a Doctor’s office is a busy place.  I am also aware that I do everything in my power to make my communications with said offices as quick, efficient, and accurate as possible.  Therefore when this story unfolded, I was ready to beat my head against the wall.

A Rx came over the fax for Joan Smith for Actonel 150mg Once monthly.  Joan has an insurance that (for whatever reason) does not cover once-monthly biophosphates. The insurance rejection stated “Use formulary alternative: Fosamax or Actonel. ”

 I took the fax, and wrote the following on it: “Plan does not cover once-montly biophosphates, use Fosamax 70 or Actonel 35″, put my pharmacy info on the document and sent it back.  Four days and 3 phone calls later my store receives a fax for Joan:  Boniva 150mg once monthly….

Can you hear the sound of a forehead hitting the counter?

I couldn’t believe the fax.  What part of what I wrote was confusing?   Was there any ambiguity?  I didn’t think so.  Nevertheless,  we were back at square one. Again, I took the document, wrote the same thing on it and sent it back to the office. I also followed it up with a phone call.  Nurse called me back…twice…to confirm what I was asking.

Two days later I got a beautiful fax:  Actonel 35mg 1 q week.  Whoo Hoo!  I could hardly wait to get that script done.  Twenty seconds later it was transmitting to the insurance.

REJT: PRIOR AUTH REQUIRED.  What…The…Hell????  If my vascular system had an pressure valve someplace on it, there would have been a spout of blood flowing several feet high.  Ya know how a woman’s voice raises a few notches when she is agitated?  Thats about where I was when I dialed up the Insurance company, whose phone number I had memorized.  It was a local number.  Feel pity for Jake. He answered the phone.

“Feel Good Insurance Co,  Jake speaking”  “jakethisispharmacychickatpharmacychickpharmacyandIamatmywitsendifyoudontfixthisrightnowbecauseI amnotcallingthisdr’sofficeonemoretimeonthisstupidprescriptionsohelpmeGod! (breathe deep).  He heard me out, and while he said the processor’s response may not accurately reflect the proper formulary, (why not???)  he understood (by now) that he was dealing with a crazed pharmacist.  He took the information from me, and told me he would contact the Dr’s office himself and start the PA procedure.

All I can say is:  he had better. 

Nobody takes care of her customers like PC. I want to do this job well, and I do not look kindly upon being made a fool. When that prompt said “use Fosamax or Actonel”…I took it at its word. I owe it to my customers to be accurate and in my opinion, the PBM owes it to me to be accurate as well.

And so it goes. Another day in the life of a pharmacist. Thankfully Joan is a patient woman.  PC?  not so much by now.

Tags: insurance rant, pharmacy life | |

I think its safe to say that we all look forward to big things, whatever they be, in our lives.  Weddings, vacations, holidays, all drive some excitement for us to look forward to.  I thing that big things drive our economy as well.  In the 80’s it was electronics.  Our economy was driven to new heights with all things computer related.  Everybody wanted a home computer, video games and cell phones.  It begat new industries and a zillion jobs, (many of which have evaporated unfortunately).

I was thinking about “big things”in pharmacy recently.  Not all big things are good for the profession but I have lived thru several of them  For me, the first big thing was computerization.  As I mentioned before, when I was just starting out, we filled everything on typewriters, bates stamped and hand priced. Computers changed everything in the pharmacy procedure wise.   Then it was the introduction of Third Parties.  This was a big thing that definitely was not a positive thing for pharmacy.    Next, I believe it was the corporate takeover (or the death of the independent rule) of the profession.  OBRA took every pharmacy and forced it to remodel down on the same level as the rest of the store. No more feeling safe a few steps up.

More recently the profession has been manipulated by HIPAA and all of its machinations that make our day long and arduous.  And, while I cannot speak for all pharmacists, I think one of the most recent big things was the introduction of vaccinations done by pharmacies.  As small as it seems, it is the first time a pharmacist has performed a PROCEDURE and gotten paid for it. 

So, the question that hangs in the air now is, WHAT is the next big thing?   I dont think it will be MTM,  if it is, its very slow to take off, but I could be wrong.

Our economy certainly could use a BIG thing to get it moving….something never seen before, transforming culture and business, and desired by everybody.

What do you think the pharmacy next big thing could be? should be?  that you want it to be?

Tags: questions | |

The day had long since slowed down.  The store had sold about all the chips/soda/salsa and picnic supplies it had.  Everybody who remained were schlepping around in flip flops as I languished in my starchy uniform. 1 more hour to go.

A young man approached the counter. He looked about college age. I asked if I could help him.  “do you dispense emergency 3 day supply of medications?”.  Hmmm thats pretty pharmacy-specific language..wonder why he knows that…  As I interviewed him, I learned a few things: 1) he had come to our store exactly once…2 years ago. and 2) he was indeed in college and 3) he had clearly used (abused?) the 3-day “emergency” supply  before, and 4) he knew very well when he left campus for the weekend he had no refills remaining.

“I am waiting for my insurance to mail me my meds and when I dont have any my pharmacy always lets me buy 3 days worth.”

Ok, that reveals to the Pharmacy chick that this man doesn’t manage his drug therapy very well if he “always” needs (expects)  a pharmacist to bail him out.  This time is wasn’t going to be me for the following reasons:  1) I am not his pharmacy.  he visited here once over 2 years ago. 2)  I didnt’ have the drug anyway, Brand name Paxil CR, and 3) the Rx was long expired.   If I cannot establish a patient/dr/pharmacy relationship then I am not bailing him out.

I told him to contact his doctor and have him call the pharmacy of choice.  

I also told him that if he was MY established patient with a current rx I’d probably do it.  I’m not an hard-ass. I advance a few days to people all the time….my people….In fact I might have helped him out with some generic CR had he produced a current bottle ( like I did with Mr Outa State the other day), but he didn’t bring me that either. There was just some weirdness with him using pharmacy language….what layperson uses “dispense” and “3-day emergency supply”??  Sheesh most still want me to fill their subscriptions with genetrics!

Call it tough love,  Time to grow up and be responsible.

Tags: weird customer stories | |

We all know that the days before holidays are oh-so-much fun in the pharmacy. Normally brilliant (or at least competent) humanoids become completely stupid.  I see it all day.  Today was simple weirdness all over the place.  In a nutshell:

Screaming kids day.  I swear it was in stereo all day.  Were all the day care centers closed?  Did all parents say “Boy, little Johnny is a brat today, Lets take him shopping and see how he fares there!”  After several such assaults on my ears I turned to my unsuspecting tech and asked “Wheres the duct tape?”  She said, “In the drawer, need some?”  I said “yes, then bring me the kid and a garbage bag”.  She about spit her soda across the counter.

Mock emergencies:  I had 3-4 separate incidents where “I am out of refills, out of pills and leaving tomorrow”  Well, good luck with that buddy.  Call your dr, explain your own idiocy to his staff and let them decide your fate.

Cryptic phone messages:  “I just left a prescription on your automatic system and I need it right away”  No name…no return phone number…no rx number…and the message was left at 4 am.  Sorry.  nobody here at 4 am.

Crash carts?  Little old ladies (and men) in motorized carts is a recipe for disaster.  First of all they are way oversized for our store.  Built like mini semi-trucks they have a grocery basket on the front and drive like a freaking car.  These people shouldn’t be driving, period, and they are driving inside of a store.  This lady smashed into my spinner rack of droppers/pill cutters/7-day pill holders.  She caught her basket in it.  Tech extraordinare rescued her and un-hooked her.  5 seconds later she did it AGAIN only this time decided NOT to ask for help and proceeded to pull the entire rack crashing to the floor scattering the display in all directions.  It took us 2 hours to sort that puzzle out.

Out of Towners:  I expect these, after all, I’ve been here too long not to.  Somebody from  Outer State brings me his empty carvedilol bottle…”I gotta have these, and we are going camping tomorrow”.   It was 8 pm.  I sold him 3 tabs for $7.  I could tell he expected them free. ( I guess I am a charity) He knew better to whine, so he paid his $7 and moved on.

I wonder what today will bring…

Happy Holiday! PC will be outside ALL weekend!

Tags: customers, pharmacy life | |

Pharmacy Chick was schooled in the era of brand name meds.  The concept of generic meds were just starting to eek out when she was in school.  By the time I was out of school, they were becoming firmly established.  I worked in several pharmacies, and without any exception, they arranged all of their shelves by brand/generic:  Alphabet by brand with generic on the shelf next to it.  It made perfect sense to me, and served a pretty unique purpose to keep a person educated in what the generic name of a med is and vis-a-versa.  I liked it that way and when Pharmacy chick took over as manager, she kept it that way.  Every tech I had was well versed in brand/generic and had a good idea of the purpose of every drug.

About 6 years ago the Company decided to standardize all pharmacies.  I think this was an idea from one of those suited pipsqueaks without an RPH after their name in an attempt to justify their pay.  They decided that all pharmacies must go completely alphabetical.  Their rationale was “Relief help have trouble finding drugs”.  Are relief help stupid?  I dont think so.  If they are pharmacists, they should know what the brand name of any generic is, even if the brand is no longer stocked on the shelf.  Most of us talk in brand still…if I tell a tech to count out 30 each of Vicodin and 30 Flexeril, she knows exactly what to count out: 30  Hydrocod/Apap and 30 cyclobenzaprine.  If I need BRAND, I state so.

I fought this losing battle for a long time before they set down a must-have-done-by date.  Their only concession was we could/should still have sections set aside for topicals, eye/ears, inhalers, and the like, but they had to be alphabetized within each section.  W.h.a.t.e.v.e.r.

We finally did it.  And a new problem immediately surfaced,  and its a problem to this day.  Drugs keep moving around….because they keep changing their name.  Some generic houses like to “brand” their own generics and its like playing tag trying to keep up with them.  Our generic K-tab was Klor Con.  It was housed in the K’s….Then it disappeared….because it was substituted by Sandoz Potassium Chloride ER TABs and now resides in the P’s.   Generic Midrin has moved all over  Duradrin, Epidrin and others.  Lomotil was under L for  LONOX and now lives in the D’s under Diphenoxylate.  We have 2 patients on Deconamine.  What comes to us as a generic switches often…one manufacturer’s bottle says CDP-PSE and the other says PSE-CDP. 

ARGH.  the latest was our chewable multivitamins.  I went to the shelf to find them missing.  ” ALLRIGHT, where are the kids chewable vits?”  I asked.  “In the R’s”  I was told.  AND why might that be you might ask?  Because our new carrier is River’s Edge who has decided that everything they make has a “RE-” in front of the product name.  so their bottles say “RE-multi vit+Fluoride” or “RE-prenatal”.   I asked the tech to disregard the RE and put it under M for multivit. 

I could bore you with more, but the issue is the same.  When we had everything filed under brand and generic, the drug had a home….ONE home.  Now they move faster than a kid skipping out on his rent.

I am not sure the relief pharmacists will have any better luck finding the drugs in this system but surely now……I can’t!

Tags: corporate crap, pharmacy life | |

Of all the calls that the Pharmacy Chick receives all day, the one I never really mind is the one where a patient calls to find out if a prescription is ready.  Honestly, I’d rather have a patient call me before they come down than get pissy at the counter when they drive down unnecessarily to find their prescription not ready.  Somehow its always MY fault if its not ready when THEY want it.  “I drove all the way down here and its not ready???”  as if the act of driving should cause me to take a prescription NOT authorized and just fill it….

In fact, I’d be happy to field calls all day from people who think ahead to call than from anybody who yells at me at the counter.   

This call about un-nerved me however, because I couldn’t seem to get him to believe me.

“Pharmacy Chick pharmacy,  Chick speaking”  yea, I wanna know if If my prescription is ready, I am Jim Smith  “Yes, I see I have 2 here, they are ready to be picked up”  Really, they are ready?  “Yes they are ready” So I can get them any time? ” sure, just come on in any time” What time do you close?  (tell him the closing time) So I can get them at 7:30 tonight?  “yes, they are ready now and will still be ready at 730″.  Can I come in right now?  “yes, you can get them now”  Can I send my wife in?  “yes, you can send anybody in you want to” And you will give them to her?  (omg, am I ever going to get off this phone?) “Yes, we will give both of them to her”. Ok Somebody will be in to pick them up…as long as they are ready… “yes, they are ready”.

Click…

Chick needs a beverage now thank you.

It would be so priceless if he came in and I, (as a joke) told them they weren’t ready. He’d probably go apoplectic!

Tags: customers, pharmacy life | |

I dont very often make a critical comment about my technicians.  They are a valuable asset to me and I appreciate them.  but today…

Right out of the chute monday morning were 2 prescriptions brought in by a man.  My technician took the information and filled the two prescriptions and set them before me to check.   The man was accompanied by a woman who I presumed to be the patient because she was walking gingerly, as if her back hurt.  The first rx was for 25 Vicodin ES and the second was for Diazepam 2mg….# 250. It was a computer generated rx so no “tampering” had been done.  As I said, the technician filled them and sat them before me.    I checked off the Vicodin ES and got to the Diazepam.  I looked at the finished product and said “Holy cow,  do you REALLY think the doctor meant for this patient to get 250 Valium? Come on!”

A quick call to the Dr verified that a key stroke error on the computer generated rx turned 25 into 250.  “My bad, thanks for catching that” the nurse said.

The tech filled this without so much as batting an eye or questioning the quantity. 

That’s what I am here for….as a pharmacist.

I don’t think it takes a pharmacy degree to have a little bit of common sense. So why did it seem sensical to fill a prescription for  250 valium with its companion 25 Vicodin?

I just don’t have an answer for that one….and neither did my tech.

sigh.

Tags: pharmacy life | |

This evening I made myself dinner.  Mr Chick is out of town so I was free to fix myself anything I wanted so I chose this scallop dish.   As I was putting it away, I thought of Erma Bombeck.

If you have never heard of Erma, you need to immediately stop reading this and head to your library or book store and find some of her books.  She was an American humorist.  A ordinary wife and mother with a gift to write, she wrote a weekly column for newspapers and completed several books.  She wrote about exactly what she knew:  being a woman,  wife and mother. I think I have read everything she ever wrote.

One of her columns was about leftovers.  In Erma’s world, you never threw good food away:  you put it in the fridge, waited until it molded and THEN thew it away.   Why did I think of Erma?  Because I didn’t really like my scallop dish.  It got rave reviews online, but in reality it tasted like garlic flavored pencil erasers…expensive garlic flavored pencil erasers.  Mr Chick will never eat scallops.  I am in no hurry to eat my left overs.

They are in the fridge.  I’ll give ’em 2 weeks.

Tags: personal life | |