The Pharmacy Chick

Every now and then we have a day that causes us to check the calendar to see if its a full moon. This day was one of them. She was in her 30’s, a yuppie type lady with high heels under a smart suit. She handed me a prescription from a clinic very nearby. She was not in my computer so I collected the basic bio-data from her and told her it would be ready in 20 minutes or so. “Oh no”, she said “I dont want to fill this here. I want it at the 99th and Standish store next week” (insert blank look here) I told her that if she drops it off HERE, it wont be THERE next week, it will be HERE at the 12th and main location (where she is NOW). She exhudes a look that says “can you be THIS stupid?” and said “Can’t you call this to them?” Just being a tad pissy that day I responded with “Cant you TAKE this to them, since you want to pick it up there anyway?” She huffily responded “I don’t have time”.

OK, lets recap. Miss I-dont-have-time drove a prescription to a pharmacy she didnt’ want to fill it at to put it on hold so WE could call somebody else next week to fill it elsewhere and she could drive and pick it up there. Perhaps I am missing something but wouldn’t it have been just as easy to have Dr Wonderful pick up the phone, call 99th and Standish, have the rx filled there? Just a thought.

I put the rx on hold and forgot about it. I have no idea if 99th and Standish ever called. I don’t care.

Tags: customers, pharmacy life | |

You know the routine, a sketchy character comes with a couple of rx’s usually an antibiotic and a pain killer and only wants the pain med. Happens all the time. We have an urgent care center nearby so this happens quite a bit. Thankfully the Dr. writes all his prescriptions on one blank so the patient cannot pocket one and fill the other. Today we had a guy bring in one of these rx’s for Ery 500 and some Vicodin. On the script the tech wrote “hold” by the Vicodin. I took a second look and asked Are you sure you got this right? Fill the antibiotic and hold the Vicodin? It was affirmed and I filled the rx. When I did the counseling he said the Dr thought he’d need some pain relief, but he didn’t hurt that much. He didnt’have insurance so he didnt’ want to buy something he wasn’t going to use.

Hell didn’t freeze over, Pigs didn’t fly…Cool.

Tags: customers, pharmacy life | |

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 | |

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 | |

I had a customer come in one day, who also happens to be the Chick’s family friend. He had a prescription filled, we had a few friendly words a the counter, I sent my well wishes and off he went.

A few days later I saw this man and as our conversation wound around, he learned that Mr Chick had no idea that he had been in to see me..

“You can’t tell him that?” “nope, unless you say something like, :say Hi to Mr Chick for me:, I don’t say anthing”.

“Its THAT confidential?..even me?”

Yes, even you. And for that you might be very grateful someday.

Tags: customers, ethics, pharmacy life | |

One of the things that makes or breaks a day for Pharmacy Chick is the general smoothness of the day, in other words, how many petty annoyances I have had to deal with. You all know what I mean, its all those little straws that add up and finally break this camel’s back. What bugs me may not bug another pharmacist, and vis-a-versa. Here are a few “straws” that start adding up after a while. Best stay away from PC when they do.

1. Visitors: when some guy from the corporate office comes by and pretends to be interested in talking to me when actually all he is doing is keeping me from getting my own work done. Giving me a firm handshake as he leaves, I have no doubt he had forgotten my name before he hit the door. Meanwhile I am 15 minutes behind from this 5 minute encounter….Any Rep who wants my time to extol the virtues of his new $400 a bottle me too antidepressant/PPI/antihistamine enantiomer.

2. The pointless cash register questions: why is it that some people cannot take one prescription from the counter without having to have it taken back to the computer for SOMETHING? “How much would this cost without my insurance?” Why? are you losing your insurance? “Just curious.” Well, I am sure the 6 people behind you are more curious as to why you are holding up the line than you are about the price of this rx. OR “I only paid $25 for this last month…why is it $35?” (trudge to computer and find that she has paid $35 every month since Jan and tell customer..to which she replies) “Are you sure?” NO, I AM A COMPULSIVE LIAR!”

3. Out of everything: Some days we get RX’s for every weird item under the sun, none of which I have and have to special order. Must be the moon.

4. The price checker who wants to know BEFORE she fills her 4 prescriptions what her copays are…right now…while she stands there….Come back in 15 minutes. If you dont want them fine, but go away for now.

5. The refill auths that have to go back because something is different and no notes are added. We ask for Fiorinal, they fax back Fioricet. We ask for Levoxyl 112, they fax back 125. We ask for TAC 0.1% cream, they fax back ointment. We ask for 90 +3 and they fax back 30+11 refills. Geez, dont they even READ the refill requests?

6. I have a transfer max. Give me more than 2 copies a day and you are pushing the Annoyance Quotient dangerously high. Same for price match requests. (an aside: Pharmacy Chick is of the firm belief that when you put the control of price in the hands of the customer, you have lost control of your business) …probably a entire other blog post on that one statement.

7. No time for food. Pharmacy chick needs to eat something between 2 and 3 pm. Thats when her body speaks to her and says “feed me or I will become surly”. I get testy when people annoy me and keep me from eating my food…especially for piddly, pointless, petty questions like “My dr told me to take Advil–should I take tablets or caplets?”

8. The normally brilliant Tech who left her brain at home. “How do I ring up this WIC?” Its on the wall, follow the procedure..” Where on the wall?”. Look up! ” I dont see it” (walk over and almost hit her nose taking it off the wall) “Oh, thanks” Then she still F’s it up despite the fact its written so clear a 6 year old could follow the directions. AND “Do you want me to ring up this insurance check?” We do it every day. why would this day any different?.. “Do we carry Harry’s Hair Potion?” I am apparently the all knowing psychic because I am assumed to know if we carry everything without having to check.

9. Any more than 2 calls per day from any customer wanting to know if a prescription is ready when they have called it in only 2 hours ago…on a friday afternoon…

10. Any more than 2 conversations that begins with ” I know you are busy, but….”

11. my Annoyance Quotient gets into the red zone when too many people come back to pick up their prescriptions BEFORE they are done. I tell them 20 minutes, they come back in 10 and hover over the counter. I dont lie folks, 20 minutes means 20 minutes. I get testier when I hear a tech say “yea, its ready, all the pharmacist has to do is check it”, like its no big thing. Sometime I have to remind my techs that THE PRESCRIPTION ISN’T READY UNTIL ITS CHECKED, SO DON’T TELL THE CUSTOMER IT IS. THATS THE FINAL CHECK, AND ITS NOT TO BE RUSHED OR TAKEN LIGHTLY. I have caught a fair number of mistakes on this final check.

12. anybody who orders a refill at the checkstand…and wants to wait…right there..and the clerk lets them… They come in bunches, they do.

Some days I skate thru a day with few of these annoyances, other days they make me ready for the loony bin. I find that its rarely the big things that make me crazy but the little ones that bring me to the brink. I dont mind the challenge of a big project, but when you tap on my shoulder every 15 seconds, the breaking point comes into view.

….I’m just sayin’

More to come. I have decisions to make.

Tags: behavior, customers, employees, pharmacy life | |

Sometimes conversations defy explainations: we had 3 today…

Number 1.

Customer craining her neck over the pharmacy counter to Tech: “Can you tell me which window I drop off a prescription?”

Tech-pointing “At that window where by the sign that says ‘drop off prescriptions here’.

Customer: “Sorry, I’m from Seattle.”

Me thinking to myself ..what? last time I was there, they read and speak English in Washington state….but then again, all that rain might mold the mind…who knows?

Then, later in the day a woman approaches the counter and asks: ” Can you tell me where the room fresheners are? I looked by the toilet paper and its not there”

Me, again thinking to myself I suppose there could be some rationale to that reasoning..you need toilet paper while you are stinking up a room, hence the need for room freshening..

Then lastly, this lady’s daughter asks for a vaccination for her mother. Mother doesn’t have her insurance card but she says she has Medicare-D, but doesn’t know which plan. She wants to know how much. I tell her the cash price and the nightmare begins. “But she has insurance.” Bring me the card and I can tell you exactly what it will be. “Can you estimate it for us?” No, every plan is different and will depend on deductibles and copays” Can you look up somebody who has a similar plan and tell us THEIR price?” what!? um no, that would be impossible on several levels including the fact that your mother doesnt’ know what plan she has. “She has Medicare D” Medicare D is a generic term for a thousand different plans. “So you have no idea what she has to pay?” That is correct.

I have to admit that in 22 years of practice I have never had anybody ask me to look up somebody “similar” before!

I am glad I have the next two days off…

Tags: customers, pharmacy life | |

My friend has little money. Jim has been coming to my store for a long time, and has job that would be considered “unskilled” because he works in a retail department store. He is always pleasant and its always pained me that as an insulin dependent diabetic, he has to make some difficult choices when it comes to paying for his meds.

DM spares no economic groups, poor and rich alike get afflicted with this disease and anybody who has it (or knows somebody who does) knows that its expensive to be a diabetic, especially when insulin is involved. Newer and cooler insulin and delivery devices have come out to make it “easier” on the diabetic and everyone of them costs a lot of money.

For a while, Jim was covered under his parent’s policy. Then he grew up and lost that insurance. He had a few jobs before this one, but none of them offered insurance. He uses Lantus and Novolin/Humulin. It is hard enough to make ends meet on minimum wage. Throw in a chronic disease for which you MUST take expensive meds to survive and things become way more complicated. Jim was excited when he gave me his new insurance card for this new job he took.

I processed his Novolin/Humulin and it came back $35…not much over the retail price of it. His Lantus came back with a $50.00 copay. $85.00 per month in insulin for a kid making not much more than minimum wage? This insurance isn’t helping too much. Its not like he is doing anything fancy. He is just using bottled insulin and syringes he loads himself, not the pre-loaded pens. He got is machine for free but the strips cost him $35 copay for the box of 100. He has to pay for his syringes.

It bugs me a bit that we have a patient who isn’t making a lot of money, but his insurance isn’t helping much. I dont have a gripe when an insurance puts a tier 3 price on a pricey drug when there are a lot of less expensive alternatives to choose from. But everything that Jim has to choose from is tier 2 or 3. Where are the generics when it comes to Insulin? Will there ever be any? It seems a clever ploy to charge a lot of money in premiums and not have to help the insured much.

At what point does the copay for a drug become too high for the insured to pay? I remember many years ago a major corporation had a 50 cent (yes one-half dollar) copay on every drug prescribed. A big shake down occurred and the copays went to $5.oo, which was actually more standard at the time. It was a big union with a lot of clout. Somehow they lost somewhere. You should have heard the whining and complaining.

Fast forward to 2008. Unless you are on state aid or Medicare-D, good luck in finding plans with copays under $10. We have plans with 50 PERCENT copays on brand meds (tell that to a Temodar or Zyvox patient). Having insurance used to be the safety net. It doesn’t seem to be that way anymore. More and more things aren’t covered, and many that are have copays that make them cost prohibitive. Not EVERYTHING has a generic, and Insulin seems to be that glaring example. For some, its not fair.

Just ask Jim.

Tags: customers, insurance, prices | |

I know I have written about this before, but it happened again today. Pharmacy Chick Pharmacy was closed. The lights were out and the gates were down. Somebody walked up and wanted to pick up their prescription after hours. I cannot explain it, but Pharmacy Chick becomes (internally) Pharmacy Biachi when this happens. It is not one of my endearing qualities and a characteristic I am not particularly proud of. I may have Jesus Christ living in my heart, but I must have Him hog-tied and blind-folded when people bother me after hours. I don’t go postal, but I am sure there is no mistaking that I am not thrilled. I guess every human has a button that shouldn’t get pushed. That’s mine.

One of the rx’s had been on the shelf for 4 days. Strike ONE. They tried to hand me a loyalty card–nope, sorry, everything is closed. Strike TWO. The loyalty card was expired anyway. Ball ONE. She was leaving on a plane for Africa tomorrow: Home run, so take your Rx go in peace.

The other guy’s had been on the shelf for two days. I told him this would cost him–he asked if his insurance would pay the fine. I told him no, but I could be bribed with chocolates, plane tickets to cancun, etc.

The third one wanted to rent crutches : “we ‘just’called (45 minutes ago) about renting crutches”. Perhaps we need to define “just”.

I cannot explain it, but when I close, I skate like a prisoner set free. I don’t even like to shop after work. I like to get into my car and go home. I give my company 100% when I work, and since they dont afford me the “luxury” of a lunch or break, I guess I don’t feel they are entitled to unpaid labor. I am surprised that I can be inconvenienced all day and not bat an eyelash, maybe I am too fiercely protective of my private time, or I am a damned good actress while I work. I think Hollywood should award an Oscar for “Best impersonation of a happy person while at work”. Every pharmacist in America should win one.

Its a tough call for me, I’d like not to have that feeling, but its been pretty consistent for 20+ years. Don’t approach a growling dog and Dont rattle the cage of Pharmacy Chick after closing. You might lose your fingers.

Time to untie Jesus.

Tags: customers, pharmacy life, ranting | |

I’ve wanted to write a post on this subject (non pharmacy related) but didn’t know how to begin until when I came across a news tidbit that a Thai restaurant in Silverton, Oregon was banning children under the age of 6. He felt it was his place and his rules and kids didn’t fit in with the experience he wanted his patrons to experience and has no plans to change it. I say hurrah for having the guts to do what you want to do.

You see, The Chick’s like to go out to eat now and then. Its a privilege that two incomes can afford, and some things just taste better when somebody else makes them. We probably eat out more often than we should, but I believe its a knee jerk reaction to our childhoods where we almost never ate out.

I can honestly say that my brain has virtually no memories of dining out with mom and dad. First of all, there wasn’t much money in the household for such extravagances and second of all, when Dad DID decide he wanted to eat out, it usually involved He and Mom getting dressed up and the neighbor girl coming over to babysit while THEY went out. Thats just the way it was.

Quite obviously there has been a cultural shift, and I pity the poor restaurants….and the rest of the diners. One night I went to dinner and was escorted to a table. Before the menus hit the table, I took a look at the view and said (quite discretly and politely) “may I sit someplace else?”. Sitting closeby were PWSC Parents With Small Children. It was clear they had just arrived because they were in an animated discussion with said children about what they were going to order. It seemed to be a futile exercise. “Do you want the mac/cheese or the hamburger?” “HOT DOG!” “Honey, they dont have Hot Dogs here, How about the Chicken strips?” …..see what I mean? F.U.T.I.L.E.

I sat down a comfortable distance away from them, but I could still hear them. Two of the kids were arguing about who got the better chair and being admonished with empty threats from the parents. The one in the high chair had been given some keys to play with because we could hear the clang of keys on the metal tray over and over. It made me wonder: How desperate were the parents to eat out that they would endure this to not cook? It couldn’t be fun, it certainly wasn’t relaxing. They were playing referee to 3 kids under the age of 6. They might have well been nailing jello to a tree for as much success they were having at controlling the situation. Had they never heard of a babysitter? For what they were paying for the kids meals, they could have ponied up babysitting fees AND a pizza for the sitter and had a nice “date night” for themselves.

I tuned them out ate the meal and got ready to leave. PWSC had left shortly before us. The carnage they left behind was embarrassing. It looked as though the kitchen had exploded all over the table. I wondered, did the kids actually consume any food? Most of it was scattered on the table, the chairs and on the floor. Someone’s milk was tipped over and was dripping off the end of the table. The high chair had food smeared on it from top to bottom. It was every server’s nightmare.

The irony of the situation is that its not uncommon anymore to have this happen. Almost every time we go someplace to eat, we see “family” dining. I’ll bet every reader I have has has a similar story to share. Because eating out is expensive and a luxury experience, I am not afraid of telling the servers that I will not sit near PWSC. I am subjected to uncontrolled kids at work all day, I certainly am not going to SPEND money to sit near their crying, whining and mess on my own time. I am not a parent, but some parents seem to be caught surprised: even I know kids can’t, don’t, or won’t sit still or stay quiet for extended periods of time, both of which are required when dining out (I am not talking fast food here..I am talking about ordering from menus, waitresses, bread, salad, the whole thing). Now I am not saying that you cannot take your kids out to dinner, it is a free country after all, but sheesh, your paying for dinner doesn’t give you carte blanch to leave a mess that a HAZMAT team must clean up.

Because this IS a pharmacy blog, I can relate this to PWSC who cause carnage and disaster in my store. I understand that its hard being a parent of a tot, but I didn’t give birth to your walking wrecking ball, YOU did. Its not my job to keep little Stevie off of my blood pressure machine and off my displays, and if he breaks this $450 porcelain figurine display because he is running away from you, you are getting the bill for it.

I never hesitate to tell a parent of a well behaved child, what a great kid they have. There is a lot of effort that went into that child and it shows. Too bad I don’t get the same option of telling the parent of Satanette, what a brat they have. One kid grabbed the electronic signing pen from my counter and ripped it from the housing. Another got into a fight with his mother when she wouldn’t buy him Grape Benadryl so he knocked over several bottles of cough and cold products to the floor. Mom didn’t bat an eye, nor did she offer to pick them up. She grabbed the one she wanted and walked away, brat in tow.

Don’t tell me its the “cost of doing business”. Thats a cheap cop out excuse for not owning up to parental responsibility.

Back at the restaurant, a teen with a bucket of water and a vacuum was quietly going about cleaning up.

Tags: customers, personal life, pharmacy life, rambling | |