The Pharmacy Chick

So, Pharmacy chick wrote a post about legit narcotics users being treated like second class citizens because their drug seeker counterparts make them look bad.  Because I implied that Doctors contribute to the problem by continuing to give narcs to seekers (cant seem to see thru their lame stories), one commenter added that it “wasn’t that easy” to deal with them.

I countered that a few phone calls to pharmacies around would garner enough info to determine the status on a sketchy patient.  Most would be more than helpful to provide dispensing information for the MD to make informed choices about servicing certain patients.

I don’t know how many PROVIDERS read my blog, but I am inviting you to comment.  Tell us why you give narcotics to people you suspect are scamming or lying to you and how  you stop,  when you finally have had enough, and finally, how often do you call pharmacies or other providers to see if the (said patient) is popping up there too.

Because…Pharmacy Chick really wants to know both sides!

Tags: doctors, drug abuse, pharmacy life | |

I always bristle when the FIRST thing out of a patients mouth is one (or both) of the following statements: “How long is this going to take?” or “How much is this?”, without even so much of a “Hello” preceding it.  I bristle even more if I am treated like an afterthought by the so-called customer whose attentions are diverted by the cellphone fused to his/her ear ” Hold on hunney, the pharmacist wants something”.  ( EXCUSE ME? YOU ARE THE ONE WHO WALKED TO MY COUNTER..YOU WANT SOMETHING..NOT ME.) Honestly, can you imagine getting away with that in a doctors office?

I got the call before I saw her face.  Barely understood because of her crappy Bluetooth device she wanted to know if we had 120 Oxycontin 40 mg.  5 minutes later she was standing before me with the prescription.  The only words out of her mouth (to ME anyway) was “How long will this take. I got a plane to catch”.  One look and I knew we were going to have a problem.  Oxycontin 40mg # 120,  1 QID. 

Maybe if I knew her..maybe if she had been filling the same rx her for the past year…but that was not the case.  New patient… and I hate those kinds of sigs.  Its the same moron who writes Tussionex  1tsp q 4-6 hours… or  Proair HFA 4 puffs every2 hours.  Give me a break. I told her I needed to verify the directions on the blank.  They were not standard or appropriate for the dosage form…it wasn’t  2 tabs bid, something completely different.

First call to the office: Voice mail.  Second call to the office (asking for a humanoid)  :  voice mail.   Third call was made by the customer getting irate.  She handed me HER cell phone to talk to the office “they are getting  Kristin” …I handed it back:  Voice mail. I guess Kristin is a machine.  She was getting livid. 

I had her naked over a barrel, not by design but by necessity.  I needed to verify the sig…and wasn’t budging.  This script was only signed by the doctor. it was written in somebody elses hand.

It happens all the time.  We get some of the weirdest crap written, faxed and emailed to us every day.

We are a nation of people in pain apparently, and we are all about quantity and not quality.  I got some nutcase whose Oxycontin 80 script reads “take 5 tabs daily”.  Based on patient interview, he does at least take 3 am and 2 hs. That (while a HUGE dose) is at least prescribing within reasonable limits based on the drug itself.

I got a script for Fentanyl patches.  Apply 1 patch every 24 hours. No notes added or explainations offered.  Even after I verified it, I didn’t like it much. Neither did the insurance who even after PRIOR authorizing it, still audits my claims about once a year.  Stick it  Mr PBM, I have every I dotted and every T crossed.

I receive quite regularily a script (from the same Dr who  just doesn’t get it) ” Oxycontin 5mg  1-3 every 4-6 hours…etc etc”.  Granted, I know what he means, but it still is not written correctly or appropriately.

OR, the E-script I got last week for Azithromycin 250mg #30.. 1qd with prn refills.  I got it after office hours which meant I had to page him. He called us back. ” We got this escripted to us..Were you intending on prescribing Mr. X  Zithromax daily  for a year?”  He decided to be funny and replied ” No, I am intending on giving it to him the REST OF HIS LIFE”.  Well alrighty then. Thanks for  your help…( the patient never picked it up..I guess his life was pretty short)

It gets kinda old doing the call-back thing.  There are too many layers between me and the Dr, and “voicemail” is the lousiest of them all. Its the professionals version of the brush off.  Its the 21 century version of “have your people call my people” …only there aren’t any people.

What would really help (and I know this is a real stretch for prescribers)…is if when you write a script that is weird by intent or design…how about elaborating on it so we know you INTENDED on prescribing it like this?  A little help here perhaps?

I recently got a script for Cymbalta 60mg  4 caps qd.  That normally would necessitate a call to the office. But the kind dr included a tag at the bottom of the fax “Patient is a heavy metabolizer and requires excessive dose”.  End of story. Now was that so difficult?

“Kristin” finally called back and was just a bit put out that I called into question the sig on the Oxy. I said ” Look Kristin,  I have never seen this lady before and likely never will again. She is just stopping by on the way to the airport (her story not mine) and Oxycontin is 12 hour release, not 4 hour release.  I want YOUR name on this RX blank assuming responsibilty for this sig…..yada yada yada”

Every time I sign off on a prescription I am putting my stamp of approval on the contents of it, including the sig.  If I dont like the sig, even if its “correct as written” I am not going to fill it. “correct as written” does not make it “CORRECT”.

For every one I have verified as correct, I have found sigs that were unintentionally wrong.  We are humans. We make mistakes.  So if you are a patient reading this and the pharmacist wants to verify your prescription,  don’t take it as an afront to your personage. And, if you are a Dr reading, help us out a bit. If your script is over the top, leave us some indication that it was intentional.

Oh, and what about Ms Bluetooth?  “kristen” said “well, if you dont like the sig, change it to 2 tabs BID”. 

What the….?

Tags: customer interactions, doctors, mistakes | |

RING RING

Hello, Dr Dipwad?  Yea, well this is Pharmacy Chick.  Uh, Pharmacy Chick,  the pharmacy next door to your office.  Yes, the one where you could drop a penny from your window and land in my parking lot…

I wanna talk to you about your addiction to E-scripts.  From a pharmacy standpoint, we hate them enough already.  Not only are they intrusive on our computer, interrupting our work with their “notfication-you-cannot-ignore”, but  you send entirely too many of them, many of them are completely unnecessary. We actually liked you better when you faxed in your prescriptions.  We had no idea you would fall completely in love with e-scripts that you would  need professional help in this addiction.  So in the interest of my sanity, I would like you give you some personal instruction and counseling on sending e-scripts.

1. READ your escript before you send it ok?   Don’t send me Protonix 40mg IV injection when you really mean Protonix 40mg tabs. 

2.  Quit sending me duplicates…or )(%&(*&#@! triplicates!  Are you friggin aware that I can’t delete them?  Do you understand that I have to process them and ADD them to your patients profile as a prescription?  Knock it off!    Mr Jones doesnt’ need 4 identical metformin 500 mg prescriptions.

3.  Please reserve escripts for Prescription drugs please!   No pharmacist appreciates getting  scripts for Vitamin C, Calcium supplements, multivites,  Ferrous Sulfate, Colace and Papaya enzymes. If you want your patient to get that stuff give them a list ok? And if you got some really weird thing like Acidophyllis Performis 5 million units, dont even think about e-scripting that.  It took me a call to my help desk to get that one out of my system.

4. KNOW your controlled substances.  Just because YOU are ignorant  that Lyrica is controlled and can’t be e-scripted, doesn’t mean the I am.  I can’t fill it any more than I could fill a C-II you forgot to sign.

5.  Do me a favor, If you wanna CHANGE something on an escript,  CALL ME.  Dont just send me a second one with some minor change and no note explaining why.  It will  save me (and you) a phone call asking you which one is the one you want.

6. AND lastly, Dearest Doctor… DO NOT SEND ME AN E-SCRIPT AND THEN GIVE A HARD COPY TO THE PATIENT.   Its one OR the other. 

And you have a really nice day…Doctor.

Tags: doctors, pharmacy life | |

Eric, Pharmacist, wrote a nice piece in Drug Topics recently about loyalty cards.  If you haven’t read it yet, click on his link on the blog roll you’ll find it there.  It got me thinking about the darn things and lacking anything really INTERESTING to write about today, I just decided to steal his own topic and simply add to it.  I’ll admit it, I have no shame…

If  I HAD to choose between either samples from the doctors office and the loyalty cards, I suppose I would choose the loyalty cards for the simple reason that I get NO money for samples that come from the doctors office but I do at least generate a sale from the latter.  That being said,  let me make this perfectly clear….Loyalty cards are a colossal pain in the Chick’s rear. 

To clarify…if its not clear enough..I don’t really mind the one-time-here-its-free cards.  Take the card, get your one month free supply of ExpensO-RXatrol and we are done. Finito, Over and out.  I never have to think about that transaction again.   Granted, there are a few brain trusts out there that seem to conveniently  forget  that the  card provided only a one month free supply and wonder rudely the next month “WHY do I have a $75 copay for Luxiq? I didn’t pay that LAST month??”  only to stomp off and refuse to take the prescription. 

No, the loyalty cards that tie the Chick’s feathers in a knot are the re-usable..monthly cards for 3 dispensings, 6 dispensings,  1 yr, 18 month…you get my drift.  Give me a break.  You get Pimple Face Finnegan in here with  Cards for Solodyn, EpiDuo, yada yada yada and his mother expects me to remember that each month this card goes with this drug and on and on…  SORRY MOM, THAT ISN’T GOING TO HAPPEN…

I fill over 6000 prescriptions each month.  99% of them are billed to some kind of insurance or discount plan.   I am damn excellent at keeping track of 1 insurance, and most of the time, if I have it bookmarked, i can sometimes remember the split bill…but not always.  Therefore, when I so these split bills, I tell the patient (in the most kind manner possible) “Dearest customer,  I take your loyalty cards, but it is YOUR responsibility to make sure they are done..not mine..so when you ORDER THE PRESCRIPTION, not pick it up, please remind the staff that you have this card because it will be  returned to the back of the line if it needs to be rebilled at the time of pick-up. ”  

Unfortunately my computer does not have any kind of “flag” that tells me that any given rx was split billed.  It just doesn’t. And while I do my best to put “split bill” in the comment line, that comment line applies to every thing we look at on their file, not just that rx.   Nothing stops the line from moving quicker than when my tech moves from the cash register TO a computer with a RX and a loyalty card…and does NOT move the customer out of the way.  I have endured too many glares from customers when I tell them to step away from the counter when we rebill cards for them…Know what??? Tough noogies. If you want to have $25 knocked off your Diovan..wait your turn.

Now we have special loyalty cards that frustrate the cashier also. Not only do they require a split bill, but they “fund” a card that has to be swiped at the cash register, in order for the customer to receive the loyalty discount.  (Insert head slap here!).  These transactions have to be very specially done, in order to work. In a nutshell, if the copay is $40 for Aciphex, and the card takes $30 off, then the clerk has to ring up  $40, collect $10 FIRST, to make the remainder $30 show on the register…then the customer has to slide the loyalty card, put in the PIN number, and process to get the #30 off. It will not work in any other order. 

My question WHAT THE HECK for??.  Why add this step when the split bill process would have been sufficient?  Im just sayin….

Recently this woman brought me 4 prescriptions for acne medications from a physician whose sole purpose in life (I believe) is to promote the most expensive dermatologicals on the planet. I believe I have written about him before.  Each of these rx’s had a loyalty card associated with it, but some were actually duplications in treatment.  “Mom” gave me this deck of cards and rx’s and wanted me to provide “whichever was the cheaper product”.  Steaming with rage because we were slammed (being a Monday).  I wasted close to 30 minutes billing, and rebilling this nightmare, for which she thanked  me by taking NONE of them.   “I just wanted to know how much they cost”. 

Maam?  may the fleas of a thousand camels find solace in your underwear tonight.

Tags: customers, doctors, insurance, pharmacy life, rambling | |

On a similar vein as dearest Dr Grumpy, here is my own entry for wishing I would read minds.

Yesterday morning we got an e-script for one of our customers.  It was Macrobid 100, #14, 1 bid.  I went to fill this rx and noted a warning for allergy to nitrofuran derivatives.  Its not a common allergy so it was duly noted.  I quit filling the prescription and called the office.  I got the nurse right away.  What she said stunned me.

PC: “Hi, PC here, we got a allergy notation on this patient about nitrofuran antibiotics and you have prescribed these for Mrs Ima Hogg.”

Nurse:  “yes, I realized that after I had transmitted it, you can cancel it”.

PC:  “Um,were you going to call us about that mistake? and do you want to give something else?”

Nurse:” we are talking to the dr. we will call you later”.

They never called us that day.  And, if you noticed…they didnt’ answer my first question.

Tags: doctors, nurses, pharmacy life | |

Going to work on a monday is like beating myself over the head with hammer. It hurts, but for some stupid reason (money??) I keep doing it. You’d think that after a while, I’d get out of the way of the hammer.

Since people who receive faxes from pharmacies probably look at them for 7 nano seconds before passing them off, I have tried to dumb them down to their basic components. I try to use simple terms (first grade) and sharpies to make my point. TWICE today, it was ignored like I was writing sanskrit or something.

Case in point number 1. We asked for a refill for a patient for 90 days supply of Atenolol 50mg She had been on 1/2 tab BID, #90. A couple of hours later a prescription was faxed for same lady for Atenolol 50mg #90 1 po BID. with 11 refills. Because this was inconsistent with what we asked for we sent it back for clarification “Did you intend to change directions from one-half tab twice daily to one tab twice daily?” Please Verify and fax back. … A few hours later we got yet another prescription from the same office–no note, nothing, Atenolol 50mg #180 1 po BID….with 11 refills. First off, do they have any idea that they just ok’ed refills for this woman for 36 months? Secondly, they did not specifically address my question. The other pharmacist said “Fine, it will be filled as written and the patient can talk to the dr if they disagree, just make sure they know whats been changed”

Case in point number 2. Armour Thyroid is on backorder in all strengths. We gave Mrs Jones the last 5 of the 120mg tabs (1qd) we had over the weekend. The patient asked US (not my job) to contact the dr to find out what she should do. We send over a nicely crafted note that said in summary ” ALL Armour thyroid is on back order, is there an alternative you’d like to use in the mean time?” He faxes back (God’s honest truth here…) Use Armour thyroid 60mg 2qd. Brilliant…Hello? is there anybody in there? Can you read? I’m not an ignoramus. If I HAD 60mg Armour, I’d have used it….

It was such a Monday…

Tags: doctors, pharmacy life | |

Ok, The large-quantity-narcotic-spouse-prescribing Dr came back to retrieve the C-II prescription that we wouldn’t fill for Spouse. This could go down as a historic moment in physician maturity. Dr huffily reported that ” I still prescribe for a few patients. If I get any refill requests from your company, I will deny them”

Knock yourself out buddy, the Board of Medical Examiners already has your number. I told them I would take the high road on this unless you gave me trouble, but If you wanna take off the gloves, I am ready. You already told me you gave the narc prescriptions you wrote for yourself to your spouse. Have a serving of insurance fraud with a side of DEA violation?

Don’t mess with the Chick..

Tags: doctors, law | |