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 | |

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 | |

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 | |

There are several constants in the world. The earth spins on its axis at a certain rate, the sun rises in the East and sets in the West, and Pharmacy Chick has to call some pissed off customer after every vacation. This time it was two…

Over the years I am less and less inclined to make apologies for things not my fault. Call it callousness if you will, but I spend enough time apologizing for stuff that my staff IS responsible for, that I am not going to make ammends for stuff that is NOT our fault.

Person #1- brought in a prescription for Anotherazepam #90 for 1/2 q 6 hours. This plan limits to 30 days so the pharmacist “took it upon herself” (quote of customer) to adjust the quantity to 60. It was completely appropriate given 1) insurance audits are unpleasant and 2) the last time the patient got the med was 4 months ago. She took some exception to this adjustment made a bit of a stink. I didn’t fall for it and I didn’t make apologies. If the doctor writes a certain sig, then we are obligated to submit a days supply that is consistent with it. Bite me. (ok, I left that out of the conversation). He had his dr change the sig so he would get the other 30 and had the pharmacist rebill. (So what are you whining about again?–YOUR dr screws up and its my fault? Bite me again!)

Person #2 ordered a refill that needed Dr’s auth. He came in later and Dr hadn’t called back. In fact, this is ongoing with his Dr, and he knows it. This time, with relief pharmacist around, he decided to bring out his bad behavior. It was “unacceptable” to have to wait 2 days for a refill .A couple of days later he told my partner that he is transferring his prescriptions elsewhere.

Personally, I agree– it IS unacceptable to wait that long, but until somebody elects Pharmacy Chick as dictator-for-life then that’s how it goes.

So here’s the deal–Don’t threaten to transfer prescriptions–it is not gonna work with me. I don’t care. I will make the same amount of money whether or not I have to put up with you. I am not going to grovel–its not my nature. Its a free country, you can go wherever you want, and I am ok with that. For every one I lose, I’ll just bring one in that’s pissed at their previous pharmacy. I call it the revolving door: In and Out. See ya around sometime.

Tags: customers, insurance, pharmacy life, ranting | |

I met this guy many years ago. I’ll call him Stew, for the lack of a better name. He was a big chested guy, a salesman by trade, and by all appearances, used to getting his way (by bullied persuasion, if I guessed correctly). We met outside of the pharmacy, when he happened to notice I was wearing a shirt with his (and mine) alma mater on it. It begat a conversation that ultimately begat him coming to the pharmacy. For a while it worked quite well. Everybody is jovial when things are going their way. The wife was a sourpuss but she didn’t come in very much.

I seemed to have inherited an inordinately large number of high maintenance people over the years, those who have been disenchanted by the treatment they get at Big Box Pharmacies. And yes, I am a chain store, but I have always tried to create a friendly and intimate environment for my customers. I was grown in an independent pharmacy (cards, gifts, and drugs in the back) and only became a chain pharmacist when my options of independents ran out. I am, at heart, an independent pharmacist. I am willing to take care of these people…provided they don’t cross the line.

Stew didn’t require too much special care, but he was loud, boorish and impatient, which meant that nobody really liked waiting on him. The clerks became strangely blind and deaf when he approached the counter, leaving me (remember the drive-me-nuts posting?? read it) to wait on him most of the time. I didn’t care–he didn’t give ME too much grief. Must have been the white coat, or the fact we went to the same school that spared me I suppose. He did travel alot however.

Frequently he would call for vacation overrides, and with the insurance he had at the time, it was nothing more than a quick code entry on a screen and bam, he had his meds. He changed plans after awhile and getting vacation overrides became more complicated. Not only did they require a departure date, but they also limited him to a certain number of overrides (2) per year. Therefore, it became complicated. We didn’t want to waste any uneccessary overrides for him should he use them up before he REALLY needed them. The problem was, he didn’t grasp that concept.

As usual, he called early for his meds and they rejected. I called Stew and he said he was leaving on a vacation. I obtained his departure date and his arrival date. He was calling almost 2 weeks before he was leaving. I was sure he would be able to fill his prescriptions without needing to waste the precious override if he waited just one more week. He would still be filling them a full week before he left.

I called his insurance and they confirmed that he didn’t need an override and said they wouldn’t even give one to him because he didn’t need it. I thought that was interesting. Never heard that from an insurance before, I suppose to preserve the limited overrides he could obtain?? I didn’t ask.

So, I called Stew back, expecting him to be happy that he didn’t have to waste the override. I told him that since he was leaving on the 22nd, he could pick up this meds on the 17th or later. It was currently the 12th or something. He responded “ok then, I am leaving on the 16th.” I asked him, “Are you really leaving on the 16th now?” and he said “No, but when I come to you, I expect superior service, I dont expect to have to make a special trip to pick up my meds”. Special trip?-he lived about 4 blocks away, and it’s not like he was having to pick them up on the way to the airport.

I was shocked. I told him I had already called his insurance once, and I dont think they would believe me if I called them 15 minutes later and changed the date of his departure. I was not willing to lie to them. I tried to explain (again) that he only got 2 vacation overrides per year and there was no point in using them when he didn’t need to. He was on some rather expensive meds. Paying for them out of pocket would be out of the question. He was a bully, yes, but not a rich one. He travelled several times a year. This was significant.

I was there on the 17th when he came into pick up his prescriptions. He was as cold as an iceberg at the register when I rang him up. I wished him a good trip and he replied ” I want all my, and my family’s drugs transferred to Big Box Pharmacy by the time I get back” and he walked off.

I never spoke another word to him. I transferred his whole profile to BBP that very next day. A couple of months later I called BBP and asked them about Stew. The pharmacist sarcastically replied “Oh, THANK YOU for this one!” “Want him back?”

No thanks.

Now looking back I wonder, in the grand scheme of things, would it have mattered to fudge the dates? No, probably not. But it would have set a precedence. I would have lied to somebody to appease a customer. Every break starts with a crack. Every flood starts with a trickle. To me, he crossed a line that day. He sold insurance. Would he lie to the agency to get me covered, cover up some disease I had to secure a policy? Probably not.

So why is it ok to ask me to do the same? Little lies dirty the character as much as big lies. It just takes a little longer.

Tags: customers, ethics, insurance, pharmacy life | |

Ok, The pharmacy Chick was hoping for a quiet Friday. It was not to be. A coughing gagging person comes in with 3 prescriptions with card from Biggest-PBM-on-Planet (BPOP for short). It came back Coverage terminated. No, not non-match ID, (which leaves open a minute possibility that we had something inputted wrong), but Coverage Terminated. I broke the news to one defiant female. “NO its not!”. Uh, yes it is. She whips out her blackberry and calls BPOP customer service who tells her her coverage is valid, and she smugly tells me that I am wrong. She hands me the phone that she has coughed on to talk to BPOP customer rep. I tell Mr. Rep: “Have YOU checked with your processing division to check her eligibilty?” Uh, no he hadn’t. He gives me a run around to try this (nope), try that (nope, again)and then he says “well, I don’t know what to tell you”

ARE YOU FRIGGIN KIDDING ME? I am transmitting the correct BIN, ID, GROUP, and PCN number. It comes back Coverage terminated. CALL YOUR PROCESSING DEPT AND UPDATE HER ELIGIBILITY, THATS WHAT YOU CAN TELL ME. Because until I get a paid claim, she has to pay for these.

Coughing lady disappears for a while, and I assume she is calling her HR and trashing me to everybody she knows. She shows up about 4 hours later and says she wants me to transfer her RX to my competitor up the street (Things are looking up, I think) BUT she wants to make one more phone call (darn). While she was on the phone I called that pharmacy to see if we had the same insurance (we did) and asked them to run ANYTHING thru to check if it worked: Coverage terminated (oh yea, things are REALLY looking up, as I hope she is about to become somebody else’s problem).

I make a visit to the wait room and she is on the phone, on hold. I tell her that I am ready to transfer her rx, but I called her other pharmacy to check on her coverage and they also said she is terminated. The look on her face was priceless. I wasn’t deaf, I could hear what she was saying to her PBM: the pharmacy won’t give me my drugs(I offered her all 3 if she paid cash), the pharmacy computer says I am terminated (correction, My computer has no mouth, it doesn’t say anything–your insurance “says” you are terminated).

Finally she hands me that blackberry (where’s the sanitizer?) again and same Mr. Rep is on phone, and we go round and round again. I tell him under no uncertain terms that I have no more time for this. Either get a conference call with himself, me and the processor or hang up, because I have wasted enough time with his suggestions. BPOP is so big that one part is failing to confer with another and the customer is confused into thinking that if one person at BPOP says she is eligible that every part of the “system” is up to snuff. Sadly it is not.

Finally they take MY advice and the two parts of BPOP confer. AND they call me back. Other than the same BIN number, I have to change the PCN, the ID and the group number. It finally works. I do a print-screen and give it to Coughing lady. I tell her “KEEP THIS, because nothing on your card works, and THIS does. ”

I ask BPOP rep, if this will work from now on–she says yes.

I don’t believe her.

And I didn’t get even so much as a Thank-you.

May the fleas of a thousand camels infest her bed.

Tags: customers, insurance, rambling, ranting | |

This is an actual summary of a recent call Pharmacy Chick had with an insurance help desk. A few things have been added for “effect”…:-)

bip bip bip bip….1-888 no-help here…ring ring.

“Thank you for calling MSPBIP provider services. to continue in English, press 1. To continue in Swahili press 2. (beeep)

For eligibiltiy press 1, For claims press 2, for prior authorizations press 3, for everything else press 4 (beeep)

For early refills press 1, for dose changes press 2, for DUR rejects press 3, other rejected claims, press four (beeeep)

please enter the subscriber ID number ( bip bip bip bip bip bip bip bip bip bip bip)

I am sorry that number does not match our files..please try again.. (BIP BIP BIP BIP BIP BIP BIP BIP BIP!!)

Please enter the date of birth in a month month/day day/year year year year format (bip bip bip bip bipbipbipbip)

Please enter the person code (bip bip)

Please enter the prescription number (bip bip bip bip bip bip)

Please hold as we research this claim (la de da musak zzzzzzzz)

This claim was rejected for too early refill, it was filled at YOUR pharmacy on this date (duh) and the next date of fill will be (too damn late, I already know all of this) If you still need to speak to a representative please press 1 (BEEEP)

Please hold as we transfer this to a customer service representative (la de da musak zzzzzzzzzz) 10 minutes later…..

“Allo, dis is Quishtaz my ID 203948. vat is the pachent’s ID numbah?”

PC: “I just spent 15 minutes entering that information.”

Quishtaz: “I still need it pease”

PC: ok, its 17399659029……..

Q: “Pachent Nahme?”

PC: “Ignotus Nobrainus”

Q: “Date of birf?”

PC: “I already entered that”

Q: “I musht veddify the dat of birf”

PC: “ok 10-10-10″

Q: “preskriptchun numbah?”

PC: “I already entered that also”

Q: “ve need the numbah peaze”

PC: (heavy sigh) ” ok, 246890″

Q: “Jour nahm?”

PC: “MY name?”

Q:…………”yahs, Joor Nahm”

PC: “pharmacy chick”

Q: “Pharmocyct or Teknichon?”

PC: “um why??”

Q: “I must rekord dat informatun”

PC: “pharmacist,” (how about favorite color or what I had for lunch)

Q: your NCPDP or NPI number?

PC (shuffling paper quickly) ” 12345689 and my favorite color is pink”

Q: Ignoring me by now….”ok, ow can I azzist chu today?”

PC: “I need a vacation override for this patient, he is leaving for Mexico tomorrow (nope,couldn’t have done this a week ago could ya pops?)

Q: “zure, I jus need hiz dat of Deparchur and hiz arrivul dat”

Um, (I make it up, plenty long)

Q: Sank you, while I go and check on dis with my zupervizor……*click***click**(ominous sound of dead silence instead of Muzak)…then dialtone….

PC: hello? Hello? HELLO? AAARRRRGGGHHH!

Its a good thing that spatulas aren’t sharp, because Hari Kari would have been performed today. Mr Mexico is just gonna have to pay for his vacation supply.

Tags: insurance, pharmacy life | |

The people who have the most time on their hands choose to bug me when its the busiest?–you know who they are–Joe Retiree-Flyfisherman has to call you at 9:30 am on Monday morning to order is 6 rx’s and Oh, can I pick them up at noon?

Every phone call that comes in at 2 minutes before closing are never simple? (don’t you just want to let them ring?)

Nobody ever loses their HCTZ?

the complexity of the problem I have to solve is inversely proportional to the amount of time I am allotted to fix it??

“quick questions” never are?

“help desks” never do?

“customer service” only serves their companies and not their customers?

an audit will never find an UNDER payment?

customers will beat you bloody if you short them a pill but will never call you if you toss in that extra 1 pill just to see if they notice??

the phone rings and customers flock to the counter just as the first bite of food enters your mouth?

GOT any more??

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

He brings the pharmacy chick a prescription and smugly announces: “I want this filled, I called my insurance–they said its covered!”

My brain is thinking this is not covered

I take the Rx, process it and behold-”REJT” “ndc not covered on plan”

Pharmacy Chick’s brain: here comes the argument

“This is not covered by your insurance”

He looked at me as if I had just insulted his mother “I CALLED my insurance company, they said it was covered” a little vein popping in his forehead.

Here is where it gets complicated: This is a vaccine, a product and a procedure. I tried to explain that it may be covered 1) if he submits it manually or 2) if its done in a doctor’s office. BUT, its not covered as billed as a prescription.

He didn’t take this well–His doctor doesn’t carry the vaccine and he was in no mood to fork out the cash. I have him a copy of the rejection and told him that the rejection is now on file in his insurance company’s computer. He spits a few complaints and takes the rejection and leaves.

Buh Bye.

Tags: customers, insurance | |