The Pharmacy Chick

This Post name reminds me of a M*A*S*H episode where Radar asks Colonel Henry Blake to sign a bunch of forms, which he does obediently. After asking “what exactly am I signing?” Radar just says ” Oh, just  Requesting permission  to order  more Request  forms Sir..”

The Prior Auth process is a little like this M*A*S*H scene.  However the Pharmacy Chick’s customer was dealt a stealthy blow on Monday.

DrY prescribed for Patient X a tube of Tri-Luma, which we all know is basically a prescription cosmetic containing fluocinonide, tretinoin and a skin bleach.  It was no big surprise that it wasn’t covered by her insurance, but it left a small door open by saying “PA Required”.  My SOP is to fill out a form of my own design, filling in the blanks and faxing it to the office to start the PA procedure.

It wasn’t 5 minutes later that a rep from the office called us back.  ” We got your request for Prior Authorization and wanted to let you know we will not be doing it.  This is an asthestic medicine clinic. We do not take insurance and we do not do prior authorizations for clients.  She will have to pay or go without”. 

I wan’t mad.  In fact I was jealous.   I think this Dr found a way to make a living away from the oppressive thumb of insurance companies and live off the vanity of the masses.

I have already seen this trend in medicine.  Asthetic medicine, Cosmetic Dentistry,  Cosmetic Dermatology,  all making a living by finding a way to wiggle out of the insurance noose. 

I only know of two pharmacies ( in my area)  who dont take any insurance. One is in a pretty small community.  Run by one guy, he calls the shots and it appears that me makes a living, maybe not a zillion bucks but his overhead is low and his reasonble pricing keeps at least the cash payers happy.  The second is a compounding pharmacy.  Finding that crucial niche, they dont take insurance and compound specialty products for humans and animals alike.  I am not talking  your basic Salicylic acid in  aquaphor mix, I am talking SPECIALTY products, bioidentical hormones, thyroid compounds, LDN, rectal rockets for cancer patients and veterinary products.  She has a great business and I have sent a lot of people there for compounds I dont have the time or the supplies to make. 

I am all for it.  I for one am sick and tired of all the compensations I have to make for insurance.  They tell me everything I have to do but how I pee. Most of my recordkeeping and documentation is to placate insurance companies.  ENTIRE PROCEDURE BOOKS are sent by corporate dealing simply with insurance issues.  AND if they find one small anomaly, they take all their money back and laugh while they do it. 

 I once had an audit for 100 claims by one of our local  providers.  They  focused on this DAW-1 Claim I had for a MS contin patient every single month.  They had me pull over 3 years of hard copies and wanted to see if every single one of them had DAW-1 written on them.  It took me HOURS of labor to dig thru hard copies.. a colossal waste of my time.

They charged me back on one where the physician’s PA had signed it but we submitted the Physician’s name.  I hope they screw themselves sideways.

Another time I had a Medicare Audit where they demanded I produce the patients diabetic testing log to corroborate the dispensing record.  well, she kept a pretty good log but she said ” I don’t write ALL of them down”.  Medicare wanted their money back.  I think the company fought that one and won however.  WTF?  why should my reimbursment be tied to Mrs C writing down her tests?  The hard copy sig AND what I dispensed were in accorance with the days supply allowed. 

I see Walgreens is dumping Washington State medicaid for all new patients.  I’d do it for ALL of them frankly.  Im no fan of WAG’s but I’ll at least say “way to go” on this one.

We’ve already seen a lot of dr’s dump medicare.  With Obama’s plan starting to cement, I can see a lot of providers girding for it by moving from the Insurance sector to the Private Pay sector.

I think thats a solid move.

What is your opinion?

Tags: insurance, pharmacy life | |

I really hate it when parents send their kids in to do their own work.  This day this 8-9 year old kid is standing at the counter and his dad is about 5 feet behind him.  “Well, go ahead and ask her!” he said and the kid meekly asks “for what?”.  I don’t have time for this crap.  “Your prescription” he says.  I play the part and ask.  “What is your name?”  and he replies “Steve” (fake name by the way).  Clearly we are getting nowhere.  We don’t file prescriptions by first name so I address the father ” What is the patients full name please?”.  He tells me. “Steven Anderson”. 

I find the prescription on the shelf, one I did several hours ago.  Its a new patient to ME but since I had his address on the e-script, I found one other family member (his mother), linked them up and filled the rx.  Only problem was the insurance was out of date.  I had filled the antibiotic for cash, about $15.  I told papa, ” we need current insurance for Steven.” to which he told me “You have it on file”.  

I truly hate it when people tell me this.  ”On file” could mean anything.  His mother was the only patient in our system and the last time she was here was in 2008.  Clearly ON FILE was synonymous with “nothing ever changes!”.  I had to tell papa that Steve was a new patient and the ONLY other family member’s insurance was expired.  The price is $15 or I need a new insurance card.  To that, he informed me he didn’t carry the card with him.  WTF?  its a 2×3 piece of plastic, keep it in your wallet!

And so I went to the cash register and run up the $15 to which he looked at me incredulously.  ” I have insurance!”.  “And you do not have the card with you, so it is $15.00″. I politely replied.  He put his hands on the counter and said “And DON’T YOU BILL AETNA?”  –this guy was from the slow class, clearly.–  I said.  ” Yes I bill Aetna and a thousand other plans, but I need your card.  Without the card that you said you do not have, I cannot bill this prescription for anything but cash.” “Bring me the card and I will bill Aetna or whomever is their provider”.

How stupid can people be?  Can I walk into the grocery store, pick out a grocery cart full of items, walk thru the checkstand, and ask “DON’T YOU TAKE VISA?”   but refuse to provide the card because ” I dont carry it?”.  Steve just stood there (as I would expect an clueless 8 year old to do) as his father finally paid the bill.  I began to provide the necessary counsel to which he said ” Tell HIM”, pointing to Steve.  Sorry buddy, I am not counseling an 8 year old kid.   I pretended he was joking  (haha), ignored  his statement and continued to tell  him about proper storage, usage, discard and side effects.

And, wished them both a good day.

Poor kid.

Tags: customers, insurance | |

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 | |

Some days there aren’t enough walls in the pharmacy to beat my head against.  We live in the information age.  All around us is access to all sorts of information.  I wouldn’t be surprised to get on wikipedia and find my own name there somehow: “Pharmacy chick, the best blog on the planet”..yea right…

That being said however,  getting information out of a patient is another story!

If you are a patient and you come to a pharmacy, you have only one job in the filling process: give information.  Thats it.  I won’t ask you to come into the pharmacy and fill it yourself.  I won’t ask you to call your own doctor for refills either.  However, when I ask you for information, I expect that you will provide it…freely and honestly.  If you dont have what I need, I will tell you how to get it. I’ll never ask you for more than I need, as I am not nosy.  I am not your babysitter/mother/caregiver however. Dont ask me to do your foot work, and I won’t ask you do to mine.

Do not hand me a scrap of paper with some scribbles on it and tell me its your insurance information.  No PBM I have ever seen has mailed out cards on wrinkled pieces of Hello Kitty paper written in crayon ok?   Its not my job to FIND your insurance.  Its my job to PROCESS your insurance, and I am happy to do so.  I am not happy if you ask me to call some handwritten phone number at 7 pm to get your insurance from some lady you allegedly “just talked to”.  If you just talked to her, then you can call her right back and get what I need. 

I’m actually pretty savvy.  I have been known to recognize the processor just by the unique arrangement of the ID numbers.  Sometimes I can guess by knowing the employer.  You work for United Napkin Holders and Paper Cups?  ok, thats Medcrap.   American ZIpper and Fastener?  Thats Expressless scripts… I had a guy today.  He’s a new employee at our hugest employer group in the county.  They always use a certain PBM.  He handed me a scrap of paper with an ID number. I recognized arrangement of numbers and letters as unique to this PBM.  I told him I believed he was (insert PBM here).  He didnt’ think so. “No, I called (big insurance company) and they gave me this number.”  I tried to explain that the (big insurance company) farms out their rx benefits to (big PBM). He was missing his group number, but they usually had 1 of 2.   I ran the numbers and neither group worked.  Of course it was all my fault.  He wanted ME to call and get the rest of his information.  I gratefully declined.  I wrote on his scrap “BIN, GROUP, ID”.  “bring me this filled out and I will do the rest, but I suspect you arent’ loaded yet.”   He stomped off mad.  “I’ll just find somebody who WILL help me”

I looked at his address.  I suspected I knew where he might go so I waited a while then called.  “Hey Tammy, PC here,  did you get some guy with a script for X with a scrap of paper for insurance?”  She confirmed that he had been there but ”we couldn’t verify his insurance so he paid cash”.

If only he had proper i.n.f.o.r.m.a.t.i.o.n.

Tags: customers, insurance | |

We all have compliance issue with patients.  For most, its issues of NON compliance, or UNDER compliance.  For many of our narc users, its OVER compliance (read: abuse).   For whatever reason,however, there is a core group of people who think that if they miss one pill of something, they will be ostracized by their friends, lose their birthday and then die a slow painful death.

Ms Wang came into pick up her Crestor prescription.  She works for one of the major companies in the area.  This company split its benefit package for the first time.  Choose plan 1 get one kind of drug plan and card,  Choose plan 2, get a different drug plan and card.  Everybody who chose plan 2 got new cards, with new id number and groups.  I know this for a fact.  No, ifs, ands or butts.  She brought in her new ‘card’.  It was the card she was to use at the doctors office only.  (turn head away and roll eyes)

If Pharmacy Chick were queen of the world,  everybody with insurance would be issued one card.  This is the card you would use at the dental clinic, the dr office, the vision center and the pharmacy.  You would have one (repeat ONE) ID number.  The card would have all eligible people listed, and their person code next to it.  In one corner would be the BIN, Group and PCN number.    There would be joy throughout the land, and all medical providers would rejoice. 

But no, there must be card-s (plural).  I am one of those unfortunates.  I have a drug card and a medical card. I do, however know which one to bring to which place, and do not try to pass my drug card off at the dr office or vis-a-versa. In fact I dont even have a dental card.  I dont understand this. “tell them you have Utna dental” I was told… WHAT?!  Is that some kind of universal plan the dentist will understand?  Apparently.  Its been 17 years and I still haven’t gotten a dental card..and I still have Utna dental, and my dentist still takes my business.  But I digress…

I wish I had a dollar for everybody who told me “This is the only card I have” and then returned the next day with the correct one.  She looked at me like I was speaking Swahili when I told her she had given me the wrong card.  She kept telling me we had her on file.  There was to be no grasping the fact that last years numbers had no value now.

She thought for sure she would die without her evening Crestor.  In fact when I told her otherwise, she looked at me like I was lying to her face.   I didn’t loan her any.  This is not a pharmacy issue, nor a doctor issue.  This is HER issue. 

I know all the stories behind why we dont use social security numbers.  I’m for it frankly, but I will tell you this: everybody KNOWS their number and there used to be a time where all I needed was that number and I could get most insurances to process.  I have a good memory.  I can remember the groups and processors for the major players around here.  I cannot however, pull ten thousand 14 digit id numbers out of my cranium, and have no intention of sitting on hold at Neverland PBM getting the numbers the patient was supposed to have. 

Call me picky, but I don’t require much from the patient.  Mainly all I need from them is INFORMATION. Give it to me and things go well, withhold it or dont have it? , well….you go to bed without your Crestor.

Tags: customers, insurance, pharmacy life | |

I need to check the calendar–is it a full moon? Is Jupiter aligning with Mars? Did a comet zoom by and spray us with radioactive dust? Because I have had to put up with some of the most assinine whining about the price of prescriptions this week, more so than their usual rants.

Over the years, my compassion for listening to complaints about pricing has plummeted and is directly proportional to 1)how much they have to pay and 2) the importance of the prescription. For example:

Son comes in and picks up Ma’s Vicodin and Xanax.  He brings $8 because thats what Ma gave him.  The copays are $4 and $7.26.  The copays have been $4 and $7.26 for 5 months and there is no price match or deals on controlled drugs.  “Shouldn’t they be $4?”  Nope.  He huffs away to get more money.

Guy comes in with a transfer for Viagra from my own chain.  I call only to find out is has been transferred already to a nearby competitor. Great, a wasted long distance phone call. I call the competitor and bring it over. Its been 6 months and its gone up about $40. Well it is what it is, not covered.  He wants to know what it costs and when I give him the price, he launched into a diatribe of how he walked away from Big Box because they were expensive and my price was $2 higher.   Being just a little cheeky, I just said “Do you want me to transfer it back?” I couldn’t resist.

Son comes in for his elderly fathers medication.  Doctor had left this message. “Cancel Lunesta order for #10 and fill it for #30, one daily at bedtime for sleep wandering/agitation. OhhhKaaay.  The Son didn’t want the Lunesta last week because it wasn’t coveredand “$50+for 10 tabs is ridiculous” so I cannot imagine that he will want 30 of them today for 3x the price.  Sadly he took it and 2 days later it was changed to Remeron. **Flush** $130 down the tubes.  I kinda felt bad for him but in all honesty I did try to tell him of other alternatives before he laid down the cash.

Lady comes in to pick up her rx.  I had filled it for cash because the 100ct price was better than using her insurance for 3×30.  At the register the tech walks back to the computer ( a HUGE pet peeve of mine) so I ask why. “She wants to use her insurance”. I tell her “its cheaper to get 100 than to use the insurance, LIKE IT SAYS ON THIS NOTE”.  But NO,  customer pipes up and says ” I’m just curious”  So this lady stops traffic like the chick in the VISA check card commercial who wants to pay cash.  My tech doesn’t use wisdom and ask her to move aside. We reverse the claim, re run the claim for 30 (her max allowed), just to prove a point.  #30 is 9.79 and #100 cash is 13.97. Valuable time wasted and we will probably do it again in 100 days. Customers have lousy memories.

International Man comes in and wants his ”Veepetor” (Lipitor) filled. He has Medicare D and a copay of $38.  He brings me a discount card issued by AAA.  My man Friday explains that it won’t help him, but IM doesn’t believe it so we waste more valuable time running thru his discount card. Its over $150.00. He completely balks. Friday explains that this card is not insurance. “Can I use both?” no. “So why did they send it to me?”.  Cuz there is a sucker born every minute?”

Mr Barrel Chest comes in to pick up his bag of goodies.  He’s in the donut hole now and knows it. He does not however miss out on the opportunity to complain about the injustice and tell me that the NEW PRESIDENT WILL FIX THIS MESS blah blah blah, sure he will…   Never mind the fact he has all tier 3 type meds where some well chosen generics might do.  I make mention of this fact only to be shut down with “I think my doctor knows what he is doing”  Then shut your mouth and open your wallet. I am done with ya.

It seems like a good time for a reminder for any reader who might not be a pharmacist:  Insurance is a contract between you ( the customer) and your insurance company.  I agree to bill the plan but I don’t write the contract. Your copays and plan limits are set by THEM not ME. If you don’t like the price, then complain to them, not me.  If it were up to me you could get 360 days worth of your meds, then I’d have to see you once a year instead of 12. I’d never have to request a Prior Auth for non-covered meds, or a vacation override. Every drug would be $1 and everything would be covered…..and while I am at it, I’d like a pony too.

Tags: customer hassles, insurance, pharmacy life, whine whine whine | |

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 | |