The Pharmacy Chick

For the umpteeth time this year, I have had to process and respond to yet another drug recall sent out by manufacturers. As I was stuffing yet another confirmation of recall response into my file cabinet I commented outloud (perhaps too loud for my employees) “Do we live in a freaking third world country? Are we simply incapable of making drugs anymore that work and last thru their expiry date?” It set off an interesting conversation.

Honestly lets ask ourselves that question. In my early years of pharmacy, we’d have 3-5 drug recalls per year, maybe less. Gads, I process hundreds a year now. Most say something like “drug my not maintain potency thru expiration date”. Some recent ones like the ever popular Digoxin recall, required a lot of work of notifying patients and processing returns and reimbursements. Who is going to reimburse me and my staff for the TIME? Nobody. And then, on the heels of that one, we got the morphine recall of an erie similarity: tablet might be of double size. Back to the drawing board: notify patients and accept returns. Ironically on this recall , of the 3 patients I had, nobody would bring theirs back. Seems they get a little possessive of their narcotics. Whatever, I am not going to beat down their door. Honestly I’d think I would notice a tablet DOUBLE the size coming out of a bottle, but hey, apparently they don’t have much quality control in the plant.

Does anybody remember the ABLE Pharmaceutical fiasco a few years ago. My company was out several thousand dollars on that one when they declared bankruptcy on the heels of their own company wide recall. Now I hear the FDA wants into Ranbaxy to look at their records.

Ya know what? Maybe we need to start manufacturing our drugs in the US again. It seems I get more and more people wanting to know WHERE their drugs come from. And since India seems to be the driving force of generics nowdays, “India” seems to be the meek answer I give people more and more. I do not feel comfortable with this. I believe I have a personal responsbility to my patients to provide them with safe and effective medications and if I dont feel very confident about the source of the drugs, why should they?

I have no more control over what I carry anymore than I do the price of gas. The company negotiates contracts with whomever and we get whatever they agree to. It creates interesting conversation at the cash registers every year at this time when the “new contract” goes into effect and just about every generic I have been using has changed. I cringe when I hear a patient say something like “oh it changed again? I quit looking, it changes all the time”. Apotex this month, Ivax the next month, Aurobindo the next month after that.

It used to be that I could identify a loose tablet just by looking at it. When I carried the same generics for years, it was easy and sometimes a fun game: Identify this loose tab: and more often than not, I got it right the first time. Now, who knows.

How many times did we have a levothyroxine recall? three? four? AND, Daytrana recently sent out their second one for the same patches. Purpac (actavis) recalled most of the vitamins they manufacture. I could go on and on.

What is going on? Are drug manufacturers slacking on their manufacturing practices? recordkeeping? Do they make it and hope nobody asks? or is the FDA crossing the line and saying “hey you didn’t dot this “i” and we are going to pull your entire product line”?

Any opinions?

Tags: law, pharmacy life, recalls | |

I am grateful that I don’t see too many phony prescriptions. I see way more drug seekers than actual phony prescriptions. I can’t even remember the last time I had a phone-in phony. The tech filled this one and presented it before me to sign off. I took one look at it and said “Nope, this one is a phony.” Man, you’d think that this guy would get a little more creative–he’s been using the same photocopied prescription for 3 years. We even had the Dr flagged as “call on every narc”. I mapquested the address he gave (didn’t exist) and called the phone number he gave us (sorry, wrong number). And of course, he came in at 6 pm on a Friday night. I couldn’t make the final verification of its phony-ness by calling dr (no answering service) but the conspicuous absence of anger when I refused to fill without verification it gave him away. I wrote on the hardcopy “pharmacy–verify with office before filling” but I am sure he had 10 more pristine copies at home to try passing. Unless I confirmed it was phony, I had to give it back when he asked, but I kept a copy for myself.

It gave the tech’s some excitement on this rather slow day.

I’ll find out its status for sure on monday–I faxed a copy to the real office. Boy won’t I be eating crow if its real..but I don’t think I will, because I don’t think it is!

Tags: customers, druggies, law | |

We have a urgent care clinic fairly near our pharmacy. For the most part, they write for the Blue-Plate special: antibiotics, pain meds and cough syrups. Its been open for less than a year. As every pharmacist knows, urgent care clinics can attract some seriously sketchy folks looking for a new ears to hear their sorry lies. Since its a pretty small operation, we can usually call and get the dr on the line if we need to “confer”. Today was such a day.

Mr. Clean-cut-nicely-dressed handed me a one of the clinic’s rx’s. Now, I can’t speak for all pharmacists but most of us have a pretty strong 6th sense when something doesn’t seem right. A dead giveaway for me was when he quickly (a little to quickly) announced “I’ve been here before and I am paying cash for these”. He had scripts for an NSAID and a C-II narcotic. I looked at his profile and the same pair of rx ’s has appeared from same clinic 3 additional times. We had insurance on file for him.

I decided to diss his request to “pay cash” and thought I’d run his insurance to see if my intuition was right on. The NSAID went thru fine….the C-II rejected: filled yesterday, someplace else. Intuition:1 Customer:0

Hmmmm Pharmacy Chick wondered if the Dr at the urgent care clinic was in on that bit of information, so we rung him up. Dr didn’t know (duh) and cancelled the C-II, which left me with the rather dicey duty of telling this guy that all he was going to get was the NSAID.

I decided to play it cool and called Mr Nicely dressed back over. My hands were a little shaky and it wasn’t the caffeine from my coffee. I told him that I saw we had insurance on file for him and wanted to save him money. I was hoping that he wouldn’t get pissy if he knew he was busted, but was spared embarassment. I explained that when the pain med rejected, we had to call the doctor for further advice, and in doing so, the Dr. cancelled the prescription. I could see his jaw tighten when I asked him if he had this drug filled yesterday, but he admitted to me that he had. (I wish I had a blood pressure and heart rate monitor on him–or me for that matter– right then).

He took the NSAID, and I highly doubt that neither Mrs Chick or the Dr. will be seeing him anytime soon.

You know, I didn’t take a lot of pleasure in doing this. In fact, there was a moment when I truly considered doing the easy thing and just filling it, knowing full well what he did yesterday. But I also know that I would be feeding a multi-headed monster, one head being his drug problem, and one head being my apathy at not doing the right thing. It would have been easy to rationalize: it was just 15 tabs, it WAS a legit script (until I called the office to confer), it would have been a decent profit on about $.50 cents worth of inventory, and I wouldn’t have to worry about getting my head ripped off. However, I would also be compromising my ethics, something I have always felt was was important in my practice. If I lose my ethical practice of pharmacy, I lose my credibility in my own mind. I would have sold out. I am not ready to sell out. I may not be popular with those “sketchy folks” ,and I might risk an unruly customer, but I will go to bed at night with a clean conscience.

So if you read this and nod your head and think “yea, I’ve been there”, I’d love to hear about it.

Tags: customers, ethics, law, 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 | |