The Pharmacy Chick

I was watching TV the other day and somehow wandered thru some post event interview with a race car driver.  The guy had patches from head to toe from companies who pay him to wear them: you know what I mean… endorsement contracts.  A million dollars to wear Viagra on his hat,  Valvoline on his sleeve, firestone on his other sleeve, and so on.  I’ll bet he doesn’t even know what the generic name is for Viagra and couldn’t tell you anything about the drug itself.

It got me thinking:  Why can’t I have endorsement contracts?  People come to me every day begging for recomendations for this and that and I dont get one plug nickel for any of them.  It would seem I would be the  perfect person for endorsements.  First off, I have this great white jacket with nothing on it but a name tag.  It could use some color and I have lots of room on it.  Second of all, I would actually know something about the products I am endorsing. Thirdly,  there is hardly a new or innovative item over the counter so with a few well placed endorsements, I could advise (and get paid for) some great recommendations. 

 I could have a Delsym contract, a Sudafed contract, and a Nature Made contract for all those vitamins I am asked about.  Nyquil and Sudafed could go to war over me getting the best patch placement on my jacket.  I could get a Tylenol, Aleve AND Motrin contract and Advil will get aced out because they didn’t bid high enough for the placket of my coat.

My own company would have to pay me big time to recommend the store brands ($ka-ching$) because we all know store brands are junk… until the endorsement comes in…

Honestly, I’d be picky so I wouldn’t cheat my consumers by recommending items I really don’t believe in, unless the bidding got really high.  I could find SOMETHING good in Harry’s Hangover Remedy if he paid me ten million dollars.  (sheesh, for 10 mil, I’d TATTOO Harry on my forehead!)

They could even put me on TV, which would be great because I wouldn’t have to say ” I am not a doctor but I play one on TV”  (like that lends credibility to the commercial?)  I could say “Hey I am a real pharmacist and this stuff is great!” “Buy it now!  I know what I am talking about”

I think I am on to something.

Tags: my mind wandering hopelessly lost, pharmacy life | |

Not doing much of anything on a slow sunday, Pharmacy Chick was eager to help anybody who wandered by the pharmacy.   This lady came up and wanted something to help her husband. He had just had hemorrhoid surgery 3 days prior and hadn’t had a bowel movement since leaving the hospital.  She had some Mag Citrate in her hands and wanted to know if it might help.  The hospital didn’t send him home with even so much as a stool softener (yea thanks on that one), and he still had 4 sore stitches to worry about.  Poor guy was miserable according to Wife.  After all, he had been eating normally for 3 days.

I made several suggestions, all of which contained the caveat “Make sure the doctor knows what you are doing”.  Leaving nothing to chance, she bought them ALL! Suppositories, Enemas, Stool softeners, Mag Citrate, you name it.

One way or the other, I hope they have more than one toilet at their house, cuz one of them will be occupied all night.

Tags: counseling, customer interactions, pharmacy life | |

 If you are a pharmacist and you have had the pleasure of filling prescriptions under some third party, you understand the nightmare of “days supply”.  Its a hot issue right now and one under which a third party payer can play “gotcha” and take their money back. Make it too short and risk an audit, make it too long and you may have to call for a refill-too-soon override.   Regardless, the Chick tries to be rather generous on the days supply of 3 groups of medication:  Insulin, eye drops and inhalers.  For obvious reasons, you cannot have a stock days supply on these groups of medications.   Some D plans seem to have decided that they can indeed desginate a hard and fast days supply on eye drops.

The Chick was doing her thing filling a Cosopt rx for a new D patient.  This woman fills this rx on a pretty regular basis, every 30-35 days.  When I fill this rx, my own computer assigns it a 50 day supply but I override it to 30 days.  I have all the documentation I need to support the days supply I transmit because of her past schedule.  I filled the Rx only to be given a “rejt-invalid days supply–plan limits exceeded” by the insurance.  At first I thought I had transmitted something wrong but after a check, I realized it wasn’t me at all. I had to call the insurance, something I REALLY dislike doing.

After being on hold for way too long I finally get their representative who wants me to verify all kinds of information (just to be sure I am not some identity thief I suppose) that I had already inputted before she finally came on the line. Name, DOB, Rx number, NPI, Cardholder ID, Favorite color..etc before she finally relented and asked me what I need.

I explain the problem with the eye drops and she drops this little bombshell on me: Her plan limits her to 1 bottle every 56 days. AND according to THEIR charts, it should last 60 days. What the hell?

So lets do the math.  If you have the perfect dropper you (in theory) can get 20 drops per ml. A 5 ml bottle of eye drops have 100 drops in the bottle. IF you use 1 drop in to each eye once daily, AND never miss the eye, and have perfect technique, you will get 50 days out of the bottle.   Ms Representative would have none of my arguments.  Plan limits might as well be scripture carved in stone.  She wasn’t getting this filled as a 30 day supply.  It was also clear that when she runs out in 35 days that she was going to have to pay cash or beg for a sample til her D plan coughs up another paid claim.

Personally, I suck at eye drops.  If I get 1 drop in 3 in successfully, I dance for joy and all is right in my world. Usually the job falls to Mr Chick, holding me down, prying my eye open and promising me jewelry if I will sit still. So, If Pharmacy Chick-Pharmacist extraordinare cannot get eye drops in properly, what makes this D plan think that they can legislate that some 65+ yr old retiree with glaucoma and shaky hands will successfully negotiate eye drop insertion 100+% of the time.

You see my point?  Well you are the only one because this scenario has repeated itself several times over already. One man purchases Travatan out of pocket every other refill for this reason. Another purchases her Lumigan every other time for the same reason.  Its unbelievably pathetic because I cannot help.

Its a sorry state.  To all those people screaming for socialized medicine:  Heres a taste of what you’ll get.  Granted, our system is flawed, grossly flawed, but please.  Put the government in charge of your health care and you might as well say goodbye to your freedom of choice…and apparently the ability to calculate days supply.

Oh, and better start practicing on your eye drops now,  you’ll need to be pretty good at it.

Tags: insurance rant, pharmacy life, third party | |

Some days are more interesting than others. I am used to being brought all sorts of things to look at, usually things ON the body: rashes, sores, cuts and scrapes, blisters and bug bites. This trumped them all.

I was working the counter one day when this lady approached the counter.  I had been a pharmacist for less than a year.  She had a jar in her hand but it looked empty.  She lifted the jar onto the counter and I noted that it contained several strands of hair.

Obviously distressed, she almost spat out “is this HEAD LICE?”.  I picked up the jar and confirmed  that yes, it was head lice (and a pretty nice case of it by the looks of it).  Was she satisfied with my affirmation of her suspicion? Apparently not because she said “Are you SURE?” as she began to unscrew the jar….

There was nothing more than instinct at work here honestly.  Before you could say ‘boo’ I had slapped my hand over hers and fiercely said “DO NOT OPEN THAT JAR!” 

Sheesh, as far as I was concerned, she might as well have had small pox in that jar because the last thing I needed was my own case of lice.  At the time the only solution was Kwell.  It was long before the OTC treatments were available.   Whomever owned those strands of hair was either going to the doctor or was getting a major hair cut.

She tried to leave the jar with me.  I made her take it with her.

____________________________________

I was reminded of this story when last week a gentleman came to my counter and wanted “clean” shampoo.  I had never heard any brand name called “Clean” and I told him that any shampoo would get his hair clean.  English was not his first language. As we worked thru this conversation, he made his intent evident.  “Dere are leetle animals in my hair…”  Allrighty Then, lets step over to the lice shampoo. :

Problem solved. I am confident that his leetle animals are gone by now.

Tags: pharmacy life, weird customer stories, why am I itching? | |

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 | |

Pharmacy chick logged in today to see that blogpharm as changed its format. Because I am a major techno-phobe, I dont appreciate having changes made to my computer stuff or my internet experience.  I mean, its taken me months just to figure out how to put a picture on my blog and now everything behind the scenes has moved.   Did anybody ask me?  They should have since I am one of only about 5 bloggers that use Blogpharm.  Harrrumph!  I cannot find squat on the composition pages.

I am the same way at the pharmacy.  Change some policy, some procedure, or move some of my stuff and expect some fall out.  Occasionally I won’t comply at all but don’t tell anybody about that.  Every evaluation I get has some comment about my “resistance to change”.  You’d think after 16 years they would give up.

Its been really bad lately in PC’s Pharmacy–We are being micromanaged to death.  Somebody at corporate is trying to justify his job. Every little movement is tracked, monitored, evaluated, then “improved”.  I suspect I couldn’t even pass gas without somebody offering a better way to do it. No longer is the end product the important issue, its all about the PROCESS–and uniformness.  After I unloaded a particular diatribe on the boss,  he exasperatedly asked “Why do you do this?”  I said.  ” I find it much more satisfying to complain than to comply without question. WHY do YOU keep doing this to ME? ”  ( it IS all about ME you know..heh heh) Lets put it this way: The sun rises in the east, sets in the west and the Chick hates change.   Except one.

Give me the winning lottery numbers and I’d be happy to CHANGE my employment status,  CHANGE my residence,  and make some major lifestyle CHANGES!

Til then, don’t mess with my stuff!

PC is checking out for a few days- time for some R&R with Mr Chick in the mountains, hence no computer, no posting, no email!

Tags: pharmacy life, ranting and feeling the squeeze | |

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 | |

One of the things Pharmacy Chick thinks is important is the presentation of the prescription given to the patient. I do not like wrinkled tape on the label, the labels crooked on the bottle, and I don’t like to have mispellings. I cannot tell you how many times I have sent a label back to be retyped because pain was spelled “apin” or THE was spelled “hte”. To me, having something spelled wrong tells my customers ” I do not care enough about this process to handle the details and do it right”

Therefore when I got (for the thousandth time) a prescription given to me with the prescribed drug spelled incorrectly, I had to shake my head. Care to guess which two drugs are mis-spelled most of all? Vicodin and Percocet. Give me a break! These two drugs are so common that even the most newly hired medical assistants should be able to spell them correctly.

So why then, do I still see Vicodan and Percoset? What does that say to the patient when the physician’s office gives him/her a drug that they seemingly cannot even spell right? Its not like we are having them spell Afluxihydrodoxyaminodinodab (don’t bother looking it up, you won’t find it). I have seen Vicodin spelled wrong so many times that “vicodan” starts to look normal…

There are times I wish I could just hand the script back to the patient. “There is no such drug”, but for obvious reasons I can’t do that. So I just decided to add it to my gripe list….and blog about it.

Tags: pharmacy life, rambling | |

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 | |

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 | |