Forget Pharmacy...

I think I've made the wrong decision on a career.  Don't get me wrong, I love what I do, but to be able to be paid for playing a game and get paid a lot more sounds awesome.

Recently, 2 major league baseball players were given contract extensions of massive proportions.  Here are the links to the stories:

Justin Verlander - $180 million
Buster Posey - $167 million

I've officially decided to have a male child and start training him early.  I myself will study how to make good investments and make sure my son will not make stupid decisions with his money.  And once he makes it, bye bye pharmacy.  I'll even give him a cool first name nickname like Chipper or Slim or Pokey (and yes, baseball players tend to have weird nicknames, point in case Oil Can Boyd).

But all kidding aside, congratulations to these ball players.  I definitely respect what you do and know that it takes years and years of sacrifice to achieve the skill to become a profession.  I tip my hat to you.

Smooth Operator...

I feel things can go much more smoothly in a pharmacy if the pharmacist can make a substitution without having to consult the doctors.  There have been talk of this before, but nothing has really gotten going.

What I'm referring to is when a patient brings in a prescription for Nasonex and their crappy insurance either doesn't cover it or requires a prior authorization.  In normal cases, a pharmacist would have to tell the patient  that they are sorry but their insurance isn't going to pay for the medication.  Then the patient gets angry and complains that they pay $9999 a month for this insurance and that it is impossible that they don't cover it.  Then we tell them that we have to call the doctor to get it changed.  We then call the office and get a nurse/receptionist that when I say "I'm calling from Blah Blah Pharmacy", I immediately get cut off and told "For refill requests you have to fax it, we don't give it over the phone".  Then I have to explain to this person that I'm not calling for a refill, I'm calling because a med is not covered.  I give them the information and the nurse repeats back to me "Ok, Lasix isn't covered", which I then have to correct them and spell it out.  Then I get told that the doctor is busy and that I will get a call back in either 10 minutes of 1 week (I exaggerate a little).  Then I have to turn to the patient and tell them we have to wait for the doctor to call back and that they have to leave and come back later.  Then I get cursed at when in actuality, this entire problem could have been avoided if the doctor used his or her brain and just prescribe something pretty much guaranteed to be paid for.

So I'm for the pharmacist being able to use their knowledge and make a substitution to fluticasone (Flonase).  See how quick and convenient that was for the patient, pharmacist, and doctor?  There is one doctor in the area where I work that I must give kudos to for his prescription writing.  When he writes for a brand that he knows there is an equivalent that has a generic he writes on the script "if not covered, may sub to any covered generic in same class".  So for example, he will write a script for Nexium and will put "may sub with generic PPI".  So, I'm able to switch to omeprazole or lansoprazole if need be.  What an outstanding idea!

Your thoughts?  Comment below...

Should Pharmacists Bill Insurances for Services?

Should pharmacists be able to bill insurances for services they perform?  I think that they should.  Pharmacists aren't just pill pushers who are like robots where all they do is count to 30 and stick a label on the bottle.  We are more than that.  The schooling we go through is pretty intense.  We don't just learn about the drugs and how it affects the body, they make us learn about the disease it treats and how to disease manifests.  We learn the tests that need to be done to diagnose them.  We also learn how to treat certain things both pharmacologically and non-pharmacologically.

Yes, I understand we don't learn how to do certain procedures, like drain an abscess and suture a wound, but for many common things, we are just as knowledgeable as the common doctor.  When I've gone to my primary doctor and I look at the breakdown of the bill, I see that I get charged for pretty much everything.  Some doctors just bill an overall "physical" for a flat fee, but others itemize it and break down the individual procedures.  Blood pressure check, $X.  Temperature check, $X, etc.  People often bypass going to the doctor's and come to the pharmacist to see if he or she can recommend something to them.

In my school, we were taught how to do these basic things, blood pressure, blood sugar, mini mental status exam, reflexes, diabetic neuropathy, etc.  Pharmacies don't offer these services because we don't get reimbursed for them.  As an independent pharmacist, I would be willing to offer these services in order to get people in my door an away from the chains.  They take enough business as it is with them being "preferred" pharmacies, offering $4 90 day supplies, and mandatory mail order.  Vaccinations is a great first step for people to realize that pharmacists are more than just a person with a spatula and an empty bottle.

Zombie Pharmacists

Those of you not in the industry may not know the hours of a typical pharmacist.  For those of you in it, I feel for you.  Pharmacists sometime are walking, talking, counting, typing zombies.

Well, the average chain pharmacy is open from 8 in the morning until 10 at night.  That's a full 14 hours.  I say full because the majority of pharmacists don't have the luxury of taking a couple of 15 minute breaks and a 30 minute lunch because it is just too busy.   And god forbid we do decide to tell a customer that it will be ready in 30 minutes because the pharmacist is taking his or her lunch.  We all know too well that that will be the customer to call the 800 number and complain to the higher ups and then we get written up.

I used to work in a pharmacy in an urban area because I grew up not too far from there.  When I became a pharmacist and finally had some money, I moved to the suburbs to get away from the city life.  So my commute is about 30 minutes if there is no traffic.  However, I happen to work at a pharmacy that is close to the Lincoln Tunnel, Holland Tunnel, and George Washington Bridge, so my commute is more like 45 minutes to an hour depending on the day.  So my day actually starts at about 6:30 and usually ends at around 11:30. I remember one week, my partner had first had to attend a funeral and wake and then at the same time had gotten really sick, so since there was no one the district manager had to replace, I had to bite the bullet and work 6 days in a row.  So that was five 14 hour shifts and one 8 hour shift.  If you were one of my customers that week and I growled at you or dropped an f-bomb or two, my bad.

I myself used to work these hours at a store that did about 600 scripts a day.  I, like most pharmacists, have made mistakes.  It's tough juggling both being as accurate as possible with each and every prescriptions and churning out the 600 plus scripts I need to fill in what the corporation deems a "timely manner."  Not going to lie, but our definitions of a timely manner differ quite a bit.

I used to be the type of person that had a zest for working in a busy store.  Then I came to an important realization that Joe Schmo working at the pharmacy in Nowhere, USA fills about fills about 100 scripts per week and get paid just about the same as I do.  Also, when the annual review comes around, he gets a raise for being about to satisfy his 100 total customers, whereas I didn't receive a raise because my drive thru time was 5.6 seconds instead of 5.0.  So I got fed up and decided to go to greener pastures.

I know there are studies out there that show a correlation between how many hours in a shift and mistakes.  Why do most big chains ignore these studies?  Why is the public not demanding those that make pharmacists work 14 hours change their policy?  If their in existence to help their patients manage their medicine and improve overall health, then shouldn't their goal be to minimize errors?  But, unfortunately, they are in existence to please their stockholders and increase their overall wallets.  So the world of pharmacist zombies will continue.

Things I hate hearing

Here are some things I have hearing as a pharmacist, so if you're my customer and you say any one of these, don't be surprised when I jump over the counter and pump your belly full of potassium pills (and try to stab you with my blunt spatula).

1.  My copay is $3.50?!?!  Why so much?!?!

2.  Why isn't the insurance paying for it, didn't the doctor write that I needed it?

3.  I'm allergic to that, it made my stomach hurt

4.  15 minutes?  But the medicine is made already, you just have to put a label on it

5.  Too soon? Oh i lost my pills/my roommate took them/they fell in the sink/etc.

6.  Why do you need my ID for Sudafed, Walgreens doesn't ask for it

7.  What aisle can I find the milk?

8.  How much is amoxicillin?  Ok, can I have it?  Wait, your saying you need a prescription?

9.  Why do I even have insurance?

10.  (Phone call) I have a prescription in my hand, can I tell you what it says and you have it ready?  I will be there in 5 minutes

I'm sure there are a lot more.  What makes you all heated?  Leave it in the comments

Seriously?!

So this happened to me the other day. It was just a regular day and the pharmacy, people coming in, thousands of phone calls, my stomach growling, you know, the usual. Then the most unusual character comes up to the consultation area.

I call him unusual because he was dressed in shorts, tshirt, and flip flops. It’s still winter and he looks like he’s ready for the beach. He’s got a plastic bag in his one hand and reaches out his other to shake mine. I shake because I don’t want to leave him hanging and we begin our conversation.

Customer: “I was wondering if you could help me with something and ask you a question”

Me: “Sure, ask me two if you’d like”

Customer: “My girl took a pregnancy test and I was wondering if you could tell me about it”

Me: “Tell you something about it, well, what it does is read the hormone levels in her urine and lets her know if she’s pregnant”

C: “No, I know all that”
Then he reaches into the bag he was carrying and pulls out the freaking stick. He then tries to hand it to me.
C: “Does this mean she’s pregnant”

After taking a step back out of disgust, I look and tell him that yes, she is pregnant. I chose my words wisely, and didn’t say congratulations because judging by the look on his face, he definitely was not expecting this.

So he leaves and during some down time, I remembered he shook my hand and handles the test with the same one. After throwing up in my mouth a little, I quickly pump about half the hand sanitzer in my hand and proceed to clean.

Seriously?! Some people just don’t have proper brain function.

When calling in a prescription...

To all the doctors, nurses, dentists, PAs, or whoever calls in a prescription to a pharmacy:  please follow these guidelines and your relationship with your pharmacist will be much better.

First complaint I always hear from all of my fellow pharmers is that people need to slow down!  I’m not sure if you realize this, but the words that are coming out of your mouth need to be written down and all I have is a pen and paper.  Don’t start rambling without any pauses because I can’t keep up.

Spell out the name of the patient and doctor and give us the DOB.  That last name might be common place in your place of origin but I don’t always know where that silent H goes.  And you might be the only Dr. Patel in your neighborhood, but my computer says there are over 500 of you, so please specify with your first name, DEA number, or NPI.  And lastly, little old Maria Rodriguez from Main Street may be your only Maria Rodriguez that goes to your office, but I have 18 different Maria’s in my system, so give me the patient’s DOB.

Please give me quantity and directions.  You guys might be able to get away without giving insurance companies exact details on what you do, but if you prescribe Coumadin #100 with direction as “Use as directed” I’m going to tell you to please give me the EXACT directions.  Because if I get audited, that money I just made off the prescription is going to be taken right back.  Same goes for insulin, prednisone, etc.

Please don’t call the prescription in and tell the patient that the pharmacist will have it ready in 10 minutes.  You are not at my store and you don’t know my current workload.  And also don’t give a price to people when you clearly don’t know how much it cost.

It’s also frustrating how many of prescribers are not familiar with the laws of guidelines that entail prescriptions.  No you cannot phone in a CII, you can only phone in a 3 day supply and must mail the prescription immediately or you will be reported to the DEA.  No you cannot give more than a 6 month supply of any controlled medication.  And no I cannot make an exception for you, it’s my license on the line. 

I don’t think I’m asking for anything that’s not close to common sense.  But, all in all, if you are nice and personable to me, you will get the same in return and maybe I will overlook the mistakes you make and not get as frustrated.

Wonderful Customers...

First off, I would like to say that 85% of the people that come in and drop off and pick up prescriptions are fine and dandy.  I appreciate them and look forward to seeing the frequent flyers once a month (or sometimes once a week for some).  But there are about 15% of you out there that just amaze me.

I admit, there are times when I can’t understand the crap that your doctor has written on the prescription.  Most of the time, I can look at the first letter, the strength, and directions and decipher it.  But when I need more help than that, I usually ask the patient “What did you go to the doctor for?”  If you tell me I went because I have a cold, my brain works and focuses on antibiotics and cough suppressants   There are way too many times when I ask that simple question and the answer I get is “I dunno.”  Or “What did the doctor tell you?”  And they respond, “Nothing…I dunno.”  So your basically telling me that you went to the doctor just to go, he gives you a medicine that you have to ingest that affects your body and possibly changes your internal chemistry and you didn’t bother to say, “Hey Doc, what are you going to give me?” or “How will this help my _____?”  No, you come to the pharmacy to fill it and when I tell you it won’t be ready in 5 minutes because I can’t understand what’s written you complain that I don’t know how to do my job.  Ugh.

Please carry your insurance cards with you.  And no, the card you give to the dentist and the doctor is not always the same card that I need.  And for the senior citizens, your Medicare Part B card (red, white, and blue card) is not your prescription insurance.  And if your copay is $1 to $15 dollars, don’t complain.  Your one of the lucky ones.  You may not know this but there are drugs where for 1 bottle the cost is over $4,000.  So your $15 copay doesn’t look so bad. 

Your insurance doesn’t cover everything.  There will be times when a med needs a prior authorization or non-formulary.  You would probably say “But the doctor wrote it so it has to be covered.”  Well, the reason for it is because that prescription for the brand new brand name medication the doc wrote for has a cheaper cousin that does the same exact job and works equally as well for a fraction of the cost.  The only reason that doctor actually wrote for the medication is because he was probably enamored by the blonde pharm sales rep that stopped by his office and gave him some donuts.  Trust me, that is the reason why.  You may wonder, “Why do I have to use the cheaper ones?”  Well, what people don’t realize is that the more generics you use, the lower the cost of healthcare becomes.  It’s simple math, if your insurance has to pay out an average of $700 a prescription to a pharmacy, then they have to charge you a higher monthly rate than if they pay pharmacies $10 a prescription.  

There are many more stories, but my hands are cramping, so I’m sure there will be a part two.

Feel free to leave your comments!