Mandatory Mail Order...

This post is in response to something I found on the NCPA website.  Here is the link...

Mail Order Waste

Basically, it's a series of photos that pharmacists and patients took of their medications that were sent through mail order.  For whatever reason, be it the unfortunate death of a loved one or just simply the doctor saying that the medication was no longer needed, people received a 3 month supply of the drug in order to "save" money.  Therefore, many boxes and of unused medication pretty much goes in the trash.

For those of you not in the pharmacy profession, you are probably saying they should just send it back and get a refund or part of their money back.  However, the rule usually is, once a medication leaves the pharmacy and is paid for, if you return it for whatever reason, we are NOT allowed to resell that drug.  So if you bring it back to us, it's going in our trash.

These mandatory mail order programs and specialty drug mailings are marketed as a way to save the patient some money.  What it actually is doing is making more profit for the insurance companies.  They tell pharmacists like myself, who owns his own business, that we can't fill your medication, even if you prefer the hassle of walking or driving to your local pharmacy.  And for specialty medications, which normally are crazy expensive, can't be filled in my store, so I lose a potential $5000 check in my bank account.

I believe people should have a choice.  If your choice is to get your drugs through mail, then I'm not going to complain, just like I don't complain if you choose to go to Walmart to fill you scripts.  But the fact that it's mandatory and because it's insurance from your job, you don't really have a choice to switch insurances either.  I've talked to way too many former business owners that had to close their doors because of this.  It's a shame.  This is America, give the patient the freedom of choice!

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.

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!