Narcotics Like Candy...

I've had the opportunity to work in both a low income urban area and an affluent suburban area.  My first job as a pharmacist was in the urban area.  There, most of the population consisted of low income families on medicaid, old people on medicare, and a predominantly Spanish speaking population from Central America, South America, and the Caribbean.  There, I thought I dispensed a lot of narcotics, and controlled meds, but when I moved and got transferred to a mainly white suburban area, I was completely dumbfounded.

The amount of narcotics I dispensed in that pharmacy was ridiculous.  We had to have 3 safes there just to be able to lock up all that we had in stock.  I figured maybe the amphetamines would be the big seller since doctors nowadays love to throw around the diagnosis of ADHD to anyone that comes through the door.  But the percocets, oxycontins, and roxicodones were being passed out like candy.  People would come in with prescriptions for "chronic intractable pain" and getting quantities of 180 or more.  Seems like everyone and their mother had "chronic intractable pain."  And what was sad was to see young adults and college students come in with those scripts.

My feeling is that the doctors in the urban area seem to have a grip on their practice and are professional about their work and don't give in to what patients say.  They are firm in their belief that they know more than the patient and even though a patient says that they want an antibiotic, these doctors will say no because you are not suffering from any sort of bacterial infection.  In the suburbs, it seems like the patient has more control than the ones that went to medical school and devoted their life to medicine.  They think that just because they did a quick google search, they know what's best for them.  And unfortunately these doctors give in to them because they are quick to post on facebook, twitter, blogs, etc. on how dumb this doctor is because he or she said that they don't need to take XY drug.  And just because you are getting bad grades in school because you can't focus on your work because there is a frat party you'd rather go to or a round of Halo you want to play doesn't mean you need Adderall, it means you need to straighten out your priorities.  I'm all for being responsible for your own healthcare, but let decisions be made by the professionals.

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...

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!