28 August 2007

Rule 2: You May Not Return Your Prescription

I assume that this rule (just like I assume every other rule) need not be explained. Let me rephrase that: need not be explained to intelligent, coherent members of Jesus-loving America. I keep forgetting that the majority of the United States are are knuckle dragging mouth breathers.

A recent dialogue with a patient may more aptly represent Rule 2:

Patient: You filled my script incorrectly. I usually get (insert drug type A) and today I got (insert drug type B).
Me: (pantomiming shooting myself in the face) Let me check the hard copy.
I check the actual prescription, and find that good ol' MD did indeed write for drug A. I get back on the horn with Patient.
Me: Your doc wrote for drug A. That's what they want you to have.
Patient: Well, I want to have drug B. That's what they used to give me!
Me: We'll have to verify that with your doctor. We can't just dispense it without having a prescription for it first.
Patient: You can take back the other one and refund my money, right? I mean, since you filled it for the wrong drug?
Me (hemorrhaging internally): I just explained to you that we filled it for what your doctor wrote for. And no, we can't take that medication back once it leaves the pharmacy. That's the law.

I've had people threaten to get me fired, to take their prescription to another pharmacy, and demand me to get the store manager. All of these threats are irrelevant, boring and utterly empty. Do I give a shit about any of the above? No. No no no.

Here's the deal: Once a script leaves the physical confines of the pharmacy, it is illegal for the pharmacy to take it back and dispense it at a later time. Period. I don't care if it was Jesus himself that picked up the script and immediately deposited said script in a kryptonite lined safe. Still illegal.

The Problem
Some people think that buying an Rx is like buying a bag of chips. Pull your head out. Imagine if your pharmacy just took back everything that all those assholes brought back on a daily basis and dispensed it to the next person who walked in.

Me: Here's your Vicodin. By the way, I just got this from that staggering mess of a human being that you passed coming in. Yeah, the one that was simultaneously lighting a crack pipe and picking at her pressure ulcers. Impressed?

Allright, I'll admit it, that scenario is fairly improbable. No one returns Vicodin.

The Solution
Educate yourself about your medications and know what your doc is prescribing to you. Instead of just giving an impatient nod or 'no no' when I ask if you have any questions about your prescriptions, put down the cell phone and take a look at what your new Rx is for. Your life may depend on it.

26 August 2007

Weekend

What an awesome weekend. I made it my goal to not plan anything, to have no commitments whatsoever so that I would be able to pursue any novelty, no matter how self destructive.

Don'tworryaboutit decided to try out a new pickup line at JUD on Saturday night. He must have been working on this little gem for awhile. We were on the top floor, watching a band that was playing mostly cover music. They actually did 'Sober', which really surprised me, because everything else they covered was pretty up-beat. It also reminded me to sober up for the drive home. How serendipitous.

These two girls started asking me about my tattoos, so I was chatting with them and doing my best to resist my natural compulsion to drink all the beer in the place. About that time, Don'tworryaboutit approaches and sits down at the table next to one of the girls. He says a few things I can't hear, as he's across the table and we're right in front of the band. After a few minutes, he leans an bit closer and offers this little doosey to the girl he's sitting next to:

'So, am I going to score with you later or what?'

Now, in Don'tworryaboutit's defense, he was drunk as a lord and fatigued by a long day of sitting by the pool and drinking beer. If he had had one more drink, he might have been slurring enough so that his oral diarrhea would have been entirely unintelligible. He was about as lucid Whitney Houston on coke binge. He might as well have asked her if she wanted to help him fund a 'kill some kittens' drive. The look on her face could best be described as shocked disgust. I lost it and started laughing my ass off. Hey, it was funny.

Girl: 'What did he say to me? What the fuck did your friend just say to me?!?'
Me: 'I think he said he likes you. How about this band, huh?'

You just can't beat that.

24 August 2007

Death From Above

I was lucky enough to be out running today (I was done with pill counting by 2) while an F-14 was maneuvering at very low altitude over my neighborhood. It was an amazing and terrifying sight. We've all seen dozens of movies with fighter jets (although only 1 with Tom Cruise, sad) but they really don't do the real thing justice. I was most surprised by the sound. At one point it flew directly overhead and was (I'm estimating here) about a thousand feet up. The sound was what I can only describe as a new orifice being torn in the sky. It literally sounds like ripping fabric. LOUD. If that thing was after me, I would bend over and kiss it goodbye. Being the victim of an air strike would suck righteously.

People all over the neighborhood people were standing outside rubber necking. Everyone from the nice offices downtown to the crackhead apartments a few blocks away. I think some of the bums even forgot bout their 40s for a second or two. I almost ran into a store when I was downtown to see how much loot I could rip off. No one would have noticed.

20 August 2007

Posting

I like seeing the comments you're all leaving on my posts. However, I do ask that you don't write my name or any other personal identifiers within them. Do to the sensitive material I write on my site, I feel that this should be self explanatory. Any information that identifies me or gives clues to who I am could compromise my work situation. Even though I never include any confidential information or identify anyone in my posts, it's still a risk. With that, I hope you're all enjoying the blog.

I realize that all I've been writing about lately is work, but that seems like all I've been doing. You can only write about getting loaded at a bar and sitting by the pool all weekend so many times before it gets a little repetitive.

With that, more work gripes!

One of my techs called in sick today. Sweet. It's not like we need the help on Monday. The phone would never quit ringing and it seemed like everybody wanted their script yesterday.

An interaction with an insurance company:
Me: I'm calling because I have a patient here who contacted you about his copay. You told him that it should be much lower.
Insurance: Oh! Yes! His copay for this medication should be much lower! That's far too high.
*pause*
Me: No shit. That's why I called you. Are you going to fix it?

An interaction with a lady who gave me approximately 1/10th of a second to acknowledge her presence at the consultation window.
Lady: Hey! Hey! I have a question (she actually yelled 'hey' twice in rapid succession).
Me: Hay is for horses.
Lady: *glare*

I had at least 3 people call in to let me know that I'd filled their prescription incorrectly. It seems that everyone has a Pharm D these days.

Rule 1: Don't Ask Me About Your Copay

This is a cardinal sin of the pharmacy going public. Here's how the usual interaction goes as the patient is being rung up for their drugs:

Tech: OK, it's X dollars today for your prescription.
Patient X: Oh, no! That's not right. It's normally Y dollars.
Tech: We submitted it to the same insurance plan as last time. That's the copay your insurance company returned to us.
Patient: Oh, I see. I guess I'll stand here and bitch about it for 10 more minutes because, even though you told me that's the price my insurance company set, you're here in front of me now so I just assume it was you who set my copay.

OK, they don't actually say that, but that's just what they do. I can always hear the exchange even if I'm not at the register. If you look over at me, I'll be staring intently at my computer screen, but what's going on in my head is far different. It usually involves me delivering a flying dropkick over the counter to whoever happens to be complaining about their copay at that particular moment.

Now that I've described the scenario, here's a little more detail about how the problem arises:

The Assumption
The assumption (remember what assuming makes you?) by the patient is that the pharmacy determines their copay. This assumption is baseless and ignorant. When your pharmacy fills a prescription for you, they send a claim to your insurance company. Your insurance company in turn sends to us the amount they're reimbursing the pharmacy as well as the amount that you contribute. That's right, your copay. The bottom line being that I have about as much to do with your copay as I do that stupid look on your face.

The Reality
I don't know why your copay is what it is. Furthermore, I don't give a shit. Your insurance situation is as baffling to me as it is to you. You are confused, but you shouldn't be. Why? When you got your insurance plan, they sent to you via good ol' snail mail a large folder full of information about your prescription drug coverage and how your payments worked. What you did was promptly shove that information up your ass and forgot it ever existed. So, when you come to my pharmacy and expect me to know your insurance inside and out, I become a bit agitated.

Sick as it sounds, this is the reality. Even after you explain the situation, they just sit there and stare at you as if you'll suddenly say, 'Oh, well, if you're that persistent I guess I'll change the bill to a figure that's more satisfactory to you. Sorry for the trouble.' And perhaps add in a cute little dance routine to brighten up your day. Right.

How can you prevent me from desiring to perform a frontal lobotomy on you next time you come to my pharmacy? Inform yourself about your own health care and quit throwing a fit like a two year old when I tell you what your copay is. Your mother taught you manners at one point in your life (I know mine did) and I'm assuming you know how to use them.

13 August 2007

Premable

"Smokey, this is not 'Nam. This is bowling. There are rules."
-Walter Sobchak (The Big Lebowski)

Rules indeed. We must all live by rules. Rules separate us from the animals. Without them, society breaks down and civilization grinds to a halt. The rules we live by ensure the food you eat and the streets you walk are safe. It is in the spirit of rules that I introduce to you a series of many (many, so many) parts entitled:

Fear and Loathing in the Pharmacy: Chasing the Apothecary Dream.

After considering many ways to literate my daily grievances concerning pharmacy life, I've decided to post a series of articles outlining basic pharmacy etiquette. Rules of proper pharmacy behavior, if you will. No longer will I merely gripe about blunders of people that come into my little drug shoppe. I'm going to explain (in excruciating detail) what you are doing wrong, and how you can mend your boorish ways. By following these very simple and straightforward practices you can guarantee that your pharmacist will not hate you. They may even begin to like you.

Expect the first rule soon. I've already picked up many ideas like so much cannon fodder.

A little tidbit from today:

A Mom calls me. Mothers are ever so concerned about their children's welfare.

Mom: My son has ringworm. I want to know if a medication we picked up in Mexico can be used to treat it (she pronounces the name of the mexi-med, which I don't remember and don't much care to).
Me: Umm... That's a Mexican trade name that I don't know. Does it say anywhere on it what the ingredients are?
Mom: Uhh... Oh! Here it is. T-E-R-B-I-N-A...
Me(cutting her off, because I'm busy and don't feel like listening to a 5 minute spelling contest): That's terbinafine, the generic name for Lamisil, an antifungal, used to treat fungal infections.
Mom: Oh, so it's Lamisil? We can use it then, right?
Me: Where is the ringworm? How large is it?
Mom: It's by his eye, about the size of a quarter.
Me(pause): Does your son value his vision?

I hadn't meant to say that it. It just came out. Sometimes I cut to the chase to try and put things in perspective for people. Especially when they're going to put mexi-med on their son's face adjacent to a valuable part of the body such as the eye.

05 August 2007

Pharmacy Magic

I just put clean sheets on my bed. They smell GREAT.

This weekend at the pharmacy went pretty well over all. Saturday was smooth sailing the whole way, and I even managed to get the monthly CII count done on time. It wasn't until the last few hours of Sunday that everything got derailed and resembled a more 'normal' pharmacy experience.

Inside of me, where many people have a soul, imagine a expansive space occupied by many little men in white coats. They're all wearing round, black spectacles, black ties and shiny black shoes. They mill about with content looks on their faces set to various errands and tasks of great importance. They are competent and determined, knowing their place in the universe and fulfilling the requirements that they are there for. All except one. On the edge of the group, there is a solitary little man who seems distracted. He senses something is... awry. Little beads of sweat stand out on his forehead as he begins to snatch desperate glances here and there. Suddenly, as if a appearing out of nowhere, a minivan spewing black smoke and noxious odors is roaring down on him. It's full of crying, indigent babies and has faux wood paneling on the sides. The driver is a cackling, raving old hag that's lighting a cigarette and applying garish red lipstick at the same time. His colleagues cry out to him, but it's too late. The minivan runs him down and careens across the expanse to somewhere else unknown.

Today, the first incident occurred at drive through, and what I just described above is what happens inside of me every time that damn bell rings. The woman in the car states that she has 2 prescriptions to pick up. I find 2 scripts waiting for her, and notice that one of them has been filled for cash because her insurance company requires a prior authorization (PA) and won't pay for it until the PA has been completed.

PA situations deserve an entire explanation of their own. For now, just understand that what it means is that the insurance company won't pay for the medication until the patient's doctor provides the insurance company with some information. Understand that this process takes time. Understand that none of it has anything to do with the pharmacy save for the fact that we're the ones that get to inform the patient about the situation, and we're the ones that get shit on.

The handwriting on the paperwork is another pharmacist who sometimes works in my pharmacy. Shit. The odds that this pharmacist informed the lady about the PA situation is worse than my odds of digging up Hoffa in my back yard.

I inform the lady of the PA situation. She does not understand.

Lady: What the hell's the problem? My doctor called the prescription in!
Me: Yes, I know. What he hasn't done yet is complete the PA, so your insurance won't pay for it. You can still get it, but you'll have to pay out of pocket. It's $500.
Lady: Well, I'll just pay for it (she starts sticking a ten dollar bill into the pass-through).
Me: You don't understand. It's $500.
Lady: (going ballistic) What is this shit? Do you want me to commit suicide? I'll just go home and kill myself!

She proceeds to scream about killing herself right then and there for the supposed enjoyment of everyone within earshot. I give her a few days worth of her medication and tell her to call her doctor tomorrow to check on the status of the PA, hoping she'll leave and not take any bystanders with her.

The next scenario takes place as I'm closing the pharmacy. On the weekends, the pharmacy closes before the rest of the store closes, so people are still in the store when I'm shutting things down. As I'm closing, a woman approaches the counter and hands me a CII script for a pain medication. She tells me (not asks) that she'll wait for it.

Wait for what? My foot in her ass? Because that's what you get when you bring in a new prescription at closing time and expect it in 5 minutes. I ask her if she has any medication at home to get through until tomorrow, and she says no, but that it's really important that she get it tonight. I look at the date on the script and see that it's dated from Friday. Today is Sunday.

Let me tell you something:

Important is not showing up when your pharmacy is normally closed to get a medication that you think you need urgently. Important is not waiting 2 days after getting a new script to go and get it filled. Important is not waiting until you run out of medication, take the very last little pill, and THEN decide to go and get more. That is stupidity, and I do not appreciate it.

Her doctor also didn't help out. He wrote for a dosage form that doesn't exist and a dosing schedule that was inappropriate based on her previous usage of this drug. When it rains, it pours. Besides the fact that I was closed, I could have told her 'no happy pills today' because I had to fix her doctors boo boo before I could fill it. Of course, then she would have been without her pain meds all night and I would have been the bad guy.

So, I get her taken care of and am closing the gate when another idiot lurches up to the counter and says she needs to pick up a script. It's now 15 minutes after the pharmacy is closed as evidenced by the huge damn sign right in front that displays the hours of operation. The script is not there and I ask her if the doc was supposed to call it in. She hands me a bottle showing me what she needs. Christ. It's for Duradrin, a headache med that's been unavailable from the producer for weeks. I explain this to her, and she flips. Completely loses her shit. She claims that she called in a refill last week and that it should be ready. Apparently, to her, 'off the market' means that I'm hiding a private stash in back for her and will supply it if she screams loud enough.

After she stops bleating, I tell her that we'll need to get a new prescription from her doctor for another medication since this medication is no longer available. She says that she knows it's not available, she had to come to my pharmacy from her normal pharmacy last time because they were out of it. I almost short circuited. She had learned last time that her drug was in short supply and soon to be unavailable, but still somehow thought that if she came to my pharmacy that she could get it. What did she think I would do, pull some out of my ass? Sprinkle pixie dust and form some from thin air? WHAT THE FUCK?

That's how it goes, I guess. It's hard to end the weekend on a bad note like the end of today, because it sticks in your head. I feel better know that I've written it down, though. Now I'm going to play video games and drink until those memories are a blurry smudge.