Wow - Life Hit Hard

Wow - for all 4 of my followers who may or may not be wondering where I've been, it all started with inventory for the end of our fiscal year, and has just snowballed from there, ending this past Tuesday with a funeral of a family member, 9 hours away from our little town.

So I have more than enough to blog about, from our Express Scripts contract and the Humana contract, and many other things.  I just need about two weeks of sensory depravation to recuperate and rest up from the things life has thrown at me since August 31.  I am thoroughly exhausted to the bone.

But I do want to give a shout-out to PharmStat, a pharmacy staffing company.  Were it not for them, I would have been unable to attend the funeral at such short notice, especially considering that I live in the middle of nowhere and would have NEVER been able to find a relief pharmacist on my own, with such short notice.  They are expensive but entirely worth it. 

I'll be back at it soon enough - nice thing about retail pharmacy - there are always things to bitch about!

     --T.Ph.RPh.

Trying not to hate on the Stupid patients...

But some days it is really, really hard not to.  It's almost as if there is an invisible "Stupid" energy force in the universe, and it's like it has its own gravitational pull that starts in the pharmacy and pulls them in...like a pharmacy black hole, sucking in all the Stupid it can find.  Once it starts in a day, it keeps rolling downhill, picking up speed, rolling up everything Stupid in its path like a Stupid Snowball from Hell.

Don't get me wrong, I have lots of patients that I just love, and I have been able to train most of my patients to call their refills in early, bring their bottles with them "just in case," etc.  I've even had a few of them stop by this morning. 

But, unfortunately, Stupid has reared its ugly head - a patient and an insurance rejection, I'm a tech down, I have a mild stomach bug, which is trying to trigger a migraine, I'm afraid it's going to be a struggle against Stupid all day, and my patience is non-existent already.  I'm only an hour and a half into my day.  I just hope I can hang on to what's left of the patience with what's left of my fingernails, not alienate anyone today, and not verbally pop off and actually call someone an idiot to their face.

Have you noticed that Stupid also goes hand-in-hand with supreme neediness?  The energy-sucking, needy, time-wasting idiots that must speak to the pharmacist and then proceed to ask what isle something is on?  That just openly revel in your attention, and ask all kinds of Stupid questions (and yes, there is such a thing, sorry to inform you!) just to keep you out front fawning over them?  Almost like a very sick, Stupid pharmacist stalker?  When I first got out of school, I thought it was kinda nice, until you learn that you are actually enabling a sick addiction.

Don't get me wrong, again.  I love to answer questions and share my knowledge with patients.  Patients who want to learn and do something better with their lives.  Not people who pull up to the pharmacy and sit in their cars until they think of something clever to ask the pharmacist, just so they can feel important.  I know it sounds mean and elitist and snotty, but I'm not here to make someone feel important.

I also understand the impact we as pharmacists can have on people's lives, so I don't mean to downplay patient interaction.  I also don't mean to downplay the compassionate side of things - I know that many of these people who are chronically ill and older may only interact with people of the health-care profession.  Many, many times we are their only social contact with the world.  So I do see that side, and have great empathy and compassion for people in that situation - I've been in that situation myself and it's a horrible place to be.

So, that would be the reason I don't call people idiots to their face and physically toss them out of the store, and spend the time out front with them, with a smile on my face and invite them back or to call with any additional questions, knowing I'll be on the phone within five minutes of their getting home, answering yet another Stupid question they thought of on the way.

But by the same token, especially when it is really Stupid, Stupid takes my valuable time away from my patients who really have a legitimate medical question and need.  Stupid also takes my time away from doing Stupid paperwork and Stupid governmental regulation-type tasks.

Most days I handle Stupid quite well.  But it's days like today when events conspire, Jupiter aligns with Mars, and the swirling pharmacy black-hole pulls Stupid into my orbit that I just hate having to be at work.

Wish me luck!  Share your Stupid stories below, so we know we're not alone, and so we can have a laugh!  I know I certainly need it!

     --T.Ph.RPh.

Thinking about what makes chains successful....

And I'm not thinking about their cut-throat, back-stabbing, loss-prevention-paranoid Zoot Suits, and other nefarious characteristics we all hate.  Nor is it their misguided sense that "convenience" and a drive-through equates awesome customer service in and of itself.  Nor is it their ability to buy en-masse, and shaft everyone else with a $4 list, and play loss-leader games.  Quite frankly, only the last item on that list helps them.  The patients hate the others as much as their employees do.

As much as I hate to admit to it, there are benefits to working for a chain store that have to do with more than mind-boggling sign-on bonuses and high salaries, or a (false) sense of job security.  That helps, but I started thinking about why, even though I had the choice to work at independents, and if I looked hard enough, could even find one that provided benefits, why did I always seem to end up back at a chain?  Especially after vowing each time I left one, no matter how decent of a store and upper management I had (and I had a couple that were awesome stores/regions), that I WAS NEVER GOING BACK TO THE BALL-AND-CHAIN WORLD.

Seriously - after the Humana contract addendum I read yesterday, I really started thinking.  What aspect of the big box makes them so successful?  Why are they able to keep stores open?  How do they pack people in that absolutely hate to do business there?  But most of all, how do they convince even the smartest of us pharmacists, who know better, to come to work for them?

I think it boils down to this.  You aren't the only one in the boat.  You aren't the only one with an oar.  If you sink, you're not going alone.  Plus, with their resources at your back, unless you just really fuck up or, gasp, rock that boat (DrugMonkey!!!  You bad, bad Monkey!!), you're gonna be ok.  And that is a comforting place to be, no matter how much crap from all sides you have to put up with.

We're herd animals, folks, and there is safety in numbers.  There is strength in numbers.  There is camaflouge in numbers - somewhere to hide, someone else to blame.  Yeah, that weak little zebra on the Savannah may have been taken down by the big bad predatory lion king, but we avert our gaze, don't make eye contact, and convince ourselves they weren't keeping up anyway, or were threatening the safety of the herd by their actions, and now that blood is spilled, we're at least all safe for a while longer.

It's much more difficult when you're stuck out there on your own, especially if you aren't in a town near anything or anyone - colleague-wise - or if you are in town that (sadly) has hostilities between the independents.  You can come to feel completely over-whelmed, alone, and abandonded by your colleagues, especially if, like myself, you never really were a social person outside of your store.

But we are all in this together, and it is only together that we will be able to turn our profession around.  As isolated as I am, and as little time as I have for myself, I have been struggling with what I can do to help, and blogging is about all I've been able to come up with.  But we can't just bitch about things, although it is cathartic, and helpful in that it can identify problems that we all share, and keeps us from feeling isolated.  But in order to fix this, we must, must, provide solid, do-able solutions, for the short and the long term.  And we ALL must take part in implementing them.

Speaking not feeling so isolated, how about some pity comments?  DrugMonkey, thanks for posting my link to the Humana addendum (thanks, I think).  My views went from 165 in about three weeks, to currently 1065 (HOLY TRAFFIC, BATMAN!) with his link post, but NOT A SINGLE PERSON COMMENTED.  Be careful what you wish for, right?  But a little feedback would be nice.  I cannot believe that not a single person out of that thousand had a thought to share about what Humana is about to do.  No "thank you for the heads up" or "wow, you stupid idiot...can't you interpret contracts?  That's not what that means."  Nada.  Nothing. 

No anger at Humana for dictating to us how we should run our stores - we all have different circumstances, and they have no right telling a store filling 500 an hour that they should be able to have a prescription ready in 20 minutes.  Sure, most of us do have them ready in 20 minutes (if management doesn't "encourage" you to sit on them while people shop), and most of us would never think about allowing a patient to go even 12 hours without a badly needed medication because we couldn't order it in "a timely manner."  Am I the only one who is outraged by this?  If so, someone please nicely tell me why I am wrong to be outraged by this.  I really would like to know.

But, before I digress....(if you've been following me, all two of you, hopefully that'll give you a chuckle.  For those who haven't, that seems to be my current fav phrase.)

Back to my point.

We have got to start having each other's backs.  We have got to start standing up for one another.  SHAME ON ALL OF DRUGMONKEY'S FELLOW EMPLOYEES WHO DIDN'T SPEAK UP WHILE THE BULLSHIT WAS GOING DOWN.  SHAME, SHAME, SHAME ON YOU!!!  YOU SHOULD HAVE BEEN ON THE PHONE, CALLING IN THE OFF-DUTY EMPLOYEES, THE RADIO STATIONS, THE TV STATIONS, FOX NEWS, THE LOCAL NEWS' I-TEAM...ANYONE AND EVERYONE WHO WOULD HAVE LISTENED!!!!!  You should have stood shoulder-to-shoulder with him, and just stared the Zoot Suits in the face.  You should have picketted outside the store on your breaks and off hours.  We all should be inundating Rite Aid's email and snail mail and Facebook and Websites with our outrage for this.

We have got to stand together and help one another.  Pharmacy has disgracefully slid from being the most trusted profession - a place that we proudly held for at least a decade.  I was proud of us during that time, but I knew if the direction pharmacy was heading wasn't stopped, that would soon go the way of the dodo, and sure enough, it did.

Folks, participate and be active with your buying groups.  If you are not successful, they are not successful, so they are there for you, and they want you to succeed.  Probably the last few people on the planet that wants you to succeed.  Help them help you.  My buying group is tiny but wonderful and provides wonderful support, but due to my location, I am the only one in my state in the buying group, and the group is out of Oklahoma, and they have had a huge fight on their hands, and may not be able to keep up with it all.  Fact is, none of us can keep up with wading through mountains of paper contracts, while also being a pharmacist, alone.  We must band together and help each other.  Nominate each pharmacist in the buying group to read a different contract and then share information.  This will work for all kinds of different tasks we do each day.

If you're getting a great price from a wholesaler, communicate with your buying group.  Found a great secondary wholesaler?  Share with your buying group.  Find a great source for laser cartridges or other supplies?  Share with your buying group.  Find a great source for labels or bottles?  Share with your buying group.  In all likelyhood, they can negotiate an even better price for the entire group!

Reach out.  It's painful for the incredibly antisocial Phrustrated Pharmacist, and if you read my post So, How Are You Feeling Today?, you'll see I've become more and more antisocial the longer I've been at this job.  I hate being on the phone.  But I'm doing it.  And if I can do it, so can you.

Gotta go - I could go on forever about this!  But I won't...

     --T.Ph.RPh.

Hate days like this -

Found out I lost one of my favorite sweet old men last night.  He passed away - he had only been out at the nursing home for about a week - not even long enough for me to get out there and check his chart, and pop in his room. 

Then saw my wonderful elderly neighbor in the store today, who has recently been diagnosed with Alzheimer's, and was shocked at how fast she has gone downhill. 

I don't need to lose any of my favorite patients - they tend to be replaced by Mr. Joe Public, and we all know how he behaves.

  --T.(sad)Ph.RPh.

The New Humana Addendum Exhibit C: I Moved to Independent to Get Away from this Shit!

Well, going through my Monday, which started out like any typical Monday, I begin fulfilling my PIC duties.  Such as reading the new Humana Retail Contract Addendum I received on August 7th.  Yes, I really read these things.  You never know when they are going to stick two sentences in these "addendums" (I call them "Audit Set-Ups") that will result in your pharmacy losing thousands at an audit.  And being an Independent store, I no longer have the legal eagles at the chains to keep me informed of these assinine little changes...I do miss that aspect of working for a chain.

Have any of you have read the addendum?  Specifically, Attachment 1, Exhibit C????  I suggest  you review it.  My blood pressure shot up about a gazillion points when I did.  As a matter of fact, I haven't even finished reading.  That's how high my BP is right now.  I'm about to hyperventilate.  I left the chains to get away from metric bullshit like this.  One of the main reasons I left.  Other than an older gentleman pharmacist getting harrassed by the Zoot Suits (my name for the Security Suits) for having his water back in the pharmacy without stickers on all of the bottles (the man did go through the bottled water).  The man has the keys to the narcotic cabinet, but they are apparently worried he is going to steal a case of water.  Gah!

They regularly harrassed me, but whatever.  Never made much difference, and I'd come right back at them if I felt justified.  Petty, stupid stuff.  And when my stores performed, as they always did, harrasment tapered off and I was left alone to be successful, the way it should be done (from 10% to 20% profitability increase, within six months at the helm - at five different employers, by the way, kinda a pattern for me - is hard to argue with, even when it isn't done the "corporate way").  And regardless of whether or not they are trying to coerce someone to quit, that kind of game was not allowed in my store - DO NOT MESS WITH MY STAFF - employers or impatient patients, back off!  Just man up and fire him....ah, but there's the rub.  If that happens, they have to pay a severence package.  And I called the Zoot Suit on it and pissed him off.  But they started finally leaving him alone...at my store, anyway.  And for those who might care, he eventually did bow down to the pressure.  They quit putting him at my store where I could stick up for him.

But, I digress (yes, that is my favorite phrase).

Back to the addendum...

Humana is introducing "Participating Pharmacy Service Standards."  Maybe it's been in the contracts for a while, and my being a lazy corporate RPh, didn't realize it.  But here it is. 

They are now telling me how quickly they expect me to fill prescriptions.  WTF???  I quote:  "If the prescription cannot be filled within twenty (20) minutes, the Member must be informed when the prescription will be available."

It takes at least 20 minutes for the electronically prescribed Rx to arrive in my computer system.  Being in a small town, even when the clinic informs patients it will be 45 minutes before the pharmacy will have their rx ready, they still show up over here in 10 minutes or less.  In bigger cities, the electronic script services may save time, but here, they could individually walk the rxs over faster.  I hate e-scripts, by the way.  Errors, and expense.  Again, I digress...

And here's this one -

"Participating Pharmacies' personnel shall not make any negative comments with regard to an individual's insurance company, prescription drug benefit, physician, or other persons associated with providing the individual's health care."

I'm sorry, when they are in here complaining about mail order, and I'm GIVING them medication to tide them over, I'm not gonna keep my mouth shut about temperature extremes not being good for medication, missing doses not being good for the patient, etc.  Sorry.  I guess I'll have to refine how I present the information...but wait, that would be playing their game.  Hmm...quandry...

Of course, on a normal day, my Rxs are ready in minutes.  Which is one reason people stay here.  But there are days, and certain times of each day, where things take longer.  Who are you to dictate best practices to me?  I can bet I have been in this industry longer than the people who came up with this crap.

They are also dictating the length of time it will take to order a drug for stock.  One business day. 

That's not the issue...here comes the issue, and I take exception to the wording:

"...the prescription will be transferred to another Participating Pharmacy that is able to timely dispense the medication as required."

They are also requiring the pharmacy to provide a 48 to 72 hour supply of medication, apparently at their own expense, in the event the eligibility of the indivudual or the coverage of the product cannot be obtained..."subject to Pharmacist's professional judgement."  Nice caveat there, thanks.

They are now requiring access to an on-call Pharmacist telephone support 24 hours per day, 7 days a week, with the pharmacist to return calls within 30 minutes of notification!!!!!  I am the only pharmacist in an extremely rural area, the only pharmacist for 35 miles in one direction, and over 50 in the other.  Am I to be on-call for my entire life?  Oh, hell no.  Might be different if I had a partner here, but I don't.  And to deny their patient members access to a quality pharmacy simply because they cannot comply with this measure is illegal at best.

They require the pharmacy to report any serious adverse event to the FDA or the pharmaceutical manufacturer within 24 hours of patient report or notification.

I am also now required to have a back-order monitoring system that can track and provide ADVANCE NOTIFICATION for potential stock shortages or outages for products.  Um, much of the time, the only "advance notice" I receive is not getting it in the order. 

We then must also be able to provide a report containing a list of all impacted drugs, at the NDC level, the manufacturer's distribution status and the manufacturer's target release date.  We must also have an inventory system to track its daily on-hand product balance. 

This type of addendum is yet another tool to chip away at the independent drug stores' ability to provide services to its community, and to direct business to their mail-order companies.  This is such a huge conflict of interest issue.  I do not know how they can get away with this, except that WE SIGN IT AND TAKE IT.

I am going to appeal the on-call portion.  I thought I had a rural contract, and perhaps I do.  But even in smaller non-rural areas, this provision will kill a pharmacy, even a chain store.  Wouldn't you rather your members have access to 40 hours of care, rather than none at all?

How did we allow this to get this far?

I don't so much have an issue with any of these policies (ok, I have a MAJOR issue with the on-call crap).  My policies are as strict or stricter (and I can't remember a month when I didn't come up to the store after hours, sometimes several times, with no requirement).  My issue is for an insurance company being allowed to dictate to me how to run my business.  I am (was?) an autonomous professional, with awesome, mad, business skills in addition to my pharmacy knowledge.  On a level playing field, capitalism works.  On a level playing field.  The people will chose what is right for their lives and lifestyle, and if the competition doesn't keep up, their businesses will suffer.  On a level playing field. 

But the deck is stacked against the independent retail pharmacy.  Has been for some time, and the stack just gets taller and taller.  The playing field is broken, rough, un-navigable ground.  I hate legislation, but I see no alternative.

GIVE ME THE SAME RULES AND OPPORTUNITY, AND I WILL SUCEED OVER YOUR MAIL-ORDER, CHAIN-STORE FACTORIES EACH AND EVERY TIME, WITHOUT FAIL.

We've done it with the odds being stacked against us, so they damn well know we can do it, which is why they stack the deck. 

Question is, when are we going to level the playing field?  How are we going to level it?  We must take a hard, hard look at these two questions, and implement the answers soon, or pharmacy, even as we unfortuanetly know it today, will disappear forever.

And that, my friends, makes me sad and tired.  As a child, there was nothing great about being sick, except missing school and the visit to the pharmacist, who always made me feel special, and gave me a sucker.  I eventually went to work for this man, and he set me on my current path.  I aspired to be him, only to find a totally different world of pharmacy awaiting by the time I graduated.  I've been sad, sad to my core, since I graduated from pharmacy school.  It's been a long career.  Something must change soon.  But I feel as if I won't last to see that change, because as soon as the opportunity presents itself, I will soon be in a position to escape.

Thanks for listening.

Have any of you seen this addendum?  How do you plan to manage? Any ideas on how to take this raging bull by the horns and turn our profession around?

I'd love to hear some ideas!

    -- T.Ph.RPh.

P.S.  There's more!  I forgot I marked some other important issues in this addendum.  This is an important addendum, and I am worried that many independents, especially those in buying groups or that participate in contract plans will miss these important additions/changes.

For those owned by Boards, or multiple partners:


All managers, officers, and directors responsible for the administration or delivery of Part D benefits are now required "to sign an conflict of interest statemnet, attestation, or certification at the time of hire and annually thereafter certifying that the manager, officer, or director is free from any conflict of interest in administering or delivering Medicare Part D benefits or services, and adopt and follow a code of conduct particular to its organization that reflects a commitment to detercting, correcting, and preventing fraud, waste, and abuse in the administration or delivery of Medicare Part D benefits."  This would include Board members and managing officers if the pharmacy is not owned by an individual pharmacist, and would also include any managers they may have hired, along with high level staff.

This one is important to me, as we serve a very wide, rural area, and were about to branch out into a nearby (i.e. almost 30 miles away) town with no pharmacy for 30+ miles in any direction, plus we mail to some of our elderly who live in the country, especially in the wintertime, as they have a hard time making into town on the ice:

Home Delivery does not include mail order delivery through the USPS, FedEx, or UPS, or other mail service carrier.  Mail order is strictly prohibited under this Agreement.  Provider agrees that neither Humana nor Member shall be charged any additional fees or delivery charges for Home Delivery.  Provider agrees that Home Delivery greater than 30% of total prescriptions to Members is prohibited.
Oh, but it's ok for them to not only mail things, but to have a huge mail-order business, and then prohibit anyone else from using the mail.

Here's something that is exactly backwards from what I was taught in Pharmacy Law:

In the event of a conflict between federal and state law, the parties agree that federal law shall govern in terms of Medicare lines of business and for Members who are beneficiaries in employer sponsered emplyee welfare benefit plans.

I was taught that the stricter of two laws was the law to apply.  This states otherwise.  I can understand, partly, the Medicare, as it is a federal program, but the employer sponsered employee welfare benefit plans?  Is the welfare system not state-run?  Or am I missing something here?

THIS IS AN IMPORTANT ADDENDUM.  PLEASE DO NOT OVERLOOK THIS!

We Are NOT A Bank....

SERIOUSLY.  I am SERIOUSLY sick of people asking if they can make payments.  Don't get me wrong.  I understand how expensive medication is.  But we aren't allowed to make payments when we purchase from our wholesalers, and if everyone made payments (like that would happen consistently - otherwise you wouldn't have to ask if you could make payments...but I digress), what would I use to purchase the drugs you need?  Why on earth would you think you can make payments?  Does the grocery store let you make payments on that steak you want to grill this weekend?  Would you even dare to walk into WalMart or Walgreens and ask that question?

So, the fourth person today just walked in and asked if I could hold a ticket.  The first two actually did walk in and ask if they could "make payments."  The last two asked if I could hold a ticket.  While I have put a stop to new charge accounts (see the title of the post), these last two were DENIED a charge account because they bounced checks.  And still they have the fucking nerve to ask.

Do any perishable-goods merchants allow you to make payments?  NO.

If you have to make payments, get a credit card.  Get a bank loan.

I am not a used car salesman.  I am not a bank.  Pharmacy may be a multi-million dollar business, but the pharmacy no longer "rakes it in" like most people think they do.  Pharmacies barely survive.  Yes, mind-boggling amounts of money flow through here, but unfortunately, the buck doesn't stop in my pocket.

So no, YOU CANNOT FUCKING MAKE PAYMENTS.

So, How Are You Feeling Today?

I didn’t used to be this way.  I didn’t dread coming to work.  I didn’t go home at night hating the world.  Once I got home, I didn’t used to cringe when the phone rang.  I didn’t feel like hiding inside the house and never leaving again.  I wasn’t a negative person.  I didn’t hate it when the doorbell rang, or when I had to come home, get ready, and go back out again for something social, and smile at the same people who made my life hell earlier that day.

I do now.

I didn’t cringe when the phone rang (and rang, and rang, and rang again) at work.  I didn’t cringe when I was told it was for me (every 5 minutes).  I didn’t cringe (and wonder if it is too late to duck behind the counter) when Mr. or Mrs. Needy came through the doors, knowing I was in for at least 10 minutes of my time wasted.

I do now.

I used to love being here for my people.  I loved coming to work.  I was a positive person, to the point of being a bit naive.  I smiled and laughed.  I loved the little old ladies and gentlemen who came in, trusted me, and respected me.  I loved teaching people about their medications and talking to them about their diets and nutrition.  I loved feeling like I was making a difference, albeit a small one, in the world.  When I did arrive at home, I used to have some energy left for the people and things I love.  I didn’t used to be an antisocial, ranting, soap-box standing Phrustrated Pharmacist. 

I am now. 

And it makes me very sad, not just for me and my family, but for my colleagues, the profession of pharmacy, and the healthcare profession in general.  It is a sign of the times, and a sign of just how bad it is getting in the world of pharmacy.  Over time, things have subtly changed.  Patient attitudes towards the pharmacy and pharmacist have slowly shifted, and practice of pharmacy has changed.  It’s no longer a practice of anything but futility.  Somewhere  “patients” shifted to “customers”, and “pharmacists” shifted to “glorified sales clerks”.  I find more meaning and fulfillment doing something in my spare time that would only have required an 8^th grade education, and it even involves a job that would deal with the public, and wouldn’t involve standing for 8 to 12 hours straight, with no bathroom or lunch break, or worries about liability and whether or not I missed something serious enough to kill someone during the chaos of the typical pharmacy day.  How’s that for irony?

I am pervasively sad and exhausted to my core today.  Actually have been for some time.  How are you feeling?

--T.Ph.RPh.

Not My Problem, Mr. "I'm Important"

I'm just sitting here (yes, sitting - for all my complaining, I do realize I have a job that comparatively, is like a working vacation) contemplating my latest, heart-warming, life-saving, professional interaction that I had trained for and spent six years in school for....(dream sequence, wavy lines, fading into the beginning of my reminiscing of the lovely encounter that typifies my "normal" day as a deeply satisfied health-care professional on the front lines...)

Mr. I-Have-An-Important-Last-Name-In-This-Town-So-You-Must-Drop-Whatever-You-Are-Doing-And-Do-My-Bidding comes in the door. Usually he is boisterous, sexist ("Hey, pretty brown-eyed thang" to my married techs), condescending, and somewhat amusing (he thinks he is God's gift) and I can come away from our interactions with at least a smile on my face. He's also a big man - a very tall, wide man. He is also flabby fat - on the edge of morbidly obese. With diabetes (surprise!). Should pick up four bottles of Lantus a month. But of course, putting down the fork and walking away, nay, walking at all, except back to the refrigerator, is out of the question. But I digress.

I'm sitting at my desk, working on the mounds of paperwork (I am one of the few independent pharmacists I know who manages to keep the top of their desk somewhat organized and cleared - I have a wonderful job) this "profession" creates. I hear Mr. Important's booming voice greeting my tech. She tells him his insulin prescription only has a quantity of two bottles left, and we would have to call the prescriber.

"Well, what's the number out there? I'll just call 'em" says Mr. Important, whipping out his cell phone.
Ms. Tech: "Well, sir, they prefer we fax the refills to them."
Mr. Important: "What's the number?"
Ms. Tech: "We will just fax the request over to them."
Mr. Important: "What's the number? I'll call 'em right now."
Ms. Tech: Gives him the number. Repeats the fax preference.

So Mr. Important gets the receptionist, trying to charm her into telling him the refills are ok (like that makes everything ok), then blows up at her, shouting into the phone, "WELL! I SHOULDN'T NEED AN APPOINTMENT OR BLOODWORK!!! I JUST HAD THAT DONE TWO OR THREE MONTHS AGO!! I'M HERE AT THIS PHARMACY, RIGHT HERE, RIGHT NOW!!"

Of course, as we all know, two or three months in patient-speak means about a year or more ago...

Mr. Important: "Who is in there with ya? Where's that nurse?"
(Receptionist obviously asks him which nurse.)
"You know, the one that was so-and-so's kid."
(She changed jobs about a month and a half ago)
"Ok, well, what about the other one?"
(Apparently receptionist has received our fax request and given it to the prescriber, and tells him they will call it in.)
Mr. Important hangs up.

By this time I've dragged my ass out to the filling line, charming, professional smile plastered on, but mentally I am gritting my teeth and shooting daggers into the blubber that surrounds Mr. Important like a shroud. Pleasantries are exchanged. Then the uncomfortable waiting begins. He stares holes into our foreheads, expectant. We fill prescriptions - not his, yet.

I know this self-importance attitude is as despised by our NP as it is by myself. I have a quite a few pet peeves, but self-importance because you have a certain last name is probably up in my top three. So I know that the refill authorization won't be coming any time soon.

Mr. Important begins to realize this as well. Gets his big feelings hurt and decides to run some other errands. Huffs and puffs and waddles out the door.

Being a small clinic and a small pharmacy, by the time he returns, all is well with his prescription. So he's all happy now...until he gets to the cash register. I hear commotion, but I ignore it. The clerk points him back to the pharmacy. He needs the exercise, so I let him waddle back to the filling line before I look up. Apparently instead of paying $39 like last month, for a prescription that cash price runs around $500.00 give or take, his insurance returned a copay of $162. Still sounds pretty fair to me...so I ask if he is in his donut hole. "I DON'T KNOW!! There's no way I can be in my donut hole!! I've only filled my insulin twice." Hmm, really compliant. If you are unwilling to put down the fork, exercise, and take your medication on time, why do you even bother? Oh, wait, it's only been $39 to this point...

It's obvious he expects me to call his insurance. I no longer call insurance companies, haven't for years. Not my responsibility, not my problem. (I don't know why we, as a profession, started calling insurance companies, or even taking assignment. Yes, customer service, and customer retention. BUT IT IS NOT OUR RESPONSIBILITY - we already baby the patient almost to the point of taking their medications for them. Yet, again I digress...oh, but trust me. There will be a post about patient responsibility and how we have, inadvertently perhaps, turned our patients into blubbering, inconsiderate idiots.)

Back to Mr. Blubber, er, I mean, Mr. Important. I sweetly tell him (daggers, daggers, daggers) that with this third fill, his Lantus alone (he does take other medications - surprise again!) has cost his insurance company well over $1500, and did he know when his donut hole started?

Exasperated, he spits out "No, I have no idea!!" So I told him to contact his insurance company and find out why the copay changed so drastically, and if there were some miscommunication, we could rebill it and give him a credit. He stands there (obviously not the answer he wanted), then stomps to the cash register and says "I'll just pay it all!!"

This is just what I went to pharmacy school for - and slaved, and studied, and sacrificed. So I can get yelled at by a fat, self-important man who cares absolutely nothing for his health or himself, and who knows more about the engine in his car than the intricacies of his health insurance policy, yet he will have spent more on his health insurance policy that his car within a few years. I guess I don't understand people.

My job satisfaction is OFF THE CHARTS!! I am making a difference!

I'd better get back to it...saving lives and making a difference, one patient at a time!

-T.Ph.RPh.

The Patient's Guide to Pharmacy Etiquette

A Patient’s Guide to Pharmacy Etiquette:

1. Be sure to stare at the pharmacist while your prescriptions are being filled. Staring makes them work faster.

2. Never remember the name of the medication you want filled. By calling it “the little white pill” you are sure to receive the correct medication.

3. When calling in 8 or more prescriptions, always arrive at the pharmacy to pick them up within 10 minutes. It is ok to hurry the pharmacist. If they make a mistake, it won’t kill you or anything. It is strongly encouraged to call them in on your cell phone while waiting in the drive through.

4. Instead of calling your insurance company, who sets the price, feel free to ask for the exact price of your prescription before it is filled. After all, the staff should know the copay of every drug, for every person’s individual plan.

5. Always ask how long it will take to be filled. If you’re lucky, you will get it free if it is not ready in 15 minutes or less. Also, be sure to ask if the prescription is ready every 5 minutes, because the pharmacist often keeps them after they are ready just to piss you off.

6. Be sure to complain about the copay. The copay is set on the whim of the pharmacist and has nothing to do with the insurance company you chose.

7. It is not necessary to present your insurance card or even know the name of the company. Pharmacists are psychic and know everyone’s insurance.

8. Upon requesting a refill for a maintenance medication with no refills, always question why the doctor has to be called when you’ve taken the same medication for years. It is only a myth that prescription medications have to be ordered by a physician. The pharmacist usually doesn’t fill prescriptions just to piss you off. NOT filling prescriptions is good for business, after all.

9. Always question why the insurance company is so concerned with you getting your medication ten days too soon. After all, you’re only paying $5.00 for it and that’s all it costs.