Random Pharmacy action

Here's a few goodies i'd like to share from the pharmacy. This was all over the last month or two, but you still deserve to read it:

-I realized that 9 out of every 10 people that complain about Obama and his government-run insurance plans either have Medicare part D or Medicaid.

- I had an old man tell me that we shouldn't have the condoms sitting on the shelves like that. He then told me that I should be walking around the store with them and randomly dropping them into our senior citizens' carts.

- A six year old boy was telling me that he was no longer having a birthday party. His mother sheepishly said "someone's not having a party because they drew on the leather couch with permanent marker." To which the kid replied "I didn't do all of it at once".

- I had a kid who couldn't have been older that twenty ask me with a Russian accent what we have over the counter for enhancement. "down there". Why someone your age would need this, I don't know.

- I had a medicaid patient come in for Plan B. This was her third time in 4 months. I asked her what she's using for birth control, to which she replied "I've been too busy to schedule a doctor's appointment". Girl, you're 20 years old. Learn how to make a damn appointment like the rest of us. It's not like you're too busy working, otherwise you wouldn't qualify for medicaid. Get off your back, close your legs and go make an appointment before we have to pay for another medicaid baby.

The last post reminds me of a favorite patient quote:

"If my daughter doesn't have her birth control she'll get pregnant!"

Is it wrong to superglue a medicaid patient's legs together?

Lady, I want to help you find your birth control rx.

I had a woman call and try and get a refill on her birth control rx. I tried looking up her name, and couldn't find it in the computer system.

What's the rx number? She tossed out the rx label.

What's the date of birth? Still cant' find you.

Did you change her last name? nope.

This is the location by the water. You sure you meant this call this location and not the other two in this town? No, she swears it was at this location.

This is such and such pharmacy. Are you sure it wasn't at Rite aid, CVS, or Walgreens? Nope, she swears it was at this location.

You tell me that you had your daughter's rx filled here. I see her rx. I try searching for the address and phone number. I can only find her, not you.

Do you have the bag tag or info sheet that came with the rx? Silly me for thinking that.

I tell her that we keep a permanent record of every transaction ever submitted, and that if she ever had a prescription filled here, even 10+ years ago, we would have it. Since I am finding nothing, she must have had the prescription filled somewhere else.

Listen, don't throw a hissy fit because you don't know where you filled your prescription. I suggested she call her insurance (medicaid) to see if they could help her locate her her rx, or she could call the md for a new rx.

And get this- she tried calling back two hours later, and then three days later, trying to get the same rx filled. Sorry, scripts don't just magically appear and disappear. My job is dependent on filling scripts. I have no desire to lose, toss or eliminate scripts. Why would I do that, then offer to do the extra work of calling your doctor for you to get a new script?

And for the love of god, please keep your legs closed until you find the rx.

Workman's comp rant

I feel bad for people that get injured on the job and need to get their medications filled under workman's compensation. It's a real pain in the arse. Your doc gives you a script for the injury. You go to fill it, and woah... hold up... you thought you'd be getting it filled? Your comp needs to verify that your doc isn't just giving you drugs for fun, it has to be related to your comp claim. The drug needs prior auth. Comp needs to contact the adjustor, the adjustor needs to contact the doctor, and so on. According to them it should take 24-48 hours.

That's just what you want to hear when you're in pain RIGHT NOW.

I have one woman who has been waiting 3 weeks for comp to authorize her pain med. Keep in mind in my state scripts for controls expire after 30 days. Thankfully she doesn't use it very often, because this happens every month!

I go to run a refill for celebrex for another woman and get a DUR reject. I know from getting this reject before that they want the doctor to consider a generic COX II inhibitor. Comp is required to pay for whatever the doctor writes for this comp claim, but they still pull this crap. Why the hell are you (cough_express scripts WC_cough) having me do your dirty work? I've called this doc enough to know that yes, they wrote for celebrex because they want celebrex, not some generic.

Congratulations, you have sunk to a new low on a Friday (daytime) when you kept me on hold for 2 1/2 hours. I hung up. I tried to call to tell you what the doctor wanted, but I suppose this is your new crappy way of preventing people from getting their maintenance pain medications. Saying that you suck would be a compliment.

Advice for druggies

Here's some advice for all the addicts out there- ER docs do not write for a month supply of Lortab. If you think you're being clever by adding a zero to the end of what was originally #12, then you are going to go from getting 12 tabs to ZERO tabs.

I was off on the day this guy came in, and he was fully expecting 120 tablets. He even had the nerve to ask for the original twelve tablets!

Idiot.

I almost wish he came in on my day off. I have fun with people who try to pull one over me; I make them wish they never came to my pharmacy. If he asked me to fill it for the original twelve tablets after altering it, I would tell him my dilemma. If I fill it, I would be filling a script that has been altered in an attempt to procure additional tablets. Altering the script is against the law. If he asked me to fill it I would have to call the cops. Did you still want me to fill it?

I wonder if anyone would say yes?

It's been a slow week at the pharmacy. The most action I've had was a man in his fifties telling me that he loves his wife very much, but he had to let me know my teeth were very pretty, and that they were pearly white. This is from the same man who asked me a year ago what I do to get my hair to fall into place so perfectly. (For those who don't know me, the answer is: not much.)

Ending on a good note: a regular came to the counter for a pickup, she saw my name tag and said "you're the one I speak to on the phone all the time. You're always so helpful and nice".

Ma'am, you made my day.

Not my job

I'd like to thank Ms. Mean for reminding me about a wonderful nurse ( can you feel the sarcasm?) I had to deal with a short while ago.

One of my older patients came in to tell me that her doctor gave her a free new blood glucose meter to replace her old one. She only had a few test strips left, and the doctor did not give her new prescriptions for test strips or lancets. She did not know which meter the doctor gave her, but i can forgive 80+ year old patients for not knowing, figuring the doc would have documented this in her chart. She has Medicare, so I fax the doc's office requesting they mail us prescriptions with the name of the test strips and lancets, testing frequency, diagnosis code, etc.

A few days have passed, and I still haven't received anything. I call the doc's office again repeating everything I sent in the fax including how I need the rx's mailed, and 30 minutes later I receive... a fax. Test strips for an old meter (aka NOT the meter she received in the office). I call the office and finally work through the phone tree until I get to speak with a nurse, and I ask if they can pull the patient's chart to verify what meter THEY gave her (you know, that documentation thing that pharmacists talk about all the time), because I know the one they faxed over was wrong. She pulls the chart, and says there's no mention of a new meter.

Me: "It's not documented? Can you check with the doctor to figure out what meter your office gave her?"

Nurse with attitude: "I don't have time to do that. Why don't you call the patient to figure out what she got, then call me back and let me know" *click*

Woah. That's low. I'm going out of my way to take care of something that you should have done before the patient even walked out of your office, and you have the nerve to assume that I sit on my ass all day and have the time to take care of your problems? What makes you think that I'm not busy in the pharmacy? In addition to taking care of problem scripts like these, I still have ten people waiting in the store for scripts. And then you hang up on me?

I'm sorry, but I get enough crap from patients, I don't need it from doctors offices too. Some patients don't know better, but you do. If you dropped the attitude and didn't hang up on me, I would probably be willing to help.

I consider myself to be someone who goes out of my way for others, but this was unacceptable. I called the office back to let them know I did not appreciate the way I was treated by this nurse, and sure enough, 30 minutes later, I received faxes for the correct test strips. It still took another week to receive hard copies of these scripts for Medicare, but I still felt like this was a victory.

Swish and swallow

Another example of why e-prescribing will not take over the world...

Rx:

Nystatin sus 100,000 units/ml

swish and swallow 4-6 ml four times daily

disp: 60ml

Congratulations, you can read the prescribing information for this drug!  At this point you're as skilled as a monkey (you know, the one that fills all of your prescriptions overnight, allowing you to call in an rx at 2 in the AM and expect it to be ready when the gates are opened).

Now, let's see if your degree can help you apply this knowledge...

4-6 ml.... Yeah, that's the recommended adult dose, but did you LOOK at the population you're prescribing this to?  If I write this on the bottle the patient will be back with an empty bottle in three days because they thought that a ml is a teaspoon, or worse, tablespoon. (And for laypeople out there, 1 teaspoon=5ml.)  Just write one teaspoonful!

But it gets better, because since you only wrote for 60 ml, they WILL be back in three days.  I really hope you don't think it will a day for this to clear up, but sadly I know you wrote 60 ml because, oh, in the prescribing information this is available as a 60ml bottle (for infants!).  What? you actually wanted your patient to be on this for one week?  Well it's a good thing I called to cover your ass.

Sorry i'm not a phonebook?

I had a woman call me trying to find the phone number for new Walgreens a few miles away.  I knew the phone call was not going to be pretty as soon as the woman started complaining about how long it takes to go through all these automated messages

Two facts you must know: 

1.  the specific pharmacy opened within the last few months and I have not had to call them yet, and

2.  I do not work at a walgreens.

I tried to tell her that I did not have their phone number; big mistake.

"What do you mean you don't have their phone number? you're a pharmacy!  You have to have it!  How do you get a hold of them?"

I'm sorry that I haven't had to transfer any rx's from there yet!  I explained to her that I would have to contact another Walgreens store to see if they could give me the number to the new store.  I started giving her the number to the Walgreens across the street, and she interrupted me mid-number saying "I SAID I NEED THE NUMBER FOR THE OTHER WALGREENS, NOT THE ONE HERE."  Again I replied "I don't have their number", to which she politely slammed the phone on the receiver.

Have fun dealing with the automated message at the next pharmacy you call, b!tch!

The only thing missing is the full moon

Fridays are not supposed to be busy.  Granted, I like being busy.  The day is over before I know it.  I filled 212 scripts.  I battled with medco (and lost, because, well, it's medco, and medco sucks).  But nothing can top the conversation I had with one of my 90+ year old patients.

 

Patient (P)- This prescription I have, this salve, it should be taken off the market.

Me- What seems to be the problem?  (he's been on this cream for years)

P- I can't apply it. I can't reach.  The sore is on my bottom and I can't reach there.

Me- Do you have anyone that can help you apply it? Any family or friends?

P- No.  And the doctor wants me to apply it as often as needed.  What am I going to do?

Me- Actually the doctor wants you to apply the cream only twice daily, and only if needed, as it says on the directions.  Have you tried contacting your doctor to see if they could help you find a visiting nurse to help?

P- The salve says to keep it covered.  How can I have someone come and apply it throughout the day?

Me- (Reitierating the twice daily directions) the wound site should be covered with a dressing, but the cream should be applied no more than twice daily.  Have you called your doctor's office?

P- They said they couldn't help.  Can you help?

Me- I would recommend seeing if a visiting nurse can come by and help you with your medication.

P- Can you help me apply it?

Me- I'm sorry, I can't.  I recommend you call your doctor's office if you still have problems.

Wow.

There's a reason why i'm a pharmacist, not a nurse.

May I also add that nurses don't get paid enough?

One of my techs was later wondering how he manages to wipe his own ass.

Lying gets you nowhere

---disclaimer- I am aware there are plenty of people with legit pain problems who are not trying to abuse the system. This post is about the 1% of abusers that make life that much more difficult for the other 99%.

You come to my pharmacy counter with a prescription for Lortab. You want this filled as cash.
Do you have insurance? of course you don't. You lost it a few months ago. At that point I ask for your ID. Sometimes I get lucky and you hand me a medicaid card as ID. No ID, no controls.
You're new to our pharmacy. Have you had this before? No, of course you haven't. Every doctor starts their patient on Lortab 10/500 four times a day #120.
I tell you it's going to be at least 15 minutes so you hopefully don't hover around my counter and observe my every move.
You set off enough red flags to make me think something is amiss. I get a reject saying this was just filled recently. People like you are the reason why I get along with the other pharmacists in the area. Turns out, Medicaid just paid for a 30 day supply of the same medication at the Rite pharmacy down the street, SIX DAYS ago.
The problem is, if you have medicaid, you are required to get all of your prescriptions filled under medicaid.
What? you lost that last bottle of lortab and your doctor said it was ok to get the rx filled again? Great! I'll give them a call and document the conversation. What? you don't want me to call your doctor? Then i guess you're not getting this script filled here.

I can't make this stuff up

Have you seen those Simple Save pharmacy discount cards recently? They're everywhere. I've received two of them in the past week, one in a coupon mailing, and a second one with my national fuel bill. If for some reason you have yet to receive one of these, I'll explain how they work. They are not an insurance card, and they do not pay anything towards your prescription. we submit your prescription information to this carrier, and they have a "negotiated" price- basically they tell us how much we can charge you for a specific drug. It's usually less then our cash price, and will save on average 10-30%, more on generics.
I had a woman come in the other day. She seemed smart, until she started talking.

Me: How can i help you?
Patient: I have this card and i would like to get these two prescriptions filled.
Me: (running scripts through) the ambien generic will be 9.99, and the retin-a generic will be 63.57.
Patient: They're not free?
Me: (????????????????????????) why would it be free?
Patient: the card says "present your FREE drug card to the pharmacist"
Me: The card is free, you don't have to pay for the card, but you will still have to pay for the prescription.
Patient: that card is misleading, it says free, it shouldn't say that.
Me: It says on the card that they can save you 10-30% off prescriptions. It is only a discount card, not insurance.

(apparently the simple save card is too complicated for most people to comprehend)