Narcs

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Today felt like national narcotic day in the pharmacy. It seemed like every couple of scripts was for a narcotic medication. It made for a very busy day. The most common complaint I got was, “Why does it take so long to fill my medication?” So, here’s my answer…

The normal filling process at the busiest hour of the day takes about 15 minutes, if all goes smoothly and there are three or less prescriptions. Why is this?

1.) The person that takes your prescription from you has to type all of the information on the script into the computer. If the prescription is easily legible or typed, the process will take about 1-2 minutes for each prescription, depending on how fast the person can type. Any questions or illegible handwriting means the prescriber needs to be contacted before it can be filled and dispensed. I can’t count how many times I have to verify the strength on prescriptions because decimal points are omitted.

2.) After that, the prescription has to be submitted to the insurance. If it’s accepted, this process takes about a minute. If it’s rejected, that can extend the time anywhere from 2 minutes to 2 weeks depending on what the rejection is. This is the step that aggravates most people, pharmacy staff included.

3.) After the insurance step, comes the actual counting and labeling step, which is the easiest part of the whole process. A good technician can count 30 pills out in about 45 seconds if they’re on a roll. But, add in 200 other prescriptions to fill during the busiest part of the day plus phone calls and ringing register, and you’ll have some back up in the production line. So, practically speaking, we allow them a few minutes to get through each person.

4.) The final step in the process before checking out is where I come into play. I need to double check each prescription that is filled, even if I was the one who counted out the pills. I have to make sure each script was entered right, billed correctly, and filled properly. If everything is straightforward, I can verify a prescription in less than a minute. But, between answering doctor calls, counseling patients, and correcting errors, the process takes much longer at the busiest hour of the day.

So, where does a narcotic come into play? In many pharmacies in the US, narcotic medications can only be counted by an on-duty pharmacist. So, this breaks up the normal production line. I have to make sure I am well caught up before filling a narcotic because I won’t be able to verify anything while I’m filling it. These medications have to be counted twice, and the remaining quantity in any stock bottles have to be counted and logged in a log book. There is more documentation that goes into narcotics prescriptions than other medications, and this can only be done by the pharmacists most of the time. The counting and filling of a narcotic alone takes a good five to ten minutes depending on how many tablets and if I receive any phone calls or questions during that time frame.

So, yeah, narcotics make for busy days. The more there are, the longer it takes for me to get medications out to my patients. I wish I could make people understand this. I feel like if they knew what went into filling narcotic scripts, they’d be a bit more understanding. Then again, maybe I expect too much out of people.

 

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Constipation

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So many people today had all kinds of tummy troubles! I couldn’t help but wonder if their holiday eatings had anything to do with it. (I live in the United States, and we just celebrated Memorial Day over here.) The most common complaint was constipation. Definitely no fun for anyone.

The story that sticks out most is one of a mother who came in to get something to help with constipation that her daughter was experiencing. She told me her daughter has physical handicaps and runs into this problem from time to time. Normally, the gentle laxatives and stool softeners work, but they haven’t this time. She asked about a recommendation for something stronger, so I begin to point her in the direction of the stronger Senokot tablets. That’s when she tells me the girl hasn’t been able to go for four days.

There is a difference between being constipated for a day or two and being constipated for four days or more. If you’re constipated for a day, usually you’re in no real trouble and a stool softener or a gentle overnight laxative will do the trick. If you’re constipated for four days or more, you’re at risk for a bowel impaction, which may need to be manually resolved by a healthcare professional. My recommendation for this woman was to have her daughter use magnesium citrate (an oldie, but goodie). I told her if she didn’t have any bowel movements after using it, to take her to the hospital to check for an impaction.

It’s funny how often I find myself recommending products for stomach ailments. There’s at least one person a day who asks for help choosing a product for bowel regulation and other related things. Generally speaking, when the tummy is happy, the person is happy.

 

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Refusing

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So, today was a relatively busy day in the pharmacy. It was pretty much non-stop action all day. It wasn’t a bad busy, just busy. The day flew by pretty quickly, and most people were in good moods. I’m sure the sunny weather helped with that. =)

There was one man who came in today who had both a Medicare part B and Medicare part D plan. Both will cover diabetes equipment and drugs, but with varying copays. We had originally billed his prescriptions through Medicare part B just over a month ago. He received a letter in the mail the other day telling him that he has had Part D coverage for those prescriptions for a few years without realizing it. He asked me to rebill it through the Part D plan. I willingly obliged.

Well, it turns out one of the prescriptions was the same price either way, but the other was cheaper through Part B. I tell him this, and he asks me to undo the second one. Unfortunately, once it’s been over 30 days, you can’t undo things like that in our store. You can only bill under new plans. You cannot rebill and then undo it because it was cheaper the other way. That is technically fraudulent behavior. You, as the patient, are responsible for knowing which billing option you want to use beforehand. The pharmacy can only rebill and refund under very certain conditions, especially with government funded insurance (Medicare, Medicaid, Tricare, etc.).

So, because the price difference wasn’t that much, I was just going to absorb the cost, since he wasn’t previously aware of the price difference, but he wanted to hear nothing about it. Before I could tell him that I wouldn’t be charging him extra for it, he walked away and out of the store. That left me with an interesting story for my store manager tomorrow morning when the register is all totaled.

Listen, if you are ever in a situation where rebilling something makes it more expensive for you, most retail pharmacies will absorb the difference and not charge you. But never EVER just leave without completing the refund transaction. We need you to sign receipts verifying you were present for the transaction. Otherwise, the store can get in trouble. This is mostly for chain store pharmacies, but even for independents…it’s just plain courtesy to stay until any transaction is finished.

 

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Magic 8 Ball

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I swear this is what many people think I do when it comes to insurance companies.

Today was probably one of the more busy days I’ve had in the pharmacy in a long time. I didn’t get time to eat or use the bathroom throughout the day. Luckily, I have a well trained stomach and bladder for days like these. Today’s central theme focused around copays. No matter how many times I tell people I do not know what their copays will be ahead of time, I get at least 5 phone calls every day asking this very question.

Let me set the record straight.

Pharmacies DO NOT know copays ahead of time. We only know what you HAVE paid in the past. We can only tell you the price WITHOUT insurance. Why is this? Well, insurance copays can, theoretically, change at any given time. Practically speaking, most copays will only fluctuate at the start of the new year. But, there are always exceptions to this rule.

Because most pharmacies follow “the customer is always right” motto, we do not want to mislead you with one price and then ask you to pay another when you arrive to pick up your prescription. It would be like a department store saying one thing in their sales flyers and then charging something completely different at the check out line. If we tell you a price ahead of time without knowing for sure, most bigger retail chain pharmacies will feel obligated to honor that price if it is lower many times. If your copay increases from last month, we will feel bad for misleading you and absorb the difference, allowing you to pay what we told you over the phone. If we did this with every person that asked for a copay ahead of time, we’d all go out of business.

Pharmacies bill instantly to insurances, unlike physicians’ offices and hospitals. We know within a few seconds of submitting a claim if it’s accepted and what the cost to you will be. If you can wait for a minute or so while we input the prescription and submit the claim, we can give you the price. If you cannot wait or want to know before ever setting foot in the pharmacy, you need to call your insurance provider for a formulary list and the costs for certain medications. I have done it myself, and it takes about 2 minutes once you get a hold of a customer service representative. Also (for the tech savvy), many carriers post their formulary lists and prices online now.

I would like to know what is so difficult about this concept for people to understand. I get the same people every few weeks asking me the same question about a different medication. My answer is always the same. This is what I feel like saying this after enough times of the same people asking:

“I do not have a Magic 8-ball.
I do not read tea leaves or dice.
I do not have a crystal ball.
Ahead of time, I can’t give you a price.”

 

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Word Salad

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Today was an interesting day at the pharmacy. It was slightly busy, but not in a bad way. There was one thing that made the day a bit more trying than others like it.

About an hour after opening, the pharmacy received a phone call from a man who could not be understood. The technician who answered the phone tried to get him to repeat himself several times, and then the call was disconnected from the caller’s end. About five minutes later, I pick up the phone to hear this man. The only way I can describe what his voice sounded like was that of a stroke victim experiencing “word salad”. His words were so jumbled together I couldn’t understand anything he was trying to tell me. I tried asking yes or no questions, which only caused him to hang up.

The same person continued to call on and off all day. He called the pharmacy. He called the front store. He called through on the physician only line (a pet peeve of mine). He must have called upwards of 20 times today. At first, I felt bad. My techs and I tried to find all different ways to ask him what he needed. We read off the hours we were open as well, in case that’s what he was calling about. Meanwhile, our patients in the store and in the drive-thru were slowly becoming more and more impatient. Finally, we asked him to either physically come to the store or stop calling. The message must have stuck because he did not call again.

I don’t even know what to think about this. It was one of the strangest things I have ever experienced while working in the pharmacy.

 

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Bedside Manner

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I chose the picture up top today because of what the character he plays lacks: bedside manner. Today’s story is not so much about a patient as much as it is about a physician treating a patient.

So, my story starts with a prescription that was brought to us by the caretaker of a bed bound man. He had been in the emergency room the night prior and had received a prescription for an antibiotic. This antibiotic is very expensive and not many insurances cover it. The caretaker for the patient said they couldn’t afford to pay for it out of pocket. I tell her I’d call over to the hospital and see about switching it to something else.

After a few transfers to the correct station and some waiting on hold, I am talking to the physician covering the emergency department for the day. I explain the situation to him and tell him the patient will not be able to purchase the medication. His response was blunt and rude: “I know the price of medications is expensive, but so is the cost of medical care.” I asked what he suggested the patient do, and he told me to have the patient come back to the hospital for further evaluation. Without any more speaking, he hung the phone.

This kind of situation always leaves me frustrated and feeling bad for the patient. Trust me, I understand that you need to select the correct antibiotic to treat the infection. I am not trying to undermine any prescriber’s authority when I call for substitutions. I am trying to make things as smooth and easy for the patient as it can be. If you refuse to prescribe something more affordable and the patient absolutely cannot afford the medication, guess what? They won’t be taking it. Period. Then, the infection will continue to manifest, and the patient will get worse. So, prescribing something the patient can’t afford is worse than prescribing something with slightly less coverage. If you’re going to give the patient a prescription, you should always be prepared for the insurance not to cover it just in case they do not because, truthfully, when a person has to choose between getting a medication and being able to provide food for tonight’s dinner, they will almost always go with the necessity. No one chooses medication over food unless not having the medication causes immediate devastation. The only exception is with pain medications.

This situation also makes me realize why some patients do not seem to care for or trust their physicians as much as they should. When prescribers do not have good bedside manner and prescribe in this fashion, the patients begin to feel like a number instead of a person. They feel like they are being used for reimbursement from insurance companies and not getting the care they deserve. They feel like the prescriber is not taking their individual needs into account.

Also, acting pompous and arrogant over the phone to the pharmacy in this situation makes patients trust prescribers even less. Many times, this is their thought process: “The pharmacy is trying to save me money and the doctor isn’t letting them. They must be getting financial benefits from drug companies for using this.” That’s when we tend to hear people complaining about the kind of care they receive at the prescriber’s office.

To sum this whole entry up, bedside manner is critical to forming and maintaining a good patient-healthcare professional relationship, as is interdisciplinary teamwork.

 

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Loss

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Today’s theme seemed to be loss of a loved one. Multiple people came in to the pharmacy to inform us that their husband, wife, father, mother, child, or friend had passed away. Each person seemed to be handling it well considering the circumstances. Nonetheless, it’s always a sad topic.

The person who’s story stuck out most is that of a middle-aged man, whose father passed away a few months ago. This was very hard on the whole family, as he was the patriarch and the elder. Not long after his father passed away, his mother needed to be placed in a nursing home for reasons he did not elaborate on. All he told us was that her condition had been ongoing for some time, and that his father had been able to care for her at home. After his passing, it was only a matter of time until she required some sort of assisted living. He informed us that her condition has deteriorated even more since entering the facility.

His sad tale did not end there. Though this man does have a brother, but his brother is mentally handicapped. He is unable to live by himself. His brother had been living with his parents, but after his father passed away, the man felt obligated to pick up where they had left off. Now, he has assumed the role of a primary caretaker, which is no easy task for anyone. The man also has no spouse or children. It just seems like everything is so very wrong for him right now. My heart broke upon hearing his story.

The thing that got me most, though, wasn’t the sad circumstances or how every aspect of his life changed so quickly, but rather, the man’s demeanor and outlook. There is no doubt he is hurting, but he persists on with his life and does not mope about. A person walking down the street would never know the pain he must be feeling. He stays strong in the face of adversity. That is a quality I admire. I don’t know if I could compose myself so well if I were in his situation.

Readers, if you are lucky enough to have friends and family that you care about very much, take this opportunity to tell them you love them. Tell them often, and never take them for granted.

If you are going through a grieving period because you have lost someone dear, my thoughts and prayers are with you. It’s never easy, and nothing can prepare us for it. Cling to the others you love, and support each other during this hard time.

If you have been thrust into a situation you did not want nor choose, have faith. Whether it be faith in a religious sense or faith in another person, having a sense of faith is the strength and backbone you need in order to carry on with your life even when the tides have dramatically shifted.

I hope you all have a great day.

 

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