Yes, I'm sure that's it

Mrs. Baked gets Fentanyl patches every month from a pain clinic. I don't get to see Mrs. Baked very often. Mostly I see her husband, usually in the middle of the day on a weekday. I know Mrs. Baked doesn't work, you know, because of her debilitating illness which requires her to be on the patch and other associated medications for breakthrough pain, etc.

The whole point of Medicaid is to help people out until they can get back on their feet again. Or that's what I thought, anyway. With the Baked family, this appears to be taking a long time because they've been in this situation since 2008. Somewhere along the way Mrs. Baked became out of sync with when the insurance will pay for the patches and when she gets the new script from the doctor. So every month it is a fight and a prior authorization process and Mr. Baked coming down to the pharmacy every day (in the middle of the day when most people are working) to check on the status.

This month Mr. Baked is especially nervous about when he can get his wife's patches. When I inquired as to the unusual "extra" urgency, Mr. Baked tells me that they need them because they're going on vacation. Well, that's nice, isn't it? So to entertain myself further I ask: Where? O where art thou vacationing, my Lord?

As it turns out, the Baked family is going on a cruise ship traveling to the Bahamas for two weeks. So the next day Mr. Baked comes in again and why yes, Medicaid has once again approved another thirty day supply of patches. And there, as Mr. Baked picks up his wife's patches with only a signature, I noticed two things. The first was a large Starbucks beverage of some kind. You know, the ones that cost at least $5. The second thing I noticed was that he was holding one of the new iPads that Apple company is selling.

Now I know all you liberals are just going to tell me not to jump to any conclusions. Yes, I know, it's all just in my mind: Mr. Baked works at night, that's why he's there in the middle of the day. His income is really low and with his disabled wife they qualify for Medicaid. And sure, the vacation was a gift from a family member to help them to deal with all the stress  And of course, the Starbucks was paid for with a gift card from yet another generous person, and he's just borrowing the iPad from someone else.

Yes, of course. I'm sure that's it.

March Laughness

This is me...

...when I lose track of time and realize the #Pharmacy closes in 10 minutes:

Just how do you treat a stuffy ear?

Gentleman, early 60s, walks up to the counter while wiggling his finger in his ear.

"What do you have for a stuffy ear?" he asks.

I ask him a few questions and determine it is probably related to allergies and nasal congestion. I tell him about our OTC nasal decongestion tablets and point him in the right direction.

"What do I do with the tablets? Do I push them into my ear?"

With this kind of confusion, I can only imagine what he does with his Flomax...

If Pharmacy was an xBox game...

I know I'm early, but...

30 minutes before closing on Wednesday night... the phone rings...

"Yes, I want to know when my Carisoopradle prescription will go through..."

He's trying to say the generic name for Soma. How cute. 

He gives me the Rx number. I put it in. The magic of insurance tells me they will pay for the refill on his 30 day supply of Soma on day 22, which is TOMORROW.

"I can fill it tomorrow," I tell him as I'm looking in our calendar file... then I see it... "I also see that we have this already scheduled for tomorrow. You've called about this already."

"I'm just making sure," he says. "What time do you open?"

I tell him when we open.

"So you'll have it ready then?"

"No."

"Why not?"

"There are many tasks involved in opening the pharmacy . I'll have your medication ready at 30 minutes past the hour."

"Well I have to have it before then. I need to be somewhere at 30 minutes past the hour. You can't give me three tablets right when you open?"

"No."

"Ok, I'll see you at 30 minutes past."

So much for the appointment. Priorities are priorities.

10 minutes after opening on Thursday morning...

"Hi, I'm Mr. Somalicious. I know I'm early, but is my Soma ready?"

"No. We talked about this last night."

"You can't give me three tablets right now? I have to be somewhere in an hour."

"No."

Funny how the stories change, isn't it?

Mr. Somalicious wanders off, dejected that he has to wait another whole twenty minutes. 

Final Score: Pharmacist 1, Soma Addict: 0

Free Antibiotics

Some states don't charge the patient for Amoxicillin prescriptions. That's led to requests like this passed through the tube system at a pharmacy with a drive thru window.

Thus indicating the "freebie" mentality continues to grow...

Get your 30 day supply every 3 weeks!

You might have read my blog post last year about "Pain Management" Clinics. If not, here's the LINK. It's actually one of my personal favorites.

I'm revisiting the topic today because I have yet another gripe about these places. I've noticed that a lot of clinics have started printing a portion of their "pain contract" on the prescriptions. By filling this prescription, you agree to various terms, such as only going to their clinic for prescriptions, only going to one pharmacy, etc. But my favorite is, "You agree to take the medication as prescribed and not ask for an early refill."

What's so completely odd about this is that most of my patients that go to these clinics get seen every three weeks, yet come out of the clinic with a prescription for a narcotic with a month supply quantity. Oh, some of the prescribers will put a "do not fill until such-n-such date" on the prescription, but MOST do not. They contract the patient NOT to ask for an early refill, THEN they give them a prescription which can be filled right away. They tell the patient not to eat the cupcake then set one right in front of them!

I had a patient last year who saw the pain doc every three weeks on the dot. Every three weeks he would give her a script for 30 days worth of Oxycodone 30mg, quantity 300. Yep, she was taking 10 tablets a day. Crazy. AND... to top it off, EVERY time I called to ask what the heck is going on the office would tell me that the doc approved her getting it filled. What was the point of writing it for a 30 day supply? Seriously. I still think there's a lot of funny business going on in these "management" clinics. Yeah, what they manage to do is get your money every three weeks.

Lazy, Laughable Sunday Funnies