Friday, June 30, 2017

Thursday, June 29, 2017

Natalie Norco Needs it Now

Natalie Norco was here again, just 21 days after she saw her "doctor" at the "pain management clinic." The doc must have conveniently overlooked her chart since he wrote another 30 day supply of medication for Norco 10/325. 

I told Natalie it was too early for her Norco since we had just filled it 21 days ago. She said that I should call the doctor because he said it was ok when she was in her office. I called "The Center for Strategic Management of Skeletal Pain" (don't you just love the fancy names for a prescription mill?), was put on hold twice, and finally put through to the doc's assistant.

"What can I help you with?" she asked.

I explained the situation. We're on day 21 of a 30 day supply and here's Natalie with another Rx for a 30 day supply from your office. I told the lady that I need to talk to the doc. I politely explain to her that typed on on the prescription itself is part of the "pain contract" and that it says NO EARLY REFILLS.

"Why do you need to talk to the doctor?" she asked.

"Because HE wrote the prescription. He's written 1 QID and after that, 'Take 1 tablet five times daily.' I need some clarification from the source," I replied.

"He's with a patient right now, but I'll have him call you."

One hour passes.

Two hours passes. Wow, that's a long consult with a patient.

Natalie returns and wants to know why we don't have her Norco ready. Upon telling her that we're waiting to hear back, she gets upset and calls the office from her cell phone. I get busy with other patients and then she's gone. Natalie Norco is nowhere near.

Ten minutes later the doctor's assistant calls back, says it is supposed to be one tablet five times daily but not to fill it until 30 days past the last fill. Ok, I can do that.

Ten minutes after that the doctor himself finally calls me back. I tell him that I just talked to his assistant but he wants to talk about it some more. Now he's changing it to 1 QID and then confirms again that I'm not to fill it until after the 30 days have passed from the last prescription.

I hang up the phone with the doc and the technician informs me that Natalie is waiting on line two to talk to me. I pick up the phone...

"Crazy, I just spoke with the doctor! He said it was ok to get it filled today!" 

"Natalie, that's really odd. I just now got off the phone with the doctor myself. He told me not to fill the prescription until 30 days past your last fill. He said you should have plenty of medication at home from the last fill date, so I can't fill it until..."

<CLICK> Natalie hung up on me.

Nice try.

Tuesday, June 27, 2017

Attention Grocery Patrons

Thank you for shopping at Goofmart Grocery. Yes, we are a pharmacy inside of the grocery store. We're here as an added convenience to enhance your shopping experience. We offer a full service pharmacy including vaccinations and can fill prescriptions while you do your grocery shopping. 

That's what we do.

But we're not experts on ziplock bags, obscure homeopathic herbs and weeds, and we don't know why no one is coming when you ring the bell at the meat department. We're not a switchboard to connect you to the other departments in the store. We don't know if Blue Bunny ice cream is on sale or last night's winning Lotto numbers. We know the name of the bank at the front of the store but we don't know when they open and close. We don't know why your dog is biting his tail and we're not fully prepared to discuss your medication issues when you fill your prescriptions at the pharmacy across the street.

So if your question is a REAL pharmacy question, we'll help you out. We'll do out best and if we don't know the answer, we'll find out for you. But that's the extent of our knowledge. Questions about postage stamps, beer, or shampoo really isn't our thing. 

And no, we don't have any Viagra samples.

Monday, June 26, 2017

10 Seconds to Type, 20 Minutes to Fix

As it turns out, this Levaquin Rx was meant to be a SEVEN day supply, not seven tabs as shown.

It took three phone calls and twenty minutes to track down the prescriber. Any pharmacist could have just figured this out on their own, but that's not the way it works.

If you're a prescriber or typing up prescriptions for a prescriber, please slow down.

Saturday, June 24, 2017

GoodRx + A Jerk = Everyone Loses

This situation we're all facing with @GoodRx is getting worse, and worse, and worse.

Yesterday was a damn busy day. I'm trying to fill scripts and I have one tech at the register and another tech at the drop off window. The guy at the drop off wants to fill his prescription on GoodRx because he's convinced he's going to save 80% on the prescription. He takes at least three minutes to pull up the info on his cellphone app while people are in line behind him... then hands it to the tech.


The tech enters the GoodRx info on the computer after inoculating himself with the guy's cellphone germs. This is a tedious process because if you're one digit off it doesn't work. To process a prescription claim, four things are required: BIN, PCN, Group, and ID. For those of you not in pharmacy, those four items aren't really important to you as a patient but on our end it routes the information electronically to the right place and kicks back a co-pay.

The tech tells the guy the co-pay, which isn't what he was expecting. After checking everything out it becomes clear that the patient entered the WRONG QUANTITY on his GoodRx app and thus it returned a different price.

Another five minutes of fiddling (we're now 12 minutes into just entering the information on this ONE prescription and the line behind Mr. Savings is now four deep) the amazing price which is a whole $2 less than our own company discount pops up...

In all seriousness, the guy says to my tech, "So, about five minutes?"

Really. He said that.

"No, we're a little behind right now. There were some dropoffs before you. We're at about a 45 minute wait right now."

"I'll just go somewhere else!" he spits out, grabbing the prescription and storming off. Mind you, he's just wasted 15 minutes of precious pharmacy time FOR NOTHING but an amazing $2 savings and he can't wait for his prescription.

And people at the pharmacy and on Twitter and Facebook really wonder why pharmacists and technicians HATE GoodRx with a passion? They really wonder?

Thursday, June 22, 2017

It's Not All Bad

It's not all bad in retail pharmacy. It's mostly bad, but not all bad. Ok, maybe it's like only 98% bad and 2% good. Or maybe it's just Goofmart Pharmacy and the band of Ferengi I work for. Or maybe it's just my particular district. I'm rambling now.

But it's not all bad.

One time I had THREE people, on THREE different occasions, come up to me and PERSONALLY thank me for the medication advice I gave them. I don't even recall the specifics. But they felt I gave them excellent counsel and they came back to tell me they appreciated it.

So yeah, it's not all bad.

Another time I dispensed an SSRI to a teenager. It was new to the patient and I counseled both the teen and the mom about the medication and talked about Serotonin Syndrome. It's a rare but serious possibility with drugs that affect Serotonin. I've only seen one case of actual Serotonin Syndrome in the past but I always mention it.

My counseling paid off. Later that week the mother called me to thank me because she caught the symptoms early with her teen and the hospital confirmed that he was genuinely affected by the condition and were able to treat him immediately. Because I counseled the mother, the issue was caught early and she thanked me over and over again.

So yeah, it's not all bad. Keep your chin up, fellow pharmacists. The company thugs we work for may mock us for not putting profit above patient safety, but you and I both know what's most important.

Tuesday, June 20, 2017

The Scariest Part? These People also Vote!

"Where's your adult Benedryl? I only see the children's Benedryl," she said.

"It's at the OTHER end of the counter, FAR RIGHT, BOTTOM shelf," I reply.

The lady steps back to the children's Benedryl at the far left and starts looking there.

"No, the far right, bottom shelf."

The lady steps to her right to the middle of the counter and starts looking there.

"No, the FAR RIGHT, bottom shelf."

The lady steps to her right to the right side of the counter and starts looking on the top shelf.

"No, BOTTOM SHELF," I spit out, stunned.

I continue processing prescriptions. Ten minutes later, and I'm not kidding, TEN MINUTES LATER I look up and there she is, still looking.

I go out to the floor and point to the bottom shelf.

"Oh," she said.

These are the kind of people that are also looking for the big savings with GoodRx.

Monday, June 19, 2017

Another Not-So-GoodRx Story

The following story is yet another example how @GoodRx WASTES everyone's time for purported "amazing savings" that just isn't there:

"I've got a story for you that explains the biggest issue that I have with GoodRx. My last shift was on a Saturday and was fairly slow. We had a lady coming in to pick up Effexor and Hydrocodone. She had just been out of surgery, and had had a very rough week. The price on her Venlafaxine was something like $48. This was with our most senior PhT having spent most of last night on it. Now we turn to the Venlafaxine. GoodRx says she can get it at $28 through us with this coupon. I want to help her, so I plug it in. Cost actually goes up to $74 for her month's supply. She panics. She does not have enough for $48, why is it $74?"

"Lunch rush hits. She's upset but understands I need to work with other customers, so she calls. She's very cooperative with us helping other customers. Eventually things calm down and I'm put on the phone with the support for the coupon company who she's been on with for 5 min. The rep tells me to tell the person to call the GoodRx number, then wishes me a good day & hangs up." 

"I get to break the news to this lady that she needs to call someone else because our system is right, that coupon does have a $74 copay. She's even more upset; doesn't understand why the email lied to her and why there's a difference. I help her find the number & she calls. She finally gets a tech at GoodRX who tells her without a doubt it will be $28. She's happy. I'm happy. I get on the phone and she very matter of factly she tells me all the information. I already notice a problem. This is the program our senior tech found... the $48 one. I cooperate and punch it all in. Yup, $48. I tell her that. "...oh." she stammers and asks for the claim number. I give it. "Your prices must have gone up!" Yes its my fault. Then she tells me that a change in price changes the copay (no shit) & leaves me on hold."

"Shortly after the phone call _cuts off_ leaving _me_ to deliver the bad news to the patient who has heard enough to know she was lied to. We are now back to square one with a patient even _more_ upset, with me having to break bad news twice, and a solution I already had."

"I then explain what I was going to explain in the first place. The senior tech had already reached out to other pharmacies. We found her one for $20 for her supply with some cards their tech used, and we'd be happy to transfer it. I had already started to explain this but she was _so insistent_ she had this nice email that said she could get it here."

"While on hold for those few brief seconds I noticed a wonderful message in GoodRx's hold music. "If the price at the pharmacy is different than the price on the coupon, the pharmacy is correct." If GoodRx hadn't sent this woman this email getting her hopes up we could have saved her a _lot_ of fucking grief. They provided an experience so bad this woman was in _tears_ and could not understand why they had "lied" to her."

"GoodRx empowers people to think that the mystical internet knows more than the pharm techs at the store. You might save 2-3 bucks but if there's a card for 80% we probably have the info already written down, and we probably use a universal identifier for it. for ex: FMLWZ. I was done with them by the time i was done trying to help this poor lady. She couldn't understand why the lady hung up. She couldn't get an answer, leaving it to _me_ to explain _their_ fuck up. _That_ is a bigger problem to me than the privacy issues. _That_ experience that I was made complicit in. I can't put into words how terrible I felt for this lady. When I screw up (saying i can fill a med that's out of stock) I personally call. I own my mistake. I had two people in two parts of the GoodRx machine pass the buck to me, and in doing so confuse this poor woman even more.

My thanks to Natalie Spencer on Twitter as @Zyradyl for tweeting this story just yesterday.

By the way... we're still waiting for Doug Hirsch to respond to my open letter blog post on June 10.