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A Prescription for Retail PharmacyA Guide to Retail Pharmacy for Patients, Doctors, Nurses, Pharmacists, and Pharmacy Technicians
By Jean-Marc Bovee
iUniverse, Inc.Copyright © 2011 Jean-Marc Bovee, Pharm.D.
All right reserved.
Chapter OneAdvice for Patients
"He that won't be counseled can't be helped." – Benjamin Franklin
Are you ready folks? Here's how it works: you drop off a rx and your prescription insurance card (not your medical or dental card). Then you go away for a while, while we type it up. Our computer electronically sends the rx to your insurance company's computer, your insurance company's computer sends the price that we are supposed to charge you to our printer, and then we physically fill the rx. When you come back you are charged whatever your insurance company told us to charge you. Simple enough concept, eh? Then why is it that, to this day, the vast majority of people still do not understand this? (Appendix A)
Due to the aforementioned in depth explanation, I trust there will be no more questions about cost while dropping the rx off at the window, right? Well, there ought not be, anyway. We do not know the price of your rx until we fill it under your insurance first. All we can do before filling it is to provide the cash price. Now you finally know why that is. I am sincerely sorry that no one has ever explained that to you previous to the publication of this book.
In point of fact, in January 2010 a 90-year-old man actually dropped off two rxs and flat out asked me, "How does this work?" I thought to myself, "Good for him for finally asking." It is lamentable, however, that no one ever took the relatively brief time to explain this to him anytime during the last century. Unfortunately, some customers, even after your dissertation, will still argue with you claiming that it does not work that way, in fact. Then you want to ask them, "Have you ever worked in a pharmacy? No? Then how in the hell would you know? Why would I make up such an explanation? Why don't you take my word for it? What's the debate about?"
Questions like, "Why is it so much?" or comments like, "It didn't cost that much before!" are grating after a while as well. We do not know why the charge is what it is, or why it has changed. We can only speculate. It is best if you call your insurance and ask them yourself. Things do tend to go up in cost over time, and drugs are no exception. "I don't remember paying that much for it before! Did the price go up from last month?" We do not know off hand. You can't remember what you paid, but you expect me too? Sure, we can look it up for you, but why not just ask for that in the first place before yelling at us?
If it was less before, then it is safe to say that the price has gone up, isn't it? Maybe your deductible has rolled over. Maybe the drug's tier has changed. Also, if you get a new card, please give it to us at the same time that you drop off your rx. If you wait until pick up, then you are only delaying the process because now we have to go back to square one.
"Why isn't this drug covered?!" Again, only your insurance company knows the answer to that question. See that 1-800 number on the back of your insurance card titled "Customer Service?" I could call them for you, but if I had to do that for everyone who questioned their co-pay, then I'd never get anything else done. It takes a mighty long time to get a human being on the phone. "Press one if you are calling from the continental U.S. Press two if you are calling from Guatemala. Press three if you are calling from south of the equator." I'm sorry, but this is one area where patients need to take a more active roll in their own health care. We are a pharmacy, not an insurance agency. Besides, you had to have received a packet from your prescription insurance company at some point explaining what drugs are covered, what tiers they are on, and what your various co-pays will be.
I particularly like it when they say, "It should be the same amount I paid last time." My typical reply is, "But apparently it's not, and wouldn't be if the price has gone up now would it?" Then they try to flank you by pleading, "Can't you just give it to me for what it was last time?" To which I respond, "Well, um, wait ... let me think about that for a seco ... NO." Do you realize that, in essence, what you are asking is that we pay for part of your co-pay?
Now for a few loose ends. Your prescription insurance card is wholly different most of the time from your medical or dental card. It usually has an "Rx" on it somewhere, and a "BIN" number, which is sort of like the insurance card's ID number. This is not always the case, of course. Sometimes one card does it all, but rarely. By the way, this will be the only instance in this book where I will take the time to point out that exceptions obviously exist whenever generalizations occur. Got that?
In any case, you signed these contracts when you chose them, so if you have done your homework, then you should know which of your cards are for what, and how much your co-pay ought to be. After all, this is your health and money we are talking about here. If your insurance rejects your rx, and you want us to call them to find out why, then that is fine, we are happy to help, but it will take time. Please do not stand there glaring at me holding up the line expecting immediate resolution. Oh, and staring does not expedite anything. In fact, I periodically have to tell my customers that, "My concentration suffers greatly when I am observed."
Not only does it take a lot of number punching to get an insurance representative on the phone, but we also have many other sick people requiring our immediate help (i.e., we suffer from constant interruptions). Sometimes we do not have time to make an instant phone call. It is much easier for everyone if you call your insurance yourself, but if you prefer, then we will do it, and then we will call you when the mystery has been solved. If you do not hear from us in a day or two, then you are more than welcome to call us back and inquire about your rx.
Hopefully you did not wait until you were completely out of pills before you dropped off your refill (ahem). If that is the case, we will certainly give you a few pills to get you by until the matter has been settled, unless it is a controlled drug or something that cannot be partially filled such as an inhaler. In these cases it is that particular pharmacist's judgment call. Again, as a single person, it is easier for you to follow up with us once ample time has passed.
The same goes for doctor calls. Often times someone drops off their rx bottle for a refill, and it either has no refills left or is expired (both of which are indicated right on the rx vial itself). So then we are ordered, I mean asked, to call the doctor's office for another rx. As the patient walks toward the ice cream section with their grocery cart I have to say to them, "You do realize this will take time." The response is usually something like, "Oh, that's okay, I have some shopping to do. What do you think, ten minutes?" I absolutely love it when customers tell me what the wait time is going to be. Giggling, I typically reply, "No, when I say time I mean 24 to 48 hours." Then I get that look. It is the look of the vengeful warrior that every pharmacist can recognize.
I mean honestly, would you prefer we provide you the number you wish to hear, or the more probable and realistic one? I can tell you it will be ready in seven seconds if you want. Listen, I'll cross my fingers and hope that your doctor calls me back in the next few minutes, but I will not hold my breath. Once he or she calls I will fill your rx as fast as humanly possible, but I can't do any better than that.
It is not we pharmacists who set the time frame, just as it is not we who set your co-pay. We are simply giving you a realistic assessment of when your doctor will get back to us. Think of us as the monkey in the middle. We simply do as we're told by the physician, and the insurance company. We are the Rodney Dangerfield of the medical professions. Helpful hint: the doctor's office will probably approve your refills a lot sooner if they hear from you as well.
Whenever we call your doctor's office, for whatever reason, we often get a machine which states, "Please provide for 24 to 48 hours for a response," and then allows us to leave a message. Have you ever tried to get a hold of your doctor right away? I rest my case.
Once I have beat this drum long enough, made my point, and the patient realizes the situation, then they always ask me, "Well, once it is approved can you call me?" Sure, in the name of customer service I'd be happy to, but again we have a hundred calls to make every day, you have one. A lot also depends on how busy we are that day, if our tech calls in sick, and many other unpredictable factors. Again, if you do not hear from us within a few hours, then check back later in the day, and we will gladly give you the current status of your rx.
All we ask is that you please do not harass us every hour on the hour. That is the number one cause of eye twitching in a retail pharmacy setting. My right eyelid spasses out so fast sometimes, that hummingbirds fluttering nearby often times try to mate with it.
"But I need it now! I am out!" Okay, so you are waiting to the last minute to get the medication that keeps you alive, and this is our fault? It seems that thinking ahead in anticipation of something possibly going wrong is a lost consideration these days.
Fine, we will make the effort when we have the time, but believe it or not, a lot of pharmacies are so damn busy that they literally don't have the time; they really do not. This is especially more the case nowadays since companies are cutting back on tech help for pharmacists, and forcing us to give flu shots, among other things. Let's all work together for your benefit. Do not be afraid to be an active player in your own health care, and remember, don't shoot the messenger.
I once had a woman call for a drug that we did not have, so she wanted me to call pharmacies all around town and try to find it for her. I explained I would when I had time, but was unsure when that would be, and that it may be quicker for her to grab a phone book and call the stores closest to her location. "Oh, but I am very sick. I can't do it." She called me three times that afternoon checking to see if I had found it for her yet. I was scratching my head; clearly she could make these calls herself.
Usually I'll call a couple of pharmacies, but if no one has the drug, then what am I to do? Am I to call ten, twenty, fifty pharmacies? No, at some point you need to chip in and grab the baton; after all, it is your health we're talking about here.
As I have come to learn, it is much easier for people to ask someone else rather than to get the answer themselves. Pharmacists and techs are no exception to this. I have worked with people who often blurt out, "Where's the rx for so-and-so?" Then I say, "All you have to do is hit F3, type in the patient's last name, and the computer will tell you which queue it is in." Of course, this exact same exchange is repeated multiple times throughout the day.
Often a customer will walk right up to me and ask, "Where are your cough drops?" Then I say, "Look down and reach out," all the while thinking, "If you had taken one millisecond to look around you would have seen the item you're looking for, and would not have had to interrupt me and break my concentration."
Also, why debate us? This may sound like a pretentious question, but we do not tell anyone anything that is not as it is. When the price prints out, don't yell at us-it is what it is. When your drug is not covered by your insurance, don't argue with us-it is what it is. If we do not have the drug in stock, don't get mad at us personally, we did not do it on purpose, I swear. And why are you mad at me because your doctor has not approved our refill request for you yet? We called him, and we faxed his office. What have you done? Have you tried to contact him yourself yet? Well, why not? Why leave it solely to us? It's your health, how about some participation? They may be able to ignore us, they hear from pharmacies all day long, but it is harder for them to ignore the patient once they call. I mean seriously, what do you want me to do, go over to the doctor's office and put him in a head lock?
Often times, the patient will say, "I'm here to pick up a rx. My doctor's office called it in." After a thorough search I respond, "No, I'm sorry, I don't see anything." Then the patient exclaims, "The doctor said he called it in," or "I saw him fax it." Then I'll say, "Are you sure they called (or faxed) the correct pharmacy?" Invariably the response is "Yes! I gave them your number." Then, after a second exhaustive search, I say, "I'm sorry. I don't have it. They must not have done it yet." What follows in a minor temper tantrum directed at the pharmacy staff.
Now, what are you people thinking? It is almost as if customers assume I'm joking with them, that I am hiding the rx behind my back, and at any minute I'll pull it out and say, "Okay, just kidding, I had it right here the whole time. You got me. I was just messing with you." Listen, if we say we do not have the rx, then it is because we do not have it yet. We are not magicians who can pull your rx out of our butt, and it is not our fault the doctor's office has failed to send it to us.
Please do not haggle with us on your wait time either. Do you honestly think we arbitrarily make up those minutes? We say it will take a half an hour because we want to make sure it will be ready when you get back so that you do not bark at us if it is not. It may only take twenty minutes, but we cannot guarantee it vis-à-vis interruptions, problems, issues, etc. so we say thirty instead just to cover our rear end.
It is what it is. Get the idea? Besides, rushing leads to errors. In a perfect world you would not have to wait at all. Also, I think I speak for all pharmacists when I say that we are tired of hearing about your melting ice cream. Of all the things we have to worry about, your melting ice cream is about 8 billionth on the list.
Now this is important, when I ask you for your "last name" please don't say your entire name. About one thousand times throughout my career I have asked a customer, who is picking up their rx, "What is your last name?" Then I hear, "Miranda Conchita Alanzo Lopez Rodriguez." See, when you do that I don't know where to start looking. I'll probably begin searching in the "M's." Please, when I ask for the last name, just say your last name. Along those lines, if I ask you to spell your last name, then do not simply re-pronounce it. There is a difference between spelling and pronouncing, okay?
Also, what is the deal with patients dangling their rxs just out of our reach when we lean over the counter to grab them? Exactly how long must we remain in these uncomfortable and ridiculous positions before you deem us worthy to take your ever so deeply valued rxs away from you? Sometimes it feels like patients are dropping their kids off at summer camp such is the strength of the apparent attachment to them. Perhaps it is the realization that they will never see these rxs again once they hand them over, but then you have to wonder how such a bond could develop after a short drive from the doctor's office to the pharmacy. Listen people, just hand us the friggin' scripts already.
One thing I thought would be common knowledge by now is that a rx is only good for one year, unless it is a controlled drug, then it is six months. All too often a confrontation ensues when a customer calls in for a refill, we see that it is expired, we state that we have to call the doctor for a new rx, the patient yells that they still have several refills, and finally we explain that it could have 100 refills but that is irrelevant if the rx itself is expired.
An entire book could be written about the various types of patients out there, and the experiences I've had with them over the years. For instance, you have the insouciant curmudgeon whose life is obviously full of much rage and free time. This chronically unpleasant person's colonic sphincter is strung so tight, that you can smell the bile on their breath as they chastise you for some minor indiscretion you committed. There is no pleasing this person, and if you stumble just a tad, then they will devote their empty lives to making as many phone calls and writing as many letters that they can to your peers and superiors in an effort to get you fired. Jihadists marvel at the vindictiveness of these people especially when one considers how little it took to set them off in the first place. You can imagine how much fun we Florida pharmacists have with snowbirds in this regard. In the appendix is an article that I was able to get published in a local newspaper on the subject. (Appendix B)
Excerpted from A Prescription for Retail Pharmacy by Jean-Marc Bovee Copyright © 2011 by Jean-Marc Bovee, Pharm.D.. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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