Friday, January 16, 2009

Copays

I could probably write a story every single day about some patient bitching about their copays. It's too much, it's not the same as last time, it should be zero, whatever - I hear it every day. But, today, I heard a new one.
A gal comes in to pick up her Topamax. She's on a dosing regimen that requires combining two different strengths. Sixty tablets of 100mg, and 180 tablets of 50mg. Each prescription had a $25 copay. She insisted that the 50mg tablets should only be half the copay of the 100mg tablets... Get real lady, the 50mg tablets have a cash price of nearly $1000, and you're griping about a $25 copay?
When are people going to realize that pharmacists don't set the amounts of the copays and quit bitching at us???? It's getting old...

Friday, January 9, 2009

Makin' 'em love ya

I usually post about stupid shit in pharmacy, including mean people. I've noticed that many of my fellow pharmacy bloggers write about the mean people they experience, too. In a comment to a recent post on my friend JP's blog, one technician estimated 98 of 100 customers were nasty. Some days it certainly feels like that, but I've tried to change that by befriending my nastiest patients, and I thought I'd share some stories about how I did that.
The first patient I'll call GS - for gunnery sergeant. I don't know if that was really his rank in the Marines, but he seems like a "Gunny" to me. GS is a crusty ol' Vietnam Vet - loud, obnoxious, and foul-mouthed. He's diabetic, and when I first met him, he had horrible neuropathy and persistent lower extremity infections. I'm sure his pain is what made him such an ass. But, he reminded me a bit of my dad, so I decided he was OK, even though my techs would practically run and hide when he'd show up, knowing he would pound his fists on the counter. I have some background in pain management, so I helped him with his meds, called the doctors with suggestions, and made sure he was never out. I think what changed our relationship was a hospital stay he had for a post-op infection shortly after having his leg amputated. I was still working on call at the hospital, and saw orders for him cross my desk. I went up to his room to see how he was doing. GS recognized me, knew where he recognized me from, but didn't know my name. I told him, and also told him that I had clarified some of his drug doses that the admitting doctor had gotten wrong. Now, GS says the amputation was the best thing that has happened to him, because he's in less pain and has fewer infections - and, he's one of my favorite patients. Sure, he's still loud and obnoxious, but when I hear fists pounding on my drop off counter and a "Get to work, girls!", it brings a smile to my face, and takes me out from behind the counter to get the biggest bear hug you've ever seen. GS got upset when I didn't invite him to my wedding, but forgave me and even offered to marry me if I was left at the altar (I told him his wife may not appreciate that). Even though I declined on that offer, I still get a loud shout of "I love you!" when he rolls his wheelchair out of the pharmacy.
Next, I'll tell you about TW - for train wreck. "Train wreck" is a term used in many hospitals to describe a patient who has MANY medical problems. TW is a woman, younger than me, who takes 30+ maintenance prescriptions. Having so many problems at such a young age, a lot of pharmacists assumed she was just a hypochondriac. It couldn't be farther from the truth - she had a pacemaker by her early 30's. When I first met her, the experiences she had with other pharmacies had jaded her. She refused to be counseled ("I know more about my diseases and meds than YOU ever could"), demanded brand name only ("I'm allergic to all generics"), and would demand that one person always be the one to help her. Over the first couple of years, she transferred her prescriptions around, mainly in response to my demand that she be counseled on new things. After 4 or 5 experiences with other pharmacies treating her like a freak, refusing to jump through insurance hoops to get her brand name drugs, and even having her scripts bagged in a garbage bag (the regular bags are too small), she came back, realizing that we really did treat her with respect. It was then that she realized she could trust me. TW not only lets me counsel her, she calls for questions before her doctor's appointments, so she can be prepared to make suggestions to the doctor herself. She now takes generic meds, after following my suggestion to be tested for allergies to dyes. Turns out the generics she was allergic to all had one thing in common - blue dye. I call TW my bread and butter patient (and she knows this) - when she picks up her scripts every 3 months, my sales for the day are boosted by about $10k - it paid off to make her love me...
Then, there's CP - for "crankypants". That's what I call him - right to his face. When CP first came in my store with a stack of new prescriptions, he immediately launched into a tirade. Threatening to sue us if we treated him the way his previous pharmacy did. He was yelling at my tech, who shot a "help me" look my way, so I walked up to the window and said "I'll make you a deal. We will treat you with respect if you treat us with respect. You have never been here before, we haven't even started on your scripts, and you're already yelling. So - you be nice, and we'll be nice. Deal?" He agreed. It's still pretty obvious to most people that CP is just a cranky old man in general, but he grins ear to ear when I say "Morning, crankypants! How are you today?"
Lastly, I'll tell you about AA - for addiction and Alzheimer's. That's not a good combination to have. For the first few years in my pharmacy, I mainly dealt with AA's husband. He would come in, looking defeated, telling me how AA was taking his meds, would physically fight him if he wouldn't give her more of her own, and asking if I could help by not filling stuff she called in. One time, AA called me and screamed at me because I had told her doctor she was taking her husband's drugs because she had used up her month's worth in 5 days. Her doctor was putting her on a short leash. I probably spent 30 minutes talking to her, explaining that she was putting her life at risk, that I couldn't let her do that, and that it was my job to work with her doctor to be sure she was taking her meds right. I finally convinced her that I do care. Her husband passed away a little over a year ago, so I have tried to work closely with AA, her caregiver, and her doctors to keep her on an even keel. Just before Christmas, AA's caregiver came in, and in our chit chat, I found out that AA's roomie had been stealing her food. I told the caregiver to go pick out a small refrigerator, and I'd buy it for AA as a Christmas gift, so she could keep some food in her room. AA came in a few days later, full of tearful thank yous. It made me feel so good - not just for the gift, but also for standing up to her when she was at her worst, to provide good care - she's doing so well now!

So - all you pharmacists, interns, and techs - next time a really obnoxious person comes through your doors, make it your mission to make' 'em love you. Not only does it reduce the nastiness in your waiting area, it will make you feel like you've accomplished something - you've done the right thing. Not all jackasses can be befriended, of course, but you won't know who can if you don't try...

Wednesday, January 7, 2009

Rules, rules, and more rules...

There are a hell of a lot of rules and regulations in pharmacy. As there should be. Most of them are intended to protect the patient. But one rule has me all worked up lately...
As of October 1, 2008, CMS (the group that makes the rules for Medicare and Medicaid) requires that all prescriptions be on security paper. Three security features are required - and the list of options for which security features a prescriber can use is quite long. I have been audited by my company's internal audit team twice in the past month.
The thing that really pisses me off about this rule is that the weight of it falls squarely on my shoulders. If the doctor doesn't comply with this rule, nothing happens to him. Just yesterday, I had to call one office 4 times, and send 5 patients back to the office to get new prescriptions. I know this doctor knows the requirements - I've seen scripts come from him on security paper. But, for some inexcusable reason (they 'forgot' to order more paper), every person who came from that office to my pharmacy had plain old white paper. The first 2 calls I made, I was pleasant, then I got progressively nastier as the day went on. I finally said "If this continues, I will refuse to take any prescriptions from your office." But who gets hurt there? Me, and the patient. Now, my techs have to take extra time when taking in a script at the drop-off window to see which insurance the patient has before they can accept a new one - that adds about a minutes to each drop off, and when we're doing 500 scripts a day, that really adds up! I have three options when presented with these kind of prescriptions: 1) Call the doctor and get a verbal order - not allowed if it's a schedule II controlled substance - which wastes MY time; 2) Send the patient back to the office for a new script - in the case of the CII's - which wastes the PATIENT's time; or 3) Fill them as they are, which puts me at risk of getting fined if I'm audited. Did you notice that none of these options creates a hardship for the doctor???
When are these rule makers going to come up with something that impacts the doctor if the rule isn't followed?