This is more for the readers

Yes, I think there is. Example from work this morning: Mom had called us yesterday when Jr. had 1 dose each of Keppra and Phenobarb left. We faxed the Dr in Pissburgh… and heard crickets for the rest of the day. Today, mom called us at 9:02AM, then the MD, then us again at 9:40AM, then the MD, then us again to ask for an E supply since he’d need a dose tonight. I got yelled at for taking the request to my pharmacist because “legally, we can’t give an E-supply during business hours”, but that rule has been bent for pediatric/acute cases before, and I’d call an epileptic child acute enough to at least consider a 10 mL loan, even though the mother really should know to call at least two days ahead. Since the pharmacist I asked was annoyed with the mother for “not being on the ball” and wanted to make her sweat, we’d had an additional 5 calls from her when I left at 3 today, still waiting for the MD. In this case, aside from the annoyance of all those phone calls, I think the fact that the child could seize tomorrow without an E supply should be on my pharmacist’s mind before she vents her spleen on a customer via yelling at her tech. But, the law is on her side, so there’s not much ground to argue with her about it. *shrug*

Frustr8ted was ABSOLUTELY in the right, when there is no guarantee the pharmacy will be paid. We only do 3-day emergency supplies on refill requests, and we fax the doctor each time we do one, so if they switch the drug or something, we just short them 3 days worth of that (if it’s something ridiculous like Valtrex to Acyclovir, well, we just have to eat the cost for 3 Valtrex)

But prior auth’s….nope. If you manage to get your doctor to convince insurance to postdate the prior auth so that any pills you buy are retroactively-covered, then yes, we will reimburse you for the 5 pills they bought. Otherwise, tough luck, the prior auth applies to future fills only.

How very rude of that nurse to chastise Frustr8ed over not giving 5 pills of a NAME BRAND MED to a customer whose attitude deserved nothing in the first place.

No way would I give him a few pills for free. Typically at my pharmacy we will have them pay for the few pills that they are going to get. If they are nice we might price modify the rx that goes through the insurance when it is approved and short them whatever they paid for. The nurse is retarded for suggesting that you forward pills. Don’t tell me how to run my business if you don’t have a clue how to actually run it.

Since when do we have to justify ourselves to a nurse, doctor, or anyone else?

I would have told that guy to buy the OTC omeprazole until he could straighten out the problem with the doctor and insurance company himself.

The pharmacy chick does not front medicationa t no charge in cases of Prior Authorizatoins. As many are denied as approved and I am not footing the bill any more. If the PA is granted quickly and I can rebill AT THE ORIGINAL FILL DATE, then will credit the patient when they pick up the balance, if I cannot rebill at the original fill date (i.e. the PA is not retroactive dated) then too bad. This is a business, just like any other. The nurse was completely out of line to expect you to front this at no charge. Like they would pay if it was denied????

Next time you can ask ” so, if you have to get a referral for an insurance for a patient, can I send them in for a quick consult at no charge while you wait for the referral????

I think it depends on the patient and the situation. In this case, I would charge for the 5 capsules, then go through with the PA. If that goes through, we run for 30 (or 90, or whatever) and simply give a refund for the difference between what the ins said and the price he/she paid.

I think it also depends on the price of the medication (ie. Nexium vs. omeprazole).

The only time I offer to give a 3 day supply is on maintenance meds. There is no reason why we should give out drugs for free especially if we have to rely on the Doc’s office to follow through with the Prior Auth. Only will give a 3 day supply if patient is being reasonable as well. Since its actually against the law to give out prescription drugs without a valid prescription if a person will be an a$$ to me I will not “break” the law for them, even though no state board will do anything about it. I will also tell people when they say so and so gives me free pills while we wait for the doc’s office, i reply with well its against the law but we will offer it as a courtesy one time so you the patient learns to call in ahead of time to get ahold of the doctor.

My policy is…you’re respectful of me and my profession, you may gladly have a few days to hold you over until I can get a refill…if you are disrespectful and a general asshole, you can go fuck yourself! See you in a few days!

There is no way any pharmacy should ever give free pills in the case of a PA. Never. As another pharmacist here said who cares what some dumbass nurse had to say. What if they got the PA approved and it came back a $60 copay. Will the customer pay it? Probably not. So there you are out the tablets once again. PAs are between a patient, his doctor, and the insurance. Until approved they are a cash paying customer period.

Patients seem to have a tendency to blame the pharmacist or tech who tells them their insuranse company requires PA. he needs to go buy the otc box and stop wasting your time.

I can totally relate to this. Happens here in the UK as well. I am sick to the back teeth with people outside of our profession trying to “advise” us on how we should be doing things!!! I would charge them… You wouldn’t go into Walmart and get them to front you a bottle of wine when you have no money! – you’d be met by a security guard built like a shit brick house throwing you out of the door!!…. I knew of one pharmacy in the UK where anyone who wanted what we call an ‘emergency supply’ would immediately pay double if they tried to get smart. Tell the nurse to naff of and stick to her area of competence which is very little in the UK anyway!

One thing to remember is that if we front pills for no charge, that’s actual product lost. Actual money being taken away from the pharmacy. If a doctor doesn’t charge, it’s time. We all know time = money but it IS different. Throwing cash out the window and wasting time are a bit different.

Advancing 5 days for something that costs pennies is one thing, advancing something that costs dollars a piece is something else.

He wasn’t going to die if he didn’t have his Nexium, so fuck him.

I would of gave that “nurse” both barrels (like I have so many times in the past when nurses act like they have any idea how a pharmacy is ran).

Golden Rule: DO NOT BITE THE HAND WHICH FEEDS YOU.
If they are nice we might give some upfront. If it is expensive, they have to pay for a few. If a Nurse would tell me to give it for free until the prior is there, I would ask for HER credit card and WE will reimburse her “behind” until the patient gets the prior or is willing to pay for it. I have encountered attitudes from Nurses in the Pharmacy which I can NOT believe. I usually ask for the name and which floor or MD office they work for and when I have my rotations THEY GET IT BACK. Oh what fun it is:-) They do learn quickly after I remind them! I do love the “power” trip every so often:-)

last i checked nurses went to school for 3 years & Pharm.d’s go to school for 6… tell that nurse once she gets her phar.d she can run the show or better yet… tell her sureeeee lady how about you come down here & pay for the 5 caps or w.e. so the asshole can have it for free… i hate nurses

“CT says June 12th, 2009 at 4:26 pm
Frustr8ted was ABSOLUTELY in the right, when there is no guarantee the pharmacy will be paid. We only do 3-day emergency supplies on refill requests, and we fax the doctor each time we do one, so if they switch the drug or something, we just short them 3 days worth of that (if it’s something ridiculous like Valtrex to Acyclovir, well, we just have to eat the cost for 3 Valtrex)

But prior auth’s….nope. If you manage to get your doctor to convince insurance to postdate the prior auth so that any pills you buy are retroactively-covered, then yes, we will reimburse you for the 5 pills they bought. Otherwise, tough luck, the prior auth applies to future fills only.

How very rude of that nurse to chastise Frustr8ed over not giving 5 pills of a NAME BRAND MED to a customer whose attitude deserved nothing in the first place.”

Although I totally agree with CT, Omeprazole is not a name-brand med, it is expensive, but not name brand. It is generic for Prilosec.

Why give him any free meds when he can buy the same thing (or close enough) otc? Had it been me I would have shown him the otc stuff and said if you are desperate for a PPI you can BUY this!!!

We get this a lot with some of the antibiotics; Jersey Care/Americhoice, for one example, won’t pay for some of them without a prior approval. They’re pretty good about granting them in that case, but only if the MD calls and requests it. Obviously you can’t front someone three teaspoons of a liquid antibiotic. If it’s not insanely expensive, we have them pay up front and tell them that they’ll get reimbursed if/when the PA comes through. If it *is* insanely expensive (e.g. Suprax), what we do is take the customers’ credit card number, and tell them they’ve got until the end of the week (or whatever) to resolve this; if we don’t get an approval within X number of days, we’re charging their card for the $123.22 or whatever it costs for 50ml. If it’s a drug that comes in a solid dosage form, we might front them a few tablets, but again with the understanding that their credit card will be charged for them if the PA is denied, or worse, never applied for. As a courtesy, we will call the doctor *once*; they need to follow up on it themselves. If they don’t… their problem, I refuse to let it become mine.

Then they get angry with us when they get charged. What, you think *I’m* gonna eat that cost? My wholesaler doesn’t care that your doctor never even called for the PA, they want their bills paid on time regardless. Why should it come out of my pocket?

“Although I totally agree with CT, Omeprazole is not a name-brand med, it is expensive, but not name brand. It is generic for Prilosec.”

Oh, sorry, I read that whole thing as Nexium, not Omeprazole. Thanks for noticing

I would have told him to take 2 tabs of OTC Prilosec. Or like all good Kaiser pharmacies–> tell the patient to go whine to urgent care doctor.

This is as hilarious as a mother who was freaking out that we won’t give emergency refill for her 16-year-old daughter’s birth control (since the lady is switching doctors so we don’t even have a doctor to fax the emergency refill request to).

Yup..that’s how we roll too…maintence meds are one thing. If he really really really needed it like he stated..then he will pay for it. Why didn’t the MD have samples? If this was something he truly needed, then maybe that should hbe been an issue to look at. I also hate those that are “not sure” if the insurance will pay for it, but order it anyway because it’s important..then it sits on my shelf for months because they don’t feel like footing the bill and are “all better”

“This is a business, not a charity. Do you go to a restaurant and demand free food because you are hungry? Do you go to Dillard’s and demand free clothes because you need them? Do you go to your hooker and demand a free blow job because you need it?” why is pharmacy different?

There’s a whole ‘nother dimension of fun added to this attitude at our compounding pharmacy.

The nurses love to leave messages about 4-5 ingredient compounded rxs with dosages that are customized “exactly” for patients that we’ve never seen before…

Said patients seem to usually arrive at the counter 10 min before we close for the weekend. And they are aghast that we haven’t already mixed it up & become angry that it’s not humanly possible to complete the compound before we close. They can’t wait over the weekend. (Yet they managed to go without during the week that has elapsed since the rx was called in.)

We try to explain the ingredients cost alot — and the pharmacy would have to “eat” the cost if it was never picked up. So we are required wait until we have confirmed that first timers are willing to cover the copay/cash price.

So they huffily give us all the pertinent info we need…including insurance (hopefully,lol) and then we have to tell them their copay (usually third tier, 50% or something for most ins..)

And then the anger is directed toward the outrageous price. “That’s ridiculous!” “I’m not paying that much.” “Forget the whole thing” “cancel it!” … etc.

I’d say a good 80 to 90 % of the people mad about it not being ready are the very same ones unwilling to pay the copay….. and they don’t even catch the irony of it all.

Give me a break. I would have pointed to the box of otc omeprazole. It’s not even worth going for the PA.

Here’s my personal favorite: The mdo screws up and sends the wrong rx in – they ask US to eat the cost. When we tell them that we did not make the error and perhaps they could forgive the pt’s next office copay to compensate or ask the drug rep for samples, they get their panties in a bunch. Where is the logic here?!?!?

My doctor N/C’d me yesterday for an appointment, that was because of a misdiagnosis, but free never the less. LOL I am always very respectful towards the pharmacists, and I have been fronted before, too. You treat them with respect, they’ll treat you nicely.

Kevin:
That totally happened to me yesterday. Dr’s office called in 12 vials of Novolog instead of Novolog 70/30. I ended up agreeing to let the patient return in, but the nurse who called about the mistake could not understand why we couldn’t re-use the Novolog that had left the pharmacy. I asked her “How do I know that the guy isn’t storing it on his back porch in 90 degree heat?” Finally, she seemed to get it…

And there’s the situations where a Dr’s office has DENIED a prescription. *THEN* the nurses and/or MD’s have the gall to tell the patient to ask us for a ‘few days worth of medicatoin’ until their appointment. Okay, what part of “Once it is denied, I can’t do *ANYTHING* with it.” don’t you understand?

If you want them to have some medication, callin a new frigging script, else your patient ain’t getting sh*t.

(The ‘rescue’ part is more about me being involved with animal rescue, rather than human rescue. The humans ought to be able to take care of themselves! The animals? Well, we humans are causing their problems a lot of the times!)

I’ve had that exact conversation with 2-3 different nurses and customers. One involved the nurse called in the wrong strength med and told the patient I would give him the correct strength for free (after he had taken 3 pills). I have found that the easiest way to deal with this is to simply say “The medication cost me 142.99 (whatever the price is). It doesnt matter to me who pays me back for this, but before it leaves my store, someone is responsible for paying 142.99 If the insurance is the one that pays, fine, but right now they are refusing. So either you can pay or your md can pay. Your choice.” Works very well with most customers. As for the nurse, ask her if she would like to come down and pay (swear on my dead dogs grave I have had a nurse come down and pay for a dental pre-med abx she forgot to call in) or where you can send the 142.99 bill. Works like a charm….