The *Angriest* Pharmacist You want your prescription filled when? Eat shit…

Voicemail prescription on Memorial Day

Posted on May 30, 2011

Had a doctor call in a prescription today...on Memorial Day. I could tell from his tone on the voicemail he left that HE WAS PISSED. He was bothered. He was angry. He was leaving a prescription for, let's call him Cal Ripkin. Here is the message verbatim:

"Prescription for Cal Ripkin. Zpak. No Refills. This is Dr. Johnson."

Luckily, I knew who Dr. Johnson was because he did not say his first name. I could just hear it in his voice that Mr. Ripkin called him at home or through the exchange acting as if he would absolutely die without a ZPAK STAT! And, rather than tell Mr. Ripkin to stop being a pussy and take a nap and some Tylenol, he just called in the prescription. Is antibiotic begging becoming some sort of weird variation of drug seeking?

Mr. Ripkin called me moments later and arrived mere minutes later. He needed that fucking ZPAK...

As I'm ringing him out, he doesn't ask about cough medicine. He doesn't ask about Advil or Tylenol. He doesn't ask me any REAL questions at all. He does hold out his hand and show me his palm. He's got a giant blister -- looks like it was from fighting a push mower without gloves.

"Will this ZPAK help with this blister?"

"I don't think it will. It's not super-red. It's definitely not infected. I wouldn't have torn it open -- maybe you could cover it with some super glue or Nu-skin to keep it from hurting."

"Oh. I kinda thought.....well....okay...thanks...."

 

So, let's recap here. Patient calls doctor for antibiotic. Doctor doesn't ask why, what for, or any questions. (It's for a blister, by the fucking way) Patient doesn't tell doctor what it's for. (It's for a blister, by the fucking way) Pharmacist fills it, patient comes to pick it up and pharmacist discovers patient wanted it for a blister, BY THE FUCKING WAY.

What a waste of time, money, resources, and my patience. This is one of the biggest examples of problems within our healthcare system -- WASTE and MISUSE OF ANTIBIOTICS. Super bug, anyone? This is how we are going to create it....

Doctor shopping and insurance fraud and asshat patients — OH MY!

Posted on March 22, 2011

Man, these folks are coming out of the woodwork!

Had a lady call me for a refill (on we'll say 3/19) on her (surprise) Norco 10/325 last week because she was (surprise) going out of town. It had been 9 days since we had refilled it. The prescription was for 50 tablets taken every 6 hours. I put it in as a 13 day supply. I told her that it would be "a few more days" before it could be filled. She, of course, did not agree with me. She tried to tell me that it was a 12-day supply and we, meaning my pharmacy, "always fill it three days early." Well, she's wrong...maybe two days early...on a 30 day supply...if the patient isn't a problem....

The fact that she argued with me about filling it early, about it being a 12 day supply versus a 13 day supply, and told me what MY pharmacy always does got me interested in her profile.

I booted up my trusted internet browser and navigated to my state's Prescription Drug Monitoring Program, plugged in her information, and I was quite shocked at what I found.

Date                        Drug                                       Qty/Days    Prescriber   Filled by:
3-14         Hydrocodone/APAP 10/325     90/30          J. Smith          CVS
3-14         Alprazolam 1mg                               90/30          J. Smith          CVS
3-10        Hydrocodone/APAP 7.5/325    50/13          B. Jones          MY PCY
3-10        Alprazolam 0.5mg                           30/10         B. Jones          MY PCY

And this shit continued for the last 3 months or so. Let me share the most SHOCKING piece of information -- there was another column titled "Payee" which will say Medicaid, Commercial, or CASH. Usually, we would expect this to say CASH at one pharmacy and COMMERCIAL or MEDICAID at the other when we encounter doctor shoppers. In this instance, THEY ALL SAID COMMERCIAL!!!

This lady was doctor shopping using her insurance card...from her benefits at work! WOW! I can only assume the insurance company didn't catch it because the strengths had different NDC -- maybe even different manufacturers? Not sure....

I called and confirmed all of this with my friend Remy at CVS, and we each canceled all of her refills. I then printed all of this out and faxed it to the physicians involved (and every pharmacy in town). I heard back from both offices very quickly -- and they were pissed. They canceled the refills (of course) and each fired her as a patient.

When she called back the next day, it was precious. She said, "Well, will it go through today? It's been 10 days and it's a 12 day supply."   I said, "No, it's still a 13 day supply, and it has come to our attention that you have been getting the same drugs in different strengths at CVS."

"That's just not true!"
"Oh, yes it is. And this has been going on for several months now."
"Well.......(long, awkward pause)......how do I fix this? I'm not sure I know what's going on...."
"Well.......yesterday, I fixed it by faxing this information to both doctors and every pharmacy in town. The doctors then called me back and canceled all remaining refills and wanted me to let you know you were released as a patient. Now, what they are going to do? I don't know. For your sake, I would hope they don't call the police because it appears crimes have been committed here..."
"Eck..." [Really odd sound she made here. I'd say it was the sound of disbelief.]
"If you really and truly have no idea what's going on, you need to call and talk to CVS and both of these doctors immediately...." [I said this in a really shitass tone]
"Okay. Thank you very much!" [Being nice...praying *I* don't call the police]

How to get a Prior Authorization — RN-style

Posted on March 15, 2011

This is a message for all you nurses out there. This post is now the PREMIER AUTHORITY on how to get prior authorizations -- in  STEP BY STEP FASHION. It's an overly simple 4 and 1/2  step process.  As a wonderful "side effect" of this process, you will waste at least one week of a pharmacist's time and, an added bonus, really piss them off as well. It's a win-win for every RN!

4) REPLY TO ALL FAXES REQUESTING YOU GET A PRIOR AUTHORIZATION BY SIGNING IT AND AUTHORIZING "1+2" REFILLS. This is a GREAT way to both waste a pharmacist's time and really frustrate them. In most instances, they've told the patient 48-72 hours. By replying to the fax with refills, you show that you really want the patient to get the medicine, but it shows the pharmacy that you've got better things to do than read their stupid faxes. To really put a cherry on top of this one, schedule the fax to send at 4:55pm. This will ensure that even if the fax even goes through successfully in the first place, the pharmacy can't contact you again until the next day because the phones cut off at 5pm on the dot (and you cut out at 4:30pm in the first place)!

3) When they call you the next morning, make sure they have to leave you a voicemail. If you're feeling particularly randy, respond to that with a copy of the fax from the day before and a SNARKY  NOTE at the bottom of the fax. Some suggestions for the note are:
"Authorized (1+2) yesterday. Is your fax machine working?"
"I got your VM -- here's the auth you need. Thought I faxed this yesterday. WEIRD!!
You could also just skip the reply all together...

2) When they finally get a hold of you at the end of the second or the third day, tell them your office's standard is at least 3-5 business days on a PA Request. Tell them you'll get back with them at the beginning of next week. After you say this, don't do anything. Don't even ATTEMPT to get the prior authorization. Why you ask? Duh -- the pharmacist will probably call and remind you again on Tuesday or Wednesday when you actually need to do it anyway. Out of sight out of mind! [If you wanna be a real bitch, at this point you need to send another refill authorization in to pharmacy. No note this time -- you don't want to appear "catty."]

1) After they call you Wednesday, if it's a different pharmacist than the one you talked to the previous week you need to go off on him. Make a huge scene. Act as if everything that was sent in and you cannot figure out why the pharmacy refuses to fill the prescription. When they explain the PA Process to you, acknowledge it, say you'll get right on top of it, and completely ignore every word of it. At this point you need to go straight to your doctor and tell them the following, "Doc, I don't know what the heck is wrong with Walgreens. They are pretty much refusing to fill Mr. Johnson's _________.  I've dealt with several different members of their staff. I've faxed in the prescription at least two different times, called it in once, and I can't seem to get them to fill it!" Then, the doctor will call and ABSOLUTELY TEAR THAT STUPID PHARMACIST A NEW ONE! Sit back and laugh. You've done a good job. You've waste almost a week of the pharmacist's time, and you've not had to do much work or call for the PA.

Final Step) Now, when the doctor returns to you,  he'll explain to you that they just need you to get a PA. They'll be so scared of the doctor, they won't say anything about your prior shenanigans. Your response should be, "Well, why didn't they just SAY THAT!?! STUPID PHARMACISTS!" He will agree and, at this point, you need to call the pharmacy again and have them fax you the information on how to get the Prior Authorization. They will probably say something about how they sent you the information -- just tell them you never got anything. Now, buckle down and actually get the PA...dag nabbit!!

And that is how you get a PA!

 

 

“I’m never coming here again!!!”

Posted on March 7, 2011

The title of this post really says it all, amiright? If you've worked in service of customers/patients, in any field, some jackass has uttered (or hollered) these words in an outlandish attempt at getting their way by bartering all of their money for future services rendered in exchange for instant gratification in the form of (most likely) you compromising your better judgment.

Obviously, this has happened to me quite recently...and it pissed me off royally because I was the nice guy being lied to and this fat bitch was the fat bitch that altered her prescription and lied to a(nother) pharmacist.

She presented a prescription from a doctor for that read as follows:

Pt: Janice Sanveritas

Hydrocodone/APAP  5/500
Sig: 1-2 tabs po q4-6h prn pain.

Dr. Ima Schmuch, DDS

 

Now, most reasonable people can see that this prescription LACKS A QUANTITY. She brought this to me at, we'll say 1pm on Sunday. After I IMMEDIATELY pointed out that it lacked a quantity and would require a phone call the next day, she remarked that she thought that this was the case, but she convinced herself that the word "SIG" which was scribbled was in fact the word SIXTY. Of course, this would be ridiculous because it is very UNcommon for a dentist to write for SIXTY FUCKING VICODIN. So, we argued about this a bit and decided that she was mad at the dentist for not writing a quantity and not me, but she was pretty sure he told her sixty....considering this lady had been a problem in the past, I didn't care what she thought, I wasn't even gonna give her 1 or 2 for that night (which I might CONSIDER, for a second, if she was a consistent, good, nice, polite patient).

So, she left script in tow. She came back at about 3pm. Now, the script had a convenient #60 written in right beneath the Sig. The ink didn't match. The hand writing didn't match. The story made no sense. She told me the drove over to this dentist's office and caught him just as he was leaving and he apologize profusely as he wrote in that #60 in a different handwriting from 6 or 7 days prior. I called his office the first time she came in and of course, nobody answered. In fact, it went straight to voicemail as if no one were in the office. I left a message at that time, but I knew no one would get it until Monday. Luckily he was there, right?

I told her, right when she handed it to me that I was going to have to call and verify the quantity...and the drama and bullshit began. You all know how this went.

"I have to call and verify this."
"Why? He wrote the quantity in plain as day. You can see it right there."
"Yes, but you must understand why I have to verify this. It's Sunday afternoon. I've seen this script without a quantity and you bring it back and now it has a quantity written on it. If your dentist DID write this in, he should have called or at least initialed next to the quantity that he wrote it in a different colored ink. He knows better. He knows how things are these days with all those druggies out there."
"Ohh so now you're calling me a druggie?"
"I don't recall saying that specific phrase. Did I say that?"
"Well, you might as well. I'll tell you what I'm fucking sick of this place. Every time I have fucking problems because you're a fucking idiot. I'm NEVER COMING HERE AGAIN!"
"And that's completely fine with me. I just want you to at least accept that you know where I'm coming from. I have to verify that quantity on that script. You've had it for several days. What's 18 more hours? I can call in the morning before I even open."
"No, just give it back to me. I'm going somewhere else. This is ridiculous. I've been coming here for 10 years. [Note: this pharmacy has only been open for 4-5 years] I'm going somewhere else, and I'm transferring all my meds away, and I'm never coming here again. Someone else would be more than happy to accept my business."
"Okay...fine...good bye" [and good fucking riddance]

-=+=-

I wanted to say, "Do you really think, for one second, that I'm not going to call every pharmacy in town the SECOND you walk out of here and let them know that you are leaving here with a prescription that I believe to be altered?"    But, that would ruin all the fun of wasting her time! I WANTED her to take it to another pharmacy -- or several if possible -- only for her to be turned away for the EXACT same reasoning. I also wanted to write something on the prescription, but that would've also kept her from mustering up the gaul to take it elsewhere.

So, I took to calling all 8 pharmacies in my vicinity. Turns out this fat bitch was already BANNED from Wal-Mart, a Medicap, and a Medicine Shoppe.  Now, she can add one more pharmacy to that list for her bullshit.

The winner of the "where this bitch ended up" contest was CVS. I'd talked to their pharmacist Remy, and she politely called me back. She let her drop it off and return 30 minutes later. Remy told her that the quantity's ink did not match the rest of the prescription and that she had no choice but to call the next day and verify it. This bitch politely said, "Okay, thanks a lot!" and putted her ass right on out of there...after showing her ass real good right in front of my eyes!

Today rolls around and I head in there and first thing call that dentist's office and apprise them of the situation. I told them that I believe that she modified the prescription, but CVS currently possessed the hard copy and would be calling. I just wanted to tell them my side of the story. Their side of the story? He intended on giving her 20 tablets and was nowhere near the office on Sunday.

Cut ahead to Remy calling me later on...She verified the script was altered by someone, and the DDS intended on 20 tablets. However, he went ahead and AUTHORIZED TWENTY TABLETS TO BE FILLED! I could not fucking believe it. Remy couldn't believe it. Hell, the fucking patient probably couldn't believe. This was the only doctor in the fucking NATION that would approve that script. He is enabling her addiction -- no doubt about it. This fucking doctor is a problem. I am debating whether or not to call the Board of Pharmacy and the Board of Medicine. I'm not sure if there's grounds for any sort of investigation -- or if I would just end up looking like a tight ass, punk pharmacist...

What are your thoughts?

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