Insurance Companies | The *Angriest* Pharmacist

Two months worth of reader email

Posted on December 2, 2011

Sorry, I've been....deficient the last two months. I'm not going to promise any more, but I can tell you this. I will have a response for Mr. Plagakis pretty soon. Don't expect anything revolutionary. Don't expect anything mindblowing. Just expect a clear, concise response. Naught but the truth. I also want to look back at some older posts in which he referenced me about releasing steam (in a hilarious masturbation simile) and how/why the post titled, "Jay Pee catches Wal-Mart peeping through the window" relates directly to all of it...

Below, I'm going to post several different things that came to me via email or the CONTACT link. I'll lead with the user's name, and if you wish to reply to one, just reference that name....or don't...I don't care...

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Liz writes: In the past few weeks, our pharmacy has started checking ID for controlled drugs, scanning in new Rx and scanning in hard copies. All of a sudden, our workload has tripled, but our company is cutting tech help. Is anyone else finding this hard to manage?

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Rodney writes: I work as a reimbursement specialist at an LTC Pharmacy, and I'm writing to share an interesting exchange I've had with representatives at Prescription Solutions over the past few days.

I've had a few basic rejections which, were the representatives at Prescription Solutions even modestly intelligent by today's decidedly low standards, should have been able to resolve with much rapidity. Instead, I got stuck with slack-jawed yokels and embittered, defensive inner-city youth. They turned requests for overrides to simple rejections into drawn out, unintelligible arguments, and once they'd been cornered or otherwise became bored with the exchange, they hung up on me mid-sentence.

I may not be the bubbliest person in the world. On the contrary, I'm frank and to the point, but never did I become enraged, and never did I insult or otherwise disrespect the reps in any way. Prescription Solutions - hell, the insurance industry as a whole - has no shortage of stupid, rude, and disinterested people, but I've never had any with the gall to abruptly hang up on a service call. Now, over the past two days, it has happened to me four times.

Though I feel somewhat vindicated by the fact that return calls yielded exchanges with intelligent reps who applied the necessarily overrides with absolutely no hassle, I am perturbed by this sudden shoddy treatment. I know PS has seen extraordinarily long hold times as of late, what are the odds the reps have been granted free reign to terminate calls from "problem callers" (that is, of course, callers who question the rep's ill-informed initial judgment)?

Any thoughts? Similar experiences?

[TAestP's thoughts: I believe the reasoning behind this is, as always, money. When the question is, "Why?" most of the time, the answer is money. In this case, I'd bet if you timed your calls, you got hung up on at specific intervals....something like 3 minutes, 59 seconds. If the agents keep their calls (or a certain percentage) less than 4 minutes, they probably get higher ratings or a bonus at the end of the day. They may also have rewards/cut offs at 10 minutes or 15 minutes. Of course, the person could have just been an asshole, accidentally hung up, or hung up on you because they are lazy and/or didn't know the answer.]

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Lillian writes: I found your blog a few days ago and I love it so far. From your posts, you seem to know a lot about retail pharmacy so I was wondering if you could answer a question for me: Is it true that the field is getting very saturated, very quickly?

A few of my professors warn us that it will be much harder to find a job in retail by the time we graduate (2016). And I've been hearing a lot of people saying that retail is going downhill.

I know there will be more competition for the jobs in several years because of there are more students going into pharmacy now. And I get the feeling that maybe one of my professors is exaggerating the situation to encourage us to go into other pharmacy fields. But do you think this saturation is something to be seriously be worried about?

For the record, I would try to go into retail no matter what the situation is...I just don't want to be completely caught off guard after graduation.

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Kristin Writes:
Dear TAestP,
I know someone who filled a Rx at a CVS. The pharmacist later called and texted her saying "Remember me from CVS? Would love to get coffee with you some time?--Weirdasspharmacist [sic] " She responded that she wasn't interested. She didn't get any more fills there, but she was afraid of contacting his manager or pharmacy baord because CVS had her information on file and the pharmacist could look it up and perhaps do something scary like stalking.

TAestP, what would you recommend doing?

[TAestP's thoughts: If this is true, it is creepy as hell. You are right that CVS would have the info, and he would have access to it. But, he's already pretty much risked his license by doing this -- taking it from creepy to full on stalking would definitely result in a meeting with his state's Board of Pharmacy. If he is not the pharmacy manager at that location, I would call and speak with the pharmacy manager about the incident. Tell her it made you (or her) uncomfortable and that you would like the manager to give your information to their district manager so he/she can call you at their earliest convenience. Then discuss the matter with the DM. I'd be almost anything this would squash absolutely any issue -- cause that DM does NOT want you making a formal complaint with the board. If he is the manager at that store, call a nearby store's pharmacy manager and do the exact same thing. If this does not get you to an ends that you are happy with -- or you get blown off at any level -- google the state's board of pharmacy. One call to them with an accusation like this would definitely result in an investigation and something would be done. Tell your friend I'm sorry my text creeped her out -- she's not gonna like the photos I'm sending tonight....just kidding of course.....:-D]

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Mike writes: so...i witnessed a patient ingest 90mg of methadone...the patient's prescribed dose was 40mg...i gave him the wrong bottle

i'm getting kicked out of pharmacy school 4 months before graduation...what do i do now? should i submit my resume to the nearest McDonald's?

[TAestP's Thoughts: Either this is untrue and you're trying to waste my time, you're just a general dumb ass, or you have done a ton of other stupid bullshit. Regardless of what anyone may think, there is only one person responsible for what pill goes out the door and into the hands of a patient -- the pharmacist on duty. I don't care if the technician accidentally typed in Oxycodone instead of Omnicef for an infant, I still believe the ultimate responsibility should lay on the pharmacist that verified the prescription. (intentional bullshit and other types of lying and deceit aside -- I'm talking about true accidents by ancillary staff not caught by the pharmacist) However, it does sound like you are in some other kind of facility or setting. Since you witnessed the patient do it -- not sure what that means as a patient should never be handed a pill by pharmacy staff to take -- that changes the role from dispensing to administering which we cannot do (in terms of pills).

If the school threw you out, and this is a true story, you're probably fucked. Sorry dude. I guess you could appeal and plead to the school, but that's the thing with private universities, they can do whatever the hell they want whenever the hell they want. Other than that, see if another school will take you or get a lawyer....or get a job and good luck paying back all those loans....]

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That'll do for now....check back for the next post coming soon....

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]

Filed under: Doctor Shopping, Doctors, Drug Seekers, Insurance Companies, Laws, Me being a dick, Prescriptions, Stupid People, True Story, Work Sucks 14 Comments

Unfortunately, this is a TRUE story

Posted on March 17, 2011

I swear on the life of my unborn children that the following conversation is almost 100% exactly as it happened. Right as it concluded, I went and recorded a "note" on my iPhone to help me remember this idiocy...

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"I was wondering, if I brought a list of my medicines up here, could you tell me how much each of them would cost?"

"Are you on file here? And do you have insurance?"

"I've never been here before, but I have Paid insurance."

"Well then, unfortunately, I cannot. Your best be would be to look on the back of your card and call the Member Services or Customer Service number listed there. They can tell you exactly how much each prescription will cost. All I can give you here is the cash price which doesn't do you any good when your insurance will foot the bill in most cases."

"I don't understand. Can't you just put it in the computer and see?" [Gotta love that all-powerful, "computer" that does all and knows all!]

"That's not how it works. If I had valid prescriptions on file for each one, I certainly could just push a button or two and tell you, but you aren't on file here. So, I can't do anything to help you. If you'd rather bring me a stack of prescriptions I can get you prices then..."

"Well. That doesn't make any sense. I've got a list at home with all the prices on it. Why can't you just tell me what they cost? You're a pharmacist!"

"Wait. You have a list of all the medicines, what they cost, and you want ME to tell you what they cost? You want me to tell you what that list already says?"

"Noooo....well, not exactly. You see, at the last pharmacy I went to they gave me special prices on some medicines. Not the expensive ones. They ran those [the expensive ones] on my insurance, but there were some that were cheaper if they didn't use my insurance."

"Are you talking about the '$4 list' generics?"

"Yeah! That's it. How much are those here?

"Well, they are $4...we honor that program. Unfortunately, I don't have them all memorized, but if you bring in what you got, I can figure it all out."

"Well, I've got a list of the ones that are $4 at Wal-Mart at home. Don't you have that list?"

"Wait. You have the list of what your prescriptions cost on your insurance at home. You ALSO have the list of ALL the $4 prescriptions at home. But, you want to bring me a list of your prescriptions. You want me to look at those two lists that you have at home in your possession and tell you what those lists, that you have in your possession, say. And you want me to compare those two numbers and tell you which is cheaper."

"Exactly. Which is cheaper HERE..."

"Really? ..........[Long Pause of disbelief].......... Sure...bring everything you have to me...I've got nothing better to do. I'll show you how to do one and we'll see if you can get it from there....If not, I'll get you a quote."

What he got from our conversation: That nice pharmacist will put my prescriptions in the computer and tell me what they cost if I bring him a list.

Filed under: Drive-Thru, Education, Insurance Companies, Just a question, Lazy People, Me being a dick, Me hating others, Money, Patient Education, PHARMACY SECRETS!, Prescriptions, Stupid People, True Story, Work Sucks 5 Comments

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!

Filed under: Courtesy, Doctors, Education, Insurance Companies, Lazy People, Me being a dick, PHARMACY SECRETS!, Prescriptions, Stupid Doctors, Stupid Nurses, Technicians, Work Sucks 12 Comments

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