Requirements versus Services
The smart alecks that post wise guy comments on my, and other pharmacist websites, usually only have one or two things they say regarding the worth of pharmacists. The root of their hatred for the profession that does so much for the common citizen is seeded in their jealousy of the wages paid to such highly trained professionals. Along the same lines, they only see pieces of paper (money and prescriptions) coming in and bottles filled with 30 pills each going out. Haters see it as overly simplified. Exoterically, from the outside looking in, it is, but for those of us that spent 6 to 8 years getting a doctorate, we don't agree. Compared to backbreaking labor outside in the hot sun, I can at least understand.
I've also had a recent brash of problems with patients being rude/uncaring about the difference between requirements of a pharmacist versus services provided by a pharmacy. Some things we do are required by laws, federal or state, while some things are done to ensure patients have a good pharmacy experience and return with more pieces of paper.
Requirements:
1. I take the prescription from you. I ensure it meets all legal requirements (Name, Date, Drug name, directions, quantity, refills, doctor signature, and in my state, the Rx symbol on the face of the prescription).
2. I input in the computer (the computer system is not required. I could use a typewriter or even hand write the labels).
3. A prospective DUR (Drug Utilization Review) is performed by either the pharmacist manually and/or the computer system automatically ensuring that there are no drug-drug, drug-disease, or drug-patient interactions requiring concern. If there is, the physician in contacted. The patient is educated or the drug is changed to an alternative at this point. If there is no problems, we move on:
4. A label is generated and placed on an amber bottle.
5. The appropriate drug is counted and placed into the bottle.
6. Final check is performed by pharmacist and all aspects of the process is verified again. Finalized product is bagged and put into the pharmacy's WCB (Will Call Bin).
7. Patient picks up medicine. Patient is provided the opportunity to ask a pharmacist any questions concerning the medicine with the magic question, "Do you have any questions for the pharmacist?" -- this requirement not being added until 1990.
Services:
1. Billing your prescription insurance (or Medicaid) for the cost of your medicine (I don't have to take any insurance - let alone YOUR insurance). Some compounding pharmacies refuse to accept insurance and are cash-only.
2. Calling your insurance if their is a problem such as them not wanting to pay for the expensive name-brand drug your doctor wrote for, the quantity he wrote for, or for any of millions of other reasons they could dream up. Perhaps you remember when CVS made the decision to not call your insurance for problems any more. They accomplished this by placing a phone in the waiting room. It didn't go over well, but it proves my point.
3. Calling your doctor for refills when your prescription runs out. This is the job of the PATIENT that has been performed by pharmacy's striving to merely keep patients from having the opportunity to take their pieces of paper elsewhere if they are forced to visit the doctor for refills.
4. An easy open lid is placed on your bottle instead of the safety lid which is the legal requirement. (Screw your arthritis - I don't have to cater to you!)
5. Paging your name overhead when your prescription is ready -- that's all southern hospitality, buddy!
6. Taking checks or credit cards is also optional. Cash is the only requirement -- read the dollar bill. Does your credit card or check say that I *have* to take it? Nope.
7. Flavoring your child's antibiotic with out FlavorRx system.
8. Anything or everything related to having a drive-thru or providing services through it.
9. Being nice to you in any way, shape, or form. I just have to be there and be sober...I don't have to be my normally delightful self...
I'm sure this second list has a BUNCH more items on it. Fill in the holes for me...I'll add them to the list.
Busting a fraudulent script
Every pharmacist has been in a situation before where they have considered calling the police on a person trying to pass off a fraudulent prescription. Some pharmacists pass the buck and merely give it back to the patient rather than deal with it. Others are pretty gung-ho and do their best to see the person into the waiting arms of the authorities. I kinda go back and forth. It's a case by case basis.
I recently got an email from someone giving out tips on how to ensure pharmacists have the best chance of busting the scam-artist. It all makes complete sense, but it may not be things that we would think of in the spur of the moment.
I've reposted the "scenarios" below with the permission of the author, but I have edited them somewhat to make them more clear/applicable. My thanks go out to the author -- Michelle.
-=+=-
Suggestion 1: Someone brings in a fake prescription. After they leave, you call the doctor and verify that this is a fake prescription. The office confirms that it is fraudulent, altered, or illegal for whatever reason and instruct you to not fill it and have the person arrested. So, you call the police, and they tell you to notify them when the person arrives and stall the scammer when they come in to pick it up. You wait until they show up. Here's a tip: tell your employees that when the customer walks into the store and announces their name, NOT TO STARE AT HIM LIKE HE HAS THE PLAGUE!! Your behavior gives you, and your intentions, away. Scammers will pick up on this -- noticing the attention and bolt.
Suggestion 2: The patient will call you to see if their prescription is ready. All fake scripts will be called on by the scammer first to "test the waters" depending on your (or your tech's) response here dictates whether they ever come in. DO NOT ASK "What exact time will you be here?" RED FLAG. Under normal circumstances, you wouldn't care what exact time it was picked it up. If you ask, the person will know that the police will be there to meet them, and he/she won't show up. This will remove the gratification you so desperately need to see the person leave your pharmacy in handcuffs.
Suggestion 3: Don't tell them over the phone that they shouldn't use the drive-thru. Scammers know it is easier for you to arrest them in the store, so when you tell them"Uhhhh, just come in the store, something is wrong with our drive-thru," or "We need you to come in the store to sign something," they will know you are lying, and they won't show up. Another thing about this that will backfire is when they do show up and the supposedly broke drive-thru is full of customers.
Suggestion 4: For the purpose of this suggestion, we'll call our prescription forger Sally Smith." If you work in a big chain, you have lots of customers. They know this -- that's why they frequent the busiest stores. You cannot possibly know all your patients by name immediately. So, let says Sally Smith walks into your Walgreens at 11:00am with a fake prescription for Xanax. She gives it to you and leaves. You call and verify that it is indeed a fake prescription. You alert all of your employees that when Sally Smith comes back in they are to call the police. You and your employees anxiously await Sallys arrival. Did Sally show up yet? Watch for Sally to some in! Well, Sally has been at this for awhile and before showing up, she decides to call you and see how you react on the phone, most often zealous pharmacists give themselves away when trying to get someone arrested. Its 3:00pm. Sally calls Hello, my name is Sally Smith. Is my Xanax prescription ready yet? If the pharmacist immediately responds with Um, YES! It is ready She immediately knows the jig is up because you knew who she was without checking the Will-Call-Bin or the computer system. What you should say is, Sally who? What's your birthday? Okay. Hold on. Let me check.....When did you drop it off? Oh, yes, Sally, yea thats ready for you. This is much more believable. If they sense anything, they just won't come in -- they can just forge another one and drop it off somewhere else.
Suggestion 5: Someone comes in with a prescription that you suspect is xeroxed. Medicare/Medicaid is slowly rolling out measures to counteract forging of prescriptions like watermarks, heat sensitive ink, and separate pads for controlled drugs. Anyway, you think its copied/altered. The customer gives you or your technician the prescription and leaves the counter but walks around the store pretending to be shopping. If you, as the pharmacist, are going to hold the prescription up in the air under a light like its evidence from a murder scene to see if it is copied, here is a tip, go somewhere where the customer cannot see you do this! They will be watching/waiting. If they see this followed by you grabbing the phone in an adulterous rage, they are going to bolt. In addition, go somewhere out of the pharmacy and call on the Rx. The patient might hear their name or see you say their name and assume you are going to find out it's fraudulent...and bolt.
Suggestion 6: If someone comes in late at night to fill a controlled substance, right before closing time, there is a reason. They know you cannot contact the doctor at that hour and you just want to go home so some pharmacists will just fill the prescription as is. Some pharmacists may decide to not fill it until they can call tomorrow and verify it. Just tell them that rather than give them the drugs or lie to them. And definitely don't blatantly lie to them by saying something like, "The pharmacist-in-charge already left for the night and took the narcotic key with them. I can't fill anything until she gets back tomorrow morning at 9am. You can come back then." These types of people have usually worked in a pharmacy or are very familiar with pharmacy workflow due to the frequency of their pharmacy visits. They will know that every pharmacist has access to the narcotic cabinet and just because one pharmacist leaves does not mean that narcotics cannot be filled -- how retarded does that sound? Turning away all prescriptions...yeah right! Assuming they are ignorant of the ins and outs of pharmacy is wrong, and it will keep you from catching them and seeing them punished for their crime(s).
-=+=-
The readers of this post are going to have varying degrees of opinions on this matter. We can all agree that is illegal, and we discourage it. Where we will have differing opinions is on what is done after the prescription has been determined as fraudulent.
1. Some will always call the cops.
2. Some will just tear the script up and tell the patient they know it was fake and tell them to not come back to their store (and make notes in the computer on the patient's profile).
3. Some will just write fake on it in sharpie and give it back to the patient when they come in.
4. Some will leave the script alone and tell the patient they don't have the drug and will give the script back to them.
5. Some will call the cops and have them come pick up the fake rx and make no attempt to have the person arrested in their store.
6. Some just fax the Rx to every pharmacy/doctor in their area and then give it back to the person and see what happens when they try and go to the pharmacy down the street.
None of them are wrong, necessarily. I am a big fan of Number 6. It's really quite humorous to hear the stories from fellow pharmacists when the person continues to peddle a forged Rx to every pharmacy in town, and they ALL know it's fake in advance.
Some employers refuse to allow their pharmacists to call the authorities or have an arrest made within the store -- as it might scar the store's reputation or bother the other customers/patients. I think this is a punk ass cop out. But, in this case, pharmacists are restricted to numbers 2, 3, 4, and/or 6.
So, what's the right way to handle the situation? What do you do? What have you done in the past? I realize that stories are sometimes pertinent to show what you have done in the past, but try and keep them short and to the point.
UPDATE!!!
Read the Fraudulent Prescription Writing Guidebook at:
http://deadword.com/site/stripmall/hogshire2/bottom.html
If we know the rules and tricks they pull, we can counter them.
The last day I'll ever be questioned…
Scumbag came in recently and wanted 12-hour pseudoephedrine. My tech asked him for his license, and he knew the routine and handed it to her...along with $5.79 (or whatever it costs...exact change -- no paper trail). She knew he was a dirtbag and a frequent Sudafed-Man as we call them. We've recently received intel from the our local DEA agent (and pharmacist) that if the laminant on the license is broken or tattered in any way, it is not a legal license (at least in my state of residence). It is a ticketable offense, apparently. We can refuse sale at this point, and the DEA agent made it seem like we should. I made this known around the pharmacy that this was our new policy.
Well, the man, probably used to being turned away, accepted his fate and slumped away. A few minutes later, he and one of our front-end assistant managers came back in a sort-of triumphant march. The look on Sudafed-Man's face was a I-got-you-now-motherfucker glare...as if this Assistant Manager was going to put me in my place.
"So, what's the deal here with this man's license." ~Dumb Ass. Manager [My tech conceded to me.]
"We no longer accept license that have a broken laminate. It's not a legal license, and it's a ticketable offense per our local DEA Agent." ~TAestP
"Well, that doesn't make sense to me. All the information is clearly readable and we'd accept this if he were trying to pass a check." ~Dumb Ass. Manager
"That's all well and good, but we're not passing checks here. We're selling a substance that is controlled by federal law and regulated by national legislation." ~TAestP
"I don't understand. I used it last week to buy some 4-hour Sudafed!" ~Sudafed Man
"Okay. I understand. This laminate deal just came to our attention very recently. How bout this. I'll sell you this box now, but from this point forward, it is the policy of this store that your license is illegal and will not be honored. You need to have a new one printed." [Then I glared at the Dumb Ass. Manager] "And you stick around. I want to talk to you for a second."
So, I made the sale. Then junior and I went into a secluded aisle.
"So, do you know what just happened here?"
"Well, I just..." [I cut him off here -- The crimson hue of my face should have told him to shut the fuck up]
"I'm sorry. That was a rhetorical question. I'm going to do the talking, and you just listen. Since you felt the need to come back here and defend a scumbag, you undermined my professional judgment. I understand that you accept that to verify checks. I'm not dealing with checks back here. I'm dealing with dangerous chemicals. Now, that man is going to take the dangerous chemical and make it into a VERY dangerous chemical by mixing it with a ton of OTHER dangerous chemicals and sell it for people to inject into their veins and get high. It's called methamphetamine.
You front end managers think you are doing people a solid by coming back here and challenging my decisions day in and day out, but all you are doing is causing MORE problems for me. You give stupid fucking idiots validation in their flimsy arguments against my professional decisions as the pharmacist on duty and the pharmacist in charge. You, by merely coming back and inquring, are saying that you and some fucking idiot are right and that I may be wrong.
From this point forward, you and the rest of your front-end staff are NEVER to come to my pharmacy and inquire about anything with related as to decisions I, or my staff have made. Your response from now on is the following: 'You are going to have to talk with the pharmacist on duty. If you don't agree with him you can ask for the pharmacist in charge or inquire about when he will be returning.' Even if I told a little old lady to shove a broom up her asshole, you tell people their only recourse is to talk to the pharmacist. You have no say in the pharmacy and you will get no say until you complete your doctorate of pharmacy in an accredited pharmacy school.
Are we clear?"
"Yes, sir. Absolutely." ~Dumb Ass. Manager
"Okay. Please pass this information on to EVERYONE else in this store that is not in the pharmacy....Good talk."
-=+=-
Now...That was fucking brutal wasn't it? You bet your ass it was.
I nearly made him cry, and I'm not shitting you all, that's almost word for word what I said to that poor bastard. And no, I'm not going to apologize or recant in any way.
That's once small step for a pharmacist and one giant leap for the profession. Never again will I let someone without R.Ph or Pharm.D after their name even attempt to question the policies and procedure I institute in my pharmacy.
Damn Bicycles
I was driving home tonight, and I came to a "T" in the road. I was turning right. A bicyclist flew across the intersection the same way I was headed. I was nowhere near hitting her, but she ran the stop sign plain and simple. I made my turn, passed her in the left passing lane, and proceeded. She ran another fucking stop sign -- passing me up. I made my way past her another time and got to the light....She didn't run the light, but I rolled down my window.
"IF YOU ARE GOING TO BE ON THE FUCKING ROAD, YOU NEED TO FOLLOW THE RULES OF THE ROAD. STOP RUNNING FUCKING STOP SIGNS YOU STUPID BITCH"
She rattled off some inane babble about "did you see that red car right in front of me? were you watching that red car???"
I think she was implying that since she was tailing a red car very closely, that the red car's stop counted as her own. Readers, I can assure you that while, in theory, this sounds correct -- she is in fact a stupid, dumb bitch and needed a good kick in the cunt...which I would had delivered had I not be on a very important mission to get home and drink beer.
Attention bicyclists! I can accept your hippie ways. I can become accustomed to your unwashed hair and your vegan lifestyle for the betterment of 'mother earth' -- but, when you're on my fucking roadways, you obey the laws of the road you hippie scum. I don't give a fuck how much you are reducing your carbon imprint...or mine!
If I had hit that fat, pear-shaped slut, my ass would have been in trouble...not hers. The cops wouldn't have said..."Ohh she ran the stop sign...have a nice day!" They would have said, "You hit a pedestrian? I'll see you in hell, motherfucker!" Then I would have been locked up.
Stay on the sidewalk, off my roads, and off my fucking last nerve.
Next time I'm going to door-check that sperm-burping whore....
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