Voicemail prescription on Memorial Day
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....
Unfortunately, this is a TRUE story
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...
----------------------------
"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.
Scaring a doctor shopper straight before it’s too late
Young lady brought in a prescription today for #14 Vicodin. I'm not sure why doctor shoppers haven't figured this out yet, but one of those ignorant comments you make is, "I DON'T WANT THIS RUN ON MY INSURANCE!" That comment immediately raises my suspicion level.
Now, this young lady didn't say that -- it was a variant that can be equally suspicious, "How much does this cost? Cash Price. I no longer have insurance." The fact someone says this isn't always suspicious, but the fact she said it twice (and awkwardly at that) did set off my bullshit detector. She told me that she wasn't on file -- luckily she was -- and lookie there....A MEDICAID CARD! I, of course, didn't tell her that I had this information.
I ran it, and low and behold, it rejects. I call up Medicaid to inquire about doses, quantities and where. They tell me a Norco 7.5/325 #90 (30 day supply) filled at a nearby CVS about 14 days ago. [The Medicaid agent gave me the Fraud Line and urged me to call. She also said that the new Rx could be filled in NINE DAYS based on carryover days, etc.] The Vicodin prescription was written 4 days ago. I called CVS, verified Name, birthday, medicaid ID number, and made sure it was picked up. Now, we have a problem.
I wrote her Medicaid ID number right next to her name (very big). I also wrote a note explaining the entire situation on the face of the full page prescription. When she came back to pick up the prescription, we had the following exchange:
[The most unfortunate thing here is that while the following is occurring, there is a 4 or 5 year old little girl stumbling around in front of the pharmacy munching on a cherry Dum-Dum I had given her...unable to comprehend the gravity of what was going on in front of her...the mistakes her mother was making before her eyes.]
"We have a bit of a problem here. We had you on file, and we happen to have your Medicaid Card and ID number on file. As we ran this it came back that it was a refill too soon and duplicate therapy."
"I don't have any insurance or medicaid. I didn't fill anything at CVS..."
"Stop lying to me. I called Medicaid and they told me that #90 Norco 7.5/325 tablets were filled at CVS 14 days ago. I called CVS and verified this information. They also checked the signature logs and found your name signed to the electronic pad. Now, if you genuinely have no idea how this prescription got filled or what is going on here, I can pursue this matter further. However, if you are lying to me, of which I have ZERO reason to believe you are telling the truth, this will end very badly for you."
"No Sir. That won't be necessary."
"I was told by Medicaid that you can fill that in 9 days. I wrote that date on the prescription along with a little note in case you decided to try and take it anywhere else. I've also notified the area hospitals, clinics, and pharmacies through our area 'doctor shopping fax tree.' I also have no choice but to call the Medicaid Fraud Line and notify them of this. I hope these measures prevent you from making any more attempts to acquire controlled medications. Up to this point, you haven't been caught. In the future, you will get caught, and what you are doing is a felony, and it's fraud. Now, for your young daughter's sake, I would hope you turn over a new leaf."
"I will. I promise. You don't have to worry about me ever again. You don't have to call anyone about me. I'm sorry. Thank you. Have a nice day...." [And she scampered off as quickly as possible with her daughter in tow.]
For what it's worth, I did not call any hospitals, doctors, or clinics, and we don't have a "doctor shopping fax tree" (but now that I invented the idea of it, it sounds like a great idea!). I also have no yet called the Medicaid Fraud Line because I was on hold for more than an hour (I left it on speaker), so I gave up and hung up. I said all that stuff in an attempt to scare a 23 year old girl back onto the straight and narrow path. Maybe it was too harsh. Maybe I was wrong in doing all of that. What do YOU think?
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