Me being a dick | The *Angriest* Pharmacist

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...

----------------------------

"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

Scaring a doctor shopper straight before it’s too late

Posted on March 11, 2011

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?

Filed under: Disgusting, Doctor Shopping, Drug Seekers, Insurance Companies, Lazy People, Me being a dick, Patient Education, Prescriptions, Stupid People, True Story, Work Sucks 28 Comments

No fix needed — you’re an IDIOT

Posted on March 10, 2011

Some of you may remember the post from a few days ago where a guy asked me to fix his inhaler / aerochamber. Well, tonight I finally filled in all the holes.

He came back in...as angry as every. I asked him what the problem was and his exact response was precious: "I asked you what I'd need to do if I get this inhaler home and it didn't work and you SWORE UP AND DOWN IT WOULD. Well guess what -- the motherfucker don't work. Ya'll are selling defective shit in here, and I've done spent like $80 bucks on these sumbitches and you, yeah, you...right here [pointing at me as if I were the master of all things Ventolin HFA]...are gonna give me my money back....plus some, find out whose got one of these Gaht DAMN things that work, and transfer this prescription there."

Can you hear a big bellied redneck saying this? HAHAHAHA!

He brought all this stuff with him so I said, "Okay...calm down just a second. Pull out the inhaler you got the other day, and let's take a look."

He pulled it out and I nearly laughed because the answer was INSTANTLY OBVIOUS to me what this guy had done. He handed me the Ventolin HFA inhaler. It was in fine shape. I even squirted it in the air to check. I saw the medicine come straight out in burst of air.

Then, he handed me the Aerochamber. It still had the little plastic piece in it from a Proventil HFA inhaler that they had used once upon a time!

He was either removing the canister from the Ventolin HFA, inserting it into the Proventil HFA inhaler (sans canister), and trying to use the mismatched pair which was obviously unsuccessful [and EXACTLY how he broke the 1st Ventolin HFA - which he attributed to manufacturing flaws and ME!!!], OR he was spraying the Ventolin HFA IN TO the Proventil "plastic piece" and bitching about how the medicine wasn't making it into the chamber.

If only he would have removed his head from his ass and the stupid little Proventil HFA shell from the Aerochamber, he might have wondered, "I wonder what goes in this little inhaler-shaped hole on this Aerochamber." And then, combined that statement with the thought, "I just BETCHA this masked end of the Aerochamber, that's shaped like a nose and mouth covering, goes over the nose and mouth!"

So, I removed the yellow Proventil HFA 'shell' and held it up and said, "this is trash." I flipped the cap off 0f the Ventolin HFA and inserted it into the chamber. I held it up to my mouth, depressed the cannister, and low and behold, the chamber filled with a life-saving aerosol. To hammer the point home, I held the mouth piece near my face and feigned a big breath as if to say, "This is how you inhale the medicine."

Now, ignorance and common sense aside, this is obviously an example where I thought I had counseled a parent sufficiently, but I failed to account for the aforementioned confounders (ignorance and lack of common sense). I mentioned this in the last post -- he showed up and I thought THEN, I didn't explain well enough how to use it. Him coming back a second time, just shows ignorance...plain and simple.

When he calmed down and realized that he now knew how to operate an inhaler, something that I had mastered at the age of 4 years old as I was strickened with childhood asthma, he didn't apologize for his swear-laden rant. He merely tried to shift blame onto me.

"Well, the other day when you were showing me how to use it, you didn't take that little piece out of there!"
"That's because I just thought you had the rest of that yellow inhaler at home. I didn't realize that was from something different. See how this Ventolin HFA has a metallic canister and plastic shell. That yellow shell is a Proventil HFA that, once-upon-a-time had a metallic canister with medicine in it as well. I just thought you would've assumed it fit into this chamber much like the other. I had no idea my not removing it would lead you to believe it were a part of this chamber itself. I'm sorry for the miscommunication."

Then...he did the thing that pissed me off more than anything so far -- more than pointing at me like a child, more than cursing at me, more than calling me an idiot to my face. He just walked away. He gathered his things and walked away.

Now, in this whole debacle, I wasn't all that rude, testy, or unkind/unthankful. I was just average...if anything I was a touch condescending. But, I would contend that if he weren't smart enough to grasp the use of an inhaler and chamber, he could not recognize the presense of condescension. But just to up and walk away? To just turn your back without a thank you, fuck you, or hell, even a thanks for nothing, that's just bogus. With all due respect, you fat bastard, eat shit and die old man...

Filed under: Courtesy, Education, Me being a dick, Me hating others, Patient Education, Pharmacy School, Prescriptions, Rude, Stupid People, True Story, Update, Work Sucks 5 Comments

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