Ethics and the lazy

Contrary to popular belief, there is a ton of ethical crap that goes along with being a Pharmacist.

Prime Example:
Family comes in who are on welfare.  They bring you Rx’s for 2 bottles of amoxicillin (one for each kid) and for some OTC tylenol liquid.  You run their Medicaid through and they were terminated.  You obviously know that they cannot be terminated because its the first of the month, and everyone gets all screwed up towards the first.  Plus it helps that this family has been on Medicaid for the past (all) generations, so the chances of them being actually terminated is nil.  The Amoxicillin runs about $9/each.  You know that they don’t have the cash on them.  Do you charge them; Do you fill and not charge them; or do you give them their Rx back with a huge “See ya!” wave.

The correct answer (as almost all if not all Pharmacists will agree, except Mail Order douches) is you give them the Amoxicillin, and tell them to get a hold of their social worker to get their insurance settled.  You tell them you’ll try to process the Rx’s in a few days.  Witholding antibiotics from a sick kid when it costs $9 each is pretty hard-ass (even for me).  Now if it were a screaming crackhead who wanted Zyvox, to hell with her.  Kids should be taught that your Pharmacist is your friend, not the man who gives mommy those white pills that make her sleep all the time.

A few days go by, and you try to process those Rx’s.  Of course they won’t go through.  A week goes by, nothing.  10 days go by, nothing.  You call the parents to ask, and they tell you they did not call their worker, and really have no intention of coming into your pharmacy to pay the $18 they owe because they have no money.  Good deed? Punishment? Thanks for playing!  Be happy it was only $18 and not more.

I got bitched out for being too PC, so i’ll lay it out plain and simple.  When advancing medication to a Medicaid patient, you must be fully prepared that you will eat the cost of said medication.  Think about it, these are the patients that have their asses wiped by the government because they are unable/unwilling to work.  What makes you think they will take the initiative to actually CALL someone when they already got the rewards in-hand.  Sure, they will get shafted next time they try to get stuff filled at your store, but they’ll just go somewhere else and do the same thing.  Its not until someone stands up and says “NO” to them that they will get off of their ass and make the call to get reinstated.

So this is where the ethical question comes in.  At what point do you withhold medication to FORCE the patient to make that call (because you sure as shit don’t have time to call HIS worker for HIM) so you not only will save other pharmacies what you went through, but also save his OWN ass when pharmacies refuse to refill drugs that will save his life.  Tough issues, and having a “come to Jesus” meeting with him will just get result in him/her agreeing with you and not following through.

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34 Comments

  1. bob thomas says:

    You always make them pay. No good deed goes unpunished. Tell them they have to pay & when they get the problem resolved you’ll rebill & give them a refund. In this particular case you could’ve filled 1 rx & instructed the babymama to share until the problem in resolved. You say they don’t have the $18. Did you see babymama buy that pack of cigs or giant taterchips or cologne on her way out. You could loan her the $18 but then you’ve got to be sure it’s a secured loan, hold a piece of that gold jewelry that she’s wearing until she repays you.

  2. broktun says:

    What I have started doing. . .I break the bottle.
    The dad/mom/sperm donor/sperm receptor gets 6 doses for each kid. If they can’t take care of it in 2 days, they are SOL, and the pharmacy is out $2.54 instead of 5.07.
    It is not about the money, it is the principle.
    In my neck of the woods, MD’s prescribe Amoxil for a possible bacterial infection, which is 9 times out of 10 a viral.
    Broktun

  3. Ian says:

    In the circumstances you described, it seems totally reasonable to fill those Rx’s once and not fill anything else for them unless their Medicaid is coverage is reinstated. And when coverage is reinstated, it’ll probably be retroactive, so Big Chain will get reimbursed by the state for those three Rx’s you filled. You knew from the family’s records at your pharmacy that they have been on Medicaid for “past (all) generations”, so they clearly weren’t trying to pull a fast on you. Next time this happens, you won’t fill them for free, but you say that they’ll just hit the next pharmacy down the street and do the same thing. But unless the next pharmacy has the records of that family filling Medicaid-covered Rx’s there in the past (like at your place), would that pharmacy also give them the benefit of the doubt and assume their coverage would be reinstated in the next few days? Since Medicaid copays are non-existent or just a couple of dollars at most, would this person really think it worth her while to go running around town to find a pharmacy to give her the benefit of the doubt every time her kids get sick? Or would she rather call and sort this out with a Medicaid representative? If the answer is that she might not get the meds filled at all because it’s too much of a hassle and screw it anyway, that sucks. It is a crappy system and it seems pharmacists, not being policymakers, have to draw the line somewhere.
    As far as talking to patients about this, it’s hard to even show up to a come to Jesus meeting when you’ve got three kids to raise on your own, have to take the bus everywhere, and would have to squeeze that call to the Medicaid rep in during your break at McDonald’s. I’m not sure it’s always that they’re just lazy, dumb and poor.

  4. Ghost says:

    This happens quite often at my store. Our usual course of action is to make them pay cash for it at the time and later we can try to reprocess the prescription. If later it goes through, we will give them the medication.
    Most people on medicaid, at least my neighborhood do have a bit of money. Not a lot of it, but most have money. I have never encountered a situation where a person couldn’t come up with $20 for their kids medication. I hope I never do.

  5. techgirl says:

    ooooh. i’m a real hardass when it comes to this. if it were pills, i would be ok forwarding them a 24 to 48 supply until they got the coverage square. a liquid? T.S. but it’s exactly like you say. if you dont give them some sort of incentive to get their coverage fixed (re: kid needs medicine) they usually don’t. and we’re not “keeping it from them” if they can pay for it. if medicaid doesn’t work, either come up with the money or get the medicaid to work. if there is some real snag in getting the coverage to work and their social worker actually calls us to let us know this, then i don’t have a problem with giving them the medicine for free because we got some sort of guarantee. of course the final say comes from the pharmacist on duty and i dont have a problem going along with what ever they say. when it comes down to it, it’s their call and if they make they “wrong” one then it’s their fault and not mine. i’m just trying to cover my own ass.

  6. drugist says:

    Very glad we don’t have to worry about this at the chains. We can’t give shit away if we wanted to. No money, no drugs. I’m sorry that your insurance is fucked, your problem to fix, not mine. Some lady got new insurance… came into the pharmacy.. her drugs cost about $600… I was like, do you have your new card? She says.. “oh I thought they would send that information to you.” Like a new insurance company knows what pharmacy you go to… I’m sure they just mass mail every pharmacy in the state your insurance.

  7. http://openid.aol.com/rgregg78 says:

    Apparently in my state if the medicaidites walk up to the counter and say they can’t afford it, we’re supposed to just GIVE IT TO THEM!!!!!! WTH????? THANK GOD, they haven’t figured it out yet…

  8. Ian says:

    I’m not a pharmacist, so let me ask:
    How much latitude do CVS/Walgreens/Kroger/RiteAid give to their worker bee pharmacists to do this sort of thing (dispense meds without charging as they deem necessary)? May you do it as often as you think you need to, until it becomes a problem and your managers get on you about it? I’m thinking this happens rarely enough that even if pharmacist give the benefit of the doubt every time and eat the cost of (for cheapish drugs like amox), it probably wouldn’t be so scrutinized that your manager would bring it up as a .0001% revenue loss for the month. I could be wrong, u but it doesn’t seem worth their time, when they can be pushing things like Minute Clinics!
    If like AngryPharmacist says, having a “‘come to Jesus’ meeting with him[/her] will just result in him/her agreeing with you and not following through,” so why not say screw it and just fill it for them and get those kids the medicine. The “babymama” is just going to go down the street and make the next pharmacy eat the cost. Hell, it’s probably the same chain you work for anyway. In either case, it’s probably no skin off your ass. Small community pharmacies, yeah, they could lose some chain on this. Big Chain, come on. Fill it so those kids can better and get back in school, graduate, and not become babymama generation number two.

  9. Sarah says:

    My daughter has primary commercial insurance and secondary Medicaid. I go to a small pharmacy because they are small and polite, and I hate Walgreens. The first time we got my daughter

  10. one_angry_tech says:

    I don’t care how “broke” you are, if you can fill your hummer with gas, you can pay $10 for your childs eye drops.

  11. Shalom (R.Ph.) says:

    There’s another scenario where this applies: if the drug requires a prior auth (e.g. ofloxacin otic drops, because the local Medicaid HMOs want you to dispense ciprofloxacin ophthalmic drops instead, and try to explain to the patient why they’re putting eye drops in their kid’s ear). If you advance the stuff, who knows if the P.A. will ever get taken care of. If they had to pay when picking it up, you know they’ll be after the doctor to get the P.A., and if they don’t, it’s Not Our Problem.
    “At what point do you withhold?”… I guess it depends on who and what it is. IF it’s someone we know, and IF the medicine is fairly cheap, then we’ll probably advance it. We’ve had to run around after people for payment on occasion, but they’re usually good for it around here.
    If it’s more expensive (e.g. Omnicef or higher) then we’ve started making them pay for it up front. We used to advance it, but like you said, we have to be prepared to eat it, and as a young independent store we can’t afford that. Sometimes, if it’s a good customer, what we do is take a copy of their credit card, and we tell them that if their insurance doesn’t come through in a few days, we’re charging the card. This usually is enough of an incentive for them to straighten things out.
    @Techgirl: you said “we’re not keeping it from them if they can pay”… Back when I worked in NYC, I had one woman whose card came back terminated start screaming at me, “You have to give me it! The law says you have to give me it! You’re not allowed to withhold drugs from a Medicaid patient! The law blah blah…” and so forth. I calmly explained to her that yes, we aren’t allowed to withhold drugs from Medicaid patients if they can’t afford the copay (because they need to spend all their cash on Lotto tickets on the way out of the store), but in your case, Medicaid has just informed me that *you’re not currently a Medicaid patient* and that law doesn’t apply. Pony up or take your script elsewhere.

  12. SnarkyRemark says:

    Tons of people are filling their Hummers with gas and then turning around not paying a $10 copay on eye drops. Does your pharmacy let you touch the cash register AND the pills? Ow ow, so fun!

  13. http://openid.aol.com/messamissy says:

    How the hell of any of you know how much money I have in my pocket? I could have a wad of tissue or lint, or a $50. My sons meds are 200 bucks of MY TAX MONEY per month. I can see vicodin for an addict. But come the hell on, how about alittle boy screaming with an ear infection??? Shit I don’t have a Hummer, if I did I sure as hell wouldn’t need medicaid. There are real people on PA who work their ASSES off. Just to spend it on a light bill and food. I don’t get stamps, I make to fucken much!! Do what you will, but know there are still people out there who are truely in need of help to get their meds. These people are not lazy, they may not have the 20 bucks right then and there, and their PA may be fucked up, gee could it maybe be the idiots that work there, fault???? I know this has happened to me one time. As soon as I got the money I paid, and as soon as they were able to process it I got a refund!!! @@

  14. Carol says:

    In my neck of the woods, they get a monthly piece of paper which is proof of coverage. If I have that magic paper, I can override or submit the bill to welfare manually. No paper? No drugs. End of story. I had a case where the client drove an hour in each direction to a doctor that was willing to write for her Oxycontin. She lived 1 block away from the store. She forgot her magic paper. Sorry lady, no drugs without that paper. She hollered about how she would have to go “all the way home and back” to get it. Give me a break. you are on welfare. What else do you have to do with your time? Besides, I am the one paying for that $600 of Oxycontin with my tax money. So forget about it.

  15. http://openid.aol.com/npage148 says:

    I have trouble believing they can’t pay for a 11 dollar abx when they have a blackberry, bluetooth headset and a roll of 100′s in their pocket. I don’t give people free stuff unless its 2 pills until their refill authorization comes in. Everyone can scrape up 11 dollars

  16. BlueTech says:

    @ Ian: As a walgreens tech, I can say that we have considerable leeway to dispense what we want. Hell, we can even give advances on C3-5′s, if the pharmacist wants (Proly not legal, but the company doesnt care). However, all pharmacists with walgreens are taught to be real hardasses when it comes to this. In 99 out of 100 cases, we’ll ask for cash, and reimburse later.
    Plus, you know they have the cash. Those chrome rims didn’t jump onto the Escalade by themselves. Many medicaid patients also get a cash supplement from the state as well, so trust me, it’s there.
    Fuck, I’ve seen people bitch at me about their $1.05 copay, then hand me a $100 bill (no shit) to cover it.

  17. We loved your post and wanted to let you know that you were the runner up for the Scrubby award provided by RedScrubs.com. Thank you for the opinions that you share with the world.
    —Dr. Incognito

  18. http://openid.aol.com/farett says:

    Scenario: Patient pulls into your drive thru in a brand new Escalade talking on her new I-Phone, hands you a script and a medicaid coupon, and almost loses her brand name sunglasses because she had to lean down so far to reach the tray. What do you do?
    My solution: As she pulls away, I take down her license plate number and then get on the phone with the medicaid fraud hotline.
    The above scenario actually happened. I called the hotline. When I told them the patient was driving a nicer vehicle than me and I make $120,000 a year and that they have a cellphone that I know costs around $500 with a monthly charge of around $100, the service rep looked her up in the computer. The service rep told me the patient never listed a car in her application, but that she did list how much money her common law husband made. Now get this, he makes $90,000 a year!!!!!!!! Needless to say I was a little upset. The service rep said she was going to get one of their investigators on it immediately. I thought, “yeah and the Olson twins are going to come over tonight and take turns choking on my cock.”
    For the small fraction of patients who actually need medicaid, I am sorry. I am sorry that there are blood sucking cum guzzlers out there that want to use the system. And what an easy system to use. Medicaid is a joke.

  19. Ian Furst says:

    In Ontario the worker’s compensatin board has an “efficiency issue”. An injured worker needs coverage so you jump through the hoops and help them get approval for coverage from their case worker. You do the work and send in the bill and get back a clarification letter. Months go by of back and forth letter then they decrease the amount they will pay you. The logic is that you let it lapse too long so WSIB will only pay a portion of the fee. I’ve had it happen multiple times. In theory you’re agreement is with the worker but legislation says that once you accept the case you can’t extra-bill the patient. Do you still accept the cases?
    http://www.waittimes.blogspot.com

  20. gmlpharm says:

    Not EVERY individual on assistance is a coniving piece of crap. Just forward them the meds and get on with your day already. As pharmacists we are being shafted by everyone…pbms, hmo’s, “audit services”, state boards, the DEA, wholesalers, and manufacturers for 100 times that amount EVERY DAY. The line has to be drawn somewhere, but this situation is not it. The main point here is the meds are for children. I did not become a pharmacist so I could chase people down or deny needed medication for a child for 9 stinken’ bucks. If they come back for omnicef…different story. The parents were given the benefit of the doubt once, after that the ball is in their court. Not sure where all of you are coming from, but I see plenty of decent people who NEED medical assistance to survive. The dollar amounts that do not sound like much to us can be a backbreaker to a young family on medicaid.

  21. rochel says:

    I’m a Pharmacist also, although my full time work is in the pharmaceutical industry, otherwise I’d likely be an Angry Pharmacist as well.
    I moonlight in retail about 10 hours a week. So although I am not one of these “mail order douches”, my policy is no money = no drugs. The grocery chain that I work for (Safe way) doesn’t give a hoot one way or the other if we give stuff away, as the pharmacy is pretty much a loss leader for the rest of the store. But I’m just not going to give even a $5.00 bottle of amox to a welfare patient who has highlighted hair, fake nails and a cell phone. They have the money to pay for the Rx and if they choose not to do so, that is their choice and has nothing to do with me.
    And to make it better they always seem to come in on the weekend with Rxs written a couple of days ago, and an invalid Medicaid card. My state Medicaid office is closed on weekends, so even if I wanted to call, I coudn’t. People know this and this is part of the game, since many Rphs will probably give them the drugs and have little luck being reimbursed for it later. Just not me. My employer doesn’t care, but I do. And I’m not saying that if a little 80 year old man comes in and has inadvertently run out of his lisinopril, that I won’t front him those – I’m not a total jerk. Controls of any class, absolutely not – I don’t care what your reason is.

  22. Joe B says:

    Heya, For starters, Love the page. Second, you always make them pay.. always. If they buy something else with the rx i just tell them they cannot purchase those items until they purchase the Rx (usually a pack of smokes and a candy bar , yea right.. food…). A few rants back you were talking about online pharmacy.. well google ads seems to think otherwise, they are advertising it on your page!
    Oxycodone for Only $39
    No Prior Prescription? Get Free CD $500-30 Day Credit, Free Shipping
    http://www.Drugstores-Online.com
    Enjoy! Keep on preaching! :)
    -Joe

  23. Noble Pig says:

    A good heart always gets you in trouble doesn’t it?

  24. KDUBZ says:

    Honestly, I am not the one who could potentially be acting unethically. I haven’t gone out and blown my welfare check on a plasma screen tv, while not thinking to set aside some money in case my child gets sick. Why don’t these parents consider their own ethical dilema? Sure having another child may seem like an easy “extra few hundred bucks a month from the state.” But you do have to take care of them
    The idea that $9 bucks is meaningless to a company but alot to a family can go a bit higher than that. For a billion dollar chain $90 bucks is nothing, should I give vigamox out for free too? In other countries if you don’t work you starve. Here you can sit on your ass and get a check from the government, they pay for all the meds that you end up needing because of your sedentary lifestyle.
    Damn, why do I work again? Oh yeah, its because I have to much pride to let myself become a cancer on the ass of society.

  25. Butters says:

    I used to work for an independent pharmacy where at least 60-70% of our customers fell into the Medicaid category and all I have to say is…you are all way nicer than we were. We told them they could pay cash or go by the local Medicaid office and get their crap straightened out! I just moved out of state and took a job with a regional chain and I tell you what…I went from doing primarily all Medicaid business to doing absolutely none!!! What a difference.
    I love TAP!! It makes me feel like I’m totally not the only one who rants like this sometimes!

  26. Chad says:

    Greetings,
    Because the winner of the Scrubby has not claimed the prize, you are be default the Scrubby Winner for last week.
    If you can contact me in regards to this, we can forward you the pair of Red Scrubs.

  27. anonymouslycoward says:

    meijer and publix phamacies are giving away a list of free antibiotics in order to attract shoppers in the store. And Wal-mart, Kroger’s, and Giant Eagle are selling a plethora of antibiotics for $4 as i’m sure you already know.
    Just threaten them with reporting them to the police…that will scare them into paying you if you really want it and prevent them from pulling this crap in the future. I know the police wouldn’t really care or do anything about it if you did report them but just the threat would probably be enough to motivate them.

  28. nodrugs4u says:

    I work for a big chain, but we still do not advance drugs without charge. We also do not charge the ridiculous cash price either. We charge whatever we were supposed to be reimbursed by MediCal. I personally do make exceptions though, but it’s on a case by case basis. Sometimes we get people yelling about how we are holding their meds HOSTAGE. Our reply has been and always will be: “Unfortunately we do not own this business; therefore we cannot give away free something that is not ours to give. The medication needs to be paid for. Since the government is refusing to pay for it, it is your responsibility to pay for YOUR medication. we already done our part by paying taxes. Now, how would you like to PAY for YOUR medication?”
    Funny how that always ends up either with a “I’ll never come back here again (which they will the very next day)” or taking our a wad of cash. We pharmacist make good money, but I bet you 99% of us do no carry that kind of cash. 100′s, 20′s, 5′s, singles. Yes, they are “pharmacists” too. Sometimes I wonder if my legit license is costing me money :)

  29. Nasty says:

    My rule is, and my techs will tell you this as they have heard it 27 times…WHEN THE GROCERY STORE STARTS GIVING PEOPLE FOOD AND LETTING THEM COME BACK AND PAY FOR IT LATER (OR ARRANGE PAYMENTS AS IS THE CASE WITH INSURANCE) I WILL THEN ALLOW PEOPLE TO GET THEIR DRUGS WITHOUT ANY GUARANTEE OF PAYMENT. Sorry for shouting but this ticks me off royally. Why do we give stuff away? No pay, no drugs. If you refuse them they will make the call to get it covered. I applaud your humanity but I have none left.

  30. Will says:

    OK, here’s the truth from Xipotec.
    Drugs are not a right, they are a commodity , like gold, silver, and of course frozen concetrated orange juice. You do not have a right to get them, even if it could save your life. Ask the person who cannot afford a kidney transplant if the have a right to the operation when the insurance denies it!
    Welfare is provided by the grace of the government and it’s people, to people who must qualify to recieve it. You must occasionally re-qualify to recieve benefits. (no you can’t get free stuff forever without showing just cause.)
    You are informed in advance of qualification problems and are rarely dropped if you follow the rules (it happen on occasion like with regular insurance).
    HOWEVER! The decision in this case is based soley on how you would raise your children. We unfortunately live in a society that takes the view that “all problems in my life are due to someone else”. (this is the reason for all your gripes and your drinking problem TAP!).
    SO, when you child screws up do you?:
    a. Brush them off say, its ok its not your fault, here’s a cookie?
    b. In a caring way, tell them they must accept the consequences of their actions?
    c. ignore the whole thing?
    Medicaid recipients are often in the situation of being on social assistance because of poor decision making skills. So they will most likely not take charge of the situation and get it corrected if they do not have to. It’s your dime, bail them out now and you will have to do it everytime. Good luck out there folks!

  31. Danielle says:

    I can’t believe some of the comments I’ve read on here! The most blatant stereotyping and racism I’ve seen in a while… Not everyone is on Medicaid or Public assistance b/c of “poor decisions” or they “spent all there money on rims for their Escalade and fake nails.” For some people to claim to be so smart, some of you sound very stupid, lol. I am on Public assistance(not even Medicaid, either) and not because I spend all my money on useless things. I am 20 years old, I lost both my parents to cancer, and I have been struggling to take care of myself and my niece and nephew for the past couple of years and sometimes public assistance has been the only thing that has helped us get by. I do work, but do you know how expensive it is to take care of 3 ppl, rent, utilities, car, gas, etc. all while being a full-time student so I can become an “Angry-Pharmacist”, lol. Try walking a mile in someone else’s shoes for once instead of making all these ridiculous assumptions and generalizations. Thank you for showing me exactly how I don’t wanna think as a Pharmacist.
    BTW, I’m not saying that there aren’t people that are commiting Medicaid and Welfare fraud, but for the sake of the people that really need the programs, don’t stereotype so much. At least judge case-by-case.
    *steps down off soap-box*

  32. tom hennessy says:

    All the ‘ethics’ of dispensing drugs and the ability to pay would be dispensed with .. pardon the pun .. IF all drugs were dispensed through one central large scale pharmacy.
    We would lower the costs of drugs through the firing of all the 120,000 dollar per year pharmacists and since it is all done with computers the mistakes would be minimized if not totally removed from the scenario.
    I know people are going to be upset they have lost their jobs through technology but that comes with technology.
    If a pharmacist hasn’t seen this coming he is pretty stupid and deserves to lose that job.
    Anybody can see a pharmacist can be replaced by looking at the stats of online pharmacies.
    One may have to wait an extra day or two for a prescription but like who hasn’t.

  33. Joel says:

    Danielle,
    We all realize that there are some needy people out there. We also realize that there are a lot of hard working people in this country. However, as a physician and my wife, as a pharmacist, we see a lot of abuse of the system. I have seen nearly every indiscretion on this list. I have had people say that, while on their cell phone and wearing a lot of bling, that since I didn’t give them their medications, only a prescription, their trip to the ER was a waste of time!!! Wasn’t it enough to know that I wasn’t going to see a dime of payment, I take all the risk if they don’t take care of themselves that, on top of me paying more in taxes than I thought I would ever make in a year to support this type of person and just as much in malpractice insurance because I am looked at as someone’s lottery ticket, then you want me to give you even more FREE!!! And, like you, I was on public assistance during college while raising 2 small children. I did budget my money, did without, rented in a less desirable neighborhood, didn’t splurge on anything (no cable, computer, cell phone). Then, when I graduated and was making $3.40/hr while putting my wife through school for a few long years before I could go on to medical school and get into ~150K debt. Now you may realize not everyone was BORN into having some money but also worked very hard at it. And, like the other posts on TAP, I agree that there seem to be a great majority of people who do anything they can to abuse the system. I say let them vent! We are all frustrated with a system that allows these people to cheat and defraud us, the taxpayers, out of our money.

  34. Mudbug says:

    Are you kidding me, they won’t even remember where they got the medication except for the label on the bottle and even then will take it to the wrong pharmacy for the rest and go “oops duh didn’t see it was from gobbledegook pharmacy” Where i work no medicaid no pills, probably the last bastion of personal responsibility, in that your healthcare is a participatory process. Get involved, call your case worker and get it straight.

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