Calling ahead – How hard is it?

Every retail pharmacist in every pharmacy around the world have dealt with this issue.

Patient comes in to the pharmacy and wants a refill.  He has 0 refills left on his medication.  You tell him that you need to request refills from the doctor. He gives you a blank stare with the response “but I’m out! ”.  Of course he wants his seizure or di-a-beetus medication (that he cannot go without).  It can’t be something stupid like Zantac or Vicodin.

When it comes to refills and calling ahead, patients fucking fail every single time.  I mean the number of refills you have left on the bottle isn’t a secret, it says right on the damn container.  However patients, being the most retarded creatures on the planet, just don’t “get it” that sometimes a little planning ahead goes a long way.   Even if you put a big note on the Rx that you must call ahead to get refills they still pull this stunt!

Moreover, this puts pharmacists in a very interesting situation.  Technically its illegal for us to fill an Rx that has no refills remaining without a doctors approval.  The patient obviously doesn’t have his bottles (you think he’s going to make it easy for you?) with him, so you can’t just put a few in there to last him.  You have the following choices:

  • Use a typical TAP Response:  “Tough shit.  I warned you the last 5 times you pulled this shit that you need to call ahead.  A lack of planning on your part does not constitute an emergency on my part.  Maybe after you seize or end up in the hospital you’ll get the simple concept of calling ahead when you have 0 refills remaining.  Quit crying, I don’t care!”
  • Waste the money on your labor, yet another vial, and another label for a whopping 4 tablets to advance him (since you obviously just cant dump tablets in his hands) until you get the OK from the Dr
  • Fill the Rx anyways and deal with the doctor if he denies/changes it.
  • Run and hide and let your tech deal with it.

Can’t say what the right answer is.  Obviously for controlled stuff (vicodin, etc) the backlash of filling it without an OK is greater than shit you can justify (BP, diabetes, seizure, etc).  I mean really, if a patient has been on the same Tegretol dose for the last 5 years, there is a good chance that the doctor will okay it, however, that’s illegal by the letter of the law, but allowing someone to seize because they are a dumbass is ethically not-right. 

Breaking the law vs caring for your patient, where do you draw the line?

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62 Comments

  1. MedicMatthew says:

    Don’t break the law, let natural selection take its course.

  2. Conni says:

    In North Carolina, it’s not illegal to do an emergency tide-over for “life-sustaining” medications (Synthroid, beta blockers, seizure meds, psych meds, that sort of thing). Controls are out of the question, of course.
    Of course, in my clinic-based pharmacy, we only deal with birth control, and people come in Friday at 4:30, long after the NPs have left, to get a refill and they’re completely out. Because nobody reads their damned labels. Ugh.

  3. Rxgirly2012 says:

    GAWD, you hit the nail on the head on that one! What makes it even better is when the patient gets pissed at YOU, the Pharmacist/Tech. for THEM being out of their damn medication! And I love it when they friggin’ freak out over running out of something retarded like Cetirizine (which is NOW OVER THE COUNTER) and want you to advance them some so they don’t have to pay another 5 measly dollars above their copay.
    The Wonderful Public, indeed..

  4. Gus says:

    One of the things that I have burned into my memory is sitting in a lecture hall listening to a member of the state board drone on about this, that, or the other thing. The one thing he said that really stuck with me though was this.
    “Under fire, behind the counter… if you don’t know what to do follow this simple rule: Do what is best for the patient. Period. The board will not punish you for using your professional judgment to help a patient.”
    Ultimately I believe in the idea of karma. If I do what I feel is ‘right’, things will work out for me and I would much rather have a censure on my record than a regret on my conscious.

  5. RxDawg says:

    Usually if you truly have the patient’s best interest in mind then your ass is covered. That said, I knew of a pharmacist in town that had a true schizo patient come into the pharmacy on a fri afternoon. He wanted a Geodon refill and of course he was out. Just a quick call to the doc should remedy this right? Well, the doc actualy went on vaction for the weekend and did not leave anyone to cover for her. She also would not take any calls while she was away. Ok, we all need to get away once in a while. The pharmacist decided to give the patient just enough till the following mon when the phsyc doc would be back. Sounds appropriate to me. Well believe it or not, that paticular doc actualy got mad when she found out and turned the pharamcist into the board for dispensing without a perscription. The pharmacist actualy had to go before the board. Of course once they reviewed the case it was thrown out. It should be noted that this doc built a reputation for being a major ass with most everyone. If that happend to me I think I would refuse any perscription from that doctor. Of course, almost all doc’s would not mind this at all but at least the board backed up the pharmacist. I just can’t believe that someone (that well educated) would actualy act like a bratty little kid. Sometimes common sense must prevail.

  6. OSURx says:

    Here’s another twist… I’m not sure about CA, but here in OH we recently went through a couple of weeks where it was impossible to get any generic for Toprol XL. Every store of every kind for miles around was out, and most were out of the brand name pretty quickly, too. We wound up having to convert most patients to Lopressor, BID, but here that requires a phone call to the pt’s doctor for permission. Now, picture a patient walking in at 7:30 on a Friday night with a metoprolol ER script with no refills… (Do you give them the med that you think the Dr. will agree to change it to when you can finally get ahold of them on Monday?)

  7. Gary says:

    Have a patient that always sends in a fax for refills one week before she runs out. Delightful woman and of the rare jewels at the counter.

  8. bill, rph says:

    if its early in the day, i make them check back later. with late day requests i’ll make sure they have enough to get throught until tomorrow. with friday evening requests (the most common time for the I-Don’t-Have-Any-Left asshole to show up) i’ll try to get them through the weekend. if its for pain/anxiety/sleep/etc.? tough shit. buy something otc and you’ll survive until the doc calls back. i do try to make it at least a little bit inconvenient so they think twice about pulling the same thing again. but somehow that never seems to work. yeah, i hate burning a label and a vial but its a small price to pay to keep a customer.

  9. pjbarnum says:

    well, at least in some provinces in Canada, we are now legally allowed to refill a previous rx for just those situations. The patient has to be a regular, have a record of care ie) a history at your pharmacy. Then, we put our name as the prescriber, and fax the md later to inform them of what we have done. There is NO LIMIT to how much we can authorize, it is on a case by case basis. I usually do 2 or 3 weeks supply, but I have done a month in some cases.

  10. Mary Augustine says:

    The last time I had my thyroid medicine filled at the most trusted name in pharmacy, it took me 20 minutes of calling and re-calling, and calling again to never get through to the pharmacy, despite using the number listed on the vial. (Guess mine was an older phone that didn’t jive with the electronics of newer phone equipment, but after about the third time of getting the store manager who ‘attempted’ to transfer me back to the pharmacy, I decided that that and the fact that their shop charged me 3 ‘co-pays’ for one 3 month supply of drugs that I paid cash for, I would fill it myself. Not everyone has that option, and I should’ve taken the matter up with the pharmacy manager in person, but jest sayin’ that problems are not always cut-n-dry about calling in for refills. (I would’ve loved being able to call that pharmacy number, enter the Rx no., and pick the 6 month supply of drugs up in a week or two when I remembered–and not yet out of refills.)

  11. Alison says:

    In my pharmacy, the techs usually choose NOT to break the law (if it’s a real emergency, we would check with the pharmacist to see if it’s okay to advance 3 days worth of pills, but that’s it).
    Unfortunately, our head pharmacist will opt to break the law EVERY SINGLE TIME. Not just about refills, either. They’ll partial narcotics, give out DUPLICATE controls, and break HIPPA laws constantly. And it’s usually AFTER the patient has already dealt with a law-abiding tech, which of course always makes us techs look like the bad guy.
    I like your TAP response and wish we could be brutally honest like that all the time.

  12. Locums says:

    I work in a VA right now. 85% of the time the 55+ crowd comes in saying their meds were “stopped” so they aren’t on them anymore. You see, that VA 1-800 refill hotline number on every bottle? The one that is automated and fast and takes your prescription ID # (conveniently right THERE on the bottle) and the pills magically appear in your mailbox 5-7 days later? In a 90 day supply? Yes? Well this crowd is so special it doesn’t apply to them. They sincerely believe their physicians job is to personally refill the script for them every 90 days and deliver it to them.
    This is the same crowd that if you did that for them to save them one phone call every 3 months would bitch and moan “I have so many of those already” or “I stopped those, I didn’t like them.” Because I am psychic, I should know these things.
    They gave these people guns!

  13. Pharmer says:

    I used to hate this. Now, everytime I dispense a prescription I tell the patient how many refills they have left. If it is zero, or the prescription is going to expire, I ask them if it is OK for me to call their doctor NOW, so that we will have a new prescription on file for them next time. Problem solved. Sure, I may be spoiling them, but its better than getting frustrated with constantly loaning out pills. I don’t want that dumb blonde getting knocked up because she ran out of pills Friday night. (wait, wasn’t that a Sunday start???)
    And I guess I got tired of advancing Ken a couple MUSE so he and his 15 year old nephew could enjoy the weekend.

  14. Cassandra says:

    Remember, Mr. Pharmacist, that YOU are personally responsible for the patient’s subsequent rise in blood pressure, sugar, or return of seizures if you can’t somehow get them their medicine. I especially love the innocent request for your counseling knowledge when the question is posed, “how will it affect me if I go without my medicine?” I don’t know, you tell me, sir/mam, it’s been months since you’ve had it filled, and suddenly you remembered that you have diabetes and need your medicine from an expired rx AT CLOSING TIME.

  15. MrBigTime says:

    The ones that really burn me are the people needing insulin and albuterol filled without Rx because they’re out of medication. Really, do you not get that you need this to live? I have gotten to the point where I will explain this to them in one of the following ways (depending on my mood):
    “You know, you really shouldn’t ever run out of something you need to live”
    “Well, I guess I’ll fill it since I’d like you to live”
    “OK, it may be illegal, but dead people don’t make us as much money as live ones” (ok, I’ve never used this, but it would be fun)

  16. steph says:

    rxdawg–
    What do you EXPECT from a psychiatrist–normalcy?
    Pfft!
    BTW, here in California, it’s not illegal to refill a maintenance medication as long as you make an attempt to call the doctor first and notify the patient that the doctor was not available to authorize the refill, and you notify the doc that you gave the refill. You do have to use professional judgement–I’d not dispense a boat-load of psych meds, and I’d only give a maximum of a weekend supply of CIII that the patient uses every damned day. Some pharmacists would send the pt to and urgent care or ED to get a prescription, but the law doesn’t prohibit you from taking care of the patient. And I would charge for it and take my time filling it, too.

  17. rph3664 says:

    One of my former co-workers sold a bottle of Nitrostat, without a prescription, to a weekend customer who said he was having chest pain. No state board is going to censure someone for that. He did call the patient’s doctor to get an official RX so everything would be above board.
    Here’s a slightly different angle. A Canadian poster on another board said that if people demanded controlled prescriptions too early (especially ADD meds) and pitched a fit to the store manager when they were refused, they could get a $10 gift card, and when the manager asked the pharmacists why they were suddenly having to give out so many cards, the chief pharmacist sat down with the manager and explain provincial law to him. They immediately started giving out a lot fewer cards.

  18. Hospital CPhT says:

    This is a topic that always struck near and dear to my heart. Had so many angry patients demanding refills on medications that there were no refills on. Or patients who would be told EVERY month, that the drug they want needs to be special ordered (such as Enbrel used to be) and so they would have to call in advance. Every time they would come in roughly 10 minutes before they needed it, and demand it get filled right then.
    My favorite, was when one of the societal leaches we called “Medicare” patients came to the pharmacy to get his RX for Motrin 800. Of course he was out of refills. We called the doctor, and recommended that the patient may wish to get some OTC motrin to last until the doctor got back with us. Naturally, rather then wait patiently, the patient left, and went to another store asking them for narcotics, and offered to pay cash for said narcotics, in a sort of under-the-table deal.
    Truly, patients can be shining examples of what to never do, if you want to stay out of jail.

  19. Cathy says:

    You sure do get the bottom of the barrel patients! You probably never notice the people like me. When I need a refill, I call my doctor’s office and request a prescription for pickup, or see the doctor himself if I need a medication review. All you see on your end is me dropping off a new prescription and waiting for it to be filled.

  20. Why is it always Friday night after six o’clock thet they “need” a refill on their Vicodin or Xanax or Ortho-Tri-Not to have babies?
    And Mary Augustine’s comments hurt my brain. Many times I’ve had patients say, “Can I get two months worth this time? I’ll pay two copays.”
    Most private insurances only allow a maximum 30 day supply for retail pharmacies. And even if by chance your insurance allows us to bill more than a 30 day supply… A prescription written for a 30 day supply with 1 refill is NOT the same as a prescription written for a 60 day supply. It’s considered fraud if we try to bill an insurance for more that what the prescription was written for.

  21. anonymous says:

    To Mary Augustine:
    For the love of G**, woman! Shut the fuck up and go to another pharmacy if you think yours sucks so bad! Here’s a shocker for you: nobody will give a shit!! First of all, maybe your troubles with your current pharmacy’s telephone system are due to operator error, not the pharmacy. Maybe if you actually listened to the prompts and pressed the right buttons you would have gotten through. Secondly, your copay is your copay, or they charged you cash. What would you like them to charge you? Wow, they charged you for three months supply and gave you three months supply. How wrong of them! Any way, as I said, go to another freakin’ pharmacy – go to Wal-Mart like everyone else, where they think pharmaceutical care is worth only 4 bucks. I guarantee that I am only saying what your pharmacist can’t because they will get fired.
    wow, now THAT was therapeutic!

    • Dan says:

      The same could be said about you and your profession, could it not? The general attitude of the public, where convenience is concerned, is extremely well documented and so very widely understood, there is virtually no way you could have gotten into the profession without knowing what was in store for you. Still, like a customer who ignores the label on their medication, you chose a profession that requires you to provide personal service to them. You asked for this, just as much as your customers asked for trouble by letting their prescriptions expire.

      If you do not want to be subjected to the wrath of impatient, entitled individuals (READ: the public at large), you should perhaps not have chosen a profession which requires you to serve impatient, entitled individuals (READ: the public at large). I do not think anyone is going to shed a tear for your rage against the consequences of your own life choices. As you might put it, nobody gives a shit, because very nearly all of us are impatient, entitled assholes, who do not feel that facts of life should apply to them.

      The rational thing to do, of course, is to either make peace with it or move on, and the earlier you do that, the better life will be for you and everyone you come in contact with. But, of course, impatient, entitled members of the public at large often defy rationality by insisting that reality should bend to their own will, and hell hath no fury like a moron ignored.

      It is quite sad, is it not?

  22. OUT FOR LIFE says:

    This garbage use to really piss me off. One comment hit it on the head. THEIR LACK OF PLANNING IS NOW YOUR EMERGENCY AND THEY’RE MAD AT YOU. What ass clowns. The part that got me most was how these idiots would always say “Oh, but this is life and death, this medication is so important”. Well jackass aparently it wasn’t all that important because you sure as hell didn’t do anything about it until you were out. The FACT IS that it is only important when I have to do something about, but WHEN YOU had to do something about it, it wasn’t important was it? I used to moonlight for an independent, he had the old “this is your last refill sticker so call your doctor, MORON” moron wasn’t acutally on the sticker, but he would cover the refill number with this. It was always a big laugh when someone would call in, and then you would hear silence as they were confused, and then “The refill number is covered by a sticker.” “And what does the sticker say sir/madame.” “Oh it says no refills.” At least, except for the brain dead (of which there are too many), they realized how damn stupid the were and most probably still are.

  23. pharmTech says:

    My favorite is when the patient comes in friday afternoon, no refills, dr’s gone for the weekend and they have been out of their blood pressure meds for 2 days already. Every freaking friday we run in to this. If you are seriously that irresponsible and STUPID to run out in the first place, then to wait until friday afternoon with no refills, maybe we should let natural selection ride its course. Oh, and I can’t forget the fact that yes, it is my fault they have no refills on a drug they have been on for 137 years, and it is my fault they don’t have an on going rx, and yes, it is my fault I didn’t know they have been out for 2 days and didn’t have them ready in the first place. Of course we always give them enough to get thru the weekend but not without pointing out the fact how preventable this situation really could have been. I think I say this everyday but I will say it again…PEOPLE ARE FRICKIN IDIOTS!

  24. steve says:

    “but jest sayin’ that problems are not always cut-n-dry about calling in for refills”
    Are you for real? Seriously? Calling in for refills is about the most cut-and-dry thing there is at the pharmacy!
    If the auto-refill over the phone doesn’t work (though I’d sooner suspect that you did something wrong), and you don’t have the Internet, all you need to do is call the store and push the appropriate buttons to speak with a pharmacy employee. Emphasis on THE APPROPRIATE buttons. We’re there to help you, contrary to what the public may think — we don’t bite.

  25. Oscar Rewitt says:

    Aw quitcherbitchin! This is what you get paid the big bucks for.

  26. Brian says:

    I know some people come in to drop their script off and go shopping then come back. But as far as refills go, I get really annoyed by the people who ask for their refills right then and there. They do not plan ahead of time…

  27. Mary Augustine says:

    Okay. I work out of town.
    I had my prescription medication filled at the local 24/7 shop which had a reputable staff.
    The problem was I worked odd days and hours, so it was not convenient to pick the filled prescription up at a certain time, nor day, which is why I did business with a 24/7 shop.
    Many times I tried to leave messages on the pharmacy’s phone.
    Dialing the correct number and following the proper prompts did not work.
    I was upset about that.
    Then, because I pay cash for my prescriptions, it was upsetting to me that I had to pay more dispensing fees than I thought I should have to pay for getting a 3-month supply at one time.
    I erroneously called it a ‘co-pay’ because by listing an insurance company in my record, the pharmacy always tagged a co-pay to a month’s supply of medication (as if it was to be paid by insurance), but since I purchased multiple months of my non-controlled drug at one time with my hard-earned cash–and, who says a script good for a year’s worth of refills is not the same as a month and 11 refills or a script for PRN refills–then, there is NO reason that I should be charged any ‘co-pays’, nor more than the one dispensing fee that was required to fill the prescription.
    And, I contributed this experience because I am sure that I am not the only person that has this situation. When I filled in for pharmacies located along major interstate thoroughfares, I would get requests from truckers to save the script until they’re in town again, or transfer the script to such and such when the authorization comes through.
    I think the business about insurance and paying cash and co-pays and dispensing fees is deliberately mixed around and confusing, and not clear to most people because most people have insurance. And, I think the business about Wal-mart and $4.00 scripts has been made pretty clear up-front, that their price of a month’s worth of their $4.00 scripts is that much for a set quantity of tablets, no less and no more, which leaves precious little for overhead, but is certainly more reasonable than what many other shops would offer to a cash-paying customer (many chains are meeting or doing the $4.00 bit as anonymous well knows) for a generic drug that costs $1.00 in acquisition.
    We can debate until blue in the face the ethics of offering for commerce scripts that cost pennies for different prices to those that have insurance or pay cash, and bring in Medicaid, Medicare, Humana, (and government and insurance fraud) and controlled-substances and refills and numerous other tag-alongs, but essentially the problem was that timely refill requests are much appreciated by pharmacy staff (as well as it’s frustrating to realize that we’ve spent 6+ years to have to deal with such trivial, but time-consuming routine ineptitude), but we are not all dumb bunnies if we have an occasional problem with logistics. and as well I could’ve used my creative powers to come up with an agreeable solution with my pharmacy had I felt so inclined.

  28. nodrugs4u says:

    In addition to no refills, I often get customers screaming about how they have refills. “but it says I have 3 refills!” You DID have 3 refills. However, they expires 2 months ago. I would then smile when I see the “what the…” look on their faces.
    This is why I like the “autofill” program that the big chains are doing. Scripts are set to be automatically filled when it’s time and the computer will process the refill and call the MD’s offices if necessary. Although the purpose of this program is customer retention, I use it one of the following ways…
    1) Mocking: If you had agreed to let us put your meds on autofill last time we talked, you would not be in this situation. Would you like to sign up for autofill now?
    2) Sarcasm: With autofill, you can ALWAYS walk in when you’re OUT and get your refill RIGHT AWAY.
    3) Too bad so sad: I’m sorry, but I cannot break the law and company policy to advance you Vicodin. Autofill? Sorry, we do not sign up controlled medication on autofill.
    4) Honesty: With autofill, you don’t need to call us, and we don’t need to answer your calls.
    It is not very often that big chains roll out programs that actually improve pharmacy operation, but I’ll take whatever I can get.

  29. Jamie says:

    There was a pharmacy that my husband and I used for a while that absolutely refused to do same day refills for anybody. If you walked in and said that you needed a refill they would take the information and then tell you to come back the next day. It wasn’t long until I noticed that nobody expected same day refills. The drop off line was amazingly short. If all pharmacies did the same thing people would be forced to learn to call in their refills ahead of time. Also, if all pharmacies refused to call for refills, instead forcing the patient to go get a prescription from their doctor it would tteach them to pay attention to when those refills were needed.

  30. http://openid.aol.com/HolidayRobin says:

    TAP, I love you. Sincerely.
    I read your posts and laugh out loud. I’m so glad these assholes are everywhere. Well, I mean, I wish they were all eradicated from the face of the earth, but I’m glad to know I don’t personally attract them. I was beginning to wonder.
    Has anyone ever studied the magnetic properties or possibly tidal/gravitational pull of water to controlled substances? I find it pretty amazing that lisinopril and metformin never fall in the toilet… only schedule 2,3,4,5.

  31. LifeandtimesTech says:

    “-and, who says a script good for a year’s worth of refills is not the same as a month and 11 refills or a script for PRN refills”
    Most state laws. For instance in my state you can’t have PRN refills or “One Year Refills” You specify a number of refills like 5 or 11.
    30 tabs with 5 refills does NOT mean 150 tabs whenever you want. It does not mean you can have 90 ts. You get 30 ts and you wait 25 days for your next refill. If your Dr puts 90 you can get 90. (or 30. You can give less, but never more than the MD wrote)
    “And, I think the business about Wal-mart and $4.00 scripts has been made pretty clear up-front, that their price of a month’s worth of their $4.00 scripts is that much for a set quantity of tablets, no less and no more, which leaves precious little for overhead, but is certainly more reasonable than what many other shops would offer to a cash-paying customer (many chains are meeting or doing the $4.00 bit as anonymous well knows) for a generic drug that costs $1.00 in acquisition.”
    There is no “overhead” to the 4 dollar program at all. Its what we call in the industry as a LOSS leader. You take a LOSS to LEAD people into your store so they can buy stuff.
    Most if not all drug stores have a minimum price to cover not only the number of tablets you are getting, but also the cost of filling the RX (the 20 mins of RPH and tech time, the bottle, label, power to keep the lights on, the software for the PCs(if independent)) and various other expenses.
    Walmart just happens to have make enough off the rest of its crap to take the hit on the drugs to lead people in its stores. They want you to browse while you fill your RX so you buy stuff and that stuff’s overhead pays for the loss on your drugs.

  32. welsh pharmacist says:

    I remember in Uni, absolutely every time we had an ethics workshop they would pose the same problem.
    You are a saturday locum and a mid 20’s dirty addict stereotype comes into the pharmacy, on morphine for pain and has run out, do you give him an illegal emergency supply?
    The next one is always, a crying woman rings up for her elderly mother with cancer that has run out of morphine, what do you do now? It is amazing how many people follow the crap obvious route of denying the dirty young man and giving to the sweet old dear.
    What do people think? although this has not happened to me yet, despite how often lecturers would lead you to believe it happens, I would, in both cases refer to an out of hours GP, maybe if i was regular pharmacist my opinion may change, but question is ALWAYS you are a locum.

  33. Dave G says:

    I had a dude many moons ago who would pull this “I’m out of my Dilantin and I need some so I don’t have a seizure>’ Of course, it was a Saturday. I loaned him 3 days worth and told him he should call it in several days in advance next time. Guess what, next month same thing. Same speech again. He wouldn’t do it AGAIN would he? Of course, he did. I told him that he should have called it in several days ahead of running out. His response, “Yeah, that’s whacha told me last time.” This time I denied giving him loaners of Dilantin. (He had been seizure free for many years—-info obtained from previous encounters). He was pissed. Guess what happened next month? SOB took my advice and called in advance. Sometimes you’ve got to play hard ball with these jokers. It’s THEIR OWN FAULT if they’re out of medicine, not the pharmacists.

  34. Some Girl that you don't know says:

    Even more annoying are the people that do call ahead, but fail to understand the concept that we must still wait to hear back from the doctor’s office.
    They call up on a Friday. I point out they are out of refills and will have to contact the doctor–I tell them I will immediately fax a request. I then offer to call them back when we have received the o.k. They thank me and hang up. I get off the phone, relieved to have spoken to someone that was polite and understanding…..
    Then they show up an hour later, to pick up the very same rx. “Oh, I thought you’d have gotten it done by now.” And then I point out that their doctor’s office (the one they have been going to for 15 years) is not even open on Fridays–and they stare at me with those blank eyes–not even understanding the relevancy of what I just said.

  35. OSURx2 says:

    Aww Mary,
    How cute that you think the total cost is $4.00! The cost of dispensing (and that includes things like utilities, rent, staffing, etc. in addition to the drug price is around $10.50. We could always stop educating pharmacists, as that would drop the cost a little bit. After all, the pharmacist doesn’t do anything important like make sure your doctor wrote the prescription correctly or verify there are no drug interactions with your other medications.
    And as for Walmart? You know how it takes a little while for you to get your prescription filled? That time is time where you walk around and shop…and Walmart/Giant Eagle/Meijer know that will make them more money.

  36. OSUrx2 says:

    “@ OSURx said:
    Here’s another twist… I’m not sure about CA, but here in OH we recently went through a couple of weeks where it was impossible to get any generic for Toprol XL. Every store of every kind for miles around was out, and most were out of the brand name pretty quickly, too. We wound up having to convert most patients to Lopressor, BID, but here that requires a phone call to the pt’s doctor for permission. Now, picture a patient walking in at 7:30 on a Friday night with a metoprolol ER script with no refills… (Do you give them the med that you think the Dr. will agree to change it to when you can finally get ahold of them on Monday?)”
    What we (my pharmacy) has been doing is calling the MD to change it to lopressor, BID. And if the patient does not like taking it twice daily, then we have them pay extra and do a DAW-2 for them to buy the brand Toprol XL. Also a lot of doctors in Columbus do not accept phone/faxes from pharmacies because they want to talk with the patients directly themselves.

  37. CPhTLink says:

    let’s not forget the zero refills, no pills left, and catching a plane to Amsterdam in an hour.

  38. refillgirl says:

    I find it annoying when I go to get refills and the pharmacy only has half the quantity I need. My spouse is taking a lot of Prograf and Valtrex, and sometimes it’ll take two trips to the Pharmacy to get all the pills. This at a Pharmacy at a big HMO center, so it’s not like they don’t have all kinds of people coming through for drugs.
    It’s bad enough what it’s costing us, why can’t they keep enough in stock so we’re not repeat visitors?

  39. ADHDCPhT says:

    $4 prescriptions = less money = fewer tech hours budgeted = more work for fewer staff = longer waits = less money = fewer tech hours = ADHDCPhT no longer a pharmacy technician

  40. crusty RPh says:

    Dear Refill girl—Back to the same problem– call in ahead of time so the pharmacy has time to get it ordered. These 2 meds are very expensive and have a minimal number of patients that take them. For that reason, we don’t have excess on hand.
    As for for the rest of it, if someone brings in a refill of a maintenance med, I do a filled and gone and wait for the Dr to call back. A small supply costs the pharmacy just as much to dispense as a full RX, but no one will pay for it. Many in a rural community, especially the elderly, do not have the ability to come back later. God gave us common sense. The degree in Pharmacy doesn’t mean you can’t use it. I am not going to tell the little old man in the walker that took 10 minutes to walk twenty feet to waddle his old ass back out to his car and come back later.
    As for the tech who is following the letter of the law–it is the pharmacist’s licence and decision to fill or not to fill. Don’t let the power to say no make any of you less of a pharmacist. Use it with good judgment, not because you are pissed off that the patient forgot. Wait til you get to be 55 or 60 and start forgeting shit.
    I have been called by DRs who questioned why I have filled these meds w/o authorizations. I explained that I was using logic(explained the situation) and asked if they wanted to discontinue the meds. Usually they say no, just checking. Don’t get me wrong the Dr is called/faxed, but the patient if has difficulity comming in–they don’t have to come back a second or third time.

  41. ERIC says:

    refillgirl, Especially at busy pharmacies, you always have new people coming in taking the drugs they have for your refills. Now if you called in several days before you need the meds, then pick them up a few days later they will ALWAYS have all of the meds for you to pick up. In order to always have everyones meds in stock, you would need a gigantic pharmacy to hold all of the stock. CALL AHEAD OF TIME, PRIOR PLANNING.

  42. JerryPharm says:

    If patients would take responsibility for themselves, problems like this would disappear. IMO, stuff like this is a violation of the patient/provider agreement, where BOTH sides agree to take responsibility for the patient’s health.
    Unfortunately this agreement is ‘implied’, and most patients have not clue that they are supposed to act responsibly. Sad.

  43. Matt says:

    I normally stay pretty calm (at least when speaking directly towards the patients) but I had someone the other day flip out on me because I didn’t call her to tell her the doctor didn’t call me back. I phoned, left messages, and faxed the doctors office sevreal times for this ladies refill and still got nothing back. Nowadays, with 95% of Doctor’s offices (around here anyways) REQUIRING the pharmacy to get ALL refill auths, (not patients), we are responsible for a LOT of refill requests.. and this lady got mad when I told her her bottle has said “NO REFILLS LEFT” for the last 90 days.. and she waits until the day before her medication runs out to call us, then gets mad when I don’t call her to tell her the Doctor didn’t call us back. I got into the medical industry to help patients.. I really did.. but I am learning more and more that patients don’t even want to help themselves most of the time. They want to have someone else do everything for them. (Patient calls pharmacy from home, want me to send a request for a medication to their doctor when they saw an ad for it on tv, then wants me to run it through medicaid so my tax money can pay for it then sit on the bum while my company hand delievers the medication to them! It’s disgusting!)

  44. As a Dialysis patient who visits the Safeway pharmacy once a week, I must say all these lunatics who can’t get their medications straight are ridiculously shortsighted and, in my opinion, should be penalized for not planning ahead.
    Here’s how easy it is:
    1) Call the phone number on the bottle.
    2) Press #1 to enter prescription code.
    3) When it says my name, press #1 again.
    4) Prescription filled.
    5) Hang up.
    How freakin’ simple is that?? If I have no refills, the phone system asks me to press #1 if I’d like the pharmacy to call my doctor for a refill.
    I really, really feel your pain, because I’m always the one behind one of these simpleton’s who are wasting everyone else’s time because they can’t wrap their brain around the simple concept of calling ahead for a refill.
    I propose two lines: one for people who have no refills & didn’t call ahead and another line for people who have their shit together.
    Thank you and good night.

  45. spelling bea says:

    RXdawg you work in a pharmacy? You’d think working in a pharmacy you would be able to spell PREscription…

  46. em says:

    My favorite is when they come in on Friday, have no refills, and “Oh no I’m totally out can’t you please please loan me?”… and it’s not a control, so here in GA we go ahead and give them 3 days’ worth per company policy. We fax the MD, and usually by Monday early afternoon we get the renewal. So we fill it and take 3 out for what we loaned.
    TWO WEEKS go by, and the patient hasn’t even called to see if we have it much less come by to pick it up. Why was it so damn necessary for us to loan you when you could then go another 11 days without it? They are usually the ones who either never return voice mail messages or don’t even have voice mail set up.

  47. Von says:

    We may be the most retarded beings on the planet, but guess what? Without us you wouldn’t have a JOB!!!!! And with your attitude, you don’t even deserve one!!
    FU

  48. OUT FOR LIFE says:

    Hey Von:
    First let me say right back at ya with your FU. Fortunately, not everyone is as retarded as you we’re just complaining about the small percentage that are. So piss off.

  49. Von says:

    I only meant Follow Up. Sorry. This whole site seems to be an expression of hatred for the people who supply your livelihood. That’s all I meant.
    I know it must be frustrating to deal with some people but we are not all like that. Just remember, we are not out to get you. We just want our medication.
    Von

    • guest says:

      You want to know why there’s so much hate at you patients? Because you treat the people in the pharmacy like second-class things, not even second-class human beings. It is not a privilege for me to serve you. It is a privilege for you that I don’t tell you to fuck off when I have you and 5 other people bitching me out for my minimum wage tech job.

  50. L says:

    You could always tell them to go to the ER. They’ll get their meds, and they’ll get to wait hours and pay probably at least $75 in ER visit copay (more if they pay %/deductible). Maybe that experience will teach them that you shouldn’t have to put your ass on the line because they didn’t call ahead.

  51. Pharm Cashier says:

    Von:
    Notice Out for Life said “Small percentage”. To be honest, depending on your location, that “Small Percentage” can become a “significiant percentage”. Seriously, if you don’t believe me, try working at a pharmacy. The majority of customers don’t give us any problems at all. But there are some that just make you want to tell them to go away and never come back.(Some people might know the term 86’ed…..heh.)

  52. Von says:

    Yes, you are right. He did say that. I should have read more carefully.
    Well, I guess it is true, the few ruin it for the many. I can imagine that it must be very frustrating when people want their medications but put forth no effort, expecting the pharmacy staff to do it all.
    On the few occasions when it has happened to me that I tried to get a prescription that ran out, the pharmacist will offer to call the doctor’s office to renew, but I always say I will call myself. First, I don’t want to interrupt their work when I can do it myself perfectly well, and also I want to make sure the call does get made, because I do feel it is my responsibility and not theirs.
    Von

  53. js says:

    In california, the law states that a licensed pharmacist may allow up to a 30 days refill on medication that have no refills on non controlled medication. Furthermore, the law also states that you may allow a “necessary supply” of controlled medications if it would do suffering to the patient.
    Or you could just work for an HMO and have the policy “keep members at all costs” even if it means vicodin hold overs.

  54. Wil da Pil says:

    I hate stupid people that are the everyday annoyances in pharmacy. I agree that for-the-most-part, patients are decent people. It’s those who feel that pharmacy is another commodity that serve solely them, without regard to the law or professionalism. To those I say, “Piss off and burn in hell!” I also give a huge thank you to those who make my day and feel that I make theirs. As a pharmacist and a consumer, I understand you “want your medication”. Do you want it filled fast or filled correctly? Each prescription needs to be meticulously reviewed befor we sign off on it. ANY disregard to the care I need to take with YOUR prescription is disrespectful and unwarranted. If you, the consumer, don’t like it, become a pharmacist, prick.

  55. Max says:

    To make things worse in this situation, when I kindly offer the patient to advance him 5 or 6 tabs to hold him over while I bust my balls trying to get a hold of his MD, the asshole makes a long face and states that he is going to Florida for the next 6 months and is leaving this same afternoon.. This is usually followed by the regular “I’ve been coming to this pharmacy for the past 30 years” and “well… I need them.” bullshit

  56. Helle says:

    My story, from a Saturday:

    “M’am, I cannot refill this birth control pill – the prescription does not have any more refills and we will have to call the doctor on Monday.”

    “So (huff, huff) you are NOT going to fill it?”

    “No, I can’t fill it until I get an OK from the doctor”

    “THEN IT’S YOUR FAULT IF MY DAUGHTER GETS PREGNANT!!!!”

    Well, perhaps she should have taught her daughter how to read (so she could read the label), how to show respect for her mother (by not sending the poor woman out on a fool’s errand) and how to close her legs for 48 hours.

  57. vanette says:

    Love this it is Sooooo true!!!I am a tech so I know this all to well! Thanks for the laugh!

  58. I’M SHOCKED AT THE SO CALLED PHARMACIST ON HERE..YOU ALL SHOULD BE ASHAMED OF YOURSELVES AND SUED OR AT THE VERY LEAST HAVE YOUR LICENSES REVOKED. DISCUSTING HOW YOU TREAT PEOPLE WITH PAIN OR SEVERE DEPRESSION, AND ANXIETY…YOU ALL ARE SICK AND SHOULD OF NEVER BEEN GIVEN A LICENSE TO HELP PEOPLE.

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