Careastatin, 0 refills remaining.

Anyone who has been in a relationship (professional – personal, it doesn’t matter) knows that it takes two to tango.  Your patients come in, put their life in your good judgement, and in return you may have to do things that are ethically sound, yet legally grey at best.

I’m talking about the dreaded ‘0 refills remaining’ with the patient being out for 2 days.  This phenomenon is so prevalent in pharmacy that we should have received a class on how to handle it.  Since pharmacy schools give two-shits about retail, here is your class on the subject.  Pay attention!

This is how 99% of the cases take place:

  • The patient will call you over every little change on the label (expiration date, change in manufacturer, quantity, doctor) yet will gloss over how many refills remaining until they are out for exactly 2 days.
  • The patient will let you know they are out of refills in person…. On a Friday… Before a 4 day holiday…. At 2 min’s to closing…
  • The mediation won’t be Vicodin, Valium or any narcs.  It’ll be something awesome like insulin.  You know, the kind of shit that you ethically can’t tell them to go fuck themselves over.
  • They won’t be out of something simple that you can drop a few tablets in their bottle, it’ll be something that comes in a unit-of-use bottle, like Januvia, Actos or Nexium.
  • In the event that they are out of something simple and stupid, they will forget their old bottle despite you telling them 10 times “MAKE SURE YOU BRING YOUR OLD FUCKING BOTTLE”.  This leaves you out the cost of ANOTHER bottle and ANOTHER label.  Regardless of how shady this all is already, dispensing drugs into their open unwashed hands is just crossing the line.
  • The patient will use the phrase “BUT I NEED THIS MEDICATION” or “CANT YOU JUST FILL IT”.

Here is where the legal waters get the product of Go-Lytely dumped into it.  What do you do?

  • Legally (sorta), you can only give a 3 day supply without authorization.  Its insulin.  Are you going to suck out a 3 day supply?  If you are, I hope your employer fires you for being a dumbshit.  Are you going to break open that box of Humalog Flexpens to dispense just 1?  To make this worse, if the MD finds out (usually patient taddling) he/she could file a complaint against your license with the state board of pharmacy for filling without authorization.  If you billed the insurance company, they can ding you for filling a fraudulent Rx and pull your contract.  This is all worse case mind you.
  • Realistically, you know you won’t get the OK from the MD for at least 5 or 6 days.  A week to 10 days if the patient goes to a county-ran clinic at the local hospital.
  • Ethically, you know that if you don’t dispense this insulin, the patient will have to go to the ER (or worse) thereby costing the taxpaying citizens a few thousand.

Pretty fucked situation all around?  Yes, yes it is.  For those of you at home, we deal with shit like this about 20 times a day.  Now this is how I would handle it:

If it’s a regular patient (regular in the term that we have a professional relationship, not that they can poop fine), then I take the potential legal hit to my license (and to the store) and give them the insulin without the authorization.  I figure the patient will stand with me against the state board (and their doctor) to justify my actions as being in their best interest.  I politely tell them to bring me a new Rx before this amount runs out, and all is happy.  Wait, can you hear the collective jaws of every MD out there dropping as I spill the beans that yes, we do dispense medication without your authorization in certain cases.  Here’s a fucking reality check, your patients are dipshits.  They can program their phones to play the most obnoxious ghetto rap-song ring-tone at 1000db while waiting for their drugs, yet they can’t program a simple alarm to remind them to call in their refills a week early so we can get the authorization.  If you are unable to grasp this concept, then actually listen to the ‘blah blah blah’ that comes out of their mouth when they visit you and you’ll realize that you’re dealing with someone that’s half-step above my dog on the evolutionary chain.

If its Joe-Crackhead who treats me like utter shit, bitches at me about EVERY-FUCKING-THING and looks for things to argue about; fuck him.  Let him sit in the ER for 10 hours.  If he paid as much attention to his medication refills as he does his fucking cigarettes, we wouldn’t be in this mess.

Harsh? Yes.

Surprised? No.

Agree with me? Probably.  Here is my rationale.

Personal responsibility is something isn’t to be taught by your Pharmacist.  Sure, everyone has a brain-fart and forgets to call their medications in.  However why should I legally put MY license on the line for someone who has no respect for me, doesn’t treat me like an equal, or always tries to pick a fight for me?  This kind of bullshit patient would be the first one to throw me under the bus to not only the MD but the state board if the shit goes south.  I’m not going to put my livelihood on the line for someone who doesn’t give me an ounce of respect, and doesn’t realize that I’m doing him/her a huge favor.  Unprofessional? Sure, if you want to look at it that way, but you also need to look at the irresponsibility of the patient who put him/herself in that situation and expect me to put my ass on the line to remedy a situation that he/she put themselves in.

The easy solution is for everyone to have a little bit of self-awareness and personal responsibility regarding their own health.  Yeah, I’ll get right on that after I finish filtering all the piss out of the ocean.

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125 Comments

  1. Sally says:

    I worked in a resort area. Every Saturday morning during terrorist season they would be lined up at the counter wanting their meds that they had forgot at home. And no, it would never be anything easy. It would always be something like eye drops, or insulin or prempro. And their insurance company never wanted to pay for it because they had just had it filled before they left. But naturally they didn’t want to pay cash for it because they had insurance, which didn’t want to pay for it because they had just filled it right before they left on vacation. Boy, do I not miss retail.

    • Crusty RPh says:

      Yup and no problem – The insurance company said it would be ok all the pharmacy had to do was call this number – wait on hold for 10 minutes for a $1.50 dispensing fee. I started making them call and hand the phone to me when the service rep came on the line.

  2. Sally says:

    Oh and I forgot they never knew what they took. Just that it was a little white round pill.

  3. Anne says:

    This has to be the most truthful thing I have ever read. If there was anymore truth to this I might catch a tear. I am a CPhT who no longer deals directly with the public, thank God. And thank you for this blog.

  4. Dr. Grumpy says:

    Awesome post. Nailed that one.

  5. JS says:

    I don’t understand why the patients can’t/aren’t held responsible for themselves? Why does the PRH have to clean up their mess? If they run out of medication, and you don’t give them a few days worth and something happened to them; would you be liable? And if yes, why?

    As a patient, it’s my responsibility to keep track of these things, not yours!

    What do you do about the patients that do this time after time? Then they just keep doing it because “You did it the last ten times, why won’t you do it this time?” That’s where I think you could get into trouble.

    And what if the MD says, “No” to the refill and you have just dispensed another four days (long weekend) at no charge (of a very expensive medicaion)? And said patient goes to his MD and tells him/her, “But my pharmacist gave me four days worth until he/she could talk to you? Then what? Not only could you be out a lot of money, depending on the medication, you have a doctor that might just report you to the DEA?

    Not looking to stir up trouble, just wondering?

    • radrone 5316 says:

      excellent points JS, and exactly why I NEVER give out anything unauthorized. ERs and walk-ins are all over town, if you have to go through that experience just once, you’ll never let yourself run out of refills again. Angry Pharmacist has balls, but needs some more in this case.

      • malaika says:

        @radrone, wish we could do that. I practice as a retail pharmacist in Ontario, Canada, and the College of Pharmacists has actually just legalized emergency refills by a Pharmacist. So technically sending patients to emerg or a walk in is not the only option we have. Go figure!!

  6. fubar0906 says:

    I’ve, hypothetically, done this more times than I will admit. But I always fax the doc asking for an Rx. It sucks, but when someone presents with an asthma attack and their Rx is expired, am I to call an ambulance? or just give them their albuterol thatthey have been on for years?

    I’d like to know what the MDs/prescribers think. yeah, i know it is not legal. I would never claim to have prescribing privileges…but would you prefer me to call you and wake you up at 3am (work overnights) when you are on call and make sure it is och that joe schmoe receives and albuterol MDI?

    • Disgusted Pharmacist says:

      Reminds me of the time a patient walked in without her prescription for albuterol because she forgot it. Had NEVER been to our pharmacy before and was out of town. She then asked if she could “borrow” an inhaler of albuterol.Hmmm–do I try to dispense that after? Maybe put a half-off–used–sticker on it??? WTF are some people thinking????

      • smartTech says:

        Or they are from out of town, no they dont want to transer their script. Leave it there. Just lend them a few. Just throw a few in a bottle and sell it to them like that. People are crazy in their expectations. Oh, and please make sure it cost under a few bucks because they already paid their copay back at home. Sheesh!!!

        • I_hatemyjob says:

          What you encountered could not compared the one I had just a few weeks ago. A patient walked in and asked me whether i could him a couple of pills. He was on vacation here and ran out of his med. He also said that he had refill in the pharmacy at his home town. I replied if you could give me the phone number of pharmacy I should be able to transfer the refill within a short period of time. He then said that he did not want to transfer his prescription but he just want to get a couple of pill. I then said ” Sir, let me put it in this way, if you have your account at Bank of American, then walk into Chase bank and ask whether you can get a few hundred dollars but you have not intention to open an account but just want to get some money.” Guess what, the man jst left without saying anything.

  7. Jennifer says:

    I am an RPH and recently had a patient ask me for an emergency fill on an albuterol inhaler. Patient’s last new RX for an albuterol inhaler was over 1 year ago (I don’t remember if that coincided with the last refill). I explained to the patient that I wouldn’t be able to refill the inhaler because of the length of time since she last saw the MD; I also told her that if she was having an emergency she should go to the ER. She proceeded to tell me that she KNEW her MD wouldn’t refill the inhaler because she had not been seen, but wanted to try anyway. WTH?

    • well played, Ive had that same thing happen to me. NOPE NOPE NOPE. see ya later sucker thats what urgent care is for.

    • smartTech says:

      Good for you! Some times I shake my head at the things people get away with when it comes to a certain push over pharmacist I work with. I wanna shake him and say, Be firm! Say no! Make them tow the line! You wear the pants and have all the control.

  8. smartTech says:

    I work in an independant pharmacy in Kansas about an hour south of Kansas City. Just far enough away from the city that most of our regular customers see the 3 doctors in town. Generally, our Pharmacists, when in this situation would rather advance a few pills than see any of our loyal customers suffer. If is a very rare that we have to advance insulin, but we will. What irks me the most is the pissy customers who are non-compliant who decide at 30 minutes after the doctors office closes on a friday night that they just have to have a refill on their lisinopril/simvstatin/metformin that has lasted them 50 days because they never take. Grrr… And its not like the idiot customers are grateful. They expect it.

  9. bcmigal says:

    You are right. Diabetics and asthmatics are the worst offenders. Next in line are the folks who have been out of their SSRI’s or anti-seizure meds for 4 or 5 days! Then, there are those with HBP whose MD denied the refill because they have not been seen in 2 years or more. ( I’ll have a stroke!) Duh! Of course, there is the ever popular excuse: “My mail order did not arrive”. We, then have to type a label from the last Rx filled at retail which is usually from 2009.
    We do not hesitate to page the doc on call or better yet, have the patient page him/her.
    And, yes, I have given Humalog, ProAir, and timolol drops and then let the doc know. The pharmacy law in our state provides for this.

  10. niterph-pacingmyselfsargeant says:

    I give them no more than 1 days supply of their oral maintenance medication, I don’t care what the situation or holiday weekend. They get jack crap from me on sleep meds and BC pills since I am a heartless SOB. I tell them all to get ahold of their MD if they need more than a 1 day supply, and that THEY can bother, that’s right bother, their MD after hours, I refuse to. If it’s Omeprazole, ranitidine, ibuprofen or some other bullshit OTC drug, I give them nothing and tell them to just buy it. Why insurances even pay for that shit has always flabbergasted me. I inwardly always take notice of how old the patient is, and then think about how many more decades each of them will be treating us like shit. Unit of use drugs I play it by ear and let myself be swayed by whichever way the wind is blowing that day.

    • I_hatemyjob says:

      I will give them a day or two on certain maintenance med. As for statins, I personally believe missing a day or two would be OK. I usually tell them do not go to Mcdonald for a week then they will be ok without medication.

    • jimbo says:

      Wow, you’re an ass.

    • Hallie says:

      Hmmmm, working with the public is an aweful job; there have been more time than I can count when I just wanted to punch the person….that said, I stumbled on this website because I heard that Walgreens was no longer accepting the Oregon Health Plan (I am on private insurance) When I Gooled why, this site popped up??? I started reading the posts on here and although I totally understand how frustrating people can be, you all are being just a little harsh. People are people, not all are trying to single-handedly trying to cause you grief……one time when I was a delivery driver and had use an inhaler in the past but my doctor said that I was doing so well that I didn’t need it any more. About a year later I was on my route and my next delivery was a Hi-school Pharmacy. I suddenly and without any warning started to have an asthma attack. I was still about a mile from the stop and rushed to the back where an employee found me and had the phamacist come out………they gave me an inhaler and I was ok. I surely had no intention of irritating the employees nor did I have a prescription.

      • aspeenat says:

        I am so glad to read your post. I could not get over how this guy thinks he is a nice guy when in truth he only treats his staff well so they will bail him out. He emphasizes with a cashier then in the next paragraph says poor people are one steep up from a dog. Hello cashiers make minimum wage the cashier is poor to. The sense of entitlement in this blog and the comment section is overwhelming. I would like to say this is the first blog by a person with an advance degree that spoke about people lower then them financially in an such an egregiously way but it’s not. I would say it is actually a common theme.

  11. Jube says:

    You said it straight up Angry Pharmacist. I love the “But I have to have it” or “but I need it”. No, really? You don’t take stuff just because you like the color or your insurance pays for it. Duh? don’t you think people buy meds because they “need” it? Although, hmmm. from your file, doesn’t seem like you need it that badly ’cause you have the compliance of a lazy cat. I always love when they come in to see if they have any narcs left on file on the weekend and I have to say no. Go see your doctor. No exception there. Maybe I’m a little sick for getting satisfaction from saying NO. But I don’t think so. :)

  12. Michael says:

    I’m amazed you’d risk your license for these ass-hats. I wouldn’t risk mine. It doesn’t matter how well I know them; if they’re not bright enough to refill their scripts on time, you think they’re bright enough to show up at your hearing on time?

  13. Zippy says:

    Had the ever popular call today from the patient wanting her lasenopralil (her pronunciation) which we had just filled 15 days ago for a 30 day supply. Of course the dr had told her to just start taking two lisinopril a day instead of one without sending us a new script. While I advance the three days, it ticks me off when the situation could have easily been avoided.

  14. Wendy says:

    My hubby is a diabetic going on 37yrs. We’ve been held up on a day trip before and he forgot his insulin at home (I know, life long diabetics are the worst). No expectation of the Pharmacist to help us out, we just paid for the vial. Luckly that was before he was on Lantus at over $100. a bottle. Now the real trouble comes when he forgets his needles.

  15. Wendy says:

    and thank God you don’t need a script for insulin.

  16. JustADoc says:

    As a doctor I can say that I have no problem with you forwarding them a few pills of routine medicines.

  17. Megan says:

    My favorites are the caregivers who let meds run out for their children or elderly parents. I have an Aunt who does this frequently to her Type I diabetic teenage daughter. Then I have to listen to her gripe about the evil pharmacist who have her crap about wanting to “borrow” a $150 bottle of insulin at 11pm on a Friday for the 10th time. I couldn’t be happier working FT at a hospital now and only working retail PRN to see what I’m (not) missing.

  18. dr-lasermed says:

    Love your web site. Agree with this rant. I hate these patients. Often they haven’t been to the office for two years or more, but think they should have a medication refill. If they get a refill after hours or on a weekend, we won’t see them again until it happens again. So – no refills until we see the whites of their eyes.
    Poor planning on your part does not make an emergency on my part.

  19. gunga din says:

    I have never heard of a pharmacist being taken to the cleaners by the board or a DM on account of giving a bottle of insulin without a refill authorization on a non routine basis. DMs and drug inspectors are assholes but disciplining a pharmacist for this would be a super assholian thing to do.

    • PA RPH says:

      Yeah dude, it’s pretty much standard operating procedure to throw people a few drugs to last ‘em till we hear from their MD for refills. I highly doubt any state board would throw you under the bus for that. If so, every single pharmacist out there should be sanctioned.

      Certainly doesn’t make it any less annoying for us, though.

    • Aibohphobia says:

      Gunga, its not the DM or boards so much. Law enforcement is also doing strange and confusing things nowadays; I had a lady give me a forged Rx for promethazine 50 mg #100 TID (heroin booster) with a ‘borrowed’ Rx card and ID. This is forgery and insurance fraud, right? After figuring this out on a weekend, I called the police. When I explained it to the officer, he looked me in the eye and said, “Just exactly what did you hope to accomplish by dragging me in here today?” I felt like saying, “I hoped you would drop your f**ing donut and do your f**ing J-O-B!” –but then, he was the one with the mace and the nightstick. In my ‘burg, police corruption is so bad that the DEA has sent word to the pharmacies to fax any detected forged Rxs directly to them. Hope its better wherever YOU are…

  20. Dave says:

    That’s one of the things I have had the hardest time adjusting to in this country (I am an American but have spent a lot of time living and working overseas). In most places I have been, pharmacists (with their many years of education and experience) are pretty much able to hand over whatever they feel is called for as long as it is what we laymen would call “basic” medicine.

    Here in the USA, if it’s not over-the-counter stuff, you have no choice but to go to a doc (often an expensive and time-consuming option) to get a prescription.

  21. FML(I,Am,A,Pharm.) says:

    A pharmacist license is nothing but a gov’t license that you need to practice pharmacy…keep in mind it says the name of your state at the top before it gets to your name. There are more than enough rules and regulations….I am not a drug inspector but I bet I could study your states’ pharmacy laws…give me 20 minutes in your pharmacy and I could find a violation to turn you into the board of pharmacy. The board of pharmacy will not protect you…they will throw you under the bus…scar your record..and depending on the severity of the issue may even post it on your license on the secretary of state website. Pharmacy law has gotten out of hand and it does very little to protect the public and is more of an abuse towards pharmacists. If you want to appeal your fine it you will have to go to court…good luck pharmacists on keeping your license clean and clear with the working conditions that pharmacists work under because you are going to screw up…but the gov’t boards of pharmacy like this because the more you screw up the more the government can drag you through the mud, the more fines they get to impose and the more reasons they have to try and justify their gov’t position to the public and the governor. Welcome to the real world. Not to get too political but Herman Cain stated in a Presidental debate that he would appoint a gov’t de-reguation committee where citizens will be chosen to be on a de-regulation board to be in charge of de-regulating every gov’t agency in America. We should pressure our governors to do this at the state level.

  22. Pitt MD says:

    As a doctor, I’m ok with (most) pharmacists using a judgment call and helping tide a patient over when (s)he is out of refills. Given that there’s a legal/license issue that puts the pharmacist in a tight spot, I actually appreciate it.

    That being said, given the legal/license issue, I would never fault a pharmacist for taking the safe approach and not dispense the meds. Like above mentioned, there’s the legal aspect, but also the safety concern that perhaps the patient’s refills ran out because (s)he is no longer on the medication and was switched to another that may or may not be filled at that pharmacy.

    For example, I recently admitted a patient who was given a few weeks of Synthroid samples by her endocrinologist at a lower dose than her usual but didn’t understand that she was supposed to stop taking her current one. She went home, took both the sample and the old dose for a few days, even refilled it the old one, and eventually got super duper thyroidy. This was, by all means, an issue for the patient and her physician to have settled, one to properly explain and one to understand. It’d be unreasonable for a pharmacist to ask patients if a theoretical situation like this has happened when they refill meds, but I suppose this could be an argument against the unauthorized refill.

    From our end of things, we also see the obnoxious negligence and gross irresponsibility patients take with their health, their compliance…hell, even their knowledge of what’s going on (“Sir, why do you take Plavix?” “I DON’T KNOW, MY LAST DOCTOR TOLD ME TO TAKE IT! READ MY CHART!” “Sir, you’ve never been in this hospital, I don’t have your old chart. Have you had a heart attack or stroke, or maybe some kind of stent placed in your body?” “ITS IN MY CHART, WHY DON’T YOU GO READ?” “What’s your doctor’s name? I can call him and ask. “I DON’T KNOW HIS NAME, WHY DON’T YOU NAME SOME IN NEW YORK AND I’LL TELL YOU” “Uhhh, sir, we’re in Pittsburgh”…no lie, this happened a few days ago with a 50-something year old guy who was for all practical purposes, competent).

    That rant aside, sometimes I’m ok with patient’s having to learn their lesson the hard way. We’re health care providers, not mommies and daddies. You’re 40 years old and run out of insulin or Coreg or whatever? Tough, find a way to get ahold of your doctor or else go to the ED. Don’t put someone else in a compromising situation to bail your ass out. Maybe you’ll learn your lesson. Sure that lesson may rack up a $10k ED/hospital bill that you very likely won’t pay/be responsible for, but I’m at my wit’s end…

    • FML(I,Am,A,Pharm.) says:

      You are stealing my thunder about my thread Dr., but I really like the way you put your reasonings on these issues. I wish there were more reasonable Dr.’s like you that understood these things. I bet you are a better Dr. than most because you have common sense. If you want to run for the president of the American Pharmacy Association, you will have my vote…even though you aren’t a pharmacist you seem to know where we are comming from and I would argue any day of the week that you are more than qualified. When are we ever going to get to the point in medicine that Dr.’s and pharmacists realize we are on the same team? I am afraid pharmacists over recent years are trying to become the king kongs of medicine a little too hard. I think it is time to stop with the pharmacy retoric and get realistic about things again and truely do what is in the best interest for the patient. This may even involve the Dr.’s giving the pharmacists a little support to help our cause about our working condidtions. I know it doesn’t make you feel good to know that the prescriptions you write are going to be filled by a pharmacist that is being explioited, doesn’t have time to take a bathroom break, and has a corporate complaint hotline just waiting for some idoit to call. That prescription we are checking that you wrote may have an interaction or allergy that is caught by us that keeps both of our licenses and asses out of court. Support us Dr. because I believe we are better off working together than against each other, and it will untimately benefit the patient better than ANY government regulation.

  23. Ed says:

    I love it when the patient comes in for their HBP or cholesterol meds and not only have they been out of it for 2 days already and they will die without it, but you loan them the 2 or 3 days of meds, but then they don’t come back for their precious refill for another 7 days. I thought it was life or death? I thought you were already down two days? What did you do for the 4 days your were out of medicine this week? What dumb MF’ers

    • Andy says:

      I hear you. Patient comes in for refills for statin or w/e maintenance drug. No refills. we give him 3 days supply because they DESPERATELY NEED IT and call their doctor the next day. get the authorization. call the patient back to tell them to pick up the refill. 7 days later, we give them a call to REMIND them the medication they desperately needed is filled and ready to be picked up. call back 10 days later, 14 days later. finally gives up and return to the shelf. comes back the very next day, asking to pick up and gets all pissy because the pharmacy called him 2 weeks ago that it was READY. GAWDD!!!

  24. got the oc's? says:

    Working in Las Vegas is great for the drama of leaving of meds at home & gonna die if I skip that dose. Wait my ins isn’t gonna pay for it since I filled it last week & left it on the bathroom counter? I’ll just skip it & die. Now that will fix that insurance company. Worked some per diem for a indy close to the strip-$15 to call for the copy or MD call and min charge of $15.99 (i.e #6 hctz). Walkins with bottles- we’d love to give you a few loaners of hepsera, plavix, seroquel, etc but we are currently out-try the chain up the road….My personal fav is always the cholesterol meds- hey buddy maybe skip that burger & fries & eat a few salads.

    • Steve_Austin says:

      I like the idea of charging for this service. Why not? I mean we already say ‘go see if some chain will take care of you’, why not set a service fee for no refills? If they say ‘screw you’ then have we lost that much?

      These people are the 20% of our business that take 80% of our time. Either set up road blocks to stop their behavior or stop catering to this non-profitable patient.

      I think that’s what the banks are doing.

  25. The Curmudgeonly Patient says:

    Just wanted to say that your blog is both funny and informative. I’m not a pharmacist, but I am well-acquainted with my local pharmacists on account of my chronic illness. Thanks to your blog, when I couldn’t afford a back-up med recently, I swallowed my stupid pride and made sure to call the pharmacy to ensure they didn’t go through the hassle of returning the drug to the shelf, and that I’d be in as *soon* as I could afford it. The pharmacist acted like I was one smart cookie. In all honesty, it’s common sense and it’s courteous.

    I also carry around a card with all of my medications and dosing on it, because it’s COMMON SENSE for me to. Herp durp durp.

    Seriously, nice blog. I’ll keep reading.

  26. Rphdude says:

    Pharmacy has become a clusterfuck of laws and regulations that not only don’t let us use our discretionary professional judgment to determine if we can help out a patient with a few days worth of medication but puts them at risk by allowing miserable working conditions.

    If the role of the boards is to protect the public, a pharmacist should not be allowed to work alone, 12 to 14 hours a day without any kind of break. On the other hand, deciding to help a patient who is out of refills, with appropriate communication to the prescriber should be allowed in every law.

    In summary, there is too much control, but not in the right place and in the right way.

    • got the oc's? says:

      All the bullshit about rph empowerment to prescribe, consult, etc. I still gotta call the MD to change HCTZ #30 refill 11 to HCTZ #90 refill 3.

      • Rphdude says:

        I hear you. Or to give 2 tablets of Crap X 20 mg instead of 1 tab of 40 mg because the 40’s are not on the disaster list…99.9% of the time you end up speaking with an office clerk who’s clueless like a deer in the headlights and gives you the OK anyway…

  27. Brian says:

    I’m not a pharmacist, but my father in his 60s is an independent. He’s not typically a computer guy, but I think I’ve got him reading your blog. It’s great! How about a post on these manufactured “shortages” he keeps telling me about?

  28. ALLEN says:

    as another doc, I will alwaya back the play of any of my pharmacy friends out there. Shit, if it weren’t for them I’m sure my ass woulda been in a sling years ago.

  29. rxgroucho says:

    sounds like what i hear at work from nurses. i need it, i want it, i don’t have it, oh im sorry i’m holding it in my hands. i wanted 10mg you sent me 2 5mg. i wanted green this is white. wait it’s pink, i wanted blue…Why is this broken? how many mg is this? Whats the generic of hydrochloride..? i don’t see it anywhere, when is it coming up.

  30. I_hatemyjob says:

    Go to the doc which mean they have to pay. If they can get loan even a few pill that would save that at least $20 of office visit ot even more for urgent care.

  31. Enigma says:

    This is probably only somewhat related to this but as a consumer/patient I have a serious question. There is only one pharmacy in my town a Walgreens that was until fairly recently an independent (5 to 7 years ago). About 2 years ago I had some minor heart palpitations and my doctor prescribed a daily prescription for me of HydroDIURIL that comes in 25mg pills where I take 2 at a time, each pill is 25mg and Lovastatin at 20 mg. I was told to take them with my morning meal and do so and have had no other heart issues and both cholesterol and blood pressure are in good shape (probably helped a bit as well that I retired and became more physically active to, but the drugs were immediate the lifestyle changes last year). I have been offered and a few times accepted to get a full script a generic of the HydroDIURIL and I think the lovastatin is a generic but not sure never been offered on that. Anyway I have requested numerous times to have the pharmacist combine this into a compound medication and either gelcap or pill press out a single pill that is a grain of the HydroDIURIL and a half grain of the lovastatin. They categorically refuse to do this at the pharmacy but I recently came across cleaning out my dresser an old (empty and all taken was using it to hold eyeglass screws) prescription bottle for Cefalexin and Pheniramine for what I am pretty sure was a fairly bad sinus infection at the time. So I know they can combine prescriptions like that. Why won’t they do that as its far simpler to take one pill than 3 and all are on the same dosing schedule? Sorry about the rather long and convoluted question that is really simple but didn’t want to miss any relevant info. Do I need to get my doctor to write into the prescription to combine them or something at my next check-up? Or is this something that used to be done and just isn’t anymore?

    • Rphdude says:

      No combo but you could get your generic equivalent of Hydrodiuril in 50 mg tablets instead of 25 mg

    • bcmigal says:

      I have not seen Hydrodiuril in many, many years, only the generic HCTZ (hydrochlorothiazide) is available. And a grain of any drug would be a about 65 mg so that would not be exactly equivalent to what you are taking. I have been in pharmacy for a long time and I do not recall there ever being a combo of an antibiotic ( cephalexin) and an antihistamine. What is your objection to taking 2 or 3 tiny pills a day?

    • got the oc's? says:

      Are u serious? #1 cholesterol meds r at night. #2 do u see a pill press anywhere in that pharmacy? Lot of time & work to compound the meds- go to a compounding pharmacy I’m sure they can do it for u for about $90 or buy some empty gelatin capsules & do it yourself.

    • MamaB says:

      I have worked in a compounding pharmacy and their are regulations about what can be compunded. If a medication and dosage form is commercially available than a compunding pharmacy can’t do it. Say if you were on 18mg of hydrochlorothiazide–that is not commercially available and could be compunded for you–but not the stuff you are on.

  32. Bowersst says:

    Does the 3-day emergency supply rule vary by state?

  33. TXCertPharmTech says:

    I wish we could post a sign in the Pharmacy “A lack of planning on your part does NOT constitute an Emergency on ours…”

    • I_hatemyjob says:

      If we could, i would rather post a sign as following “we reserve the right not to serve certain request”.

    • rph3664 says:

      When I worked in retail, we always said that we needed a sign that said, “Abusing the staff will not result in lower drug prices.”

  34. rph3664 says:

    Earlier this year, I temped at a place that services nursing homes, and we had NO contact with the general public. We dispensed those meds in 30-day cards, and the last week was marked by a dark blue stripe on a white card. So guess what? “My patient’s out and WAAAAHHHHH!!!!! you must fill it now!”

    I got a permanent job and left that racket. This company also wasn’t paying their regular employees, which was a whole ‘nother story.

  35. Rphdude says:

    I think this original post might have been a troll…

  36. Rphdude says:

    I think this original post might have been a troll…how do you navigate from milligrams to grains? Seriously…

    • Rivalry says:

      I grain is approximately 60mg, 1/2 grain is approximately 30mg, etc.

      I learned this from the front of the Armour Thyroid bottles.

      Still, the OP is an idiot. Compounding two drugs into one is like blending your burger with your fries into a shake. Sure you can do it and save time, but why the fuck bother?

  37. ADHDammit! says:

    Dear TAP,
    I am doubtlessly posting this in the wrong place, so feel free to move it, delete it, or whatever you please.

    First off, i’d like to say that I fucking love your blog. It’s poignant, witty, and spot on. Here’s my situation. I have ADD. I have a great psychiatrist, and the best pharmacy in Georgia. They take care of patients with compassion, skill, and are as good at what they do as the thrice-damned Joint Committee on Horseshit and Asinine Obnoxiousness is at cluster-raping Anaesthesiologists.

    They always go above and beyond the call of duty. Lemme just get that out of the way. Also, I love my shrink. This is my problem: not one pharmacy has enough Adderall to fill my prescription, which is an admittedly ludicrous quantity of 60 20 milly tablets. Not ONE pharmacy in a sixty mile radius. Actually, a 180 mile radius.

    I get that the pharmacies and the prescriber are blameless, and basically helpless in this situation. But, while I am somewhat intelligent and articulate when I take my meds, I probably couldn’t find my ass even with both hands, a medical tricorder and divine intervention WHEN I AM OUT OF GODDAMN ADDERALL.

    It occurs to me that you *just maybe* be able to point me in the direction of who caused this cock-up, since I had to illegally borrow enough Adderall to get me through whenever “backorder” is fixed, and drive home with it, risking jail, forcible, non-consensual butt-rape, and a felony record. This is why I am not happy. Please, bear in mind that though I will forgive you for assuming I am just a speed freak, I’d
    really appreciate it if you gave me the benefit of the doubt here.

    Is it the manufacturing folks? The DEA? Jesus? UPS? An itinerant herd of herbal medicine quacks? Scientologists?

    Please believe that should you rat out whoever caused this rather tacky inconvenience, I swear that I won’t do anything more malicious to the fuck-ups than write an extremely ornery letter, sort of like this one.

    Thank You, and bless you for what you, and all your ilk do.

    -Really Screwed But Neurochemically Unable To Do Much About It Till Backorder is Over.

    • JamesRPh says:

      I’m a manager of a pharmacy. Generic Adderall has been on backorder for over a month now. None of the generic manufacturers are allowed to manufacture it now….the DEA regulates how much can be manufactured. It’s a completely fucked up situation and its ridiculous that the DEA has the power to essentially practice medicine by preventing people from getting the drugs that they need, but its the way it goes. Talk to your Dr. about getting something else.

  38. WiscRPh says:

    Dear Angry (and readers), each month Wisconsin Public Radio asks what their listening audience would like to have as a program topic during the following month. I’ve seriously been contemplating asking them to address the issue of retail pharmacy workload as it relates to public health and safety (including increased Rx volume, time constraints, constant distractions, reduced technician hours, flu shots, MTM, 12-14 hour shifts with no help or breaks, BP/cholesterol/A1C testing, etc.) It seems to me the state boards of pharmacy have been deliberately silent on this important issue. If they are charged with protecting public safety in regards to the profession of pharmacy, one would think they might have a say in the dangerous staffing practices of the large chains. Instead, these corporations are allowed to push their employees to the brink, creating a threat to the safety of the general public in the name of profitability, recording record sales and profits as they go. Meanwhile, the general public remains mostly oblivious to the plights of the fine people who are working feverishly every day behind these pharmacy counters to serve them to the best of their abilities despite having one hand tied behind their backs. Unfortunately, Big Business will never listen to the common-sense pleas of their minions, but only to their customers and shareholders. I truly believe this subject needs to be brought into the public light before someone is tragically injured or killed as a result of these corporate “standards”. It’s obvious that we as pharmacists are too weak to stand up for ourselves and need someone to help us “put their feet to the fire.” I believe public radio can do just that. SO I ASK ALL OF YOU: WHO WOULD BE THE BEST PEOPLE TO SUGGEST AS GUESTS ON WISCONSIN PUBLIC RADIO TO SPEAK ON OUR BEHALF AS PHARMACISTS? In addition, I urge all of you to contact your respective state’s public radio association to address this issue. We need to take a stand against these unsafe practices and get the public on our side if we ever hope to improve this dire situation.

    • Aibohphobia says:

      WiscRPH, this is easy to document. All it takes is lawyers and your State Board of Pharmacy;

      Fact 1) All the Huge Chain Stores (HCS) like CVS, Walgreens, Rite-Aid monitor the poop out of their pharmacy staff. Not only is every burp and butt-scratch recorded on digital color video, with sound, and attached to the employee record, but there are also extensive statistics like Rxs filled per hour, phone calls taken per hour, and error rate per 1000 Rxs for each pharmacist.

      Fact 2) All the HCS’s are cutting their staff hours while increasing the work rate.

      Suggestion:
      Have your Board of Pharmacy subpoena all the staff data from the chains. It will then be easy to correlate Rxs per hour with error rate, and you can link the onset of additional services such as flu shots with any detected bump-up in error rate.

      Whoever has that information would be the speaker you want. Once you’ve got it, you would also be able to document that the CEO’s knew they were putting the public at risk with the high workloads, but did it anyway.

      Of course, it would take some serious deep lawyer pockets to pry that info out of the CEO’s hands. Maybe the ACLU would be interested– No wait! ACLU is too busy keeping Christmas Trees out of municipal parks. Oh well, there’s always WikiLeaks…

      • bcmigal says:

        The subpoena should come from the labor department. Then it would be revealed how most pharmacists work through their unpaid lunch breaks (if they even get them) or stay after their shifts are over because staff hours are cut to the bone. So you are screwed either way: you can be terminated due to working off the clock or terminated because you do not “meet expectations”. Think the BOP will help you? They will fine you and your name will appear in their newsletter.

  39. Kenpharm says:

    My coworker gave a 4 day emergency supply on prednisone for a transplant patient (law allows 3 days in my state, but it’s was a long weekend) and the pharmacist called tuesday to alert the provider. The provider proceeded by yelling at the pharmacist for “Having no right and over stepping” she then asked why she wasn’t contact before as she was on call all weekend and would have answered the phone “even if it was 2am on sat). The provider filed a formal complaint with the board which has given the pharmacist an official “letter of warning” additional law Ce and a 100 Fine.

  40. bcmigal says:

    That is a great idea, but I seriously doubt that public perception will change. If someone is sickened or dies because of our working conditions, only the pharmacist will be blamed. We sold our souls to the corporations long ago. You are of no value. Only the “metrics” count. And if you cannot meet “expectations” than you are dead wood. You will be replaced faster than you can say “waiter in the queue.”

  41. Crusty RPh says:

    The expenses (labor,bottle,paperwork etc) of giving a few tablets to last the weekend are just a much as filling the entire prescription. We are expected to do it for free. Bullshit – If I give a 3 day supply, I run it thru the insurance for a 3 days supply – with the usual copay. If ok I will fill it for the full amount on Monday with the usual copay. It is real simple – just bill the patient and the Insurance for the amount given and collect the copays. A dispensing fee is just that – you get paid for dispensing, it is low enough without doing it for free.

  42. Alan says:

    Totally agree with your post! 100% to the point. In New Zealand where I practice there is a 3 day emergency supply leeway where a pharmacist has the discretion to dispense without a prescription, and guess what – “I run out of my Ventolin, I can’t breathe gonna die” is the most common thing they tell ya. Best part is that most of the prescription drugs here are government funded, meaning they usually pay 3-4 USD for a puffer. So when you present them a bill of $20-25 they will think you’re the evil drug lord trying the exploit their misery and rip them off big time (somehow they all think chemists are millionaires that goes on holidays all year long)

    Sadly a few young pharmacists went the long way of paying for the patient. And guess what- 9 out of 10 never come back again! Big fucken surprise there
    The way I see it- if you cant help yourself and look after your own health then you don’t deserve to live.

    • PA RPH says:

      “The way I see it- if you cant help yourself and look after your own health then you don’t deserve to live.”

      It’s funny ’cause it’s evil.

      And true.

  43. pill pusher says:

    It is no longer possible for a pharmacist to be a dependable health care provider… just keep pumping out those scripts, we’ll pay you a 6 figure salary. It doesn’t matter who gets hurt, we’ll cover your ass and you will still get paid. Thank you very much from the pharmacy chains of America. “In Pharmacy We Trust.”

    Why do we let this happen? How well do you sleep at night?

    • bcmigal says:

      Cover your ass? I don’t think so. If you are too busy to counsel or check an RX with more than just a cursory glance and an allergy, drug interaction, or an error gets overlooked, your head will be the first on the chopping block. Unless you are lucky and work for Zappos, the chains don’t give a hoot about you and your delusion that you are a health care provider. You are just an expendable commodity.

  44. CORINN says:

    I wish just ONCE I could tell them it’s not MY medication, I DON’T CARE!

  45. garybsp says:

    Sheesh, I thought I was a bitter pharmacist.
    Maybe things are different in Canada but I would say that it is quite common practice to advance a few days worth of chronic medications (excluding narcs and controlled drugs of course) without batting an eye lash. Some provinces including mine (Saskatchewan) have given pharmacists prescribing priviledges which helps greatly in these circumstances. As long as the medication is for a chronic condition (bp, DM, thyroid etc. etc.) we can write an rx for a full month.

  46. rph3664 says:

    Isn’t hydrochlorothiazide available commercially as a liquid? I know Diuril is, and have dispensed it for a child with congestive heart failure.

  47. CeliaHoover says:

    I am done with all of this. It is a never ending cycle of poor behavior because people know that they can get away with this. I never went into this job expecting people to be perfect, however I will not tolerate the abusive atmosphere that upper management of these big chains has cultivated. Frankly if someone were to demand that we touch our nose and twirl in a circle before their RX was rung up, we would be expected to accomodate such a request without question and with a “its no problem”

  48. Anonymous says:

    What we do here is:
    1) if we know the patient as a regular and trust a script will be forth coming, we issue the supply as a ‘loan’, charge the patient a $5 fee per item loaned, and deduct the quantity from their forthcoming script and they still get charged the regular script costs at that time too. They usually pay up quite happily as it gets them out of a fix. At the end of the day its a service charge, and maintains some sense of good will.
    2) If the patient is unknown to us or we are not sure we’ll get a script, we supply item as an EMERGENCY SUPPLY and bill patient for the entire costs as a ‘retail transaction’. If they can’t or wont pay, they can go to local hospital.

  49. sstevens says:

    I’m a patient who is trying to find out how to handle a situation where the doctor hasn’t bothered to return my calls or the pharmacy’s calls and faxes. I take Lexepro and haven’t had it for 2 days because of my doctors negligence. The effects are painful and thank God my pharmacist gave me a 3 day supply. Reading this article is disturbing. We’re f—ing idiots to you? My doctor is the idiot in this case. I know many people can be irresponsible and irate, but for me to find this while I’m looking for help on how to handle my doctor’s negligence??? Just remember that someone, somewhere finds you to be an idiot for whatever reason too. I hoped to find a professional solution and I come across this instead. You’ve been jaded by societies worst no doubt… but publishing this holier than thou article gives respectable pharmacists a bad name. I pity you and I hope your not my pharmacist.

  50. Patients do get it says:

    Sstevens – You probably only gave your doctor 1 day notice you were out of your Lexapro. Most docs offices now require you give them 3-5 day notice for refill requests. You act like you’re the only patient the doctor sees. As a compassionate pharmacist, I would have advanced you a 3 day supply, but we are not required to. You need to take responsibility for your own problems and not get pissed off at your doctor, they are extremely busy and don’t have the time to renew your Lexapro in 1-2 days. If you need to be pissed off at someone and pull the blame game, it should be yourself for being an irresponsible idiot.

    • HollyP says:

      Sstevens,
      You have to understand, and get it out of your head that the angry pharamacist is specifically talking about you. In our profession we are extremely thankful for all the patients that are considerate of us, and work with us, and are responsible for their own health. And we get that every now and then, something happens, forgetfulness on your part, or a doctor that is unreachable for a week. We can work with you, and we usually don’t mind forwardind the emergency supply. But for everyone like you there are 200+ of the kind that treat us like crap, yell at us for situation beyond our control, situations that they could control, if they took an intrest in their own health, and have this total sence of entitlement.

      You also have to understand, that in forwarding a three day supply, pharmacists are risking their license, their contracts with insurance companies, and their jobs.

      If you are a good patient, treat and respect your pharmacist well, then turn a deaf ear to this site. The Angry Pharmacist is not complaining about YOU. However I do have to question since you are so sensitive about this post, whether or not you just might be a PITA afterall. Cheers and hug your pharmacist.

  51. REMSA says:

    I have ms and get so pissed when people are giving my pharmacist a hard time three minutes until close. I also recently had my C_4 and C5 fused. I’m on every narc you can be on. Oxy, Vic, and Dan. It pisses me off when someone is giving my pharmacist a hard time for their fake ass drug issues and I’m standing in line with a 9 on the painscale to the tenth power. This happens almost every time. Fuck these dickheads. If it’s not the drugster it’s the bitch who didn’t take her three shits for the morning. So look the fuck out and let the real patients get meds so I can go home and lay down.

  52. pill pusher says:

    A pharmacist won’t make money unless he sells medicine. Pharmacists would love to sell you everything you want because that means more money! Ca Ching! Except it’s illegal without a prescription not to mention opens up a tremendous amount of liability for the pharmacist. However, there is a responsibility that lies squarely on the patient’s shoulders and that is to supply the pharmacist with a prescription.

    My other question to you is why would you wait until you are completely out of your medicine to do anything about it? Now you force the pharmacist into a compromising position. (but you don’t care about that, because you think the pharmacist owes it to you)

    Think of the prescription like a check that your doctor must write in order for you to buy your Lexapro. The same way that you would need your check book to pay for your groceries if you were at the grocery store. Do you think the cashier would give you 3 eggs if you forgot your check book to hold you over until you brought in a check? Hell, do you think the cashier would even bother calling your bank and ask them to send a check on your behalf? So why in the world would you think that it’s the pharmacists responsibility to give you anything at all, especially after the pharmacist went to the trouble to contact your doctor and wasn’t able to obtain approval?

    You know what the cashier would say to in the grocery store? “Go home and get your check book and then come back.” You want to know how to get the pharmacist to give you your Lexapro if you are out of refills? Go to your doctors office first instead of the pharmacy and get a new prescription! Why would you even think about going to the pharmacy if you don’t have a prescription? That is like going to a concert without a ticket and asking the usher to let you sit in a seat for only a few minutes because you weren’t able to get a ticket.

    This is why pharmacists are so jaded, it’s because of people exactly like you. We help people like you all the time and still you don’t realize all that we really do for you. Beyond that you are so ungrateful, that you chastise us when things don’t go your way. What pharmacy needs customers like you?

  53. joe says:

    The reason patients act this way is simply due to third party payment. My solution all along would have been to outlaw third party payment. Watch prices plummet, middleman PBMs disappear and patients actually give a damn about THEIR money . So long as a deep-pocketed third party is paying, the patient isn’t paying, and cannot pay in any case because the prices are tailored to what the third party is able to pay, and the patients will continue to ignore the value of what they’re getting.

  54. Mad Monica says:

    You know, I just don’t get people. I have NEVER been bitchy with a pharmacist. Why the hell WOULD you? They’ve got your life in their hands for fuck’s sake! I’m grateful for the assistance I get from my medication. It’s made my life bearable. The pharmacy that I go to deals with junkies and other nasty folks because its the closest to the only chronic pain specialist in our area.

    I get so pissed off sometimes because you can spot the folks who legitimately need the heavy pain medication and you can spot the folks who are in it for the “fun.” And the ones who dont’ really need the stuff are generally the ones who act like a complete asshole whenever possible. They’re the ones that come out with verbal gems like “You’re’ so lucky you get to take Oxycontin! I wish I could get me some of that!”

    I have lost my temper on a couple of occasions and only avoided an out and out attempt to kick someone’s ass (I’d probably kill myself trying to do it, but I’d give it a shot if I could) by remembering that these people are ignorant and that my children woudl probably not enjoy visiting me in jail. Instead, I simply tell them this: “I’ll tell you what. Let’s trade. I’ll let you have all of my pain pills, as many as you want. BUT in addition to them, you have to take my Parkinson’s and fibromyalgia along with my deteriorating spine and all the pain that comes with them. You will get to spend all night, unable to move, crying because you can’t find a position in which to sleep that doesn’t hurt. You get to watch your body deteriorate to the point that even though you’re not even 50 years old, you’re the oldest looking parent at your child’s baseball game or school play. You also get the joy of rarely having a romantic relationship with yoru husband or wife because THAT is painful. You get to throw up several times a week because the medication makes you sick. And the best part, the really GREAT part is, you get to jump through hoops like a little doggy every month so you can get your “fun” pain medication. You get to sit for hours in a doctors office hearing idiots say the sort of things you’ve just said to me and you get to have poeple look at you as if you’re a junkie because the minute they find out what you take, they remember Anna Nicole, Michael Jackson and Heath Ledger who were ALL celebrities and did not have to abide by the rules us peon pain patients have to. Still wanna trade, asshole?”

    Ok.. I didn’t put the “asshole” part. But by the time I get done, I think they usually keep their smart ass comments to themselves anyway.

    Thanks for your hard work. Believe me. The customers that matter are VERY grateful to you for all you do for them.

  55. Mad Monica says:

    AS for SStevens… Do you blame Charmin when you are unable to correctly wipe yourself? You’ll claim this is NOT the same thing, but it really is. You see, doctors are NOT required to do your bidding when you decide its time to ask for refills. Are you telling me that for an entire month you called for your medication and the doc blew you off all month? Because if that is the case, then you DO have a complaint. However, I suspect that you looked at that package all month and then decided a few days before would be plenty of time. In MY doctor’s office, there are signs all over that say “DO NOT WAIT UNTIL THE LAST MINUTE: Refills will be available 72 hours after the time you make the request.” Despite this sign being plastered all OVER The office there are at least three people that show up while I”m waiting to go in who come in panicked and pissed off because their refills are out. They leave even MORE pissed off because the receptionist always has to tell them “They’ll be ready (insert day 72 hours forward from the date on which they came in to demand their prescriptions).”

    I’m sorry you feel as if you’ve been poorly treated. But I suspect if you really do feel as bad as you say you do, you won’t forget to get those refills settled before you run out ever again?

  56. Grumpy1969 says:

    I haven’t worked retail for over 4 years, and boy, I don’t miss it one bit.

    A number of years ago when discount pharmacies started cropping up all over the place, people, of course, tranferred over. Only problem was, none of them were open on Sundays.

    I had a gentleman saunter in one Sunday and present his Rx bottles requesting me to sell him a few. I refused. He wasn’t too happy but I didn’t really care. Not my fault if he couldn’t get his shit together.

  57. THECapedCaper says:

    We do emergency fills for drugs in Unit of Use bottles all the time, though I suppose it’s easier for a retail chain to get away with it than an independent. I don’t think we’ve ever done insulin though, so that makes you a way better person than anybody at Walgreens!

  58. Don says:

    Maybe if you Angry pharmacist hate your jobs so much, then find a new career!!! You less then average people are a bunch of whiny ass low life’s who couldn’t make the grades to become a physician. Wonder why your treated like shit? Because you are!!!!

    • VulcanianRX says:

      If it was so fucking easy retarded monkeys like you would be doing it!! And don’t give me that horse shit line about “How hard is it to throw some pills in a bottle?” The science of these medications and what they do as well as what goes into them is far beyond that or much of anything you probably could comprehend. I’m sure medicinal chemistry, receptor based signaling in cellular membranes, pathophysiology of disease states is something you’re an expert at.

      • notu says:

        ” I’m sure medicinal chemistry, receptor based signaling in cellular membranes, pathophysiology of disease states is something you’re an expert at.”

        no but your fucking computer comprehends it for you. a retarded monkey can Google any of that shit… wait doesn’t the fucking warning labels and pamphlet you put in the bag tell you most of what you need to know anyway?

  59. Oldtiredrph says:

    Here’s a good one for you. Had a “friend’s” husband come in as we were closing on Sat. & needed an important drug. No refills. No problem, his wife has the Rx at home & he’ll bring it in Mon. I gave him 3 tabs, submitted the Rx to the insurance, as he certainly didn’t want to pay cash & after all, a legit Rx was on it’s way Mon., right? Well Monday rolls around & I get a call from the Chain down the road telling me I have to back out that Rx from Sat. as she’s trying to fill it today & it’s backing up against my claim. The dumb jerk-ass was mad at me for only giving him 3 tabs & took the Rx to the Chain! I called my “friend” and she miraculously got an Rx for 3 tabs from the Prescriber to cover my butt. They’ve never set foot in my store again. Sheesh…

  60. Oldtiredrph says:

    Nice job, Don. You must be really smart to know I flunked out of Med School, which I did not. Believe it or not, I actually WANTED to be a Pharmacist. I thank the good Lord the majority of my patients are nothing like you. Hope you don’t ever have to put your life in our “less than average” hands.

  61. RealisticRPh says:

    EUREKA!

    Here in California, we have authority do dispence the WHOLE F..KING PRESCRIPTION if the doctor can’t be reached. Thst’s right folks, an albuterol inhaler, a bottle of insulin, an Advair diskus, a pack of BC’s, even a 100 day supply of metformin 1000mg at 1 BID (that’s 200 tablets for you slow thinkers). We can even dispense a sufficient quantity of Norco until the doctor can be reached if we want to keep enabling our favorite crackheads. (In both situations, some conditions and documentation must be met.) 100% legal and the doctor can’t do sh*t about it later. Why should we do this? Well…that’s up to you. You don’t HAVE to, you just can. But you better know the law and document it correctly. But it does give the pharmacist the ability to use his/her professional judgment to take care of a patient without fear of legal or doctor retribution. Most CA pharmacists have no clue that the law says we can do this because the law courses in CA pharmacy schools are a joke or they were schooled out of state or they are just plain ignorant. What about our law esam you ask? In CA, the law exam isn’t about the law, just ask any recent board candidate. But that’s for another rant. Can the PBM retroactively deny the claim on an audit? Some have (or have tried), but I work for chain who wants us always to take care of the customer and it’s their loss, not mine. I get paid the same no matter what happens on an audit.

    • I_hatemyjob says:

      I am aware of that my CA colleague but do you really do F&G for control medication???? At least I do not. There are a few medications I will do F&G such as insulin, rescue inhaler, OHA, HTN agents, coumadin. As for statins, I will advice them to stay away from IN and OUt for a few days, they will be fine.

      As for CPJE, I agree with you, there is no pure law questions but 99% of question are related to clinical pharmacy. I guess the BOP is a group of persons who think every pharmacist in CA is practicing in the hospital setting.

  62. Techie says:

    Thank you for a great place to vent!
    At our store when we dispense last refill we stamp in red ink right on the label “last refill, please contact your prescriber” AND we fax a request to the doctor at the same time! (sometimes we get lucky and dr faxes back within a day or 2,not often) You’d think it’s great, I have a whole month! Well when next month comes in and patient brings that same bottle with red ink stamp right there and says that he/she ran out and has nothing left and is gonna die right there in front of me and gonna sue me for letting him/her die and will report me to BBB and to theDEA and FDA. Anyway when we ask if she/he saw the red ink stamp on the label the response we get is why should I look at the label? I know what I need to take! Really? Can I see which medication we are talking about? Oh thanks! Aha! Aspirin you say! Spend the fucking 2.00 for 120 tablets and leave me the fuck alone so I can go and type some more aspirin prescriptions and maybe take a sip of tea , (which is cold by now) because I have a 102’f fever, my throat hurts and I can’t breathe, but can’t take a day off because my cover is sick too!

  63. Tired of It says:

    So if I came to your pharmacy with a refill a week early for a controlled substance you would refill it? What if I’ve been trying to fill a prescription for days but am being told that it is out of stock, etc?

    The reality check here – not everything is caused by patient irresponsibility. Mostly, it is from healthcare providers not communicating the regulatory requirements for filling vital medication to their patients. The reason that they appear naive is because they did not attend medical school and are not expert in the myriad of constantly changing healthcare rules that apply to prescription handling. Is that your fault as a pharmacist? Partially.

    The same regulatory system that causes headaches like this is what makes the ‘pharmacist’ position so valuable. Without all the insurance rules, medicare hoops and chains of legal responsibility, a pharamacist would be a menial job.

    Try focusing less on the absurdities that your profession has created and focus more on getting people well.

    Dont be offended when people demand life saving or pain-reducing medication. Wouldn’t you?

  64. moviedoc says:

    Regardless of who wins the blame game the solution is to include the patient in the eRx loop so the patient — not the doctor — decides when and where to get the refill. The doc just OK’s it — or not.

  65. astonski says:

    Patients should be paying for their emergency supplies $10 at least out of pocket or the full cost of the medication no refund and no way to claim the money back. That’ll teach the morons to order their medication on time!! If we are late paying our rent there is a “late fee” of $100!! If you are late paying your credit card there is a late fee of $40!! $10 late fee for not filling your prescription on time is DIRT CHEAP and will make the morons think twice before they demand an emergency supply!!

  66. dan says:

    You stereotype your customers Slick. The one who would throw you under is bus has the business suit on. The Crack Head just wants his, her meds. They don’t have the wherewithal to make your life miserable.

  67. PAITA says:

    I think pharnacist for the most part are assholes.U think its ok to screw a client because you know you can stop there meds if u want by dennying to fill a 100 percent legitamit script.I think no-one should have the right to control how much a fellow human being should suffer as these pharmicist do.U think its a joke not to fill someones meds,THATS YOUR F-ING JOB!!!!!!!!!!!

  68. Propharmpt says:

    @PAITA: I have been in the same situation-had a pharmacist deny my Rx because he didnt like the way i looked. How it is that some people think they can tell if A person is legitimate or not simply by looking i havent a clue. And it hurts-and i dont mean just physically speaking. but when it comes down to the nitty-gritty It was a foreseeable situation and I should have planned ahead for by asking my doc for a refill earlier in the week. I damn sure learned my lesson, I’ll tell you that!
    Have you really read all the above? Do you see how much shit these guys have to put up with? Sure, some of them are pricks and self-righteous dipshits-but what group can that NOT be said of?

  69. AngryBastard says:

    I love how people on narcotics are treated. We’re all fucking drug addict losers. The two unsuccessful cervical fusions and the hip I can’t get replaced until my shiny fucking new stents have been in 12 months must be my fucking imagination.

    We’ve gone to the same pharmacy since we bought our house here 11 years ago with no problems. We’ve never had anything but normal interaction with the employees. Hi, nice day, I’ll pick it up tomorrow etc. Same shit you’d say to anyone else you interact with anywhere else.

    I’m now suddenly an asshat for taking pain meds. Miss fucking I-don’t-like-pain-meds tech counts on her fingers how many days since the last fill. It’s been 29 days, you have to come back tomorrow. WTF lady, I gotta work too you know.

    So the next day I go back on my lunch break. Sweet as shit miss I’ll-count-the-fucking-days-for-you tells I have to come inside. Inside she tells me sorry, we’re out, you’ll have to go somewhere else. Fucking great, you couldn’t tell me that the day before or at the fucking window? Does my limp amuse you, you bitch? Now I’m out of the fucking things, wonder-fucking-ful.

    They never run out of anything else like BP or statins or plavix. In fact the fucking automatic refill service robot calls the fucking second insurance will pay for the fucking things.

    I go here because they have a drive through. I need a new hip, it’s fucked, I’m fucked since I can’t have my surgery until cardiology says I can. I had my heart attack a month before it was scheduled Hobbling around a machine shop for 10 hours a day sucks enough, now miss-pain-meds-are-evil has me traipsing into the store just to tell me it can’t be filled.

    The next month same thing. WTF? I ask for the pharmacist, get told he’s on break. Same thing 5 hours later when I get out of work. This guy has more breaks than a a mirror factory in an earthquake. This all on day 29, it ain’t like I’m trying to pull anything over on anyone.
    Finally I go find the store manager. He says, the pharmacist is that guy in the coat, who told you he’s not here?

    Mr pharmacist looks at the script, says you been filling this now for seven months but not last month. Your insurance says it was filled at rite-aid, what’s the problem? The problem is that woman over there takes it upon herself to count out days for my refills and says I have to come back at 30. Well tomorrow on day 30 I got one left and gotta waste my lunch break waiting here or somewhere else if you are out of it.

    I can’t ever remember being out of this, who told you that? Same woman over there, who is now busy looking for something invisible under the counter. You don’t need to wait. I can fill this even 2 days early as long as your insurance will pay it.

    So all this fucking bullshit is because of some bitch who has a personal problem with narcotics. Well fuck her, she should find e different career if it bothers her so fucking much.

    So here I find this guy bitching on his blog about refills not being called or turned in early enough. That’s just fucking grand when your help treats me like I’m some kind of loser of an fucking addict and wont even let me leave the script at the store ahead of time like you would prefer.

    Before you go bitching about every fucking “crackhead” looking for meds keep in mind some are legitimately prescribed them and need to battle a fucking self important douchebag every fucking time we show up.

    It ain’t always the customers fault that you get shit on.

  70. Propharmpt says:

    @AngryBastard: I feel ya, man. I think its a cultural problem we have. On TV the only people taking narcotics are junkies and deathly ill “goners”. Almost EVERYONE treats pain patients like criminals. I go to a mom-n-pop usually, but sometimes have to go to a chain-where i am regarded as a total piece of shit. I did not ask for RA. I do not want RA. But if i have to live with it I need help-and im hardly alone in this! Fuck the DEA and the CSA. Junkies always get their goddamn dope-pain patients…not so much. And noone who hasn’t experienced chronic pain TRULY understands. NOONE. My doctor even only Rxs enough meds to last me 30 days-even in 31 day months!

  71. Labrat says:

    You go Jube-I like your style

  72. Alyssa says:

    I don’t get it: why is anyone taking anything considered a “controlled substance” automatically labeled as some kind of drug addict? I understand that there are those cases, and I’m sure that being a pharmacist you have to deal with rather questionable people at times … I don’t doubt that its stress-inducing. However, I always take care to be responsible with my medications, and visit my doctor monthly to monitor any side-effects, etc. Yet I’ve still encountered pharmacists who will act as if I’m some kind of addict because I want to fill a medication for my panic attacks a few days in advance if I’m going out of town. Many pharmacists don’t seem to care that laws vary in different states, and that many states will refuse out-of-state prescriptions.

    I understand that you’re probably just ranting, but isn’t it unfair to be so judgmental of patients who take a medication you deem “unnecessary?” I just can’t understand why so many pharmacists look at mental health patients as subhuman … its just upsetting. Please let me know if I’m off base, but I truly am curious as to why this so often seems to be the case?

    • Dr.Dave says:

      Speaking as just another Pharmacist, we don’t look at every user of controlled substances as some kind of drug addict. That’s just the way the majority of them act. And, if you are taking some random controlled substance on a fairly regular basis, you probably ARE addicted.

      What sets you apart is how you act.
      -is your pharmacy / pharmacist your ONLY p / p ??
      -or, do you “shop around for the best deal” ??
      -have you established yourself with the pharmacist in question ??
      -how often do you need an early refill before “going out of town” ??

      Do you know how many users want early refills ??
      Do you know the laws that govern how we have to treat controlled substances ?

      We don’t look at mental health patients as sub-human, unless they act that way; and just because they act that way.
      -would you put up with the behavior of these people at your job ?
      -there are acceptable behaviors when in public – cussing me is not one of them

      There is a saying: the race doesn’t always go to the fastest – but that’s the way to bet.

      • Wut? says:

        Um I hope in pharmacy school they teach you the difference between physical dependence and addiction. Addiction is about how you relate to the medication psychologically – are you obsessed with it? Do you crave the medication psychologically? Are you looking for the high when you take it (rather than its medical effect)? Addiction often, but not always, entails physical dependence, but physical dependence does not equal addiction. Many people are physically dependent on medications in that they would feel physical withdrawal if they stopped abruptly, but they are not addicted in that they don’t have an unhealthy psychological relationship with it.

        So based on what the poster you were responding to said there is no reason to jump to the conclusion that she is addicted. She is likely physically dependent. But your rush to judgment – especially if you don’t make any distinction between addiction and physical dependence – is not helpful.

        I get what all the pharmacists are complaining about here and hopefully this is just a place to vent, but I wonder if it instead encourages cynicism and snap judgments. That said, this blog is funny even if it goes over the edge.

        I know this is an old post but I wanted to draw the addiction/physical dependence distinction.

  73. Jesse B. Haley says:

    Dont feel bad, I go thru the same humiliation and degradation. I’m a chronic pain patient who takes methadone, I also take adderall for ADHD, plus go figure I drive an 18 wheeler cross country for a career. Yet, I have to be 100% sure I’m home same day every month, or man am I in a time of it w opiate/amphetamine withdrawals. No government bureaucrat could ever understand the hell that is my life… Truck breaks down a day before my appointment, top damn bad fucking withdrawal city, which then places me in no condition to operate a commercial motor vehicle! But government doesn’t consider these factors when passing dumb fucking unconstitutional prohibition laws that violate our civil liberties & cause us to be treated as the scum of the earth. Even if soneones an addict, what’s it the pharmacists business when its between that patient & their doctor their medical issues. It’s none.of the fucking Dick pharmacists business y I’m on such a high dose of methadone, that’s the dose me & my pain specialist agreed upon & not me & Mr doctor pharmacist who thinks he’s an MD just because he gets control over my life by controlling my narcotic consumption. So any pharmacist who’s done me like that when I drop an out of state methadone script down on their counter for 300 tablets & their jaw drops, the get in a panic, & then decide to judge the condition of my health, FUCK U U INCONCEEDED PHARMACIST KNOW IT ALL BASTARD, EVER BEGIN TO STOP & THINK BOUT THE FACT YOUR CUSTOMER IS A FUCKING HUMAN BEING WHO HAS FEELINGS AND EMOTIONS AS WELL AS HARD CIRCUMSTANCES? WELL FUCK ANY OF U THAT HAVE TREATED ME N THIS MANNER WHEN I’VE BEEN MORE THAN POLITE! SAME GOES TO ANY NURSE WHO THINKS THEY’RE A DOC AS WELL & TREATED ME LIKE AN ADDICT WHO DON’T KNOW TGE DIFFERENCE BETWEEN ADDICTION & DRUG DEPENDENCY, FUCK ALL U! JUST BECAUSE I’M DEPENDENT & N PAIN DON’T MAKE ME AN ADDICT! IF ANY U COCKSUCKERS HAD TO LIVE ONE DAY IN MY SHOES & EXPERIENCE THE PAIN I GO THRU U WOULDN’TLST TWO FUCKING DAYS W/O BLOWING OUT YOUR COCKSUCKING BRAINS U KNOW IT ALL FUCKS!!!

    • Dr.Dave says:

      Well, I’m glad to see you are doing so well with your prescriptions.
      However, did you ever stop to think … ah, to continue: did you ev er stop to think that you are one person. I have worked in a methadone clinic and I was the clinical pharmacist for a spinal cord injury unit. ALL my patients had issues with chronic neuropathic pain. ALL had the same issues you talk about. But, and here’s the difference, THEY WORKED WITH ME on their issues.

      One problem you mention is that you don’t think the pharmacist has the right to question your medication regimen and the patterns of use. Wrong. Not only do we have the right, we have the oblgation placed upon us to do so; by our profession, by the state, by the feds.

      It is unfortunate that you feel the way you do.
      The laws are not unconstitutionl, nor do they violate your civil rights.
      YOU have violated the “civil” rights by your attitude – not very civil.
      I would love to work with you if I could, but I don’t believe that I would want you for a patient.

      BTW, my “significant other” takes methadone, Percocet, amphetamines, pregabalin, and duloxetine for chronic pain. I have C5-C6 & L1-L2 disc disease which causes chronic pain. She & I both live in constant pain because drugs do not alleviate the problem. I have never seen her act in the manner you have, nor have I. You don’t have a clue about us & how we have to deal with you. As I said before, we react to you depending on how you present yourself. The way you have reacted here demonstrates exactly how I would deal with you. If you want to rant and rave, take it somewhere else; if you want to talk, we can talk.

      But, I’m done.

    • Anonymous says:

      You’re a piece of trash.

      Kill yourself.

  74. Dr. Dick says:

    Jesse, you want fries and a coke with your methadone? Pharmacies have to deal with shady ass doctors and patients everyday. So it is our job to monitor and question Rx’s everyday. Oh and I’m sure you really have ADHD…. You not abusing those adderalls on the job. Lol just another typical junkie, whoops I mean dependent lol

  75. Stephen Downey says:

    I take OxyContin. Pharmacy didn’t have enough to fill entire scrip so they ‘owed” me. I went to get the balance the next week and they have lost them. This is my regular independent pharmacy, and now are having to do an audit before they can give me the meds. Today I will either have to get them, or go to my doc and try to explain all this to him. My pharmacist is great, I don’t want him in trouble, but what else can I do?

    • Dr.Dave says:

      The patient information paper in the bag is for YOU to read.
      And judging by your reply, you haven’t read it.
      And the warning labels ?? they too are for you !!
      Oh, and if you think the computers are as up-to-date as I am, well think again.
      And if you want to, find somewhere that will treat you like you want to be treated … and accept what you get.

  76. HerpMcDerp says:

    Jesus, it’s like you described my entire day. So many idiotic patients expecting me to do their thinking for them.

  77. Anonymous says:

    “…thereby costing the taxpaying citizens a few thousand.”

    You mean the retarded public? :D

  78. FillMaster2000 says:

    With insulin, you can sell Regular Human and NPH insulin LEGALLY without a prescription. Yes, I know regular insulin doesn’t work quite as fast as Humalog and, yes, I know you have to inject NPH twice a day as opposed to once a day Lantus, but, unit for unit, they work about the same.
    Problem is that most diabetics would rather their blood sugar spike to 900 before paying a cent out of pocket for their “life saving” insulin.
    (and, no, I don’t remember what ‘NPH’ stands for… Neil Patrick Harris insulin?)

  79. kevine says:

    I plan to call my pharmacy to ask for an ADVANCE on my antidepressant. I suspect I will get a few Paxill. I didn’t realize this action’s frequency, or the jeopardy in which it placed my pharmacist. My only justification is the effect my illness (major depressive disorder, & related ones), has on my life. It is greatly reduced by this MED (in combination a benzodiazepine – for which I will not request an advance), but is not eliminated. I still have to work harder than I once did to keep my life productive and satisfying. Hopefully, the people in my life; friends, family, and those who provide services for me (as I may for them) know I have the best intentions, but I sometimes fail to meet our shared expectations. For that, I apologize. For their care, and understanding I am grateful.

    Kevin

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