Not so hypothetical situation

OneAngryTech (http://one_angry_tech.livejournal.com) wrote in:

Ok.. Pharmacist(s): Time for WHAT WOULD YOU DO?
Cash-Patient A comes into your pharmacy with 2 prescriptions, 1 for Vicodin and 1 for Xanax. The prescription for Vicodin is 100 tabs, TID and Xanax is doesn’t matter. Patient inquires as to the price for the Xanax, but not the Vicodin.
Your enterprising tech (me) for some unearthly reason decides to do a central search (which checks all the pharmacies in your chain) and finds that Patient A just filled the same prescription for Vicodin 7 days ago (30 day supply) at the neighboring town store.
What do you do?

This brings up a good point. Whenever someone who usually uses insurance comes to you with a narcotic and demands to pay cash, something isnt right. I always do a courtesy run-through to see what the magical insurance company pops up with. 9 times out of 10 they received some narcotics from another doctor and another pharmacy just like in this instance.
Then I outright ask them if they picked up the Rx from [storename] a week ago. Usually thats enough for them to give me the deer-in-the-headlight look as if to think “holy shit, how does he know?” If they say “no” then I call the other store to see if they are lying (which they are). If its from another doctor I outright ask “Did you tell Dr. A that you are getting pills from Dr. B?” When they say “Yes” I call. You wouldn’t believe how many people I get kicked out of practices that way. They especially get pissed when they tell me “I specifically asked them if they were getting vicodin from another doctor and they outright said no!” Whoops.
Sometimes they demand the Rx back (to try another store). Before I give it back I write on it in pen “Filled [date] [quanity] [store]” on the front of it. Is that an asshole move? Yup. Do I care? Nope. Whats the doctor going to do, bitch at me that I defaced his Rx that he gave to someone who is fraudently doctor shopping? Yeah, lets call the police on that drug dealer that put borax in my cocaine while we are at it. I mean seriously, if there is so much deception going on that they need to outright lie to me, what legitimate purpose do they have trying to get it filled?
If they are up front with me and dont lie/give me any lip, I give it back without question and say that I wont fill it until its due. What they do from there is their own dealing.
Lets see how this story pans out:

When Patient A comes to pick up both RX’s, the Pharmacist in Charge lets patient know we didn’t fill the Vicodin prescription since it was just filled 7 days ago. We have said prescription in the bag.
Patient then remembers that “well.. er someone stole my Vicodin so I went to Dr. Pain Clinic and he wrote me another one.. der der der”
Pharmacist let’s patient know that we will need some kind of proof as to this happening (maybe say a Police Report.. it IS theft after all) and patient angrily walks away and shows us birds.
We then decide it would be a good idea to give neighboring store a call and let them know what happened. They thank us.

Good move. Usually when you say the word “Police” they bail. Works especially well when they use the line “Well I didnt pick up my vicodin Rx, you gave it to someone else”. Just saying “Well I’ll call the police and pull the surveillance tape” turns their bitch into “Oh, I forgot my cousin picked it up for me, no need to call the police”. Its like magic!

They then proceed to fill that prescription the very same night.
I am only a tech, so of course I don’t know shit, but would I be within rights to say WHAT THE FUCK IS WRONG HERE AND WHY THE FUCK WOULD THEY FILL IT??!!??
The only response: “Well, it is the pharmacist license..”

Pharmacist, Pharmacist in charge, your store license, and a whole bunch of DEA paperwork. Yeah, fun shit. I hope they jacked the cash price up to cover the cost of all of the crap that could of went down.

A plea from a fellow independant

Working for an independent gives you sort of a bond with other independent pharmacists. From shitty reimbursements to dealing with patients; we don’t have the luxury of a ‘corporate office’ and people in suits with fancy lawyers to cover our asses.
So I recieved this letter from a pharmacist in California. Since he claims he has bitched to everyone he can get his hands on via phone, I think its time to give some good ole public harassing.

TAP,
My name is [Name Removed] from [Store Name Removed] in [City Removed]. California. Long time listener, first time caller. First off love your website. I was wondering if you could light a fire under a problem that I’ve been having.
In case you are not from California, our Medicaid system (Called MediCal) has a 6 Rx limit per patient per month. Any Rx over 6 needs to have a Treatment Authorization Request filled and sent in (Think of it as a retarded prior auth that they approve for like 6 months to a year). Since it is being done electronically now vs fax, the usual turnaround time was a day or two for maintenance medications and a bit longer for stuff that was non formulary.
Over the past few months, I have been getting TAR’s back for stuff like Lisinopril, HCTZ, glyburide with only 3 authorizations. Now why they would only give 3 fills for something the patient is on chronically is beyond me. To make matters worse, the turnaround times for maintenance meds is now approaching close to 14 days in some instances. Imagine if I did not dispense insulin or digoxin to a patient until I got that TAR back so I could get paid.
So I call the TAR office, and they say the delay is because they are “Really Busy” (yeah, who isnt?). Them giving us only 3 fill units on a lisinopril Rx is like if I dispensed 10 tablets at a time then used the “Really Busy” bullshit when they bitched as to why its taking so long.
I think they are giving away a low amount of refills for approved maintenance medications to save their own jobs. Unfortunately their shortsightedness is giving them such a backlog that approvals are not being sent out in a timely manner and people are not getting their medications.
I hope you publish this letter to your site to light a fire under the MediCal TAR office and to see if any other pharmacist from CA is having the same problem. I can be reached at [email TAP for address].
Thanks
[Name Removed] RPh

Thats pretty shitty if the MediCal TAR office is screwing over TAR’s that THEY THEMSELVES REQUIRE in order to save their jobs. I always thought that PA approvers are just pharmacists/techs who could not cut it in the “real world” so they have to get some desk job hiding from the public behind an ID number so they cant be called out for being a fucking retard. If there is anyone from the MediCal office reading this, why don’t you get your own shit in order before you force your problems down the throats of the pharmacists who actually work for a living. I have his email address if you wish to get a hold of him and explain your case. 3 fills for a maintenance med, thats fucking absurd. “We’re busy” is also fucking absurd. Wah wah wah, cry me a fucking river and let me powder your balls while we’re at it. Hate to break it to you, but we ALL are busy, and judging from this letter you are just adding more shit onto this poor independent.
I’m just glad that there are still some people out there like myself who will fill an Rx even though they will not get paid this very moment just so they don’t end up in the hospital (actually, I think all pharmacists will do this, huge $ items excluded of course, we’re kind but we need to eat too).

HIPAA Primer for BravoRx

Dear BravoRx,

Please get your collective heads out of your asses and research what is and is-not information that is protected by HIPAA.  Today I had to spend 20 min on the phone yelling at one of your representative because they would not give me the birth date they had on file (which was wrong) because they said it was a HIPAA violation.   Because your company sucks and you are lazy, I will spell it out for you.

If I fill Rx’ for a patient, I fall under “patient care” therefore no medical information can be withheld from me in the name of HIPAA.  Go look it up.

Here, I’ll do it for you:
http://www.hhs.gov/hipaafaq/administrative/259.html


Yes. The pharmacist is using the protected health information for
treatment purposes, and the HIPAA Privacy Rule does not require covered
entities to obtain an individual’s consent prior to using or disclosing
protected health information about him or her for treatment, payment,
or health care operations.

See that? FOR TREATMENT PURPOSES.  However this clause does not apply because a birthdate is not MEDICAL INFORMATION!!!  Its a fucking birthdate! Get your head out of your ass!  Its not a SS# but something that is pubically available!

So thank you BravoRx Rep, for wasting my time with your shitty substandard service and lousy reimbursement rates.

May the pox of Argus be upon thee,

TheAngryPharmacist

Is the insurance company telling the truth?

This is a comment by a “Med Student” to that 4-degree doctor comment. I love getting emails from students.
— Part 1 —

I completely understand what this Dr. is talking about. I always have problems with insurance at the end of year, start of new one. I have chronic pain and also am on a maintenance drug, I take daily for my heart. I went to refill both as I normally do on day 28-29 since the last refill and of course I get the dreaded “It’s too early” from the insurance..but no problem right?

That right there tells me that something is up. Most insurance companies will give a 5 to 7 day window before it kicks back the “refill too soon” error.

Because they tell me to pay cash, and send them the receipt, so I tell this to my pharmacist. Well now, even though I have been going there for over a year, same meds, same amount, same Doctor..she parrots the insurance company (who doesn’t realize there is a HUGE difference between the meaning of THEIR “too early/soon” and a Pharmacies “too early/too soon”) and I ask her, how is it too soon? It’s been 28 days since I last picked up my meds? She wouldn’t answer me. She instead says that she would fill it next week (which btw is at day 33, which means, I’m without my meds for 3 days, which is HUGE, if I miss even one night without my heart med, I start getting some major palpitations..) but it seems she’s made up her mind. She decided to make her OWN medical decision without knowing my complete medical history, as my own personal doctor of over 7 years knows.

To be honest, you are giving me only the information that you wish to give me and I’m sure there is a key bit of information that would make sense that you aren’t giving me. There could of been an ER script in there for a week supply thats throwing everything off, another pharmacy involved, etc. Something however really doesn’t jive with what you are saying. I’m not saying that you are at fault, but with all of the insurance companies I have never heard of one that will kick back a ‘refill too soon’ error when its 2 days remaining on a 30 day supply. Even if you had no coverage, it would say ‘patient not covered’ not ‘refill too soon’.

So, tell me, why is there NO recourse for me for Pharmacists like this when I assure you, I’m no crack addict. I’m a normal person who unfortunately got JRA at 13 with horrible joint damage and chronic pain that I have been living with all my life. Instead of collecting disability like most would, I instead went through school (honors) and now am in my 3rd year of Med school getting my MD/PHD while also working with Congressional members and House members on a daily basis.

Dont take this the wrong way, but if I had a dollar for everyone assured me that they didn’t have a problem as I am looking at their state narcotic report and seeing 4 doctors, 3 ER’s and every Walgreens in town I think I could retire. When everyone and their brother lie to you day in and day out, you tend to not believe everything at face value unless compelling information states otherwise. I hope you would actually read the study on a new drug rather than take at face value what some drug rep tells you, right?
You may think this is bad medicine, but wait until you get out and get a visit from the DEA because you are shoveling vicodin out of the door to everyone who gives you a half-assed sob-story. Its amusing to see new Dr’s backpedal from their ‘we must treat everyones pain’ after I tell them that their patient is going to 3 different pharmacies and 2 other doctors for their narcotics. Its like a real-world shock that there are people who lie and deny to get what they want.
I deal with tons of legitimate pain patients every day, and you know what? I never deny them their pain pills if they are a day or so early. However, this being ‘The Angry Pharmacist’ it doesn’t make for a good read to tell how much I help people. People want to read what pisses pharmacists off, and I know that I have been extremely clear stating this in the past.

There is WAY too much stigma attached to ANY type of pain killer. If it’s for legitimate pain, one shouldn’t be denied healthcare.

Yeah yeah, save me the ‘chicken for every pot’ story. There is no stigma unless you make it a stigma, and in your example above something red-flagged that pharmacist. Vicodin + “Refill Too Soon” = something is going on. Now if your insurance company would not have given that error message back, do you think this would be even an issue? I dont think so. I would also like to hear your definition of ‘legitimate pain’, because last time I checked people don’t go into the doctors office saying “Hey, I need a vicodin Rx to make my car payment or to deal with my bitchy ass wife”.

I do want to point out that:
A. This has never been a “problem” for the Pharmacist before, until insurance denied my claim for a week or so until coverage kicked in
B. The amount, doctor, strength has NOT changed and it IS a legit script, so you cannot argue that she may have denied it on basis of some sort of “suspicion” that it may be fraudulent, etc..

Blame the insurance company, not the pharmacist. They are the ones who threw back a “refill too soon” message. As I said before, if the insurance company wouldn’t of thrown that back, would we even be having this debate now? So, lets break this down a bit more.
Something happens and DEA gets on your case for something. DEA officer comes in and asks to see the hard copies. DEA also has subpoenad your insurance company. DEA asks pharmacist “When you filled this Rx, it came back from the insurance company as ‘refill too soon’. Why did you fill it?” Whats the pharmacist supposed to answer? “Because shes in legit pain and says that she isnt a pillhead?” Yeah, that’ll fly like a turd on a birthday cake.

THOSE are the types of Pharmacists that are trying to practice Medicine without a degree. There should be some sort of consequences. *I* was ticked off at the fact that she “offered” to call my doctor to see if it was ok to “refill early”..MY argument here was, it was NOT early. 28-29 after getting the original fill is NOT early, ESPECIALLY NOT when your on maintenance medication in which you must take it every day.
My doctor is a nice guy, but he REALLY is busy, he spends 12 hours at a busy ER and the rest of the time at the practice, he does NOT have time to get on the phone (which can be backed up by his wife!) to be questioned about nonsense!

I think you should nail your insurance company for practicing medicine without a degree. If the insurance company is kicking back an early fill error, then something else is going on. I would call your insurance company to see who possibly stole your identity or your insurance card and is running up some vicodin scripts with it.
— Part 2 —

I’m sorry, I forgot to add a little more background.
I had been at Walmart Pharmacy last year and the same thing happened then. At the end of year, my insurance changes because that’s what the company forces us to do, they LOVE making life miserable. Well, Aetna has 2 numbers, the business number for customer service and the PHARMACY number the pharmacies are supposed to call. Well, when I needed my refill, the computer denied the claim and the tech called the BUSINESS line, which BTW they are completely useless. All they said was basically it was “too soon”

Wait, so this has happened with 2 pharmacies? Something now is really fishy especially if its coming back ‘refill too soon’ both times.

Well, at THIS point, I had been EXTREMELY busy, I was the campaign manager for a House member and forgot to call in my refill, so I called at day 30! (I almost NEVER do this..or at least try not to..with my luck, something comes up and I forget to pick it up..so I always give myself 2 days wiggle room)

Filling your Rx on day 30 when you have a 30 day supply should go through with no errors. Unless you are getting it filled somewhere else, the Rx was mistakingly put in with a days supply higher than 30 (doubtful with Aetna, it would of gotten rejected), or someone else is using your card.

Well now, I get there and the pharmacist and I literally get into it, she starts screaming that it’s TOO Soon! I KNOW this is wrong, so I sit there and call the CORRECT number for the Pharmacy portion of the insurance and I actually am able to get the DIRECTOR of Aetna on the phone, she tries to speak with the Pharmacist, but the pharmacist will have NONE of it. the director feels bad for me and apologizes and says, I’m sorry, but she just wont listen to me. (The director tried to explain it’s all about the coverage and end of year etc..that it’s NOT too early for the refill)

You got the Director of Aetna? I’m sorry, but I’m having a hard time believing you. The pharmacist has to go by what is on his/her screen, and if Aetna is claiming its too soon then tell them to fix their shit to give back accurate error messages.

So, my DOCTOR calls the pharmacist (keep in mind, Im standing there at the pharmacy for 2 HOURS watching all this) and he tells her, you HAVE to fill this refill! The pharmacist REFUSES, quoting the comment of the clueless wonder at the insurance company the very 1st time, “Insurance is saying it’s too soon” which at THAT time, everyone in line almost faint FOR me because the director actually called and the pharmacist would NOT listen to her. So, my doc calls me on MY cell phone and boy, is he pissed! He’s like, I dont know why she wont listen to me, I’ll go ahead and call a new script at a different Pharmacy because this is ridiculous.
THATS when I go to this new pharmacy, I explain what happened and even though I feel as if I dont HAVE to or need to, I actually go through all my medical conditions, etc. MY thinking is, this is a smaller Pharmacy, I want a more personalized interaction. I want to feel like a person and NOT a refill number, ya know? My Physician even went as far as to stop in and introduce himself! Seriously, we have gone above and beyond here.

Its always good to explain yourself even though you don’t HAVE or need to. You know, we’re just stupid pill dispensers and don’t need to know ANYTHING about you. Give me a fucking break, you must really be a med student with an attitude like that.
Pharmacists tend to get a bit pissed when you withhold information especially when the words “another pharmacy” and “refill too soon” are in the same boat as your narcotic Rx.

So, That is just another reason why I’m sooo ticked that I’m having this problem. Is it so difficult for her to look at the dates?
I’m thinking (in both cases) it’s a matter of their pride, they were wrong and don’t want to admit it. But *I* am paying the price for that while they have absolutely NO consequences for their actions.

Blame Aetna, didnt they give back the refill too soon message that started this whole thing?

After reading quite a few posts of yours, I know you have this thing about thinking everyone is a “pillhead”, but I’m guessing even you would be able to put aside pride or ego and not actually DENY a patient legit care…afterall.. isn’t that why you became a pharmacist? One has to wonder about these pharmacists, is it an ego trip that put them in this field or is it helping people.

No, I dont think everyone is a crackhead or an addict. I however dont take people’s word for anything now days unless I have good and solid evidence that they are being legit with me. Its not pride or ego, its doing our fucking job to control narcotics and to manage the medications that multiple doctors prescribe because its impossible to call each other to see what the others is giving. Amazing how stories change when I get a refill too soon error, ask the patient if they received some at another store about 4 times, call the insurance company to find out what store filled it, then ask the patient point blank if they got it as that store. Then I asked why they fucking lied to me when I have to crowbar out of them that they did get some at another store. Get this done to you (which is a complete waste of my time) about every other day, then you’ll realize that its not “pride” or “ego”.
Lets face it, Aetna probably gave that pharmacist some bum information. If it would have been me, I would of called Aetna and had them give me the pharmacy that last filled it. If you had no idea about this other pharmacy then I’d ask for a copy of the sign-out log and inform the police about narcotic/insurance fraud. You would not believe the amount of shit dropped in pants when I threaten to call the police. Amazingly they manage to remember that they got 30 from an ER doc YESTERDAY. Must of slipped their mind.
However from what you have wrote, you don’t really sound like the easiest person to get along with or work with to get this sorted out. You probably just started screaming at the pharmacist which really doesn’t help anything. Screaming isn’t going to get your pills filled when there is documentation (from the insurance company) that it was too early to be filled (something had to trigger that message).
Of course I will also entertain the fact that you gave me everything and the pharmacist is just being a dick. It happens just like there are asshole doctors in the world who think their shit is worth as much as Zyvox and their farts smell like Warrick Albuterol MDI’s.
So good luck in Med school. When you get out you can rant to me about that mean ole asshole pharmacist who wont fill the Rx’s you write for yourself.

Medicare Part D – 1/1/2008

Did it go smoothly? No.  Was it a complete clusterfuck? Yes.  Am I suprised? No.

Today was a diaster.  I had some insurance companies publish the completely wrong information on the cards, bunch of stuff that isnt formulary, “card? what new card?”, and a shitpot full of people whom a deductible = rocket science.  Lets not even get into how fun it was to try to get through to any helpdesk.  The only shining moment is that Argus did not go down, and to be honest most of the big processors were not down for any length of time.  They had 3 years to figure this shit out, good job boys.

Yes, please bitch at me a bunch because you have a $0.05 increase in your copay for your $100 medication.  Plus, just to show how much fate hates TAP, it made one of my printers blow up today, and our pharmacy software glitch like mad.  Wonderful.

I barely have the ambition after a good night of drinking Jack Daniels to even write more.  I’m just so happy that today is over.