Today we have another episode of Ask The Angry Pharmacist, where our very own TAP answers YOUR questions about life, pharmacy, drugs, and why that soma is too early to be filled!
Today we have a question by Adrienne:
Your rants are fantabulous. I agree with you and share your disgust. Thanks for exposing the real drug underworld. I have to deal with much of the much of the same BS; and then some. (Perhaps More about me another time.)
I have a billing and medical record question. I don’t have prescription coverage (self-employed so to speak).
Scenario: Someone with BC Fed brings in a Rx and the pharmacy says they have to “run it” to see if it’s covered.
Pharmacy fills the rx; it’s ready for pickup; but the patient doesn’t want to pay the copay or for whatever reason, they don’t pick up the script.
What happens to the meds? back on the shelf?
what does the insurance company/pbm pay the pharmacy?
what does ins co pay the pbm?
how does it go down according to the ins co/ pbm as though the patient received the meds?
Wow, fantabulous eh? Is that like Fantastic and Fabulous?
To answer your question, what you speak of is what we (in the “industry”) call “Returned to Stock” or RTS. RTS’d items are the bane of our existence and are a bigger money hole than a 19 year old mistress. Heres why:
1. We get the order for an Rx. We bill the insurance company and recieve cost+$1.50 (if you’re filling a MedImpact managed plan. Fuck you MedImpact!) for the work we do. We fill the prescription (using the insurance reimbursement thats above the drug cost to pay for the labor to fill your Rx. ie: the power bill, vial, label, my payroll, my tech’s payroll, computer costs, rent, etc)
2. You don’t pick up the Rx within a set period of time (usually 1 month, but varies between pharmacies). The Rx just sits there taking up space.
3. When the time is up, one of the clerks goes through every Rx waiting and picks yours out to be RTS’d. Since you did not pick it up, we have to REVERSE our billing to the insurance company, lose whatever money they gave us, and put the drug back. The PBM reimburses the insurance company (we hope) and the entire Rx filling process gets thrown into reverse. However knowing PBM’s, I doubt this happens.
4. This means that the pharmacy spent the labor to fill and unfill that Rx, but did not get paid. We lost all labor costs in filling that prescription (but we did not lose the actual drug cost since we can resell that drug that you didn’t pick up). Sure we can recoup the cost of the vial, but the label is lost, our labor in filling the Rx is lost, rent, power, etc. All lost. Plus we need to spend labor dollars to put that drug back in stock.
Obviously antibiotics are RTS’d sooner than other drugs, since why pick up an antibiotic 1 month after the ER called it in for you. Usually we do everything in our power to make sure you come in to pick up that Rx. Not only does it save us money, but it reinforces compliance and the feeling that “we care(tm)”. This involves paying someone to call you when you have medication sitting here looking for a home. We hope you would take the Rx after leaving the pharmacy, but once your signature goes into that log and you walk out that door, its all yours. No give-backs!
This is the reason why pharmacies are so reluctant to transfer medications that they have already filled for someone. If I call a pharmacy for a transfer, and the medication is filled and waiting for them at the other store, I will make them get it there this one time. Nothing pisses me off more than to fill 15 discharge medications from a hospital to have another pharmacy (*ahemWalgreensahem*) call and want me to back out (reverse from the insurance company) everything and send their way. I usually tell them to go fuck themselves (unless its a pharmacist I know, but those would never ask me to do something like that).
I hope that answers your question. If you at home have a question that you wish answered by a real-life angry pharmacist, please email firstname.lastname@example.org and I’ll do my best to answer what troubles you. Obviously more ripe/risky/personal questions get priority. Think of it like Love Line, only with someone a lot more angry (and funnier) than Adam.