"Still Being Worked Out"

If you missed a post I wrote in May of this year titled "Retail Pharmacy Rant," take a moment to read it some time soon. Within the next week or so I am going to write a follow-up to the post.

Today, a drug rep visited the pharmacy to talk about three drugs. She was excited to tell us about Xyzal --- I was excited because I love learning about medications that are about to be released. The rep tells us that the drug is a cleaner version of Zyrtec and that's it! I asked her how the drug is tiered for the most popular insurance companies (Medco, BC-BS, Humana, Caremark); she had no answer. I asked her about the half life of the medication; she couldn't provide me with an answer. I asked her about the Tmax (max concentration time) of the medication ; she couldn't provide me with an answer. She was excellent at saying, "It's being worked out." If all you can is that it is a cleaner version of Zyrtec don't waste our time. It is sad to say but the best thing she gave me was she a cute coffee mug. While I love the new mug and will use it tomorrow morning, I really wanted information on Xyzal.

Retail Pharmacy Rant

At the ripe ole age of 24, I have eight years of retail pharmacy experience. I have worked in various positions within the pharmacy field from working in a district office to working behind the counter (in a store). Last year, my being a college student and the fact one of my bosses was a royal jerk, I transitioned from the district office back to a store. At first I was unhappy and angry about the change; however, most of the unhappiness and anger stemmed from my being screwed over. I was going to write once I got over the anger I started enjoying being on the counter again, but I honestly think it was being on the counter, having the interaction with people and being able to help patients, is what got me over the negative feelings/emotions. (The wonderful coworkers I have probably helped too!)

Pharmacy staffs tend to receive a lot of negative attention; seven out of ten patients always seem to blame their pharmacy before they will blame their doctor's office, insurance company, and especially before the blame falls on the person looking in the mirror. With this in mind, it sure didn't help when Dateline aired its one sided special on pharmacy errors. If you didn't see the special, well, I'm glad, but I'm sure you can look it up on the Dateline website.

There is so much I want to write, so please bare with me. I don't even know where to begin, but I must vent.

PATIENCE: I think problems stem with patients being impatient. Seinfield once joked that pharmacy is simply taking pills from a large bottle and placing them in a small bottle-- if only that were true! There is more to pharmacy than a bunch of people behind a counter counting pills.

TASKS: The pharmacy staff and especially the pharmacist have a lot to deal with on a daily basis. People come in to drop off prescriptions to be filled, speak to personnel via the phone to have prescriptions filled, people use an automated system to have prescriptions filled, and they can email refills in. Doctors basically have the same options; however, new prescriptions can be faxed in from a doctor's office. An important fact to note is that only a pharmacist or an intern can transcribe prescriptions from a doctor's office.

Not all calls are requests to fill prescriptions. People have questions, oh yes do they have questions. We receive questions that range from:
"The label on my bottle says I don't have any refills; is that really true?" to
"I found a white pill in my daughter's bedroom. Is she taking Vicodin?" to

"What's the name of that shop next door to you guys?" to
"Can you spell tourette's syndrome? I want to know because --insert a ten minute story that has nothing to do with pharmacy at all--" to
"I'm taking Coumadin, and I need to take something over the counter for pain. Can you recommend something?" to
"What is the best medication over the counter for a cough?" to the spring classic,
"What can I use to treat my poison oak/ivy?"
Most of the questions, well the serious & medical ones, have to be answered by a pharmacist or an intern.

Questions are also asked by patients when they pick up a prescription. Some of the same questions I listed are asked by patients in the store. And still, these questions must be answered by a pharmacist or an intern. (Hope you're keeping a mental tally of all the tasks of a pharmacist.)

All of the prescriptions filled must be checked by a pharmacist-- no interns allowed on this one. At times your pharmacist might need to check with your doctor, while as a patient you become frustrated with your pharmacy since your wait time is increased, the pharmacist can be saving you from something slight or your life. I've seen numerous doctors miss a patient's drug allergy; however, the pharmacist or a member of the pharmacy team caught it. Remember, this kind of situation only works when YOU provide your pharmacy team with your allergies. I can't even count the times I've been yelled at for asking a patient for allergies-- people seem to forget a person can develop an allergy at any point in his/her life.

Put all of the patient care aside for a moment-- a pharmacy is a business, and pharmacists are the bosses in the pharmacy. Pharmacists have to deal with hiring, training, firing, and scheduling associates. They are ultimately responsible for inventory management and tons of tasks that come down from corporate-- failure to complete tasks or have poor inventory management can result in a pharmacist being written up, no matter if the pharmacist does an excellent job in the filling and counseling portions of the job.

INSURANCE: There are THOUSANDS of insurance plans. It is impossible for any person to know the details of every plan, so you should not expect your pharmacy staff to develop ESP to provide you with the information. The average insurance company lists the names of medications that are preferred and non-preferred on their website. Take advantage of the information on your insurance company's website; take it with you to your doctor's appointment.

If your insurance does not cover a medication or requires a prior authorization before the medication will be covered, it is NOT the fault of your pharmacy staff. Unfortunately, your pharmacy staff has to relay the bad news, but they shouldn't be punished for it. If you need a prior authorization follow up with your doctor's office after the pharmacy has contacted them; let them know you are in the loop because it typically speeds up the process. Beware that insurance companies love to misplace completed prior authorizations, so it might take a couple of tries.

TECHNICIANS: Pharmacy technicians are the cornerstone of a pharmacy. Every pharmacist I have ever worked with will tell you he/she couldn't do it without his/her techs. Dateline mentioned that some techs are in high school and portrayed high school techs as a sin. Well, hate to break it to Dateline but I did an awesome job as a tech when I was in high school-- such a good job that my district manager had me visiting other pharmacies on the weekend to prep them for inventories. It isn't age that matters; it is maturity, and a thorough interview will screen for proper maturity. But in any case, most pharmacies now require techs to be 18 years or older.

Most techs receive on the job training. Yes, there are tech certificates that one can earn from attending classes, but the difference in pay for someone getting on the job experience vs. someone who went through a program isn't much, typically fifty cents. Would you pay a few thousand for a fifty cent pay difference? Your average tech makes $11 an hour. Do you think that attracts America's best and brightest?

Techs do have the option to take a national exam to become a Nationally Certified Technician. Most pharmacies reimburse techs when they pass the national exam and implement a fifty cent raise. Remember the fifty cent raise I mentioned in the above paragraph; the reason it is implemented is because after taking the courses the tech students must take the national exam.

REMEMBER: A pharmacist has a tremendous amount of responsibility upon his/her shoulders since a pharmacist is caring for thousands of people while each person only has to look over him/herself (and possibly other family members). Take some responsibility for yourself and ask all members of your health care team, from doctor's office to pharmacy, questions.

It wouldn't hurt to remember that your pharmacist is someone who completed five to eight years of college to earn his/her degree, not someone who walks on water.

I have more I want to post, but I'll want for another day!