Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, May 28, 2008

Warning: Another Pharmacy Rant

I hate:
  1. Idiot, moronic, too-stupid-to-live patients who don't bring all their meds in, even though they say that all their meds are in the bag.
  2. Fucking asshole gastroenterologists who can't be bothered to drop me a line after scoping said patient, giving them Protonix and then changing it to some other PPI; again, without ever letting me know.
  3. Cum-burbling trout-fucking (thanks again, CrankyProf) chain-store pharmacists who send me requests to preauthorize Prilosec WITHOUT EVEN FUCKING NOTICING THAT THE PATIENT ALREADY HAD A SCRIPT FOR ANOTHER PPI-- complete with refills -- ON FILE!!!
So what ends up happening is that I spend forty-five minutes of my life that I'll never get back on the phone with a West Virginian who tells me that:
  1. Prilosec will never be covered because it's available OTC (even though he needs 40 mg. BID) but that,
  2. Another PPI will go right through.
So I call the patient -- who doesn't answer, of course, so I leave a message -- to let him know I've changed the Prilosec to something that's covered for him; only then, upon calling the pharmacy to call in the other PPI, TO DISCOVER THE SCRIPT ALREADY ON FILE!!!

Jaysus H. Kee-reist! Any independent pharmacist -- excuse me, I mean any pharmacist with more than 2.5 functioning neurons; oh, wait; that's the same thing -- would have noticed the therapeutic duplication and would have called me on the spot to help clarify the situation. I know; they do it all the time. But no; not this IDIOT working for a pharmacy chain that will remain nameless (though its initials could stand for CardioVascular System) just looks at the new prescription (that the patient waited almost a month to fill; that's why he's #1 on the above list) and FAXES ME A FUCKING REQUEST FOR A GODDAMN MOTHER-FUCKING PRE-CERT!! Angry Pharmacist would never do that. Then again, AP probably already fired your idiot ass and the only place that would hire you without a brain was that stupid chain.

So not only have I lost an hour of my life -- did I mention that it's an hour I'll never get back? -- but I'm also shaking with fury, wasting perfectly good catecholamines that could be used ranting about something I haven't already beaten to death.


At Wed May 28, 07:52:00 AM, Blogger Resident Anesthesiologist Guy (RAG) said...

Another wonderfully explosive post, Dr. Dino. Loved it - as always.

At Wed May 28, 07:53:00 AM, Blogger Resident Anesthesiologist Guy (RAG) said...

Oh - as an FYI, this is the former MSG, now RAG.

At Wed May 28, 09:53:00 AM, Blogger Lynn Price said...

This is the only complaint that I have about you, Dino; you beat around the bush and never let people know what you're thinking.

Okay...two don't like Reiki.

At Wed May 28, 10:48:00 AM, Anonymous Anonymous said...

It's highly unlikely that the pharmacist ever saw the PA request. Technicians usually do it as a matter of course, unless they've been doing the technician thing for a while and know what drugs are in the same class. (Most don't.) So when a script is rejected for a PA, the tech automatically deletes the script, faxes a PA/med change form, and puts the rejected Rx on hold so it can be found later if necessary.

Not disagreeing with the substance of your rant, btw. Merely explaining how pharmacies work. I think it might help if medical students had to do a retail pharmacy rotation in much the same way that pharmacy interns do rounds with med students. It might facilitate a little understanding. (Though retail pharmacy practice is changing so rapidly now, that knowledge might be obsolete by the time one is done with residency.)


What you *actually* dislike is the fact that there's no mandatory centralized repository for medical histories, lab results, images, and med lists, viewable to anyone with an NPI number. I can assure you that irritates pharmacy types, too.

Something like that would solve your rad rage problem, too, no?


Fun fact about Prilosec 40mg: there's no generic, and the 40mg brand capsules are more expensive than Nexium. (They're about $250 for #30, where Nexium is ~$100 less. No, I don't know why, either.)

At Wed May 28, 11:01:00 AM, Anonymous Anonymous said...

Hey Doc, don't be so cheap. Hire a receptionist to do the phone calls. You can spend your valuable time saving lives instead!

At Wed May 28, 11:32:00 AM, Anonymous Anonymous said...

To be 100% honest here, if a PPI isn't covered (and the patient has not ever been on one), I just auto-switch it to whatever is covered. No question, just a fax from me to you saying "here is pt's insurance, here is what its changed to, chart and learn plz." Doctors around here know I do it and absolutely love me for doing it.

I'm tired of faxing 10 times a day and wasting both of our time only to get 10 responses saying "change it to whatever's covered". This isn't rocket science, its a PPI for petes-sake.

For all of the time I save both myself and the Dr's, I will gladly get yelled at once a month by some newly graduated resident prick who drank drug-rep kool-aid and demands his patient use protonix over whatever is covered (plus I'll have stuff to rant about on my website!)

At Wed May 28, 12:13:00 PM, Anonymous Anonymous said...

Anon Pharmacist back again with yet a bit more pharmacy education than you received from the first two pharm. posters. I don't work for CVS, but I do work for a large chain & I would NEVER let a tech send a PA request without my knowledge - thats just irresponsible on the pharmacy's part, IMO.

But, you provided some insight into your own pt - you acknowledge he/she does not bring in all the meds, although he/she claims to. That same pt knows he/she has this standing rx on file for the other PPI. But, what your pt won't tell you is he/she doesn't think it works. You'd know that if you would pick up your phone & call me - or perhaps what TAP sugggests - we have complete medical records from all providers. I have pts who have Protonix, Prevacid, Aciphex & Nexxium on file - all from the different drs seeking that one who would get the PA for omeprazole 40mg bid.

Guess what? As TAP says - we know you're never gonna get that PA - call us, just ask! 40mg is not generic & not OTC. Its branded & will remain that way until the patent expires. None of them will get a PA for bid dosing (unless extenuating circumstances exist supporting that & for that you'd have to be a gastroenteerologist) because they're all designed for qd dosing. Most won't cover OTC meds anyway (think Claritin, Zyrtec in addition to Prilosec).

So - relax (you're colleague can write an rx to help with that!). Call us - talk to us - stop ranting about things you can do nothing about. If you had done either of those first two things - we could have told you some of the rules of the drug coverage game. In fact, when issues like this arise, I run all PPIs, ace inhibitors, SSRIs,, whatever thru the insurance even while I have your receptionist on the phone,, then you have your choices that work without a PA. When it comes to dosing frequency - you just need to explain to your pt, your insurance will pay part, but you will need to pay the rest. I'm guessing your patient said that rx on file doesn't work - I want Prilosec 40mg bid. Well - I want to not have to work weekends anymore & thats not going to happen. We've done our part to try to educate her - now you do yours! Your pt "nagged" us into contacting you with the need for the PA. You don't have to do it, just call me & ask what other alternatives will work. I can't write everything I know on that fax because I have no idea who in your office sees it & what you do with it. Call me & talk to me! I'd try to call you, but I can't get thru your front "lines" unless you or your staff initiate the call.

CVS - You are too damn big to allow techs the ability to send harrassing & excess faxing to be to physician offices. There is absolutely NO excuse for this not to have gone thru a pharmacist before getting to the patient or to the prescriber. If you're a CVS pharmacist - there are ways to find out what is & what isn't covered. Don't blame it on the tech - you're the one with the responsibility! Act responsibly! None of us have time to waste on nonsense requests.

At Wed May 28, 06:57:00 PM, Blogger Ian Furst said...

omg - dino, i'm begging you to stop. I can't breath, the top button on my pants just burst, my wife thinks I'm a laughing idiot and I think I may have just messed my pants. No -- seriously -- tell us how you really feel. Don't hold back man, you could hurt yourself.

At Wed May 28, 07:52:00 PM, Anonymous Anonymous said...

Ahhhh...another idiot doctor who has no idea how things work in the real world. Outside the little perspective of your little office you can't see the forest for the trees. Pity, I too have to waste hours of my time everyday explaining how things work to idiots like you.

Minor point here..if the gastroenterologist precscribed the PPI THEN WHY THE HELL ARE YOU DOING THE PRIOR AUTH FOT IT?!?!?!?!

You know when you are sitting around your office and it gets really dark and starts to smell? Pull your head out of your ass life is much easier that way.

At Wed May 28, 08:08:00 PM, Anonymous Anonymous said...

When did prior auths become the Pharmacists responsibility? I think you forget that it is the PATIENTS insurance that is requiring this and not the pharmacy. Like I have a whole lot of extra time to waste going through ten different members of your staff before I get someone who understands what I am talking about. I swear I am going to lose it if I have to talk to one more idiot nurse of MA who can't even say the name of drug correctly.

9 times out of 10 I tell the patient their insurance does not want to pay for the drug the doctor prescribed. I then tell them to call the 1-800 number on the back of their insurance card and ask them what drug is covered. Then I tell them to call their doctor to discuss switching to the alternate drug that is covered. Why as a Pharmacist do I even need to be involved?

The folks who have less than 2.5 functioning neurons go to med school. The ones who are not smart enough to do that end up as office staff in a doctors office.

At Wed May 28, 09:58:00 PM, Anonymous Anonymous said...

I just tell the patients to call the 800 on their card I think it's "customer service"--hee, hee, those insurance companies are SO witty--and ask for a PA form be faxed to the office. We don't, as a matter of policy, call PBM's on the phone, they just waste our time. The patient has the interest and the time to do PBM voice mail hell. I don't and we don't get paid for that anyway. If they get uptight and ask their benefits people to change insurance well, so much the better.

At Wed May 28, 10:04:00 PM, Blogger Doc said...

They have phones in West Virginia?

At Wed May 28, 10:33:00 PM, Blogger Unknown said...

Oh Lordy. You all do realize that the hoops we have to jump through just to do the simplest of tasks on a daily basis, the paperwork, the latest brain farts of CMS or Joint Commission could very well be a plot by the major HMO's to make all of our heads explode, making it unlikely to ever have to use our own health insurance?? Don't do it. Don't let the greedy money suckers win. Take a deep breath and squeeze your brain back into your head and keep it there.

At Thu May 29, 03:47:00 AM, Blogger LicensedToILL said...

I have nothing to add to this entry other than
1) as a nurse/janitor I love watching two groups of assholes bicker, as I suffer at the hands of both you assholes. (doctor writes script wrong:pharmacist won't fill in the inpatient pharmacy because he/she needs the MD to indicate the route for a banana bag)

2) As a sufferer if some mysterious bullshit gut disorder IBS/Fibro/stress from dealing with two groups of bickering assholes I will say that PPI's are okay but I don't know why but protonix is THE BOMB! That shit gets rid of gut pain like nothing else. But for some reason Blue Cross doesn't cover it. Stop bickering and help me get my hands on that shit.

I dig the blog and I hate you all, so much.

At Thu May 29, 04:23:00 PM, Anonymous Anonymous said...

I am laughing so hard, I can't type.

At Thu May 29, 10:36:00 PM, Anonymous Anonymous said...

I didn't know nurses could be male.
When did that start?

At Tue Jun 03, 07:16:00 PM, Anonymous Anonymous said...

lmoa @ frank... i think they are called "murses"


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