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Happenings

Ok, so yeah. I always promise I’m going to post more and I never do, so I’m not going to do it this time.

I mentioned in my last post that I was moving to New York. Well, I’ve been here for about 3 1/2 months now. What can I say? Everything costs twice as much, I’m broke all of the time, and I don’t know anybody…

And I still love it here.

NYC is one of the best places to people watch; one of my favorite past times. I still think it’s cool that I can head down to Times Square and just sit at a table, literally ON Broadway (they finally got rid of those cheap lawn chairs a while back), and just read a book and watch the tourists gawking at the tall buildings and advertisements.

I spend some of my time off in the subway busking; playing music (for me specifically, the Irish flute, and tin whistle) to make some spare cash. It’s a quick way to make a buck, and I usually don’t get moved on by a cop. (That only happened once, during rush hour, which I’ve since learned doesn’t pay well anyway.)

As far as pharmacy goes, there isn’t much to tell. For the first couple of months that my new store was open, I was spending half of my time floating at other stores. HR at my new store goofed and hired two technicians for a 1-tech store. Thankfully (for me anyway) the other tech didn’t work out, so I get to work full time at my store now. Of course, since I’m at a very slow store (we finally did 200 scripts in one week just last week), I’m running out of things to pass my time with.

About the only bit of drama I’ve had was at one of  the other stores I was floating at; I opened that morning and was filling scripts in the workflow that I was used to. Later in the morning, two other techs (with much less experience than me) came in and completely disrupted the workflow and undid about 2 hours of work (It’s a busy store). One of them literally yelled at me for not doing things “their” way; So I just left. Not the best way to handle things for sure, but I left my store in Virginia to get away from that kind of drama, so I just figured I wasn’t going to put myself through it here.

Otherwise, it’s just been the usual; clueless doctors and nurses, patients that refuse to listen to you. (“This can’t be the same vitamin; It comes in a green bottle.” “Yes, ma’am; we have a different manufacturer here.”) Nothing much worth posting about. I guess I’ll try and post some on my non-pharmacy experiences here in New York. But, considering I’m broke most of the time, I don’t really do much except people watch and play music on the subway.

Anyway, I hope that gets anyone who’s interested up to date. Ciao.

Big Changes

Well, obviously, I haven’t posted in a while; not a first for me I’m afraid.  As I’ve mentioned before, a lack of stable internet access (i.e., coffee shops don’t count), really doesn’t make for easy blogging. Though, if I’m to be completely honest, I’ve grown tired at my job. Since I haven’t posted a substantial post in a very long time, I’ll fill you in first on what’s happened in the past year and a half.

Last year I transferred from a slower pharmacy to the one I’m at now. At the time, the pharmacy was a mess; records were completely disorganized, there were tons of expired and unneeded drugs on the shelf, and staffing was pretty much in disarray. I came in with the idea that I would clean up the place and make some changes that would get the pharmacy back on track.

The first thing I did was go through the shelves, pull all of the expired drugs, and return about $60,000 worth of unexpired (and unneeded) drugs, including my personal favorite, Brand name Diflucan 150mg that had been ordered in 2004 and never used.

I went through the paperwork and shredded all of the old files we didn’t need, and in general just got the pharmacy organized. Staffing, however remained an issue.

At the time, we had 3 techs (including me) that basically ran the weekday shifts, and we had students and techs from other stores fill in the weekends (or if we couldn’t, we would work them and find coverage for the week). My other two techs were both female, and were both pre-med, very close to taking their MCAT exams.

One of my personal pet peeves in pharmacy has always been techs that don’t want to work in the pharmacy. The best techs (in my opinion anyway) are ones that have a passion for pharmaceutical care, not the techs that treat pharmacy as just a paycheck.

Well, around March (or maybe May, I forget) of last year, one of my techs decided she needed to take almost a month off to study for her MCAT exam. Needless to say, this placed an undue strain on the pharmacy. (The Pharmacy Manager basically acted like it was my place to manage the tech staff, and didn’t really back me up when I told her she couldn’t take a month off.) Since my other tech (also studying for her MCAT) refused to work full time (which I couldn’t do anything about, as that was her availability on file), I basically took up the slack.

By the end of June, both of the girls had quit, citing differences with me as the reason. (I’m sorry if I get annoyed when people decide not to show up for work.) I was working 60+ hour weeks because we couldn’t find enough techs from other store to fill in. At one point I worked for 20 days in a row, mostly 12 hour shifts with no breaks. The store leadership was no help in hiring new techs or giving us cashiers to help out. (There were some days back then that the pharmacist could have worked without a tech, as long as they had cashier help. I could have had a day off if only the store had been willing to loan us a cashier.)

Well, obviously nobody could work that hard and that long without a break and not get stressed out. I became very combative with anyone that got in my way. (including patients, salefloor employees, and even the store manager.) I was told that I wasn’t a team player, to which I responded (screamed, really) that it’s hard to be a team player when you don’t have much of a team, and the team you do have (store leadership in this case) seems intent on blocking you at every turn.

Over the next few months we had techs coming in and out, but by October, we finally had a decent pharmacy team in place. However, our script count was dramatically increasing, much faster than our staffing level could accommodate. So, my stress level didn’t go down much at all. Corporate decided that we didn’t need any more staff, and in fact cut our hours. My pharmacy manager and I basically decided to say “Screw Corporate” and schedule what we needed anyway.

Fast forward to the end of February/first of March, 2009. We finally seemed to have a good team in place, with the resources that we needed. Pharmacy was finally fun again, and I didn’t dread going into work. Then, our world was pulled out from under us; Our pharmacy manager was fired for forgetting to set the alarm one too many times. (Or at least that was the excuse; I won’t get into the details, but suffice to say, he wasn’t known for following the party line.)

So, the stress was back, but this time we were understaffed in terms of pharmacists. Before, we had 3 pharmacists; one full time (the pharmacy manager) and two that spent part time at our pharmacy and part time floating. Now, our pharmacy manager was fired, and one of the others had accepted a job at a hospital. So the remaing pharmacist, basically became defacto Pharmacy Manager.

Not long after that, one of my techs moved back home to Michigan, so it was down to me and one other tech. So we weren’t quite as understaffed as back when I was working 60 hour weeks. But with only one pharmacist and two full time techs, we were very stressed with an ever increasing script count. Having been through severe understaffing the year before, I could read the writing on the walls; so I decided to start looking for a way out.

Well, about a month ago, my way out finally came through; I received a transfer to a new store that’s opening up in New York City. Today was my last day at the store here in Northern Virginia. On Tuesday, I’ll board a bus in Washington, DC that will make the 4 hour trip to the Big Apple, and I start work the following Monday.

Moving to New York is a big step for me. I’ve lived in the DC area all of my life, first in Maryland growing up, then moving to Virginia after high school. I’m hopeful that I will be able to make a fresh new start in the big City.

I want to start posting to this blog again on a regular basis. I’m sure New York will present me with a lot of new stories to share, both with those of you in the DC area that know me, and those in the online pharmacy community (aka, the pharmasphere). For now, I’ll just be nervous, excited, anxious, and all of those other things that you’re expected to be when you make a big change in your life.

Well, I’m sitting here with Internet access and nothing to do, so I may as well blog about my second job. I give tours and work the front desk at an apothecary museum:

The Stabler-Leadbeater Apothecary Museum is located in Old Town Alexandria, Virginia. It operated under the same family for 141 years from 1792 to 1933. (It closed down mostly due to the depression and other factors such as competition from chain drug pharmacies.)

The entrance to the museum is located at 105 South Fairfax Street. Admission is $4 for adults ($3 if you’re a AAA member), $2 for kids 11-17, and free for kids 10 and under.

During the off-season months, the museum is open Wednesday to Saturday, 11am-4pm, and Sunday, 1pm-4pm. From April 1st to October 31st, the museum is open Sunday and Monday, 1pm-5pm, Tuesday to Saturday, 10am-5pm. (If you’re in the DC area for Inauguration, we’re also open Monday the 19th 11am-4pm)

The tour consists of the retail shop, which dates originally from 1796, and the upstairs manufacturing room, which dates from around 1890.

In the retail shop, you can see the spot where Robert E. Lee (allegedly) got his orders to go to quash the rebellion at Harper’s Ferry, a note from Martha Washington in her own handwriting, and various items that were available for purchase, including bloodletting devices, poison bottles, and even veterinary medications.

Upstairs, you walk back in time, as the manufacturing room has been preserved almost entirely from 1933. You can see drawers full of original herbs and ingredients, some of the original tools used in compounding medications a hundred years ago.

If you’re a pharmacist, pharmacy student, technician, or other health care worker, you’ll be blown away by this unique time capsule that preserves a large portion of the history of our profession.

(And now for the legal stuff: PharmCountry is not owned or affiliated by the Stabler-Leadbeater Apothecary Museum or the Office of Historic Alexandria. No recompense was offered or solicited for this post, and my opinions do not necessarily reflect those of the City of Alexandria, it’s departments, or their staff. So there. )

Seriously, though, if you’re in the area, check out the museum. It’s really a unique, once-in-a-lifetime experience.

To Pee or Not to Pee

Ok, so again, haven’t been here in a while. This is just priceless though:

A patient brought in a prescription for her husband for Flomax, which is used for BPH (that “gotta go” feeling men sometimes get.)

Unfortunately, TriCare doesn’t cover it. We told her that his doctor would have to call in a Prior Authorization, otherwise it’s $300, and her reaction was priceless.

Well, if he doesn’t get it soon, to pee or not to pee will no longer be the question!

I just thought I would share. Toodles. :)

Oh, Murphy, I hate you

Ok, so it’s obviously been a long time (almost 8 months, in fact, mostly due to not having internet access at my apartment) but yesterday was just so blogworthy, I couldn’t stand it anymore.

I walked into the pharmacy at 2pm. The wait time was already more than an hour. (We’re not that busy a store, but I had a new pharmacist and two new techs working without a cashier.) By an hour in, this was up to 90 minutes.

Then, all horsehockey started breaking loose. We had some kind of crash (I’m still not sure whether it was a power outage or what) in the server room. This means:

  1. The IVR system went down, so no “press 1 for this.” It also means no faxes coming in, since our IVR system handles those as well.
  2. Our central database connection (with other stores) went down, so we couldn’t update patient profiles.
  3. And finally, we lost the ability to print labels, so we were essentially dead in the water.

It didn’t help that I still had to do the order (we had about 20 prescriptions on order for yesterday. When I started opening the totes, I almost started to cry. I knew that my employer had decided to force ordering of larger quantities on Top 200 drugs, but they were supposed to use a 1:1 ratio (i.e.order 5 100-ct. bottles, get 1 500-ct. bottles). Instead, I got 5 500-ct bottles, along several 1000-ct. bottles of other drugs. I got 3 1000-ct. bottles of KCl 20mEq, which, if you’ve never seen them, are bigger than footballs, and weigh about 15 pounds each.

I was at wits end at this point, and I said a word that I almost never say: “F@%K” (I can’t actually bring myself to type the word on a blog post; that’s how little I curse).

Between the computer troubles and what felt like an insurmountable goal of finishing the order (about half of it will be sent back), I couldn’t see any way we would survive the day. But, I took a deep breath, called a time out, and we started coming up with a game plan. I put one tech on the register, one tech filling the prescriptions that we DID have labels for, and I focused on checking in the order.

Once the order was finally put up, I called helpdesk to get an update on the server issues, and they finally got my printers working. So I kept one tech on the register, one filling, and I started typing the 50 or so prescriptions that we had received since the printers went down. This was about 5:00, so we were still telling people to come back the next day. Of course that made a few people angry, but they tend to give you a little bit of leeway when you mention the phrase “fatal system crash.”

Finally, by about 7:00, that pile of 50 was being finished off.

So, when 8:00 finally came around, I was able to start giving 20 minute wait times, instead of tomorrow. I never thought that would happen. I figured we’d be there an hour past closing (9pm) finishing up.

I guess the point of all this is that, yes, things will go wrong in the pharmacy, sometimes terribly wrong. But if you face it with a game plan, stay organized, and remain optimistic, you will get through it.

Liar, liar, PBM on fire

Ok, Cigna, you really need to get your act together. The other day, I had a patient (one of our regulars) come in with an Augmentin Rx for her son. Her employer had just switched their carrier to Cigna, but she hadn’t received the new card yet.

So, I think, no big deal. Call Cigna, give them name, DOB, address if neccesary. Wrong!

Once I finally got through to somebody, I was asked for my name, pharmacy name, NPI#, Rx#, and the patient’s name. (after I had given all of this to Cigna’s lovely IVR system.)

I explained the situation to the representative. She told me that I needed the primary cardholder’s social security number due to the “new HIPAA law.” (What, you mean the one that was passed in 1996 and its “final rule on Security standards” went into effect in 2003?)

I calmly explained to her that HIPAA doesn’t apply to me because I am a health provider using the information for provision of health services. As long as I can verify basic information (such as name, DOB, address, and phone number), I am entitled to the account number. Her response: “Sorry, I’m just following the law.” My response: “Well, then every other insurance company is violating it.” Click.

I called back, to get a second opinion, as it were. This time I was told the same thing, except that it was due to Cigna policy, not HIPAA. So, I called the mom back and asked her for the account holder’s SSN. She was understandably reticent to give it to me, until, of course, I told her how much it would be without insurance. I had her write it on the back of the Rx, but she made me promise that the pharmacist would cover it, so other nobody else could see it when we were done.

So, I called back (again), this time with the SSN in hand, and got the ID#. I asked this representative, “By the way, is it Cigna policy that I have to have the social security number to get an ID number?” She told me no, so I asked, “Well, then why did not one, but two other reps tell me that it was?”

“I apologize for that. It’s easier to look it up by SSN than by using name and dob, and some of the other representatives are just lazy.” They must have felt my jaw dropping to the ground in China when I her that. I told her that I wanted a complaint filed that Cigna needs to get their reps off their butts and stop lying to pharmacies.

This is particularly annoying when Medco (don’t get me started on Medco) will give you the ID without even having to speak to a live person (which is no fun with Medco).

Happy (Pharmacy) New Year

So, did you work today?

If the answer is yes, and you work in a pharmacy, you know what Pharmacy New Year is. For those of you who don’t know, let me explain:

January 2nd is the first day doctor’s offices are open again, many of them since before Christmas, or at least since last Friday. That means, a ton of faxes (though for some reason I got even more on New Years’ Eve than today), and a lot of “patients” realizing they are “sick” because they don’t want to go back to school/work.

Plus, it’s a new insurance plan year, so lots of people have new cards or deductibles (that they never seem to know about until their script turns out to cost $300) or formulary changes.

On top of that, Zyrtec just went generic, and is going OTC later this month, so all of the insurance companies’ computers are confused.

So please don’t complain that your prescription isn’t ready when you didn’t tell me you had a new insurance card, didn’t respond to my repeated pages to return to the pharmacy, and then hand me a card written in igPay atinLay that doesn’t have the essential information (like the bin number or, god forbid, the ID number.)

I offered to switch three people to generic Zyrtec today. All three of them (all of them Argus/Carefirst), were rejected for “non-match NDC number.” Well, ok, it’s new, not in their system yet. Let’s try the brand name Zyrtec: Reject “NDC not covered; OTC available.”

Umm, you mean it’s January 27th already? Because as far as I’ve been told, that’s when it’s going OTC. Thankfully, all three patients were willing to wait until tomorrow, when Argus says they’ll have it straightened out.

Today was also the day for people to call in all their refills (as in 8 or 9) at the same time. Some because they were waiting to be out of the dreaded Medicare donut hole, some because they’re trying to get everything on the same schedule.

We had one patient who used to be on Avalide, and was warned ahead of time (a shock, I know) that is was no longer going to be covered. He was prepared last month with a script for Benicar HCT, another ARB+diuretic that was on the list the insurance had mailed him. When he called in the Avalide, it was rejected (as expected; hey that rhymes). So, I tried the Benicar HCT and it was rejected, too. It turns out the insurance had a change of heart, and now prefers Diovan HCT. I faxed the MD for a change, and thankfully got it fairly quickly.

An 18-year-old girl (I can’t call her a woman) brought in 3 scripts: Doryx 100mg, Tazorac cream, and Duac. We filled the scripts; the two creams came to about $120, and the Doryx was about $300; she had a $1500 deductible, then everything is $7. Of course, she didn’t understand that. “Last month at the other pharmacy they were $7! Why are you charging me almost $600!?” Because, girl, you have a dumb-as-dung insurance plan. So, she put me on her cell phone with her mom, who argued with me, but ultimately seemed to understand that I couldn’t do anything about it. I handed the girl back the phone (did I forget to mention I had a cold?) and she demanded the scripts back.

So, Happy Pharmacy New Year. Are you ready for a vacation yet?

So, unless you’ve been under a rock (or working 12-hour shifts in a pharmacy), you’ve probably heard that the FDA is considering a third class of drugs called “Behind the counter,” where certain drugs will be made available without a prescription as long as a pharmacist counsels the patient.

The prime example of this is already in effect: Plan B. I was just reading an article on the subject of BTC, when I came across this doozy:

Citing Plan B as an example, [Kristin Moore, an opponent of BTC] said placing it behind the counter has unnecessarily delayed access to this time-sensitive treatment, potentially increasing the risk of unintended pregnancy.

Wait a second; making Plan B available without a prescription has delayed access to it? Let me get this straight; being able to show ID at any local pharmacy takes longer than scheduling an emergency appointment at your doctor’s office, waiting for hours to be seen by a doctor, then driving to the pharmacy and having to wait for the pharmacist to fill the prescription?

As John Stossel would say, give me a break.

Article

Yesterday, a concerned father came into the pharmacy with a pill his wife found in their 13 year old son’s bedroom. We took a look at the pill, knowing full well that it was most likely a narcotic, but we gave the kid the benefit of the doubt.

It was a round, white pill, with the number 30 on one side, and some other numbers on the other side. When we looked it up, it turned out to be Morphine Sulfate ER 30mg.

The pharmacist told this to the father, who just about lost it. “What!” he said in disbelief. He asked for a printout about it, and of course all we could do was print the patient info sheet that goes in every prescription bag. (He wanted something with a picture, but none of our sources had one.)

Personally, I feel no sympathy for the kid, only for the parent. If you’re smart enough to hide it from your parents and stupid enough to get caught, you deserve whatever your parents dish out. (If this had happened when I was 13, my parents would have smacked me so hard, I’d still be feeling it.)

Besides, there are enough illegal drugs out there with fewer side effects.

I know more than you

So this lawyer-type came up to the pharmacy counter the other day with a script for Keflex. Of course, he had never been to our store before, so I had him fill out a patient profile. When he was done, I looked over it to check for missing information (which is common in my store; I mean, who really forgets to write their name down?)

Well, he had forgotten to write his birthday down

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