PharmCountry

If you work in a pharmacy, the words “Prior Authorization” can run chills down your spine. Normally, when a medication requires a PA, we just fax a form that we print out to the doctor’s office that has all the pertinent information:

• Patient’s name and DOB
• name of the medication and why it’s rejecting (if we know)
• Insurance ID# and phone#

In the rare case when a doctor doesn’t have a fax number, I get to call and leave all of this information on their voicemail (god forbid they should actually answer the phone, yet they still complain when I pick up the phone and they have to wait 30 seconds to speak to the pharmacist.)

An hour or so after I called in one particular PA today (well, yesterday now; man I hate it when I can’t sleep all night) the doctor himself called back.

MD: “Hi The is Dr. Highandmighty. I need to speak to the person who called in this Prior Authorization for my patient Mrs. Outofluck.” (Don’t you just love my nicknames for patient?)

RPh: “Hold on one second that was my Tech.”

Me: “This is Andrew; How can I help you?”

MD: “Hi, Andrew. I just wanted to let you know that you did a better job than most when you called in the Prior Authorization; you gave me the ID# and insurance phone#” (at this point I’m expecting that he got it through quickly and was just letting us know) “but you forgot one thing.”

Me: “Oh, what was that?” (puzzled, since I was sure I had left all of the information)

MD: (in a very condescending tone) “Well, don’t you think I could’ve used the patient’s date of birth?”

Me: (doh!) “Oh, sorry about that, it’s 1/5/62.”

MD: “Well, next time just make sure you don’t forget it so I don’t have to waste my time calling you back.”

Here’s the response I gave:

Me: “I’ll be sure to do that. Thanks, uh huh, bye.”

Here’s the response I wanted to give:

Me: “First of all, how many times have you called in a script without a DOB, and we had to look it up” (he does this a lot, actually) “or forgotten to write the date or your signature or a strength (etc.) and we had to call your staff to verify it. Plus, if we had had a valid fax number or if your voicemail had listed it, I could have just faxed you over this nice clean form we have with all of the information you need laid out very nicely, instead of having to leave it on your voicemail while trying to count out a script and tell someone where the toothpaste is (something you don’t have to deal with because you at least get to hide in your office and actually schedule when patients are allowed to come in).

“Second of all, you’re going to have to pull the chart anyway (unless, of course, you have it memorized, which I seriously doubt) to be able to document for the insurance company what other medication’s the patient has tried and the medical reasons the patient has to be on this medication, so unless your charts are organized by DOB or date seen by the doctor (which again, I seriously doubt) you could’ve kept from wasting both our time and just gotten her DOB from her file. Thanks, bye.”

So instead of wasting 5 minutes calling us, he could have just looked at the file he was going to have to pull (or have his staff pull, since most MD’s farm PA’s out to their nursing staff anyway). I wish I could make that much money for being such a moron.

If you work in a pharmacy, you will definitely encounter your fair share of them:

witch doctor – noun

a physician, dentist, or other medical practitioner that is a real PITA, or otherwise makes working in a pharmacy a living hell

Well I had the honor of talking with a real witch of a doctor this morning. But the story starts yesterday, so I will, too.

Yesterday, a woman (call her Ms. Dill) brought in a prescription for her 91-year-old mother-in-law (I just love hypenation) for Carafate, a liquid medication used to treat, in this case, most likely duodenal ulcer (based on the dosing).

The prescription was written for 10 ml’s, four times daily, dispense 32oz. Surprisingly, we actually had that much in stock, so I filled two 16oz bottles with the chalky pink stuff, and gave them to the pharmacist to check. We sold it to Ms. Dill for $68 (pretty high copay, but she paid it.) Everything was fine.

Or so we thought. Later that night, Ms. Dill called the pharmacy, surprised that the medicine wasn’t in individual dose cups like the doctor had said. (I’ve never seen them outside of hospital pharmacy.) She wanted to return the medicine and exchange it for the kind that comes in dose cups.

Unfortunately, our company has a policy that once medication leaves the pharmacy, it can’t be taken back unless there was a mistake on the pharmacy’s part. Since we dispensed the correct medication, with the correct directions, we hadn’t made a mistake.

So, we told Ms. Dill we could call the doctor and request a refill in order to give her the dose cups, but that she might be required to pay full price ($170), since the insurance had already been billed for one fill. She seemed okay with that, so we left a note to call the doctor the next morning.

Ok, back where we started. Before we had a chance to contact the doctor (call her Dr. Meanie), we got a call from her, in her fake british accent, demanding to know why we wouldn’t take back the medicine when the pharmacy made a mistake.

I told her we didn’t make a mistake. We dispensed the correct medication, in the correct amount, with the right directions.

“But I wanted dose cups! You didn’t give her dose cups.”

“Well, Dr. Meanie, it doesn’t say anywhere on the script that you wanted dose cups.” And I read it back to her.

“And nobody questioned it when the prescription didn’t say that!?”

“No, doctor, we always pour it into a bottle. I’ve never seen dose cups outside of hospital pharmacy. If the patient wants individual dosing, you can either authorize a refill, or we could offer to prefill oral syringes for her.”

Well that set the doctor off. “Don’t you DARE offer her that! Her hands are too week to handle a syringe, that’s why I wanted dose cups!” Ok, doctor, so she can’t hold the bottle (too heavy) and she can’t use a syringe (too small), but she has the dexterity to pull the foil off of a small cup of medicine? (Imagine one of those ketchup containers they used to use at McD’s but even harder to open.)

Well, to make a long story short not quite as long, the pharmacist ended up deciding to just eat the cost of the original medicine (at least we’ll be able to send it away to be destroyed and get some money back) and order the dose cups.

$200 down the drain; and the government’s worried about wasting medicine (google “fraud waste and abuse” or wait for me to complain about it at some point.)

Ugh. I need some Carafate.