Pharmacy Nightmare

[alex44]

Iwent to my doc. the other day, got my standard refills. Most i take to the pharmacy there, thet are all part of one medicaid group. 1 I took to a differant pharmacy, where I have known the P.I.C. for years. the nightmare starts. At first, he told me he had a certain brand in stock and could fill MOST of it with that brand and the rest with oone i do not tolerate well. My doctor is WELL aware of this arrangement. I go back and am told by the P.I.C. that he was wrong and further that I WAS lucky to get HALF of what was prescribed. He hemmed and hawed (basicly B.S.) that i needed an overide, that the insurance would not cover more then 90 - i need 180. He would not give me a straight answer but by his attitude, he made me feel very small, and a drug addict. After trying to get ahold of the doc, I called the insurance Co. (Which was changed over recently) and was told that I violated some kind of policy since the two scripts, one was for IR. dropped at the Medicaid Pharmacy, and the other at the store Pharmacy for my ER. I was told I needed a whole new script and the doc would have to do an overide due to the quantity. In the meantime, I had occasion to go to the store where I was denied, and unknowingly, disturbed his lunch. He was Very rude, even though i apolagized, how was I to know. Anyway, have a new appointment, 15 dqys from the script, and finally was able to get thru to a nurse on my Doc's Staff. I know they are busy - we played phone tag. So - here I am, with half my meds, a rude pharmacist, who I belive should not have filled it at all, I could have taken it back to the medicaid pharmacy and they could have straightened it out since the doc was still there - in hindsight, I should have refused and asked for my script back, wheather that would have worked out, I don't know. The part that gravels me the most is the pharmacist treating me like apiece of S... and telling me how LUCKY i am that he filled it. I should have been given the choice. I hope this all works out when I see my doc. My old Prescrtion provider NEver had a problem and I don't see where an insurance Co. gets off telling me how much relief I can havev-THAT is B.S.
Thank ya'll for letting me vent.
Blessings
Alex44
Skypilot
PS I will be checking with admin to see if i can name names, like the pharmacy,dosing,etc. I want to stqy within T.O.S.
Happy holidays to all

[Pharmacist.steve]

Alex... insurance companies are taking more and more latitude in what they can do in limiting the amount of drugs - any drug for that matter - that they believe is appropriate. IMO.. it is practicing medicine without a license.. in fact .. it has been reported that 75% of the medical directors at insurance companies are GP/FP.. and they make medical decision outside of their skill set - or credentials - on what the insurance will pay or not pay for. I don't condone such actions.. just stating how things are.
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Bottom line .. the paper Rx BELONGS TO THE PATIENT... if you had asked for it back before you accepted the filled medication.. you have that right.
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Were you told that the Pharmacist was at lunch? If the Pharmacist was at lunch.. if it was me - the Pharmacist - would have stayed at lunch until I finished... IF on the hand, you were told that he was at lunch and you demanded to see him.. IMO.. you got what you deserved.
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You stated that your insurance had changed.. which means that what is covered or days supply limits could changed... it is the nature of the beast...
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Why don't you use the same pharmacy for all your meds... some people will jump to conclusion that a person uses two different pharmacies is probably a doctor/pharmacy shopper.. and the person that you talked to at the insurance company may have looked at the billing records and saw where you got Oxycodone at two different pharmacies and jumped to that conclusion.. they either didn't look at .. or was not bright enough to see that one was long acting and your maintenance meds and one was IR which was for breakthru pain.
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I would strongly suggest that you use one pharmacy... and quit jumping around... if I remember correctly.. every time that you have done this... things go wrong and you are unhappy.
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Talk to the PIC at the store that you want to use and see what you have to do to make things run smoothly.. it may involve giving them a call a week ahead to make sure that they order and have on hand what you need when you need it. Most Pharmacist don't want to argument with patients... nor cause problems for patients... but likewise.. most Pharmacist do a poor job in educating the patient in how the system works and what the patient has to do.. to work with the system and not against it.
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Any patient that won't bother to find out how/what they need to do... to make things work smoothly or insist that the system conforms to the way that the patient wants things to happen... they are going to run into problems .. some of the time or all the time...
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Because I work in long term care.. I have to get mine and my wife's prescriptions filled at a retail/community pharmacy.. I know how the system works and I very seldom have a problem getting things done... because I allow time for the pharmacy staff to do their job and give them a heads up .. so that they have on hand what I need when I need it.
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If you feel that the Pharmacist did not have a reason to be rude.. call their corporate HQ and express your concerns.. or if they have a website... send them a email about your concerns.

[Diandra]

Hi Alex,
I bring my scripts to the pharmacy the day I get them from the doc because, I too, need 180 of a specific script and they often don't have enough, and because I need a generic brand from a specific manufacturer, it takes a day or two to get it. I know it is hard sometimes to plan ahead but, it will mean less headaches in the long run. Basically, giving the pharmacy a couple days to get what you need may solve all your issues. Try not to take the pharmacist attitude personally. Anyone can have a bad day and I know how much it sucks to be treated like a illicit drug seeker when we are not but, that is the nature of the beast right now. You know you are not, hold your head up, contact your insurance company and see what their policy is about 90 or 180 pill count and ask them to send that to you in an email so you can show the pharmacy the next time it happens or perhaps you have a policy or their is a website to print out the info. Most of all Alex, try not to get defensive or angry because it just makes the situation worse and that is how they will remember you. Believe me, I know it is hard, really hard when we feel like shXXit and have to deal with this to boot. Hope it all gets straightened out. All my best, Diandra

[alex44]

Pharmacist Steve, Diandra - Steve - I did Not know he was at lunch, I simply saw him standing there and asked for a moment - Not to have my head bitten off, had i known he was at lunch, i would have come back later as i agree with steve - when i am at lunch, unless it is an emergency, do not disturb. I have used both pharmacys for a long time. I know the P.I.C. and have for years. The reason is the clinic pharmacy does not/cannot/will
not get E. the M brand has a differant filler, so I have been told by my doc and she is well aware of thre fact that i use both the clinic and this one. You are right - after this is streaighened out, i will use the clinic pharmacy ONLY and count myself lucky to have P.M. Diandrea I did stay polite, i simply took what was offered and left. I do suspect they have a certain # that they use since i was told by the insurance Co. I needed the doctor to do an overide. Wheather it is this once or everytime, I don't know.
Thank both of you for good informative answers.
Happy Holidays
Blessings
Alex44
PS P.Steve - I take er and ir Morphine - i cannot stand oxy and for the life of me can't see where people use it to get high.
Regards
A.

[alex44]

UPDATE - Spoke to my doc. today, by phone, she had me come by and pick up script they will fill it on the 18th. Which is fine - Now I don't have to see her till the 7th. I don't know how they are calculating things as I got a 15 day supply on the 9th. from the ninth to the 7th. of January is 21 days but I will make it work. Express Scripts seems like they want to dictate how much relief I can get. Fortaneately, I have a caring doc. who will make everything right. Found a policy memo if a generic is not tolerated by the patient, they are SUPPOSED to get brand, don't care if it's brand, just so long as its NOT Mallencroft. I don't care at this point. I know better then to make waves -Not my nature but hopefully by doing this I can get back to the way it was. Get my scripts, drop them off (One pharmacy only, at the clinic), go to lunch and pick them up. As far as Fry's pharmacy goes, I consider the PIC - well, he is a good man and may have been having a bad day. I think he has the corporate boot on his neck and do not hold that against him. I just will never go there again. Hopefully, this nightmare is over.
Merry Christmas
Blessings
Alex44
Skypilot

[Mark N]

Alex, sorry to hear about the bad time at the pharmacy but it is good news your doctor is working with you and getting the other 15 days of meds prescribed.

[Eva 14]

Alex, I'm so sorry this happened to you. As if we don't have enough to deal with just being in chronic pain!

I'm usually in such severe pain that I can barely think clearly. If the above had happened to me, I'd be confused and angry and exhausted. It really is troubling to keep hearing stories of chronic pain patients being mistreated at pharmacies.

You did absolutely nothing wrong but they still treated you badly. I've gone through similar experiences myself, although nothing as bad as what you just went through. So sorry this happened to you.

I'm actually in a position now where I'm forced to go to more than one pharmacy to get my meds. My pain doctor knows all about this and is fine with it. I shudder to think about being treated poorly when I'm not doing anything wrong, but I know it happens to CP patients often. I WISH ONE pharmacy could get ALL of my meds, but that is no longer possible.

I'm currently using a second pharmacy and may well have to use a third. My chain store takes 10 days to get their deliveries of C-II meds, and sometimes I can't stand to wait that long. Especially since I'm in the process of trying a new long-acting med. I'll have to go to a third pharmacy to get the new long-acting med because my chain store doesn't yet know what dose or what quantity to order ahead of time.

If I was ever treated this badly at a pharmacy, I'd be angry on the inside and probably cry when I got home. I do make sure to never react with anger when dealing with pharmacy staff. I do try really hard to try to see their "side" of the issue, but we all know that there is often no good reaon for thier rude behaviour. Maybe they are just having a bad day....who knows? I'm in so much pain that I really cannot stand to be mistreated. I think that the constant pain makes us even more sensitive to rude behaviour at the pharmacy; at least that's the case with me.

Glad to hear that your doctor is working with you to get the 15 days of meds that you are owed. I hope you're able to get this resolved so nothing like this happens in the future.

Eva

[alex44]

Nightmare still going - More later -
Blessings
Alex44
Skypilot

[Diandra]

Geez Alex....this jumping through hoops just to get your script filled is nuts. I would never be able to keep all those dates and amounts straight and would be frustrated too. Sorry to hear the nightmare is still going on. Thinking of you....this is the last thing you should be going through, especially this time of year. Hope it gets resolved.....and hopefully 2013 will be a better year. Take care, Diandra

[alex44]

Diandra - I FINALLY got the call i was hoping for, my DR. put in an expedited request for the other 15 days - It was APPROVED - thank God. I see her tommorow to pick it up and I do plan to ask her what brought about this SNAFU. IF is was the pharmacist as i suspect, I will never do bussiness there again. I would complain to the Board of Pharmacy but, why rock the boat. I don't know what triggered the change, having known him for years but everyone has a bad day, I suspect he did not realize the consequences of his actions. If there was a problem, he should have handed me back the script instead of doing a partial fill which started this whole mess - bottom line, I will ALWAYS use the pharmacy at the clinic where I go I hate the brand but this way they can contact the Doc. right away if there is a problem. My doc. is an angel, she did the nessacary and I am very grateful for that. How are you doing? Well I hope have a very happy holiday, you and yours and thak you everyone on this board for their support - Blessings to all.
Blessings
Happy Holidays
Alex44
Skypilot

[Pharmacist.steve]

@Alex... I would suspect that your insurance is at the core of this... you said that it has changed.. The fact that your doc had "to make a call" again I suspect that the insurance decided that your dose or the frequency of your dose was "too high" and the doc had to get a prior authorization to get the insurance pay for your appropriate dose. You may have witnessed the Pharmacist's frustration with your insurance company... all insurance companies have designed the system that the Pharmacist is the one that has to tell the patient - the bad news - that the insurance said no, raised your deductible/copay and other issues. If this pharmacy does a lot of billing to this insurance company.. the Pharmacist may have gotten grief from one too many patients that day over issues generated by THEIR insurance company.
Before you jump on the Pharmacist... ask your doctor's office or your insurance company if there was a prior authorization required to get you the total number of doses that you need for the month.. if the answer is YES... then you need to direct your discontent/anger at your insurance company.
If this was the case... when the Pharmacist filled your prescription and submitted it to the insurance company - via the pharmacy computer - and the insurance company's computer sent back a denial.. that they had a quantity limit of xx/month instead of the yy/month that your prescription called for... So at that point.. the Pharmacist had the choice to hand your prescription back to you and let you go thru the same thing at another pharmacy or fill the prescription for the insurance company's limit.. and let you deal with the insurance company .. because the quantity limit matter was out of his hands. Maybe his communication style was not the best... but.. on the other hand.. he may have been looking out for you.. not letting you go into withdrawal and giving you two weeks to get the issue resolved with your insurance company.
I don't believe that there is a single healthcare professional that is happy with our payment system.. especially with the dictatorial stance of the insurance companies ... we spend too much time dealing with the insurance company's decisions ... which means we have less time to take care of patient... which is our job... not arguing with some insurance bureaucrat why their decision in how to treatment the patient and their decision does not have the patient's best interest in mind... just looking at some guideline as to what "should be"
I can understand your frustration... but.. ask some questions... to find out who is really at fault here...

[Eva 14]

Steve, interesting info. You may well be correct that the problem lies with the insurance company, and the pharmacist just had to deliver the bad news. From what I've read of Alex's post, it does sound like insurance was the main problem. True, maybe the pharmacist was just feeling frustrated by all of the insurance red tape. It's hard for everyone involved.

When I just switched to Exalgo, I needed a pre-authorization from my insurance company. The pharmacist told me I need the pre-auth, but didn't really tell me what I should do to try to get it. I ended up waiting almost 3 weeks, at which time I was ready to call my pain doc's office. But I called my insurance FIRST, and they told me that the my Exalgo had JUST been filled that very day. My pharmacist actually HAD contacted my PM, and my PM had contacted my insurance co. to get the pre-auth. I was really amazed that the Exalgo was ready at all, because the pharmacist told me that *I* needed to call my pain doc to get the pre-auth.

So there was a lot of confusion and some miscommunication, but the whole thing actually worked out WITHOUT me contacting my pain doc OR my insurance company. I'd never had to do a "pre-auth" for a med before, so I was totally confused as to what to do. But it all worked out in the end. It took my chain store a long time to get the meds even after the pre-auth, but that is par for the course with them.

Alex, maybe the pharmacist actually was trying to do you a favor so you would have SOME pain meds and wouldn't go into withdrawal, due to the new insurance regulations. I know I'm pretty much repeating what Steve said. That's why it's helpful to have a pharmacist on this forum! In my case, my pharmacist faxed my pain doc, who then contacted my insurance to get the pre-auth on the Exalgo. All of this happened without my knowledge, so I realized that there is sometimes a lot going on that we (the patients) are not always privy to.

I hope you get your med situation straightened out soon. I suggest you call your insurance company as soon as possible to find out what is going on. I know how tough it is to be without sufficient meds for the holidays. Best of luck to you!

Eva

[Pharmacist.steve]

@Eva... the bottom line is that you are the beneficiary of your insurance policy..it is a contract between you and the insurance company.. the Prior Authorization requires the MD signature and often requires information about the patient that the Pharmacist is not privy to. Some Pharmacists... depending on how busy the pharmacy is.. will contact the MD.. but.. IMO.. it is not the Pharmacist's job...
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The typical pharmacy is so marginally/understaffed.. that stopping to do something that is not your job.. means that everyone behind that person has to wait longer to get their Rx.. I went out to lunch today and the tip that I left the wait staff is MORE than most pharmacies get paid to fill a prescription...and I ate at no special place ..just a local bar/grill and only had a sandwich... no fries and just water to drink...
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IMO.. we Pharmacists should have a form with check boxes and we check what the patient needs to do.. to get their Rx paid for.. so that there is no miscommunication or misunderstanding. He may have had a conversation with you and said "you need to contact your MD" and you may have not heard those six words ..while you were "distracted" trying to figure out in your head.. how you were going to get your medication paid for.
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Patients that are toward the passive side of involvement in their care.. will typically end up on the short end of the stick. Most likely our system will increasing tend to "punish" passive patients on a every increasing amount.

[alex44]

Thanks to all for your replys

So I will try to explain. now that things are resolved. When I got my Presciption's. I dropped all but one off at the clinic pharmacy. This is because, with prior notice, my Grocery/Pharmacy can sometimes get a differant brand. This is due to the filler. I have my doc's word on this that differant fillers can cause problems. So she is aware I used to use two differant pharmacy's - no more, everything goes to the clinic so if there is a problem, they can deal with it. Anyway, the pharmacist did a partial fill ( without consulting me. I did not know at the time i could have asked for my prescription back. He did so because he evidently did not have enough to totally fill my prescription. I now know that my insurance will only cover 1 long acting and one short acting med. When my doc wrote me a NEW prescription,since i only got a 15 day supply, it was considered a third prescription which required an override to be filled since the 1st. long acting was considered "filled". My doc is an angel. she told me, and i don't doubt her, that she spent over a half hour on HOLD ( I hope and pray she was on a speakerphone) to get the info to get an override. This went thru and now I should be O.K. I will never use a pharmacy except for the clinic, I have a severe panic disorder and I was on pins and needles the whole time. I believe the pharmacist ( who is a friend - I have known him for years) and I believe he was trying to help me. Everyone has a day every now and then - hey, I have bad days too. I hope this clears things up - It was a nightmare for a while as if I had not cleared it up friday I would have been in a very bad place. Again, thank you ALL for your support, Esp. P Steve who who gave me insight into the "Process" with Ins. Co.'s and the like. I am wishing everyone a safe holiday and a joyous one.

Blessings
Alex44
Skypilot
(Ordained Spiritualist Minister)

[Pharmacist.steve]

This is not going to happen.. but.. if those patients that keep running into problems with a particular pharmacy and/or with a particular drug.. if you just ask the PIC ( Pharmacist in Charge) what you can do to help them provide you the medication you need when you need it... there may or may not be a ready answer.. but at least you asked. If nothing else.. it will move you up on the Pharmacy's "nice customers list"...believe me.. those pts that are a regular pain in the A$$ .. don't always get the best service nor will the staff go out of their way to help them... I very seldom have a problem with getting mine or my wife meds at a local chain pharmacy... but I know that the MD office that my doc is in is bad about returning calls for refill authorization.. so I start a request for a refill 7-10 days before we need them.. Most often we get a 90 days supply.. so it can amount to more than the pharmacy has in inventory and they have to be ordered. I check their pharmacy's on line system to check if the Rxs have been filled.. if I have not got a text or email that they are ready. If the MD has failed to call back authorization on the refills... 99% of the time it is a problem with the office and not the pharmacy... so I call the office and clarify... the doc has no reason to deny a refill and never has in 15 yrs... If the issue is with the insurance company.. I make the phone call... Bottom line is I am the one who pays the MD and sends the money to the insurance company.. I am the one who deserves answers from the insurance company and or the doc's office... all depending on who is at the root of the problem...If at all possible, I try to order all the meds at one time.. one trip to the pharmacy and otherwise one transaction at the Rx counter. I have a intimate knowledge of how the system works and I don't try to change it.. to fit my needs.. but .. you can have the same knowledge ... that will benefit you... if you just ask the PIC.. how you can help them...
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When I temp in retail.. and a patient gets unnecessarily demanding, or wants me to put their order in front of everyone else.. I can make sure that their 15 minute wait turns into 30 minutes or more. A patient that makes the statement why it takes so long to get their Rx filled because all it involves is putting some tabs in a vial with a label.. - with me - gets a automatic 15 minute wait penalty.. each time they say it.. Most usually get the message.. sooner or later.. I can expedite the filling of a order ...but.. it is my decision not yours... If you just got out of the Dentist and you are in pain.. or you have a sick kid.. you need/deserve expedited service.. If you are always running a day late and dollar short and you expect special treatment.. this is not going to be your lucky day.. at least when I am on duty.