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·2608 words·13 mins

I hate cherry-picking pharmacies.  If you are new to this term, this is what it means.

Cherry-picking is the act of filling a bunch of easy Rx’s for a patient, then giving the Rx back (with the filled Rx’s crossed out) to the patient telling him/her to go to another pharmacies to get the other (harder) Rx’s filled.  99% of the time the unfilled Rx’s require a prior-auth or paperwork to be filed for payment.

This pisses me off to no end.  Give me the shit-work while you get money for the easy ones.  I hate pharmacies who do this.  If you are going to make me fill the hard ones, then give me the easy ones as well.

So say a patient hands you an Rx which another pharmacy has pulled this shit on you.  What do you do?

  • Do the paperwork to get the hard Rx covered?
  • Call the other pharmacy and bitch at them as to why they got the easy ones while you are stuck with the hard ones?
  • Give the Rx back to the patient and tell him/her to go back to the other pharmacy and make them do the shit-work?

There’s no real right answer here.  Pharmacies who preform this bullshit backstabbing should be fucking firebombed and their pharmacist strung up by his testicles/labia.  If you are going to fill an Rx for the patient, then do all of them, not just ones that are the easiest for you.  Not only is this bullshit for the patient, but bullshit for the pharmacy that has to face the patient and tell them that their Rx is going to need a prior auth.  Just because I do prior auths does not mean that I’m your bitch for you to walk all over me.

Typical how chains are notorious for doing this.  Fuck your company policy about not doing PA’s.  If thats the case then just send them to me with ALL of their Rx’s and I’ll do what your lazy ass wont.

Comments #

Comment by on 2008-03-13 09:50:58 -0700 #

As a patient that had this happen – I was super pissed. I didn’t go to the first pharmacy to get half my stuff filled, I went to get it all filled. I ended up using my medical plan’s mail-order pharmacy, which was probably by design, anyway.

Comment by Cathy Lane RPh on 2008-03-13 10:31:08 -0700 #

Working a variety of jobs, the thought comes to mind when hearing ‘cherry-picking’ is that the drugstore I’m currently working for has a reputation for being open late, convenient location, specially discounted drugs, etc. and the patient brings the scripts in a handful on discharge from the ER at the local hospital or Urgent Care. We fill most of them to get the patient started on the treatment, but find that there’s a problem with one e.g. we don’t have enough drug, the patient’s insurance won’t cover it, it’s not one a $4 script, we don’t carry the drug, etc. so we fill what we can and the patient goes elsewhere. It’s usually a matter of the patient’s choice. Many times, if the patient chooses to wait, we can get the drug in the next day, or resubmit the insurance in a couple days while getting a few ‘loaners’, or the patient can decide they don’t want to pay for the expensive antiemetic right away or wants to wait ’til getting back to school break or home from the truck stop to fill the balance of a prescription. If it’s a matter of one or more controlled substances that we won’t be able to fill completely, then we have to send the patient along depending on State laws.
If it’s a matter of ordering interferon injections or something like Accutane or clozapine which requires considerable expense or withdrawal of registration to the pharmacy itself, if an initial decision has been made for us to provide it we sort of like to cancel the prescription and have the patient get another one, but legally the prescription belongs to the patient. (Remember those three elements of filling prescriptions; agreement by prescriber, pharmacist, and patient?) If meds are something the patient gets every month and we’ve got a patient-pharmacist relationship going on, it might be reprehensible that we send the patient away, unless the patient wants to go somewhere else for a prescription. If the patient doesn’t want the pharmacist at one shop to know that they take such and such medication or can get the prescription for a better price at another shop, I don’t feel anything bad about it.
Cherry-picking would sort of be like a patient choosing to be inconvenienced to go have scripts filled here and there. It’s done nowadays.

Comment by AttorneyMedic on 2008-03-13 14:11:56 -0700 #

You should start a running list of the names and addresses of these places.

Comment by techgirl on 2008-03-13 16:54:42 -0700 #

i live in a small town area where there are only 4 pharmacies, so i have never heard of such a thing. we are all chain pharmacies these days, but we all know each other and have to deal with each other pretty much every day, so we treat each other with a little more respect than that. if we ever cannot fill something for someone and we send them elsewhere, it’s because we genuinely cannot fill it for when it is needed or at all, not because we didnt feel like making a few calls or requesting paperwork. that’s kind of lame.

Comment by Rob on 2008-03-13 17:52:49 -0700 #

Yo, enable typekey signin.
Which chains have this policy? PA’s are a PIA, but it’s still business worth doing. Give some names.

Comment by retail whippin’ boy on 2008-03-13 17:59:09 -0700 #

Hey TAP,
I’ve never seen this, and I’m proud to say. never done this, in the decades that I’ve been a pharmacist. I think you’re going too easy on the store/chains that would do such a thing. Firebombing, unfortunately in this case, is illegal, and I don’t have nuclear first-strike capability, but it would be appropriate to “educate” the patient about what kind of total scum-sucker he/she went to in the first place. I would even suggest to the patient that if the pharmacist would treat his/her colleagues this way, how might the patient expect to be treated in the future. “Count your change and double check the count on your meds….he’ll probably cheat you eventually.” Then pray that the weasle did short the patient a tab or two (accidently, or otherwise) and wait for the shit to hit the fan.
Attorney/Medic may be onto something.
Cathy L. has been drinking the corporate Kool-Aid.
I used to have a partner that would fill the easy scripts and leave the compounds and difficulties for me. “Used to” being the key words. ‘Nuf ced.
I’ve seen pharmacists carve each other up over pennies and nickles, but this is a new low. No wonder we get treated like shit by our bosses! We stoop so low to pick up so little, who could respect us?

Comment by limari on 2008-03-13 20:05:50 -0700 #

Cherrypicking! That’s what we call it in LTC when the prescription labels come chugging out of the printer, and “Miss Super Tech” runs over and starts picking out all the easy ones…the pre-packaged cards, the full bottles of lactulose or Mi-Acid that only need a label slapped on them, the dressings, etc…leaving the rest of us to do the hand-drops, the 1/2 tabs, the warfarins, etc.
That’s what happens when the corporate boffins in charge of LTC ops. give the techs a 35-scrips-an hour-minimum quota. It’s like a frickin’ stampede when the labels emerge..because don’t you know…IT’S ALL ABOUT THE NUMBERS, YOU LOWLY TECHNICIAN!
Back in the day, I used a have a pharmacist, who, if he caught you “cherry-picking”, would slap your hand, and make you do compounding for the rest of your shift. heh-heh.

Comment by John on 2008-03-14 00:36:22 -0700 #

I don’t know about where you are, but in states I’ve worked in, the pharmacy is legally required to keep the hardcopy they filled from. If you get one thats been filled elsewhere, keep it and call the Board of Pharmacy. That should fix that right quick.

Comment by Matt RPh on 2008-03-14 08:20:37 -0700 #

Whenever this happens, I usually say, “Avast, ye cherry-picking bastard!!!” Just kidding, I’ve never seen this before. Seriously, I thought I was a lazy mofo

Comment by rph3664 on 2008-03-14 16:07:55 -0700 #

Techgirl, your experience and mine is similar. I never sent a patient elsewhere unless we didn’t have the drug or didn’t take their insurance plan. Of course, the latter got me called into the manager’s office one time when a woman, who had to go on the neighboring state’s public aid because she had cancer, alleged that I refused to fill her scripts.
No, I didn’t. I would have been happy to fill them, but she would have had to pay over $1,000 cash so I sent her across the street to the “W” monster which did take that plan.
When I worked in mail order, we had a technician set up people’s meds for us to check, and there was indeed a pharmacist who did things like what Limari described. He would yell at the techs and everything! I could always tell when they had just spent a few days working with him, because they would set up something that would take a while and ask me if it was okay. Yes, it was – we got paid by the hour, not by the piece!

Comment by intern2010 on 2008-03-14 18:32:32 -0700 #

The only time I’ve remembered filling all but one script for a patient and sending them to another pharmacy was for a patient that had been coming to the pharmacy for years and was discharged from the hospital with a stack of scripts. We had all the medications but 2 and one we got rush shipped to us for the next day. The last script we had to send them to a local independent/surgical supply house/compouding pharmacy because it was a for a vaccine that we couldn’t stock because it needed a special freezer to store it. All the other times we get scripts needing PAs, we just call/fax the doctor to tell them they need to fill the prior auth paperwork on their end.

Comment by Carolyn on 2008-03-14 19:55:03 -0700 #

I’m a tech in Ontario… If we fill a prescription, we have to keep it… We can’t fill for one drug, indicate it’s been been filled, and give it back to be taken to another pharmacy… That’s illegial…
If a pharmacy did this to me, I’d be pissed… What a waste of everybody’s time…

Comment by RJS on 2008-03-15 06:49:31 -0700 #

Never seen that happen. Granted, it is illegal to have more than one Rx on one piece of paper, so it might mean that it’s done, and that I wouldn’t know about it when the patient comes in to see us. Incidentally, this has the added benefit of requiring discarge orders to be written as individual Rxs each. Exceptions are when the scripts come out of an EMR itemized and can be cut/torn to make individual scripts.
I’ve never seen or heard of cherry-picking, however. Where are you located that you have such shitty across-the-board behavior from all sides of an apparent healthcare oligopoly? (At least in your neck of the woods.) In the northeast, there are so many doctors, so many pharmacies, so much bloody healthcare for anyone at any time that everyone has to be on their best behavior at all times because competition is so damn stiff.
Treat someone badly and they’ll just walk down the street to another pharmacy/doctor/medical park.

Comment by rph3664 on 2008-03-15 07:45:55 -0700 #

RJS, where do you live that it’s illegal to have more than one prescription on a blank? Here in Illinois, it isn’t. Now that we don’t do triplicates any more for C-II’s, you can have any combination on a blank but the non-controlled RX’s have to be separated for filing purposes. You know, put the sticker on a separate blank and write the number of the controlled substance on it so it can be located.
IMHO, it’s because half the kids in Illinois are on Adderall or Concerta but we already addressed that issue. I have heard about school districts who strive to get 100% of their kids on meds, so they can get more tax dollars, but that sounds like a disaster waiting to happen on so many levels. I am aware that schools are VERY aggressive about getting kids diagnosed, and no shortage of doctors who will do it just by looking at the child. This, of course, does a grave disservice to people who really do need those meds.

Comment by BkueTech on 2008-03-19 21:01:52 -0700 #

At our walgreens, we’ve never done that. Simply because we have a hive-mind mentality of “Call the doctor and insurance, and badger them until they fill it.” This proly happens with only us, since I’ve received awful service at places I’ve later worked at. >.<

Comment by Ribeye of your Dreams on 2008-03-20 02:56:40 -0700 #

I deal with a form of “Cherry Picking” at my job all the time. Serving in a restaurant that gets a high black “ghetto” clientele as you can see from my site, many of the servers in the first come first serve areas simply refuse to take tables they deem “undesirable”. As a leader, I don’t have that particular option. I take all guests, no matter how condescending or hateful, until they disrespect me. I will, however, refuse to deal with an unruly guest after they’ve stiffed me before.
I also deal with this particular form of laziness in the kitchen. Servers will do what I call “window shopping”, which means they hunt through the food window until they find the food for their tables, and leave everyone else’s food to “die”. When they are ordered to run food, they choose the tray with one or two plates on it, the closest to the kitchen. If there is an order for a party, containing more than one tray of food, they scatter.
I know it’s a poor comparison to what you’re dealing with, but I just wanted you to know that we are more alike than you might think, we servers in the restaurant industry. At least, those of us who work rather than laze around getting high.
Love your site, and would love to see a link to mine here, perhaps in a new category or other.
Thanks for being such awesome entertainment, Angry Pharmacist, you make my after work time a great thing.
Steven, aka, the Ribeye of your Dreams

Comment by rph3664 on 2008-03-20 16:31:56 -0700 #

Ribeye, I worked in restaurants for 15 years before I got my pharmacy degree.
A lady I know who used to be an assistant manager at Steak & Shake once asked me, “How do you know so much about fast food? I thought you were a pharmacist.” I replied, “I am, but I haven’t always been, and the jobs aren’t as different as you might think they are.”

Comment by RJS on 2008-03-29 07:15:54 -0700 #

Sorry for the late reply, rph3664.
In Massachusetts it is illegal to have more than 1 Rx on a prescription blank. It’s one of the few rules in MA that actually makes sense. 🙂