Table of Contents
Today we have another episode of Ask The Angry Pharmacist, where our very own TAP answers YOUR questions about life, pharmacy, drugs, and why that soma is too early to be filled!
Today we have a question by Adrienne:
Your rants are fantabulous. I agree with you and share your disgust. Thanks for exposing the real drug underworld. I have to deal with much of the much of the same BS; and then some. (Perhaps More about me another time.)
I have a billing and medical record question. I don’t have prescription coverage (self-employed so to speak).
Scenario: Someone with BC Fed brings in a Rx and the pharmacy says they have to “run it” to see if it’s covered.
Pharmacy fills the rx; it’s ready for pickup; but the patient doesn’t want to pay the copay or for whatever reason, they don’t pick up the script.
What happens to the meds? back on the shelf?
what does the insurance company/pbm pay the pharmacy?
what does ins co pay the pbm?
how does it go down according to the ins co/ pbm as though the patient received the meds?
Wow, fantabulous eh? Is that like Fantastic and Fabulous?
To answer your question, what you speak of is what we (in the “industry”) call “Returned to Stock” or RTS. RTS’d items are the bane of our existence and are a bigger money hole than a 19 year old mistress. Heres why:
- We get the order for an Rx. We bill the insurance company and recieve cost+$1.50 (if you’re filling a MedImpact managed plan. Fuck you MedImpact!) for the work we do. We fill the prescription (using the insurance reimbursement thats above the drug cost to pay for the labor to fill your Rx. ie: the power bill, vial, label, my payroll, my tech’s payroll, computer costs, rent, etc)
- You don’t pick up the Rx within a set period of time (usually 1 month, but varies between pharmacies). The Rx just sits there taking up space.
- When the time is up, one of the clerks goes through every Rx waiting and picks yours out to be RTS’d. Since you did not pick it up, we have to REVERSE our billing to the insurance company, lose whatever money they gave us, and put the drug back. The PBM reimburses the insurance company (we hope) and the entire Rx filling process gets thrown into reverse. However knowing PBM’s, I doubt this happens.
- This means that the pharmacy spent the labor to fill and unfill that Rx, but did not get paid. We lost all labor costs in filling that prescription (but we did not lose the actual drug cost since we can resell that drug that you didn’t pick up). Sure we can recoup the cost of the vial, but the label is lost, our labor in filling the Rx is lost, rent, power, etc. All lost. Plus we need to spend labor dollars to put that drug back in stock.
Obviously antibiotics are RTS’d sooner than other drugs, since why pick up an antibiotic 1 month after the ER called it in for you. Usually we do everything in our power to make sure you come in to pick up that Rx. Not only does it save us money, but it reinforces compliance and the feeling that “we care(tm)”. This involves paying someone to call you when you have medication sitting here looking for a home. We hope you would take the Rx after leaving the pharmacy, but once your signature goes into that log and you walk out that door, its all yours. No give-backs!
This is the reason why pharmacies are so reluctant to transfer medications that they have already filled for someone. If I call a pharmacy for a transfer, and the medication is filled and waiting for them at the other store, I will make them get it there this one time. Nothing pisses me off more than to fill 15 discharge medications from a hospital to have another pharmacy (*ahemWalgreensahem*) call and want me to back out (reverse from the insurance company) everything and send their way. I usually tell them to go fuck themselves (unless its a pharmacist I know, but those would never ask me to do something like that).
I hope that answers your question. If you at home have a question that you wish answered by a real-life angry pharmacist, please email [email protected] and I’ll do my best to answer what troubles you. Obviously more ripe/risky/personal questions get priority. Think of it like Love Line, only with someone a lot more angry (and funnier) than Adam.
Comment by Dan on 2008-08-29 10:59:30 -0700 #
You forgot the bastards that come in like 5 min after you return the scripts and stare at you in bewilderment when you tell them you are going to have to fill it again
Comment by Jen on 2008-08-29 17:21:13 -0700 #
You forgot the bit where it was an unusual/unlicensed/ out-of-stock drug and you not only went the extra mile to get the drug in specially (having been begged by the patient), but you know for a fact that no-one else will come in with a script for it in the 18 months before it expires. Thus losing you the cost of the drug also.
Comment by Google Account on 2008-08-29 18:46:08 -0700 #
Oh–I have worked for a large chain, let’s call them, hmmm…Large Mart. It is their policy that all rxs not picked up after 7 days must be RTS. Not only that, but if you don’t get it RTS by day 10, it gets locked up in the computer tighter than Richard’s hat band, and you have to go find a floor associate to loan you a telxon so you can get it out. And it never fails that Ms or Mr “I called it in a few days ago, why isn’t it still ready?” will come in the same day you’ve gone through all this trouble. Thankfully, when I worked at large Mart it didn’t cost ME any money, but it was a huge pain in the fanny. Now that I own my own store, I want to shoot those people.
Comment by Onco Dude on 2008-08-29 19:16:53 -0700 #
How about charging a restocking fee? This wouldn’t fly at the chains, but if I were an independent, I would kindly ask for 5% of the cost of medication (minimum $2) as the customer either turned up their nose at the price, or wanted the pharmacist to step-and-fetch.
Comment by AZ RPh on 2008-08-30 07:42:59 -0700 #
Even worse is RTS-ing compounded medication. I work at a WAG, without the benefit of any nearby compounding pharmacy, so get the benefit of taking time out of my busy day to whip up miracle mouthwash, butt-paste, etc. Insurance often doesn’t cover these items, so we always call the patient to confirm that they want to pay the $34.79 before making the product. Even after they agree, I’ve had numerous patients turn up their nose at the price once they came in to pick it up. grrrr…. thanks for wasting the time and money, pricks.
Comment by Todd on 2008-09-01 04:38:49 -0700 #
a restocking fee would be great if the person had insurance but if the person had no insurance I don’t see how the restocking fee would work.
The pharmacy I work at returns to stock after only 2 weeks. Then I hate it when people come back 3 weeks later wanting to pick it up…It’s like um..sorry but that is returned to stock but I can fill it for you if you give us some time.
Comment by cardiiogirl on 2008-09-01 05:54:20 -0700 #
Ouch. I just decided I don’t actually *need* or want to go back on Paxil just to deal with my obsessive thoughts. Got that under control again after my doctor called in the prescription.
So, I never picked it up.
Sorry. Didn’t realize all the paper trail red-tape that occurs.
Forgive me Angry Pharmacist for I have sinned. I shall never refuse to pick up a prescription again.
Comment by KDUBZ on 2008-09-01 06:51:45 -0700 #
Oh, God can we add the I dropped my rx off 2 months ago and was wondering if it was still filled bitch to the previous post about patients who kill your patients. If a patient fails to show up for an appointment a physician will still bill them. I realize the chains like to bleed money to keep people happy, but we should start charging restocking fees.
Comment by Just A Doc on 2008-09-01 18:20:47 -0700 #
When I was working ER shifts, back before I went back in PCP practice, I had a notation printed on the bottom of my script forms. It said “ALL medications listed are to be FILLED, and filled completely. Pharmacist, please notify prescribing physician if these medications are not completely filled and picked up within 4 days”. This cut down on an amazing amount of cases where people just filled the narcotics or the Benzodiazapimes.
It also cut down on people blowing off picking up their medications from the pharmacy. If the pharmacist was polite enough to actually call me and notify me about someone not picking up a script, or a part of one (since the instructions on filling EVERYTHING didn’t always get followed, sometimes for legitimate reasons such as lack of money) I would call the patient and find out why they had not picked up their scripts. If they seemed to be drug seeking, I would follow up with their PCP and give them the whole story.
It was a pain for a while, but word started getting out in the small town and the surrounding area that I worked in that our particular ER was NOT the place to go to score dope or fuzzy pills. After a while drug seekers became less and less prevalent and we started getting more legitimate patients who were less afraid to go to the ER and be accosted by hilibbiles wanting oxycontin and xanax.
I am curious – for the pharmacists and CPT’s, etc reading this, what IS an appropriate time for a pickup before it starts looking like a drug seeker got the narcotics and left the rest? I would value the wisdom of your experiences.
Comment by sickofstupidpeople on 2008-09-02 06:49:39 -0700 #
We RTS after 9 days, and I totally hate the people who come back on day 10… It doesn’t do any good to tell people why we do it, but I’ll tell the readers here – they might actually care. If I receive payment from an insurance company, but haven’t actually dispensed the product, that’s insurance fraud. Most payments come in 10-14 days after the claim is submitted (I’m not talking part D here, that’s a different animal) – so, 9 days pretty much guarantees that I’m not committing fraud (except in the case of one company, which pays at 7 days – reversing those claims is a total pain) Compounded items don’t get mixed until the patient shows up to pick them up. They don’t want to wait? Too bad… ER scripts must be filled completely or not at all (the only exception I make is when the person says “I don’t need the pain med right now” – doesn’t happen very often). If the “I only want the Vicodin” patient has the script from their PCP, we call the doc to make sure that’s OK first.
I know, I’m a bitch – but it’s my pharmacy, and I’ll run it the way I want to…
Comment by WAGslave on 2008-09-02 09:12:25 -0700 #
To Just A Doc, most pharmacists I know have a “all or none” approach to filling ER scripts that have a control drug as part of the presciption. If they don’t want something, I make them wait until I get “permission” from the prescriber … and most ER docs are happy that I called, as it gives them an idea of what kind of patient they are dealing with. Also, if there is some drug seeking behavior, the script is always picked up. What burns me is when patient’s are on state assistance, they go to the ER to treat a minor skin infection, like an abcess on their ass, and get keflex and percocet (we all know abcesses are SOOO painful). I make them fill both, they don’t care because the state is paying for it, and leave the pharmacy and promptly chuck the keflex. (I can’t count the number of antibiotic scripts that have turned up in the garbage or parking lot in some of the places I have worked). Of course, the abcess festers and doesn’t heal, so they make the pilgrimage to the ER, and repeat the process, thus aquireing more narcotics on the tax payers dime. I know, that’s off topic. ER scripts that include a controlled drug: all or none.
Comment by chemgk.wordpress.com on 2008-09-02 20:23:01 -0700 #
I love your blog. I am passing this on to all my pharmacist friends. I work in Product Safety at a medical device company and let me tell you the stupid people…they are everywhere.
Comment by laura on 2008-09-02 23:54:29 -0700 #
we do hormone replacement compounding at my pharmacy. i don’t understand why the patient takes the time to go to the doctor, get blood tests done, go back to the doctor for the results, call the pharmacy, give us their information, tell us to get their prescription ready, ask when it will be done and NEVER pick it up. not to mention that when you go call ms. upper middle class her phone line has been disconnected. since these are made to the specifications of the doctor for that persons specific needs, we can rarely reuse the creams/troches/capsules that we make. ever looked at the price of pregnenolone? estrogens aren’t that cheap either. not to mention it takes about 2 hours of time to mix, melt, cool, and cut each troche. and we don’t have a pharmacist or tech who only does compounding, so everything we do is taking time away from working on the scripts of people who will ACTUALLY come pick them up.
Comment by KDUBZ on 2008-09-03 07:53:37 -0700 #
I would say no more than a day or two for them to pick up the other medications. If pain is their primary concern, and they are cash strapped I could maybe (and that is still a big maybe) see them getting their narcotic and getting the ABX etc later. But if they fail to return within 24 to 48 hours I would bet two weeks pay (and that is pharmacist pay!) they never will return for the other medications. If someone is sick to the point of needing ABX they won’t want to wait long.
Interestingly enough some of the people with fake rx’s in my area are now filling large amounts of narcs but also putting cheap ABX on the prescription as well to make it seem more legit.
Also Just ADoc, I like your approach on following up with whats been filled and what hasn’t. Sir, I believe I owe you a beer!
Comment by Just A Doc on 2008-09-03 15:04:21 -0700 #
I’ll take a Miller Lite, thanks!
Comment by returnguy on 2008-09-05 18:15:51 -0700 #
I do returns of expired drugs for a living. The dirty little secret is that if you don’t sell that full bottle of RTS pills, many of the pharmaceutical manufacturers will not reimburse you when it expires if you broke the seal on the bottle. I can’t tell you how many full bottles of Kaletra RTS I have had to destroy over the years. If you don’t remove the Rx label properly, you also greatly risk not getting reimbursed
Comment by VATech on 2008-09-09 22:21:57 -0700 #
I agree with you completely, not only about the hassle and the money loss for insurance…but also with what ‘Jen’ commented. How about those that order a refill for a 90 day supply, which is oh…maybe a large quantity like 180 or 360 pills. The order gets filled, more is ordered to replace the stock and the person never comes, so you are stuck with God knows how many bottles that will all expire and now the on-hands are messed up so the computer accidently orders more thinking that everything is kosher.
I had a pt look at me the other day and ask a fellow tech if she felt stupid and embarrassed because we had to return his medication after 11 days (7 days is our policy)..when I explained to him the reasons behind it (hanging claims, insurance policies, etc.) I also added in a bit about over-ordering and other pts requiring that same med, he promptly told me that he didn’t give a ‘flying f***’ about other pts and that I was here to serve him and him only.
made me feel wish I could pass along the address to this blog
Comment by http://openid.aol.com/igotitcheap2 on 2008-10-26 19:29:00 -0700 #
I love your blog and I have questions reguarding phamacy school , which I have been considering for some time now I wanted to know what could I do to stand out during the application process and study for the PCAT the school I am looking toward is UF < FAMU < NOVA
Comment by cmartin3 on 2008-11-22 11:28:56 -0800 #
My doctor charges $25 for missed appointments, so in all fairness pharmacists should be allowed to charge a restocking fee.
Comment by UR ARROGANT on 2008-11-28 23:23:07 -0800 #
You all are a bunch of arrogant jerks. Enjoy your BEERS doctors and pharmacists, you all would have probably been withdrawing or moonshiners during the prohibition. I have never seen such a judgmental group of people. Do you have any idea how difficult it is for a person in LEGITIMATE PAIN to get a LEGITIMATE PRESCRIPTION? I have NEVER broken the law and written or distributed a fake RX but how about some compassion for the people in pain? My cardiologist had the arrogance of you all, treated me like a junkie because he did not believe I could have the heart condition I do, though I have never put a needle in my vein. Turns out it was the tongue piercing of my foolish youth that gave my valves trouble, but most of you aren’t even aware of that problem today. For a person in pain to have to write a fake RX so that they can get 40 pills instead of 20 is a lynch-able offense to you all. To me, it is SAD. You have no idea the people in pain who’s doctors refuse to adequately medicate their pain. I know many people who are suffering because of that problem, but you all just scoff at their pain, and arrest them if they try to do something – anything to relieve the pain. What arrogance! What do you all do when your alcohol loving selves get mighty painful hangovers? I’m sure you take a couple of aspirin … riiiiight. Self-righteous, and self indulgent, compassion lacking jerks is what I see posting here. But remember you reap what you sow. That doc that thought I was a junkie years ago, well, I just heard on the local news how he will be paying $135,000.00 to the federal government in restitution for the settlement in the case against him for making fraudulent Medicare claims. How many doctors lie to insurance companies and justify it to themselves? But the people in pain, God forbid they get a little relief – send them to jail, and make sure they suffer more. You all are what is wrong with the world and you can’t even see it. No one would feel the need to write these minor amendments to their prescriptions (and no, I haven’t done that either, but I do not fault the people in pain that do.) You must have no idea what it is like to be in pain. Did you all see the movie with William Hurt called “The Doctor”? If you haven’t seen it you should. You should learn what it is like to be a victim of people like yourselves. And if you don’t see the movie, and don’t learn from it, you will probably learn from the experience called “LIFE” down the road. You will learn what is so despicable about your tight-assed attitudes towards suffering people at some point, and you will be sorry then. Let he among you who has never self medicated cast the first stone. And it better not be one of you alcoholics!
You all disgust me. You all give a lot of people a lot more reason to be angry than they give you. And you don’t even have a clue because you are peons with power that enjoy to play “God”. What a bunch of narcissists. You all make me, and others SICK. And I thought you went into your professions to heal people. SHAME ON YOU ALL!
Physicians and pharmacists, heal thy compassion! You are a group of power hungry sick jerks for the most part, from everything I have read here, and from all of the suffering people that I know that can’t get their doctor to give them anything stronger than Tylenol, ibuprofen, or naprosyn for legitimate chronic suffering. And if they do get a script, it is for 20 Tylenol with codeine without a refill. Just wait until you all are at the mercy of people like yourselves. Maybe you will change your tune then.
You all can hate me for speaking the truth, but I ask you again, didn’t you go into your fields to help the suffering? If so, you have gone so far off course you no longer remember the original objective. You have user names like “people suck” – so why in the world are you in the business of helping those people. Do us all a favor, and become the power hungry animal control officers you deserve to be. Then you can inflict all the pain you want on patients that can’t complain, or sue you, and you don’t have to deal with the “people that suck”. Instead you can focus your cruelty on victims without a voice.
YOU ARE THE PEOPLE THAT SUCK!
ENJOY YOUR DRUGS OF CHOICE, AT LEAST THEIR LEGAL. YOU NARROW MINDED LEGALISTIC PLEBES WITH POWER!
Comment by druggy fuck on 2009-01-18 13:48:52 -0800 #
Who cares if you have to refill the same prescription 100 times? I certainly don’t. It’s your job. You should be grateful to have a career in well paying field. Not only are you not god… you’re not in a position to make the policy decision regarding restocking fees etc. Have some humility.
Keep it simple. Have an attitude of gratitude. Keep coming back it works. Get off your pitty pot. (that one makes me laugh).
I think I see what the problem is here and it makes the complaints about drug seeking patients all the more amusing. Oh the irony!
Comment by pharmacygirl2007 on 2010-03-22 00:00:58 -0700 #
Yay for you. I don’t fill pain medication without the antibiotics. However, I do fill sorry for the pharmacists at publix. Since they have the free antibiotics alot of drug seekers take their scripts to Publix. I love this blog. I just found it today. I am so happy I did. People have no idea what we suffer.
Here is a pet peeve: For those of us who work for chains where we pull 12-14hour shifts with no lunch break; it infuriates me when I am trying to get doctor calls, answer ridiculous price questions on the phone, verify prescriptions, pay attention to what my techs are saying since some the new ones don’t have filters on their mouths, and I have to stop to answer your all important question of: \ Can you help me pick a lipstick!
Comment by pharmacygirl2007 on 2010-03-22 00:20:04 -0700 #
Wow and you call us judgemental. Here is the deal. You are forgetting something very important. We worked hard for those degrees you frown upon. Me and my peers suffer insufferable pain too, but we don’t try to cost someone their license or livelihoods to medicate ourselveds. You are talking about people who work 12-14 hour days(that is just the hours pharmacy open, doesn’t include when we are closed), don’t get lunch breaks, barely have time to use the bathroom, filling 500+ prescriptions a day, who are praying that they don’t make any mistakes and that they catch mistakes of the physicians, PA’s, or even our own mistakes, while trying to make your insurance go through(while suffering severe hunger headaches, back pain, leg pain, etc…) and are being cursed out, spit on, and being blamed for others failure to be responsible. We do all of this and people who are in pain(half the time not nearly as much as the pharmacists, technicians, nurses, etc… are experiencing but we don’t medicate so we can have a clear head when checking your prescription) trying to scam us, get us to fill prescriptions early, which could result in us losing our licenses. You think we are stuck up and we suck, but at least we wouldn’t try to jeopardize your lively hood. Do you know what really gets me. All of you scream, you don’t know my pain. Are you kidding me. One day in my pharmacy I had a technician who had just lost her aunt, she personally just had surgery and couldn’t afford to miss work, was going through a divorce; while at the same time, the pharmacist grandmother died that morning, she herself had a torn disc in her back and was standing on her feet with no food for 14 hours. We could have closed up shop, but no we are the good employees we come in and get abused and lied to and then 5 customers had the nerve to say we didn’t know their pain. Did they know ours? We learn to deal. Pain is a horrible fact of life but it does not excuse you or anyone else to mistreat the health professionals that are there to help you. I had a lady screaming about tooth pain and again telling me I didn’t know her pain. ARe you kidding me!!!!!! I had the flu(vomiting, diarrhea, fever) and back pain. Do you know what me and my technicians medicate with for our unbearable pain while at work….tylenol and ibuprofen. So ask yourself as you put yourself up on this superior high horse, do you know the pain and trials and tribulations of the people who no matter what kind of physical pain, divorces, death, and mental anguish go thru? No, because we do our jobs so well that you think we are problem free!!!!!! So don’t begrudge us a place where we can go and let it all out without compromising patient confidentiality and best of all not take it out on the poeple(customers) who care nothing about our licenses(which we worked hard to get), our working conditions, or the sacrifices we make to come in to serve you.
P.S. Most of my doctors have tried to give me control medications, but I refuse. I also don’t abuse alcohol. I am sad that your world is so bleak you assume that everyone has some kind of addcition.
Comment by NEEDS MEDS HAS CANCER on 2012-11-21 16:03:10 -0800 #
Amen to UR ARROGANT.. all the pharmacists ive ever dealt with have treated me like dog crap when i fill my pain meds… guess what, I HAVE CANCER YOU SONS OF BITCHES!! try living with that and the chemo and the radiation and so on.. you’re all judgemental. and im sure im not the only one who has been subjected to that type of behavior, in fact id make a bet ALL of you have done it at one point or another.. making rash assumptions of people without knowing the FACTS just because of the type of medication theyre getting. GO TO HELL!!