Shady, Shady, Shady

[All4MyDaughter]

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So it's the Kentucky Derby. The BIG race is tomorrow, but the freakshow has been goin' on all week long. My pharmacy is near Churchill Downs (literally across the street) and and the whole area sorta resembles a combination of carnival sideshow/lifestyles of the rich and famous/police state right now. We had to prove we worked at Kroger just to get into the parking lot this morning.

Today was Oaks Day. It's the Derby, but for fillies. It was really slow in the pharmacy because no one could get in. Midday, this strange looking guy comes in with a script for OxyContin 40, disp #60. He has medicaid but wants us to run it on cash for brand name. $400+, I tell him. No problemo, he says he'll be back in 20.

The rent-a-pharmacist floater doesn't really want to fill, but can't find a reason not to. Script looks real, but quacky (long story). Out of town doctor. Not like we could get a narcotics cop down to the store even if we wanted to today. So we fill.

While this is happening, I decide to walk out to a street vendor for a hot dog. As I'm walking back in OxyBoy and his chick are hanging out on our motorized wheelchairs in the parking lot. OxyBoy yells, "There she is" and takes off toward this car that just pulled in. I enter the store but stop to see what's up. They talk for a bit, then OxyBoy leans into the car and the driver hands him a WAD of cash.

I turned and went back into the store. As I was telling the pharmacist what I saw, the patient comes up to the counter and asks for his meds. Says he is in a hurry. I think, "yah, I bet you are in a hurry. There are 100,000+ people down here today and you gotta make some SALES."

Am I cynical? The pharmacist gave me the final call whether or not to fill. I said yes because the script was not an obvious forgery and I knew that the store manager and the pharmacy manager would want the sale. I didn't like it, but I didn't know what else to do. The floating pharmacist was kinda like, "I dunno, I'm here today, gone tomorrow - you decide."

What would you have done? Any thoughts?

 

[DrBowtie]

Nice story...I wouldn't have filled it.

 

[All4MyDaughter]

Nice story...I wouldn't have filled it.

I thought you'd like that one. Were you down there today?


What would you have told the patient if you refused to fill?

 

[All4MyDaughter]

I should also clarify that my decision to go ahead with the fill was made BEFORE I saw the little "cash exchange" in the front the store.

I felt a little differently after that but there was no time to do anything about it.

 

[DrBowtie]

I thought you'd like that one. Were you down there today?


What would you have told the patient if you refused to fill?

Although Oaks is for the locals, I didn't go. I'm going to a big Derby party tomm though which should be fun.

I would have just told him that you aren't filling controlled substances today. I mean the loss of business wouldn't be worth the liability. I mean the guys seemed quite obvious in their intent.

 

[All4MyDaughter]

Although Oaks is for the locals, I didn't go. I'm going to a big Derby party tomm though which should be fun.

I would have just told him that you aren't filling controlled substances today. I mean the loss of business wouldn't be worth the liability. I mean the guys seemed quite obvious in their intent.

I THOUGHT about telling him we didn't have it.
However our pharmacy manager specifically forbids lying to patients.

There was also the off-chance that he was a cancer patient or something and might complain to Kroger higher-ups if we didn't fill it.

Plus, and this SUCKS about retail pharmacy: you get flack from store management for p*ssing off customers and turning away sales. Especially big sales on a day when your numbers are naturally going to be down anyway.

I did get praised by management for convincing an AIDS patient to transfer his six very expensive meds to our store today. That's not why I did it, he was super nice and I wanted to help him out BUT that kind of thing wins gold stars in retail pharmacy...

 

[ForgetMeNot]

I wouldn't have put my name on that prescription. I've told people that we need some clarification on the rx, and if it's legit, they always say it's ok. If they dispute or get kinda bitchy and want their rx back, I will just write on the rx itself to call the physician before filling. Then I call to the other pharmacies in the area to tell them to watch out! 😀

 

[DrBowtie]

I THOUGHT about telling him we didn't have it.
However our pharmacy manager specifically forbids lying to patients.

There was also the off-chance that he was a cancer patient or something and might complain to Kroger higher-ups if we didn't fill it.

Plus, and this SUCKS about retail pharmacy: you get flack from store management for p*ssing off customers and turning away sales. Especially big sales on a day when your numbers are naturally going to be down anyway.

I did get praised by management for convincing an AIDS patient to transfer his six very expensive meds to our store today. That's not why I did it, he was super nice and I wanted to help him out BUT that kind of thing wins gold stars in retail pharmacy...

There should be some sort of system that forces people to go to a regular pharmacist for regulated drugs. Kinda like the push for people to get a PCP that knows their history. People popping in from out of town all of a sudden having scripts is highly suspicious.

If a pt is going to be travelling and due to run out, they can talk to their doctor and often times get a few extra for travelling so this scenario doesn't happen.

 

[imperial frog]

After performing the necessary due diligence, I'd be willing to give the person the benefit of the doubt when it comes to pain meds. I know what it's like to be on the other end of the pain problem and it's not a pleasant thing to deal with. Yeah he could have been dealing but you're only going with your gut feelings at that point, and I don't know about you, but my gut has been wrong on occasion.

 

[All4MyDaughter]

There should be some sort of system that forces people to go to a regular pharmacist for regulated drugs. Kinda like the push for people to get a PCP that knows their history. People popping in from out of town all of a sudden having scripts is highly suspicious.

If a pt is going to be travelling and due to run out, they can talk to their doctor and often times get a few extra for travelling so this scenario doesn't happen.

He was a local, but the script was from out of town. This is why I said it was quacky. It was from a "Cancer Pain Clinic" in rural central Kentucky.

Brett, I know you'll understand where I'm coming from on this one. Why would a cancer patient from HERE be going to a clinic in BFE, Kentucky? The JGBrown Cancer Center isn't good enough?

Still, we looked up the doctor, DEA, clinic stuff. All seemingly legit. The clinic was already closed for the day. Closed at noon on Friday.

So, the script was weird, but not OBVIOUSLY illegal.

I forgot the best part! Kroger has a new rule in our area. If you call the police on a customer or refuse to fill a script because you suspect something's not right - you have to call Kroger risk management first to get permission! And guess what - RM was closed today!

 

[DrBowtie]

He was a local, but the script was from out of town. This is why I said it was quacky. It was from a "Cancer Pain Clinic" in rural central Kentucky.

Brett, I know you'll understand where I'm coming from on this one. Why would a cancer patient from HERE be going to a clinic in BFE, Kentucky? The JGBrown Cancer Center isn't good enough?

Still, we looked up the doctor, DEA, clinic stuff. All seemingly legit. The clinic was already closed for the day. Closed at noon on Friday.

So, the script was weird, but not OBVIOUSLY illegal.

I forgot the best part! Kroger has a new rule in our area. If you call the police on a customer or refuse to fill a script because you suspect something's not right - you have to call Kroger risk management first to get permission! And guess what - RM was closed today!

If you're local you would go to BCC or a local private practice. That seems odd.
On second thought....I would have just stalled. I think eventually the person would ask for it back and leave. Had to get into the Oaks before the end of the 5th race.

 

[All4MyDaughter]

After performing the necessary due diligence, I'd be willing to give the person the benefit of the doubt when it comes to pain meds. I know what it's like to be on the other end of the pain problem and it's not a pleasant thing to deal with. Yeah he could have been dealing but you're only going with your gut feelings at that point, and I don't know about you, but my gut has been wrong on occasion.

Yup, my gut is not always right.

Especially right now. I think I had some bad sushi earlier.
The lucky charms I ate for dessert probably didn't help.


It's not easy to make these calls. I have limited experience (almost none) making these types of decisions. I was working with a floater who may never be back to our store and will never be held accountable for anything (although, ultimately - his name went on the script). If we HAD refused, and the guy had been a cancer patient or just a major complainer and raised a ruckus with corporate, it would be ME called into the store manager's office to account for it. Not the floater. I was the senior PERMANENT staff member working today. Pretty scary because I am a peon, really!

 

[bananaface]

If you questioned the script's legitimacy, why not call for verification? Was the place it was written at not open today?

 

[All4MyDaughter]

If you questioned the script's legitimacy, why not call for verification? Was the place it was written at not open today?

Closed at noon on Fridays. We tried.

I think it was a real script, written by a real doctor. However I suspect the doctor to be a pill-pushing quack!

I think I'm going to call that doctor on Monday. I have a hangnail and I think I need 100 Percocets. Actually, I like Tylox better, that's the ticket!

 

[bananaface]

Doh! I missed that post above.

In WA we aren't supposed to let Medicaid patients pay cash for a covered item. It comes in handy sometimes.

 

[All4MyDaughter]

Doh! I missed that post above.

In WA we aren't supposed to let Medicaid patients pay cash for a covered item. It comes in handy sometimes.

OOOOH, that's a good rule.

I did run it through Medicaid first with a DAW2 (patient requests brand), just to get the reject. Supposedly someone at KY Medicaid actually looks at those and notes that a patient who gets free meds paid cash for something very expensive. I don't know that I believe that, but that's what they tell us.

Today's pharmacist was from India, and he asked me how someone poor enough to qualify for medicaid could afford to pay the $400 for brand. I was like, well - he can sell it for $2500+ easily. Pharmacist looked shocked. Welcome to America!

 

[All4MyDaughter]

If you're local you would go to BCC or a local private practice. That seems odd.
On second thought....I would have just stalled. I think eventually the person would ask for it back and leave. Had to get into the Oaks before the end of the 5th race.

My neighbors (a houseful of young college guys - your peers HAHA) just got back from the Oaks about 11 or so. I dunno what they were doing all that time since we are pretty close to the track. Maybe too drunk to find their way back on foot? They are still partying. Someone just threw up in the front yard of their house and I'm pretty sure a couple is having sex in car outside my bedroom window. D*mn these Germantown houses only 10 feet apart.

I love Derby weekend!

 

[DrBowtie]

My neighbors just got back from the Oaks about 11 or so. I dunno what they were doing all that time since we are pretty close to the track. Maybe too drunk to find their way back on foot? Someone just threw up in the front yard of their house and I'm pretty sure a couple is having sex in car outside my bedroom window. D*mn these Germantown houses only 10 feet apart.

I love Derby weekend!

Did you make any money parking people in your yard?

 

[bananaface]

I think alot of people pay their rent by selling the drugs Medicaid pays for. It's sad all around.

 

[All4MyDaughter]

Did you make any money parking people in your yard?

I wish. Not that close to the track. I'm due east of U of L.
Still close enough to walk.

 

[DrBowtie]

I wish. Not that close to the track. I'm due east of U of L.
Still close enough to walk.

you have any picks for tomm.?

 

[All4MyDaughter]

I think alot of people pay their rent by selling the drugs Medicaid pays for. It's sad all around.

We had a customer who was always picking up his grandmother's benzos and pain meds. Then she would try to come get them and they wouldn't be there. Or she'd call for an early refill because she was out. It took us longer than it should have to figure out what was going on. Our store uses a lot of floaters and info doesn't always get shared shift to shift. Plus the grandkid was on the "authorized rep" list. He isn't anymore!

I'm actually very, very sympathetic to the poor. But I have my limits.

 

[All4MyDaughter]

you have any picks for tomm.?

No, I suck at that. You?

 

[DrBowtie]

No, I suck at that. You?

I like SteppenWolfer. It's a come from behind horse with 30-1 odds. Definitely worth a $2 bet.

 

[All4MyDaughter]

I like SteppenWolfer. It's a come from behind horse with 30-1 odds. Definitely worth a $2 bet.

Who is the trainer? I like Bob Baffert. For jockeys I like Kent Desormo (not spelled correctly) and Lafit Pincay (probably butchered that one too). I'm so out of it though, those guys could be retired for all I know!

Well, I know Baffert's still active. The jocks, not so sure.

 

[DrBowtie]

Who is the trainer? I like Bob Baffert. For jockeys I like Kent Desormo (not spelled correctly) and Lafit Pincay (probably butchered that one too). I'm so out of it though, those guys could be retired for all I know!

Well, I know Baffert's still active. The jocks, not so sure.

Trainer, I don't remember but the jock is my fav. Robbie Albarado. Oh yeah...its also GREY!!!!

 

[All4MyDaughter]

Trainer, I don't remember but the jock is my fav. Robbie Albarado. Oh yeah...its also GREY!!!!

OK, I looked it up. Baffert has three horses in the race.

Sinister Minister (great name), Point Determined and Bob and John.
All 12-1 right now.

Kent Desormeaux is on Sweetnorthernsaint at 10-1.
Laffit Pincay IS retired. Boo.


I like grey horses, too!

 

[npage148]

I wouldn't have filled it. Our area has way too many drug addicts/sellers to be that lax. I would have just told him we needed to verify it monday. we are strict at our store and have managed to get rid of a couple problem customers by refusing to fill early regardless. There is one more we really like to get rid of casue shes REAL bad. Like friday, she was screaming and yelling how we were killing her becasue we wouldnt fill her duragesic patches early. This after she conviced the MD taht she needs one every 2 days, not 3

In NY, the MD has to put brand medically necessary on the script or it is filled generic regardless of what the PT wants (we make exceptions for narrow TI drugs, warfarin and like).

Plus, anytime they say something shady like fill it for cash, we automatically run it through their insurance looking for something shady and if it pops up its not getting filled.

 

[vafcarrot]

My husband did a dinner last night for some folks that have two horses in the race today. And he got a $300 tip last night. Here's hoping that one of their horses wins cuz he's running another dinner for them tonight in Lexington. Whenever happy people throw money at my husband and he doesn't have to take his clothes off in the process, that makes me happy 🙂

 

[rxlynn]

It's not easy to make these calls. I have limited experience (almost none) making these types of decisions. I was working with a floater who may never be back to our store and will never be held accountable for anything (although, ultimately - his name went on the script). If we HAD refused, and the guy had been a cancer patient or just a major complainer and raised a ruckus with corporate, it would be ME called into the store manager's office to account for it. Not the floater. I was the senior PERMANENT staff member working today. Pretty scary because I am a peon, really!

Oh - I hate when this kind of thing happens and we have a floater. I caught a forgery one time - guy had been coming to us with quite reasonable looking Norco scripts - we had done a few for him with low quantities (around 40 or so) and then one fine evening he walks in with the same script but written for a different patient name. I even pulled the earlier one and let the pharmacist compare the two, but because she was a floater she didn't want to call the police. When our regular Rph came in the next day, he called the MD and they had us call the police and file a report. Anyway, in the end he got caught at another CVS a few weeks later, and they linked with our report, so the detective came out and I had to look at a lineup of photos and id the guy.

We've also had one instance of selling oxycontin in the parking lot - in that case the police busted several sellers and one buyer. However, we found out this week that they may all go free on a technicality.

 

[All4MyDaughter]

My husband did a dinner last night for some folks that have two horses in the race today. And he got a $300 tip last night. Here's hoping that one of their horses wins cuz he's running another dinner for them tonight in Lexington. Whenever happy people throw money at my husband and he doesn't have to take his clothes off in the process, that makes me happy 🙂

Win - Barbaro
Place - Bluegrass Cat
Show - Steppenwolfer (good call Brett)

I hope your hubby gets great tips tonight!
Hope did finals go, Carrot?
Are you doing your EPPE?

 

[pharmaz88]

I forgot the best part! Kroger has a new rule in our area. If you call the police on a customer or refuse to fill a script because you suspect something's not right - you have to call Kroger risk management first to get permission! And guess what - RM was closed today!

This might explain why every Fry's (Kroger in AZ) pharmacist I've ever had the pleasure of taking transfers from has been a grump.

"Gee, that's nice that you've got a doctoral degree and all, but we're still going to strip you of any sort of professional autonomy."

 

[insipid1979]

Show - Steppenwolfer (good call Brett)

The jockey who rode Steppenwolfer rode a horse named Purim today at Arlington Park (IL). He made me money 😀

 

[Rhythm]

Doh! I missed that post above.

In WA we aren't supposed to let Medicaid patients pay cash for a covered item. It comes in handy sometimes.

In MN if you allow a Medicaid/Medical Assistance patient to fill for cash then your pharmacy stands to lose its ability to bill ALL state run programs. This law comes in handy quite often, but for some reason we only have to use it with controlled substances.

 

[All4MyDaughter]

In MN if you allow a Medicaid/Medical Assistance patient to fill for cash then your pharmacy stands to lose its ability to bill ALL state run programs. This law comes in handy quite often, but for some reason we only have to use it with controlled substances.

That's a good rule too.

It gets out of hand sometimes here. We have people calling up asking us if we carry the "blue watsons" and then asking to SEE the generic pills before we fill. A Passport (Ky Medicaid) patient was getting lortab and flexeril and wanted to SEE the actual generic we carried before she has us fill. I guess different generics have different street value??

We don't carry name brands of a lot of stuff but for some reason we have these brand name pain meds. For instance we don't have Prinivil or Zestril at our pharmacy, only lisinopril. No Tenormin, only atenolol. But we have TONS of brand name Oxy. I know the reasoning behind it but I don't like it.

 

[Aznfarmerboi]

So it's the Kentucky Derby. The BIG race is tomorrow, but the freakshow has been goin' on all week long. My pharmacy is near Churchill Downs (literally across the street) and and the whole area sorta resembles a combination of carnival sideshow/lifestyles of the rich and famous/police state right now. We had to prove we worked at Kroger just to get into the parking lot this morning.

Today was Oaks Day. It's the Derby, but for fillies. It was really slow in the pharmacy because no one could get in. Midday, this strange looking guy comes in with a script for OxyContin 40, disp #60. He has medicaid but wants us to run it on cash for brand name. $400+, I tell him. No problemo, he says he'll be back in 20.

The rent-a-pharmacist floater doesn't really want to fill, but can't find a reason not to. Script looks real, but quacky (long story). Out of town doctor. Not like we could get a narcotics cop down to the store even if we wanted to today. So we fill.

While this is happening, I decide to walk out to a street vendor for a hot dog. As I'm walking back in OxyBoy and his chick are hanging out on our motorized wheelchairs in the parking lot. OxyBoy yells, "There she is" and takes off toward this car that just pulled in. I enter the store but stop to see what's up. They talk for a bit, then OxyBoy leans into the car and the driver hands him a WAD of cash.

I turned and went back into the store. As I was telling the pharmacist what I saw, the patient comes up to the counter and asks for his meds. Says he is in a hurry. I think, "yah, I bet you are in a hurry. There are 100,000+ people down here today and you gotta make some SALES."

Am I cynical? The pharmacist gave me the final call whether or not to fill. I said yes because the script was not an obvious forgery and I knew that the store manager and the pharmacy manager would want the sale. I didn't like it, but I didn't know what else to do. The floating pharmacist was kinda like, "I dunno, I'm here today, gone tomorrow - you decide."

What would you have done? Any thoughts?

I dont get it? There are obviously protocols in place. How did you know that he was a medicaid patient? Did you take down his profile? If you did, why didnt you report it to your states DEA office even after you filled the prescription?

I am from new york and we are one of those conservative places. Every controlled has to have the pharmacist name on it and his/her signature in the back of it. There are also regulations like any suspect of fraud, call them asap. Inspectors although swamped will always make an effort to try and come (they have public relationships to care about too).

I guess I care about this issure because this was one of those cases where every sign and hint points to abuse (or you wouldnt post it up). Ethnics play a huge part in this especially if you did not follow up on it.

 

[sdn1977]

Anzafarmerboi - I'm not sure I quite understand...are you saying ethnics (like in ethnicity) or was it just a typo...ethics plays a part??? I'm not trying to flame about spelling...but...I think there was a reference at one point to the pharmacists ethnicity I think???? That wouldn't be a factor here, but ethics surely is one.

My personal habit only - I don't fill CII from out of the area prescribers. I've always been supported by many employers & that solves many problems. Yesterday, I refused a lorazepam 1mg #100 that had been filled on 5/2 (not at my rx). She wanted to pay cash...I just said no - I wouldn't do it. She went away.

 

[Requiem]

Anzafarmerboi - I'm not sure I quite understand...are you saying ethnics (like in ethnicity) or was it just a typo...ethics plays a part??? I'm not trying to flame about spelling...but...I think there was a reference at one point to the pharmacists ethnicity I think???? That wouldn't be a factor here, but ethics surely is one.

My personal habit only - I don't fill CII from out of the area prescribers. I've always been supported by many employers & that solves many problems. Yesterday, I refused a lorazepam 1mg #100 that had been filled on 5/2 (not at my rx). She wanted to pay cash...I just said no - I wouldn't do it. She went away.

ME WANT ATIVAN! ATIVAN MAKE ME SLEEPY! MAKE ANXIETY DISAPPEAR!

 

[DrBowtie]

The jockey who rode Steppenwolfer rode a horse named Purim today at Arlington Park (IL). He made me money 😀

He's my favorite jockey. Robby Albarado

 

[All4MyDaughter]

I dont get it? There are obviously protocols in place. How did you know that he was a medicaid patient? Did you take down his profile? If you did, why didnt you report it to your states DEA office even after you filled the prescription?

I am from new york and we are one of those conservative places. Every controlled has to have the pharmacist name on it and his/her signature in the back of it. There are also regulations like any suspect of fraud, call them asap. Inspectors although swamped will always make an effort to try and come (they have public relationships to care about too).

I guess I care about this issure because this was one of those cases where every sign and hint points to abuse (or you wouldnt post it up). Ethnics play a huge part in this especially if you did not follow up on it.

Actually, I posted it because I thought it would make for good discussion.

Protocols were followed, to the letter. I already explained (ref post #10) why we could not call the police.

I knew he had Medicaid because he filled at our pharmacy before.

I agree with you that the signs SUGGEST abuse, but without ABSOLUTE proof... it's just not black and white.

And don't worry about my ethics. The first thing I did when I got back to work this week was report the situation to the pharmacy manager, who agreed that it was handled correctly, for the particular (and somewhat unusual) circumstances. Any follow-up is in his court. It isn't my place to call the DEA, report the fellow to Medicaid, etc. I'm an intern.

 

[All4MyDaughter]

Anzafarmerboi - I'm not sure I quite understand...are you saying ethnics (like in ethnicity) or was it just a typo...ethics plays a part??? I'm not trying to flame about spelling...but...I think there was a reference at one point to the pharmacists ethnicity I think???? That wouldn't be a factor here, but ethics surely is one.

My personal habit only - I don't fill CII from out of the area prescribers. I've always been supported by many employers & that solves many problems. Yesterday, I refused a lorazepam 1mg #100 that had been filled on 5/2 (not at my rx). She wanted to pay cash...I just said no - I wouldn't do it. She went away.

We refill controls only if it is 28 out of 30 days. People are always trying to get around that. I guess there are some exceptions - it's snowing like mad, and grandma wants to get her ambien a little bit early before the roads get bad - OK. Or we have a patient who has severe Lyme disease and can only get to the pharmacy occasionally. We'll do those a little early (as long as the pharmacist approves).

I did mention that the pharmacist was from India, but I agree that it isn't relevant to the point of the story.