The most irritating conversation with the clinic, ever.

[iloveclementine]

I'm sure you guys have experienced it.

This is how it goes.

A patient has a med that needs PA for Medication A1 (gel). Doc called in a script for medication A2 in a different formulation (spray form). We filled, and the insurance was covered, but the copay was ~$1000. After speaking with the patient, they were not willing to pay. Called the clinic to explain the situation and ask why they called in that medication.

Me: I'm called regarding the medication you called in. It's covered, but the copay is high, patient is not willing to pay. Also, I want to know the status of PA from Med A1 (gel).
Medical Assistant: What? You guys recommended me that medication!
Me: ? We never did. (We were wondering why you came up with such an irrational formulation that I have never heard of.)
MA: Now you guys recommend me medication that was covered and now you are saying it's not covered?
Me: I never said it's not covered. It is covered but the copay is high.
MA: But why didn't you guys send me that information in the first place without researching, wasting everybody's time?
Me: We sent the information? Can you give me the name of the person so that we can keep it in our record for misinforming you?
MA: (reading the notes)..got a fax (from the insurnace company) that this is a covered medication.
Me: This is from the insurna...
MA: Can you run Med A2?
Me: we already ran it. it's covered, but the copay is high.
(from the phone, there is a girl with a very condescending tone: Well?! We got the fax from them that it is covered? And that's what I did. What do they need now?! I don't understand)
After some mumbling and the repeat of what I said multiple times..

MA: Can you try to run brand name Med A2?
Me: there is only brand name. There is no generic for this. (it's like they called in pregabalin, and asking me to run twice for pregabalin and lyrica).
MA: What do you mean there is no generic? What do you mean there is no brand? WE CALLED IN THE GENERIC. Now I'm asking if you can run brand of it?
Me: Like I said, there is only one product. There is no generic. Even if you called in generic, it comes up as Brand name MedA2, so that's what we ran, and it's the same...
MA: YOU ARE CONFUSING ME, MA'AM. So what do you tell me to prescribe?
Me: That is what the prescriber decides. I am a pharmacist, I don't make that decision for you. (well, I could have recommended an alternative, but I was acting up too, at this point)
MA: Well, what am I supposed to do?
Me: I just want to know the status of the Med A1 prior authorization. Maybe you can continue with that?
MA: OK. FAX me everything for the prior authorization.
Me: (No ****. I am not wasting a second with you) only thing you need is a phone number. I don't fax.

Shared a phone number, and that was the end of it.

Just because you called in generic of brand only product, doesn't mean we can magically come up with the generic.
Know where you got the fax from. I wish I was able to explain myself, but the girl was too crazy and kept cutting me off when I was saying.

I'm so done with retail.

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[zelman]

I'm sure you guys have experienced it.

This is how it goes.

A patient has a med that needs PA for Medication A1 (gel). Doc called in a script for medication A2 in a different formulation (spray form). We filled, and the insurance was covered, but the copay was ~$1000. After speaking with the patient, they were not willing to pay. Called the clinic to explain the situation and ask why they called in that medication.

Me: I'm called regarding the medication you called in. It's covered, but the copay is high, patient is not willing to pay. Also, I want to know the status of PA from Med A1 (gel).
Medical Assistant: What? You guys recommended me that medication!
Me: ? We never did. (We were wondering why you came up with such an irrational formulation that I have never heard of.)
MA: Now you guys recommend me medication that was covered and now you are saying it's not covered?
Me: I never said it's not covered. It is covered but the copay is high.
MA: But why didn't you guys send me that information in the first place without researching, wasting everybody's time?
Me: We sent the information? Can you give me the name of the person so that we can keep it in our record for misinforming you?
MA: (reading the notes)..got a fax (from the insurnace company) that this is a covered medication.
Me: This is from the insurna...
MA: Can you run Med A2?
Me: we already ran it. it's covered, but the copay is high.
(from the phone, there is a girl with a very condescending tone: Well?! We got the fax from them that it is covered? And that's what I did. What do they need now?! I don't understand)
After some mumbling and the repeat of what I said multiple times..

MA: Can you try to run brand name Med A2?
Me: there is only brand name. There is no generic for this. (it's like they called in pregabalin, and asking me to run twice for pregabalin and lyrica).
MA: What do you mean there is no generic? What do you mean there is no brand? WE CALLED IN THE GENERIC. Now I'm asking if you can run brand of it?
Me: Like I said, there is only one product. There is no generic. Even if you called in generic, it comes up as Brand name MedA2, so that's what we ran, and it's the same...
MA: YOU ARE CONFUSING ME, MA'AM. So what do you tell me to prescribe?
Me: That is what the prescriber decides. I am a pharmacist, I don't make that decision for you. (well, I could have recommended an alternative, but I was acting up too, at this point)
MA: Well, what am I supposed to do?
Me: I just want to know the status of the Med A1 prior authorization. Maybe you can continue with that?
MA: OK. FAX me everything for the prior authorization.
Me: (No ****. I am not wasting a second with you) only thing you need is a phone number. I don't fax.

Shared a phone number, and that was the end of it.

Just because you called in generic of brand only product, doesn't mean we can magically come up with the generic.
Know where you got the fax from. I wish I was able to explain myself, but the girl was too crazy and kept cutting me off when I was saying.

I'm so done with retail.

Sometimes you need to tell the person on the phone that they don’t know what the f*** they’re talking about, so they need to get someone else on the phone, or get their s*** together and call you back.

 

[Sine Cura]

This is one reason why retail pharmacists say their lives suck. They actually call the doctor's office to follow up on non-critical issues. Like there isn't enough **** to do

Fax the office for your alternative suggestion or tell them to write something else that isn't $1000 and be done with it and make the customer harass their prescriber's office. Their employees can figure out less expensive alternatives.

 

[deleted480308]

It’s part of the problem with insurance being expected to handle literally everything. No one bothers with learning how much the meds they prescribe actually cost and everyone begins to falsely equate “covered” with “free”.


I’ve had patients come back to clinic screaming about how dare we prescribe such an expensive med when we knew their insurance when in fact the med was covered and the copay was $30.

I’ve also had people offended at the ~$2/day cost of smoking cessation meds when smoking >$10/day in cigarettes

Sometimes you can’t win

 

[npage148]

Why does it always seem this is a problem with dermatology. Refuse to budge on some unnecessary bs drug the rep told them was hot stuff. If I called a cardiologist and said xarelto wasn't covered they'd switch to a different anticoagulant without hesitation. But switch from epiduo (or whatever the hot topical is)?!

 

[297point1]

I can imagine a far more irritating conversation with the clinic.

This is how it goes:

You: "So, how did the results come out?"
Clinic: "You tested positive for HIV, Hepatitis C, herpes, and syphilis."

Count your blessings.

 

[Apotheker2015]

I'm sure you guys have experienced it.

This is how it goes.

A patient has a med that needs PA for Medication A1 (gel). Doc called in a script for medication A2 in a different formulation (spray form). We filled, and the insurance was covered, but the copay was ~$1000. After speaking with the patient, they were not willing to pay. Called the clinic to explain the situation and ask why they called in that medication.

Me: I'm called regarding the medication you called in. It's covered, but the copay is high, patient is not willing to pay. Also, I want to know the status of PA from Med A1 (gel).
Medical Assistant: What? You guys recommended me that medication!
Me: ? We never did. (We were wondering why you came up with such an irrational formulation that I have never heard of.)
MA: Now you guys recommend me medication that was covered and now you are saying it's not covered?
Me: I never said it's not covered. It is covered but the copay is high.
MA: But why didn't you guys send me that information in the first place without researching, wasting everybody's time?
Me: We sent the information? Can you give me the name of the person so that we can keep it in our record for misinforming you?
MA: (reading the notes)..got a fax (from the insurnace company) that this is a covered medication.
Me: This is from the insurna...
MA: Can you run Med A2?
Me: we already ran it. it's covered, but the copay is high.
(from the phone, there is a girl with a very condescending tone: Well?! We got the fax from them that it is covered? And that's what I did. What do they need now?! I don't understand)
After some mumbling and the repeat of what I said multiple times..

MA: Can you try to run brand name Med A2?
Me: there is only brand name. There is no generic for this. (it's like they called in pregabalin, and asking me to run twice for pregabalin and lyrica).
MA: What do you mean there is no generic? What do you mean there is no brand? WE CALLED IN THE GENERIC. Now I'm asking if you can run brand of it?
Me: Like I said, there is only one product. There is no generic. Even if you called in generic, it comes up as Brand name MedA2, so that's what we ran, and it's the same...
MA: YOU ARE CONFUSING ME, MA'AM. So what do you tell me to prescribe?
Me: That is what the prescriber decides. I am a pharmacist, I don't make that decision for you. (well, I could have recommended an alternative, but I was acting up too, at this point)
MA: Well, what am I supposed to do?
Me: I just want to know the status of the Med A1 prior authorization. Maybe you can continue with that?
MA: OK. FAX me everything for the prior authorization.
Me: (No ****. I am not wasting a second with you) only thing you need is a phone number. I don't fax.

Shared a phone number, and that was the end of it.

Just because you called in generic of brand only product, doesn't mean we can magically come up with the generic.
Know where you got the fax from. I wish I was able to explain myself, but the girl was too crazy and kept cutting me off when I was saying.

I'm so done with retail.

That was funny. I love it how you admitted that you would've volunteered some alternatives but at that point, you were acting up, too. LOL. You're only human.

That aside. In my humble opinion, that was not a call for a pharmacist. Next time just have a technician fax them back stating the copay on the medication they prescribed and to contact the insurance company for covered alternatives.
I get providers calling asking for alternatives and what's the point of me investing time ensuring x,y or z drug is clinically appropriate, if I have no way of knowing if it's covered or not? So I tell the tech to tell the prescriber, it's best they call the insurance to find out what's covered in that drug class. Patients can also make that phone call. "I have acne. What's covered?"

Your shifts will be more tolerable if you limit the phone calls you take to those that require the clinical judgment of a pharmacist, even if it means re-routing the call back to a tech after you've answered the clinical question. That's my humble two cents.