What do you do when......

[pharmdog22f]

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I have a hard time when patients come to the counter or on the phone and their total for prescriptions is under 20 bucks or lets say any amount and they say that they cant pay for it. What is something I can say to turn them away or make them pay I especially find this hard when it is something they need that day! What do you do?

Also what do you say when joe doe-do-brains walks in off the street on a sunday and says i need enough pills to get me throught until tomorrow and he is not in your system but he gives you a bottle from a pharmacy he fills at but they are closed sundays??

 

[PharmDstudent]

I have a hard time when patients come to the counter or on the phone and their total for prescriptions is under 20 bucks or lets say any amount and they say that they cant pay for it. What is something I can say to turn them away or make them pay I especially find this hard when it is something they need that day! What do you do?

Also what do you say when joe doe-do-brains walks in off the street on a sunday and says i need enough pills to get me throught until tomorrow and he is not in your system but he gives you a bottle from a pharmacy he fills at but they are closed sundays??

What?????

If the medication isn't controlled, I would loan them a day's supply until you can call the other pharmacy. If they don't want to leave the bottle, I wouldn't loan them anything. You can just make a new label for the loan by hand until you get the script transferred properly.

 

[OUTexan]

I had a PIC once that would sell 3 days worth of a pill. Say it cost $0.75, he would do a non-taxable item and sell it for $2.25. Then the person can just go back to their own pharmacy on Monday.

What I hate is how people are so irresponsible. They come into the pharmacy on a Sunday because they are out of pills. Patient say, "I need a refill on XXX drug." I say, "It is out of refills, we will have to contact the Dr. on Monday." Patient replies, "Well, can I get some?"

The problem is it is hard for our store to keep up with who got loaned a certain amount of pills. We used to try, but it would just cause for more paper and we wouldn't catch it. How do y'all keep up with pills loaned over the weekend to your regular customers?

Some guy came in today for his albuterol refill. Again, it has no refills. He wants to know why we hadn't contacted his Dr. and how come we do not see it on his last fill when he has no refills left. I explain that some patients don't want there Dr. to know that they are taking a medication so often and that we have had complaints on our auto-refill sending faxes to Dr.'s. He explains to me that it is just albuterol and he uses it every day and we should do that. When did Americans start to rely on other people to take care of them? Why can't he call on Wednesday to get his refill or notice it didn't have any refills?

Then we make calls after a week to let people know they have a RX ready. Our PSA called some guy who we were waiting on a PA. The guy comes through drive-true expecting his medication at the $35 copay. He said we called him at 9:30 this morning (We don't open until 10 a.m.). Then, I tell him the PA hasn't gone through and he is irrate. He says his Dr. called the insurance on Friday and it should go through. I get on the phone with the insurance and find out that the PA had been denied because Dr. didn't give enough information for the PA to be approved. I relay the info to the guy, he starts cussing at me through the window. So, I have one phone up to my left ear for the drive thru and one phone on my right ear talking to the insurance. Here is how the conversation goes:

Insurance: "The Dr. will need to call back and let us know that he has tried generic Ambien."

Me: "The Insurance says Dr. needs to be more specific and tell them you tried Ambien."

Patient: "S***. I can't sleep through the d*** night without the CR. Tell him that."

Me to the Insurance: "Pt. says he wakes up in the middle of the night with just the ambien...."

Patient: "Let them know I've been on CR for over a year. D*** it, I switched insurance companies and the old one used to cover it. S*** they are just playing Dr."

Me back to the Insurance: "He has been on this for a while, what would be the copay if the PA went through."

Insurance: "$35"

Me: "sir, it is going to be $35 and I will get all the insurance stuff straightened out with the Dr."

I sure hope the Dr. is able to get that PA to go through.

 

[cycloketocaine]

I had a PIC once that would sell 3 days worth of a pill. Say it cost $0.75, he would do a non-taxable item and sell it for $2.25. Then the person can just go back to their own pharmacy on Monday.

What I hate is how people are so irresponsible. They come into the pharmacy on a Sunday because they are out of pills. Patient say, "I need a refill on XXX drug." I say, "It is out of refills, we will have to contact the Dr. on Monday." Patient replies, "Well, can I get some?"

The problem is it is hard for our store to keep up with who got loaned a certain amount of pills. We used to try, but it would just cause for more paper and we wouldn't catch it. How do y'all keep up with pills loaned over the weekend to your regular customers?

Some guy came in today for his albuterol refill. Again, it has no refills. He wants to know why we hadn't contacted his Dr. and how come we do not see it on his last fill when he has no refills left. I explain that some patients don't want there Dr. to know that they are taking a medication so often and that we have had complaints on our auto-refill sending faxes to Dr.'s. He explains to me that it is just albuterol and he uses it every day and we should do that. When did Americans start to rely on other people to take care of them? Why can't he call on Wednesday to get his refill or notice it didn't have any refills?

Then we make calls after a week to let people know they have a RX ready. Our PSA called some guy who we were waiting on a PA. The guy comes through drive-true expecting his medication at the $35 copay. He said we called him at 9:30 this morning (We don't open until 10 a.m.). Then, I tell him the PA hasn't gone through and he is irrate. He says his Dr. called the insurance on Friday and it should go through. I get on the phone with the insurance and find out that the PA had been denied because Dr. didn't give enough information for the PA to be approved. I relay the info to the guy, he starts cussing at me through the window. So, I have one phone up to my left ear for the drive thru and one phone on my right ear talking to the insurance. Here is how the conversation goes:

Insurance: "The Dr. will need to call back and let us know that he has tried generic Ambien."

Me: "The Insurance says Dr. needs to be more specific and tell them you tried Ambien."

Patient: "S***. I can't sleep through the d*** night without the CR. Tell him that."

Me to the Insurance: "Pt. says he wakes up in the middle of the night with just the ambien...."

Patient: "Let them know I've been on CR for over a year. D*** it, I switched insurance companies and the old one used to cover it. S*** they are just playing Dr."

Me back to the Insurance: "He has been on this for a while, what would be the copay if the PA went through."

Insurance: "$35"

Me: "sir, it is going to be $35 and I will get all the insurance stuff straightened out with the Dr."

I sure hope the Dr. is able to get that PA to go through.

I don't know what software you use, but where I worked, we used ComputerRX. There was a spot on the edit (F 11) screen where you could put in an IOU (or any message) and it would pop up everytime that rx number was opened, until it was deleted. We would simply mark in this box that we loaned 5 pills or whatever, then when we got the refill ok back from the doctor, we pull the number up to renew it, and the box would pop up. I hope that makes sense.

 

[OUTexan]

That definately makes sense, but the CVS software isn't that advanced. We still have to keep tons of paper around. I figure if corporate can give away $30 gift cards left and right, then we can give away a few atenolol here and there.

 

[alwaystired]

That definately makes sense, but the CVS software isn't that advanced. We still have to keep tons of paper around. I figure if corporate can give away $30 gift cards left and right, then we can give away a few atenolol here and there.

We can't keep track either....and do the same.

 

[sdn1977]

My routine is - I never advanced controlled drugs. I don't care how much you hurt, how badly you sleep - go to the doctor & get the rx. You're a grown up....act like one. I've got quite a few "doctor shoppers" and they don't get anything out of me, but then....I've had the state board in looking at records. So, once bitten, twice burned. My pain patients are very well cared for & never, ever run into this.

If its a matter of a PA - they can buy it & I'll reimburse when the PA comes thru. Six times out of 10, the PA is denied - problem solved! They can buy as little or as much as they want & I'll apply it toward the PA when it is approved, but it usually isn't.

If its a matter of no refills - 9 times out of 10, the doctor won't OK it until the pt comes in. They usually need an appointment or need to do that labwork which they should have done 2 months ago. Yeah - I get no end of *hit on the phone.....but, its not my problem they are going to a prescriber who requires $$$ for rxs - my "pain" patients (one of whom spent the weekend in the jail - I know - I gave them info Friday night!).

For routine maintenance medication, I'll advance 3 days worth....depending. I have 3 physicians I know of who are absolute p*icks - they won't give me an rx until they have the pt ranting & raving...even after I've requested 4 times. Too bad! You choose to go to a guy like that - you get what you get.

If the albuterol rx is over 1 year old & there is a good hx of filling - yeah, I'll advance an albuterol. But, more often than not, the albuterol was filled once - 15 months ago & now the school needs a current rx. No - your kid needs to go to the dr - for lots of reasons beyond just the albuterol!

I will always give a bottle of 25 ntg tablets - no question. Ditto for an epipen.

I give away lots & lots of amoxicilin suspension for outpts when I work in my hospital at night or on holidays. There are very few rxs open & these kids have been in my ER for hours & hours. I just give it away free.

I don't worry about the $$$ - neither does my dop or dm, but I don't abuse it either (nor will I break the law - advance controlled without rxs!).

 

[Old Timer]

That definately makes sense, but the CVS software isn't that advanced. We still have to keep tons of paper around. I figure if corporate can give away $30 gift cards left and right, then we can give away a few atenolol here and there.

When you have a prescription that has no refills, the system places it in the QR and asks if you would like to make a voice call to the doctor or fax if there is a fax number on file. After you select this option there is an option to enter a comment. You have three lines of about 75 characters to type what you need. I usually place the following comment in the vain hope the MD or his/her staff will notice the patient is out of medication:

Patient is out of medication.
Gave 3 No Charge.
Please expedite your response.


This will print on the fax that goes to the doctor and when the call comes in and you generate the prescription out of the QR, it will print on the paper you use as an order. The person who types the prescription and the person who checks the prescription should be able to catch the comment and you can deduct the tablets/capsules you have advanced.