What is the rate limiting step...

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

toxic-megacolon

Toxic Member
15+ Year Member
Joined
Oct 27, 2004
Messages
555
Reaction score
6
when you have a prescription filled. As an outsider, I'm so curious. I went to the Pharmacy to pick up my Restasis, and they told me it would be 30-40 minutes. I could see the box sitting up on the shelf and wanted to grab it myself! But in general I've found this is the wait time (even longer in hospital pharmacies). Obviously you can't go to Best Buy or McDonald's and pick out your merchandise and have to wait that long. What part of the transaction takes the bulk of the time? Waiting for insurance approval?😕
 
when you have a prescription filled. As an outsider, I'm so curious. I went to the Pharmacy to pick up my Restasis, and they told me it would be 30-40 minutes. I could see the box sitting up on the shelf and wanted to grab it myself! But in general I've found this is the wait time (even longer in hospital pharmacies). Obviously you can't go to Best Buy or McDonald's and pick out your merchandise and have to wait that long. What part of the transaction takes the bulk of the time? Waiting for insurance approval?😕

The inability to prioritize or the total lack of common sense?
 
Well, it takes several minutes (2-5) to fill an rx. New, refill, E-script. So it's pretty easy to see how it piles up. Even w/o distractions or issues it's easy to get behind. Unless you are working there you have no idea what's going on. It's not like Wendy's where I can have 50 baconators ready for the lunch rush.

And if you happened to have said "well it's already in a box and I see it" The 40 minute wait was punishment for you being a D
 
Well, it takes several minutes (2-5) to fill an rx. New, refill, E-script. So it's pretty easy to see how it piles up. Even w/o distractions or issues it's easy to get behind. Unless you are working there you have no idea what's going on. It's not like Wendy's where I can have 50 baconators ready for the lunch rush.

And if you happened to have said "well it's already in a box and I see it" The 40 minute wait was punishment for you being a D

At least that makes sense. I like how its quicker to diagnose the disease than to dispense the medication. And I think I'm going to get a baconator now, so hopefully they will have some Lipitor on standby for me.
 
Ive never waited longer than 10 minutes. If a store tells me it's gonna take longer than that i'll just drive down the road to one with a shorter wait. In my experience, HMOs always fill in under 15 minutes, at least in my hometown (small city). I was not curious WHY it took so long , in my earlier post -- more curious about what the most time consuming step is.
 
At least that makes sense. I like how its quicker to diagnose the disease than to dispense the medication. And I think I'm going to get a baconator now, so hopefully they will have some Lipitor on standby for me.

OK. You have ten people coming up to you at the same time and asking you to diagnose them all at the same time, and someone else to get a second opinion and verify the diagnosis, all this in 2-5 minutes altogether (not per person). Go.

Keep in mind that pharmacists don't just scan the drugs to verify but also check interactions and do have to call the doctor once the doctor screwed up the Rx (they're not gods, you know).
 
At least that makes sense. I like how its quicker to diagnose the disease than to dispense the medication. And I think I'm going to get a baconator now, so hopefully they will have some Lipitor on standby for me.
Great. Doctors don't have to produce anything tangible other then a script they scratch down so fast he can't even read it. Pharmacists have to deal with limitations of how quickly a human can move to produce the finished product, whereas doctors have the advantage of near instantaneous mentally processed diagnosis.
 
I realize that the question sounded troll-like, for that I apologize. I really was just curious which specific step took the longest. Sheesh.
 
I realize that the question sounded troll-like, for that I apologize. I really was just curious which specific step took the longest. Sheesh.


I don't think any one step universally "takes the longest." There are numerous variables and it can depend on anything from the medication in question, the customer, the insurance, the doctor, the queue, the # of phone calls, etc. What takes the longest for one script may or may not be the same for the script before or the script after.
 
See at McD if you have 5 people in front of you, they all move at the same speed forward. Order...pay cash...step to the side...get order.

At your local pharmacy, the 5 people in front of you will be like as follows:

1) One Rx, quick and easy, insurance works and adjudication is quick.

2) 3 Rx's, pt is on state assistance and one requires an override...that eats up 5-7 mins of the tech's time (at the least).

3) 3 Rx's, quick and easy.

4) 2 Rx's, MD screwed it up, gotta call to verify (missing a signature, wrong units, whatever...).

5) One Rx, but pt has new insurance or some goddamn coupon card to punch in.

That's on the drop off side. On the production line with the tech filling it and the pharmacist verifying it, here's what can eat up time.

1) Phone calls.
2) Phone calls.
3) Phone calls.

At CVS, phone calls fell to the person filling, so if a call came in, production stopped or fell entirely to the pharmacist to fill + verify whereas they were simply verifying it before. This part is quick.

4) Problem with prescription, DUR/interaction/etc...

These happen now and again...med/dose is inappropriate so pharmacist halts its progress and sends it back/makes a note to contact the physician. Pt needs to be alerted as well that their med won't be ready.

After that....cash register (outside the purview of your question, but i'm adding it anyway...

1) Line
2) n00b clerks not knowing where things are.
3) n00b patient that is taking up the poor clerk's time asking ******ed questions.
--> Actually, this last bit should be in part 1 as well. People are dumb.
 
I guess I should answer the question even though this is a troll looking to stir up trouble. The rate limiting step is the other 16 idiots who dropped off prescriptions in the 15 minutes before you dropped off yours. You don't see them becuase they are all wondering around the store mumbling to themselves about why it takes so long to fill thier prescription when no one else was there when they dropped off.
 
In my experience when I worked at WAG, the rate limiting factor was the IQ of the clientele. When you gotta call 1800-MEDICAID, get a PA, put in a coupon they didn't give you when they dropped off, hand you a zip-lock bag full of bottles and say "I'll wait", etc., that all tends to limit my ability to pump out scripts.

In the hospital I work at now, the rate limiting step is MUCH more simple. ******* residents 👍
 
when you have a prescription filled. As an outsider, I'm so curious. I went to the Pharmacy to pick up my Restasis, and they told me it would be 30-40 minutes. I could see the box sitting up on the shelf and wanted to grab it myself! But in general I've found this is the wait time (even longer in hospital pharmacies). Obviously you can't go to Best Buy or McDonald's and pick out your merchandise and have to wait that long. What part of the transaction takes the bulk of the time? Waiting for insurance approval?😕

One other issue not mentioned is the result of all those phone calls. Prescription call ins, transfers, fax requests, e-requests.

I've walked into our pharmacy, before it's even opened, and have at least 30 rx's waiting to fill with noone in line. The were faxed in, phoned in, or e-prescribed after closing by patients, student health, hospital discharges, etc. Hence, you walk in, first person in line, it's still at least 30 minutes because all those people you don't see are still in front of you. Not to mention all the other stuff people have mentioned.
 
I disagree. You can go McDonald's and there can be 30 people in line, yet it doesn't take them 40 minutes to make your burger. My prescription was already called in, and actually already in the system, and I was the only person in the pharmacy.

I guess the difference would be that the kid at McDonald's doesn't have to check your meal history and then make sure that your Big Mac doesn't produce reactions with your Biggie fries.

He also doesn't have to call and convince your insurance company to over-ride your order because you've already had a value-meal filled at the McDonald's across town earlier that week. :laugh:

Cheers
 
Pharmacy gets backed up the same reason why doctor's offices do. Patients pile up. That's simply not the problem, although its one reason. The bigger reason, I feel, is because each patient has some sort of problem we have to deal with.

In a clinic, a doctor will be scheduled to see a certain number of patients. It's so easy to get backed up when a patient has some complex problem, which happens a lot. Same with the pharmacy. How many scripts do we get? Like hundreds a day. This is hundreds of medications for possibly hundred of people a day. Making one insurance call can take up to 20 minutes some days. Then there will be problems with certain prescriptions, or things that don't make sense. Then you have to deal with patients/customers and talk to them and help them. That's why people wait 30 minutes to an hour for an Rx.

If you want your prescription faster, go to a pharmacy that does not get a lot of business. You will get the same quality of service (hopefully).
 
If you want your prescription faster, go to a pharmacy that does not get a lot of business. You will get the same quality of service (hopefully).

Less business = less staff, you might get lucky one week but over time district managers will notice the drop in script count and cut staff accordingly.

Better yet show up with low expectations... get your prescriber to transmit electronically/by fax and call 2hrs later and tell them you're coming in and to get your script typed/adjudicated.
 
I disagree. You can go McDonald's and there can be 30 people in line, yet it doesn't take them 40 minutes to make your burger. My prescription was already called in, and actually already in the system, and I was the only person in the pharmacy.

this just shows the idiocy of the masses.

Pharmacy isn't fast food. Fast food can be pre-made, and doesn't require a 4 years post-graduate degree, or insurance, or verification, dosing instructions, prior authorization, or patient educations.
 
I am on a rant right now, primarily because I am in my last week of a three year journey working at CVS as slave-ition.

Our store is moderate in volume, averaging 250 a day with 350+ mondays (mondays always suck).

We are budgetted one pharmacist a day, no overlap.
We are budgetted one tech from 8 to 1
At 1, overlap begins until 5 when morning tech leaves and 1 oclock tech works until 9.
We also have 1 intern each day which works a 2-7 shift.

Thats it, all our staff. All the staff we're budgetted, because if we were alotted more hours, we'd definitly hire.

My typical day at CVS
Walk in the door quarter till 8, log in all computers, do some fast cleaning and restocking, etc.

By 8, we open and line is there, plus we already have two pages on queue of overnight refills and ready fills. Not counted are the 4-8 on E-Script and the 3-10 pages on fax.

As a seasoned tech, I pump out around 80 scripts an hour barring any big stops such as Prior auths and non-overridable DUR rejects from insurance. However I tend to encounter two - four of these an hour which cuts my efficieny to about 50-60 and hour.

9 O'clock rolls around and morning rush slows, start catching up on ready fills. But oh crap! PCI calls need to be printed and started, 14 day return to stocks need to be done, yet we still have two pages on queue do to phone ins, e-script, and drop off.

spend next few hours slaving away

11 o-clock rolls around we seemt o be caught up on queue, but havent made pci calls yet, but being the start of lunch hour, we get slammed. again. (reminding you just 1 tech and 1 pharmacist to run drop off, drive thru, in store pickup, typing and production).

1 o'clock appears all the sudden in a blur and still behind on queue, no lunch break yet, people still breathing down our necks and in a flash of glory, the overlap arrives! Huzzah!

130, take a 5 minute lunch break which turns to an hour due to the every 15 seconds having to stop and answer phones, etc...

300 rolls in, sitting at about 170 scripts done, evening rush kicks us into overdrive. Typically have between 50 and 70 scripts come in in the next two hours, yet the 5 oclock pick up madness begins as everyone gets off work and the morning tech goes home.

madness insues until 8'ish at which time we are caught up, finish return to stocks, cycle counts, out of dates, catch up the CII log, finish majority of PCI, and other misc non-patient stuff.

930 last minute rush and get stuck until 1015 in which we close and are out by 1030...

Story of my life.
 
Our store is moderate in volume, averaging 250 a day with 350+ mondays (mondays always suck).

We are budgetted one pharmacist a day, no overlap.
We are budgetted one tech from 8 to 1
At 1, overlap begins until 5 when morning tech leaves and 1 oclock tech works until 9.
We also have 1 intern each day which works a 2-7 shift.

Thats it, all our staff. All the staff we're budgetted, because if we were alotted more hours, we'd definitly hire.

That is f-ing horible! Why would anyone put up with that? That is unsafe and dangerous. What a ****ty company!
 
No fast food jokes. You have no idea of how many I hear at the drive thru. "I need to pick up my prescriptions.....oh! and can I also get a side of fries with that har har har???" gets old for the 100th time.

It takes a long time at the pharmacy because the pharmacist is the rate limiting step. There is only ONE on duty usually. If you go to Wendy's they can multi-task and do multiple orders at once. Think of it this way. When you go to the airport, it takes 30 seconds to walk through a metal detector right? Then why is there sometimes 30 minutes to 1 hour lines to get through security? Because each and every person has to be examined individually.

I have also rounded at a doctor's office. Average time the doctor spent with the patient was maybe 10-15 minutes. But it wasn't unusual for some patients to wait 1 - 2 hours. Why? B/c while the doctor was seeing that one patient, there were 5, 6, or 10 patients waiting to see that doctor. Or something serious takes up the doctor's time and everything gets behind.

Pharmacy is the same way. The pharmacist MUST look at every single prescription and every single drug on that rx and verify it. He MUST look at everything on the prescription and verify everything is accurately typed in - the doctor who wrote the rx, the phone number of the dr's office, the drug, the strength, the sig, the date, the name of the pt, etc. He has to make sure it is within the scope of practice of the doctor. He has to make sure the RX isn't expired. Then when the medication has been filled, the pharmacist again has to verify every prescription is filled accurately, one by one. If you don't think that's important? I've seen a script written for Coumadin 5mg #30 - take one tablet by mouth every HOUR. That surely would have killed someone.

Another reason is because pharmacys are most likely short staffed. At my work, there are 2 techs on duty and 1 pharmacist. When 1 person leaves to go on break or gets held up by a needy customer, that leaves only 2 people to do all the pharmacy duties. Here are just some of their duties:

1 tech responsible for filling, typing scripts, answering phone calls, resolving insurance issues, maintaining the filling machine. Phone calls are the major thing that will get this tech behind. Working with insurance and getting claims to adjudicate is also another time crunch. Unlike medical, pharmacies have to adjudicate before the script is sold.

The other tech is responsible for ringing up customers, drive thru, maintaining the OTC shelves, filing the prescriptions. Not everything goes smoothly. Insurance usually like to play games and do everything in their power not to pay. Guess what? When something isn't going through and the patient is right there waiting to pick it up, the tech has to fix the problem. Ringing up people isn't normally a problem, but when masses of people come, it is a problem. My pharmacy sells about 300-400 scripts in an 8 hour day. Now, each tech has to take a 30 minute lunch, leaving only 1 pharmacist, 1 tech on duty. And on top of that, 3 register drawers have to be counted by the tech and double counted in front of the tech by a manager before the pharmacy closes. 1 register takes about 5 - 10 minutes to count. So when there's only 1 pharmacist and 1 tech on duty, things get behind.

Now, the pharmacist has to verify each script that is scanned in and typed by the tech. He also has to verify the actual product after the tech has filled it. He has to address interactions that the computer alerts to. He has to handle transfers, take in new phoned prescriptions, call doctor's, and make sure the tech's aren't selling the wrong drug to the wrong patient. He also has to deal with the drug addicts that are demanding, yelling, and cursing for their narcotic prescription to be filled 2 weeks early. He has to deal with customers who are threatening the pharmacist that they will report him to the board of pharmacy because their insurance won't pay for their Brand-only prescription or that their co-pay is $50 and not $5 (while their insurance paid $350 of the prescription). Now the pharmacist also has to answer questions by customers and give flu, h1n1, and pneumonia shots. The pharmacist also has to check off that he has counseled each and every new prescription - either the patient accepted the counsult or rejected it.
I am sure I missed a lot of things. Even if you are the only one in the waiting room, there may be 20 - 30 other patients who said they would be coming in to pick up their script in the next half hour and they all have to be filled and ready.

Oh yeah, and the pharmacist also has to deal with corporate reports - calling pt's, making sure inventory is counted, file DEA 222 forms, file all the RX's in order, etc.

Next time you are at your physician's office and have to wait 30 minutes or more. I dare you to tell him, "What's taking you so long, doc?" with a look of disgust, "Does it really take that long to talk to a patient and tell him whats wrong with him??"
 
Last edited:
Next time you are at your physician's office and have to wait 30 minutes or more. I dare you to tell him, "What's taking you so long, doc?" with a look of disgust, "Does it really take that long to talk to a patient and tell him whats wrong with him??"

Next time I go to the Doctor and it is 45 minutes past my appointment and I haven't been seen I am saying this! I like it. Or better yet I will ask the Doctor what the rate limiting step is for seeing patients....
 
Next time I go to the Doctor and it is 45 minutes past my appointment and I haven't been seen I am saying this! I like it. Or better yet I will ask the Doctor what the rate limiting step is for seeing patients....

I can give you a very concrete reason why that is. The rate limiting step is that we overbook patients in our clinic (i.e. schedule 3 appointments all at 10am). We can't be in 3 places at once, hence, people wait. I don't think that's right or fair. But that's the reason. I guess it is possible to answer a question like that without being offended (or insulting).
 
I can give you a very concrete reason why that is. The rate limiting step is that we overbook patients in our clinic (i.e. schedule 3 appointments all at 10am). We can't be in 3 places at once, hence, people wait. I don't think that's right or fair. But that's the reason. I guess it is possible to answer a question like that without being offended (or insulting).

You forgot to mention compensation and no-shows. In order to pay the bills, exam rooms need to be full.
 
No fast food jokes. You have no idea of how many I hear at the drive thru. "I need to pick up my prescriptions.....oh! and can I also get a side of fries with that har har har???" gets old for the 100th time.

how about a bank joke? my pharmacy is next to a bank and this old guy when he comes to the pharmacy he always passes by the bank and asks if they're giving out free samples
 
how about a bank joke? my pharmacy is next to a bank and this old guy when he comes to the pharmacy he always passes by the bank and asks if they're giving out free samples

Oh yeah, I know that guy.
 
I can give you a very concrete reason why that is. The rate limiting step is that we overbook patients in our clinic (i.e. schedule 3 appointments all at 10am). We can't be in 3 places at once, hence, people wait. I don't think that's right or fair. But that's the reason. I guess it is possible to answer a question like that without being offended (or insulting).

If I'm at the doctor's office and my appointment is at 3PM, I will arrive at 2:50PM, and if I'm not with the doctor by 3:10PM, I just tell them that I'm leaving. When that happens the doctor stops what he was doing and comes in to see me.
 
It's the fact that in reality there might be 40 prescriptions ahead of you, but those people aren't physically in line so you can't see them. Many people call prescriptions in ahead of time - there might be 60 in the queue first thing in the morning even in a really slow store. Plus sometimes people bring in like 10 or 15 prescriptions at a time - if someone (or even a couple people) like that gets ahead of you, it's going to be a wait. Or one person ahead of you has a drug interaction between 2 of their meds and the pharmacist has to call the doctor, or there are a ton of insurance problems to clear up, or there are suddenly 11 messages for the pharmacist to check and 14 transfers.... There's a lot of stuff that can slow things down even if YOUR prescription is easy to fill. And it doesn't matter if it's 300 tablets or one pack of birth control - the actual counting of the meds doesn't take much time. It's that whole taking turns thing.
 
If I'm at the doctor's office and my appointment is at 3PM, I will arrive at 2:50PM, and if I'm not with the doctor by 3:10PM, I just tell them that I'm leaving. When that happens the doctor stops what he was doing and comes in to see me.

I do this too. I decided to start doing it after i waited an hour once.

If you schedule an APPOINTMENT, it is the dr's personal and professional responsibility and courtesy to see you at that time. I mean, if you dropped off a prescription at a pharmacy and said you wanted it at 3pm in two days, and they didnt have it ready, what kind of freaking service would that be?
 
Dude, if you dont wanna wait, just go to an independent...takes me 5-10 minutes to fill 1-4 rx's...Now, independents are smaller, so they may not carry everything...but you cant have your cake and eat it too...when I worked for CVS, I had voicemails, consults, MD calls, checking...I had baskets up the ass to check...we have to get the rx's ready by a certain time...so just because you are the only one in line, does not mean that i am back there picking a wedgie..At my store today, i dont fill 500-600 daily, so i have time...u will get out quick...if you dont wanna wait...dont go to a chain...
 
Dude, if you dont wanna wait, just go to an independent...takes me 5-10 minutes to fill 1-4 rx's...Now, independents are smaller, so they may not carry everything...but you cant have your cake and eat it too...when I worked for CVS, I had voicemails, consults, MD calls, checking...I had baskets up the ass to check...we have to get the rx's ready by a certain time...so just because you are the only one in line, does not mean that i am back there picking a wedgie..At my store today, i dont fill 500-600 daily, so i have time...u will get out quick...if you dont wanna wait...dont go to a chain...

exactly. independents ftw, plus they have higher levels of service
 
when you have a prescription filled. As an outsider, I'm so curious. I went to the Pharmacy to pick up my Restasis, and they told me it would be 30-40 minutes. I could see the box sitting up on the shelf and wanted to grab it myself! But in general I've found this is the wait time (even longer in hospital pharmacies). Obviously you can't go to Best Buy or McDonald's and pick out your merchandise and have to wait that long. What part of the transaction takes the bulk of the time? Waiting for insurance approval?😕
Jump over the counter and grab that Restasis, why don't you. Then see what'll happen! 🙄
 
This is what I don't get, why do people want to wait for their medication? It astounds me. Even if I know that they are going to be ready in 15 minutes, I hate just walking around. Whenever I need to fill a prescription, I just drop it off, and come back like 8 hours later, or a few days later or w/e.

If you weren't admitted into a hospital, you don't need to start the medication the same day.
 
Top