“Catch of the Day” or what we do behind the scenes!

These are arranged from newest to oldest

06/14/2016

I was paying for my lunch the other day and it hit me when presented with the bill the old saying ” There’s no free lunch”  

Well awhile back  we had a prescription sent into us from an off island Dentist for a special prescription fluoride toothpaste, yes there are such things.  They’re not real expensive and some of them have generic forms that are less costly.  In this case there wasn’t a generic, but even so without insurance it would have been less than $20.

However in this day and age over 90% of patients have prescription drug coverage, and even if the patient doesn’t have dental insurance they still have prescription coverage.   Anyway on with the story, the prescripton sat here in the pharmacy for the 10 days the insurance companies allows before we have to reverse the billing, but before we did reverse it, we called the patient to remind them we had it, thinking they might have forgotten about it.  The patient said they were sorry but they bought it from the Dentist, because the young woman at the office told them it wouldn’t be covered by their insurance, and it was only $19, which she then paid.  I wonder how the young women knew it wasn’t covered by the insurance, since we usually don’t know what is covered until we electronically submit the claim to the insurance company.  I told the the patient her insurance did cover the toothpaste and it only would have cost her $1.00 on her insurance…. this is the tie in to my opening “free lunch” line, because this would have bought the patient lunch.

Back when I was in my teens first working in a Drug Store there was as system for the clerks call “PM’s”, which I don’t remember what it stood for.  The system worked like this.  Sometime there was a brief employee meeting where the clerks were shown certain items that if they sold them they would get points for PM’s, items such as special vitamins, etc.  At the end of the week each clerk would tally up their PM’s and get a few dollars for what they sold.   I’ve seen this same type of meeting at Wal-Mart, it’s pretty demeaning to the employee’s in my opinion, much like a High School pep rally, rah-rah, lets go out and sell some shoes, or in this case toothpaste.

I had hoped this uninformed young woman at the Dentist on the mainland was just uninformed and not working for PM’s, but just to be sure I think I’ll call and let that office know these type of products are usually covered by insurance, at least for the 90% of those patients  that now have insurance.

01/06/2016

This is a true story, just happened today. A patient who had been using a mail order pharmacy provided by our local Seattle based CO-OP that just decided to merge with another HMO decided to have us fill their 3 bottles of glaucoma eye drops.

The mail order pharmacy had been giving them brand name eye drops, probably because they usually get a huge rebate from the manufacturer, anyway it cost the patient $200 for 3 bottles.

We filled it today with the generic for…….wait for it … $30, and this will happen every 3 months.

We’ve got your back Lopezians

12/11/2015  So right when we opened today at 9 AM a patient of ours was waiting for us to open, she spoke to Rick about a sore neck she was having and it was obvious she couldn’t move it much.  After more questions and more answers from the patient Rick picks out a Thermofore Neck Heat wrap for quick relief, but then he thought let’s get a second opinon, plus she’s going to need help getting the pad on, so let’s have Marge hear her problem.   So Marge took her into our consultation booth and help her get the pad on and then asked some more questions.  She found out that the patient had a 11 a.m appointment at the clinic to be seen, it was the soonest she could get in.  Not liking what she was hearing from the patient Marge called the clinic and spoke to one of the nurses and suggested the patient be seen ASAP, so the patient went right over to the clinic got seen, and guess what, signs of a heart attack.   A short time later with our records faxed to St. Joseph’s cardiac unit the patient was airlifted off.  

11/30/2015  So the other day we were talking to a new patient and in the papers they gave us there was a old receipt for a medication they picked up at a big box pharmacy I was just about to put it with the other papers with I noticed the line that said the following.

“Call your Doctor for medical advice about side effects.”

We encourage our patients to call us with questions about their medications, and hopefully they receive enough counseling before they leave the pharmacy so they will understand their medications  right there and then, but if not they can certainly call us back.

10/29/2015  Most of our tourists have left, but occasionally we still see a few.  Today a retired Dr. came in with his 50 ish son.  The son had ran out of his two blood pressure medications and needed us to help him out.  First the son was lucky in that his father was able to write two new prescriptions.  Had the father not been able to help the son, we might not have been able to either, you see the two prescriptions were from a mail-order pharmacy, and they are impossible to talk to if you need a prescription transfer.  So we filled his two prescriptions, and because both of the prescription were new to us we treated them as if the patient had never taken them before.  During our counselling on the new prescriptions we mentioned a side-effect, a low grade tickle cough that happens from time to time.  After we were done the patient said he had been on these medications for a number of years and NO one had ever told him about his medications and the side effects.  

Sad to say this happens quite a bit.  In closing on the news this morning they were interviewing a aviation specialist about a plane that caught fire on the ground. Seems the airline was a new discount airline with a total of 6 planes.  The specialist commented that these discount airlines usually do more than just discount the price, they also discount the service on their equipment.  It’s the same with mail-order pharmacies, but they don’t just discount the service, they eliminate it.

08/30/2015  August like most of the summer months was a busy one in the pharmacy our ability to diagnose, treat and prescribe was very popular, it’s called a CDTA.  Seems that Urinary Tract Infection happen late on Fridays.  Read more about how we can help you.

08/07/2015 Why we ask what medications you are taking.

Today’s head scratcher……..when visitors get an Rx filled while here, we always ask for a list of their other medications so we can check for drug interactions. About 25-33% refuse to give it, or will only give a partial list. Why risk a drug interaction? They often say, “My doctor knows.”

Well…….a man came in late today, and said, “You helped me out when I was here 2 yrs ago. I was sick and my doctor sent in an Rx for an antibiotic. You caught a potential serious interaction with my anti-arrhythmia medicine and called my doctor. He changed the medicine. I just wanted you to know how impressed I was and that I appreciated it.”

So if a pharmacist asks for your med list, please give it to him/her.

08/05/2015 When we see patients and prescribe medications per our Washington State approved protocols we collect a ten question survey at the end. These are some of the comments from these services.

“I was absolutely thrilled that this service is available on Lopez! Wonderful!”

“I have so recommended already. Also the “much worse” is my perception of what I would end up paying after Aetna adjudication of encounter at the clinic. Aetna’s unwillingness to reimburse for a superior delivery method of health care is indicative of BIG Health’s resistance to America ever getting a real health care system like France, the rest of the EU and a lot of the rest of the world.”

“As usual, Marge and Rick McCoy (owners and pharmacists) went above and beyond. they seem to find a way to make every customer/patient feel like the top priority even when the need is unexpected and they are busy and other customers/patients are waiting.”

“The service I received was caring, kind, and competent. The results so far are excellent.”

“Great compassionate care. I felt I was in good hands. The Pharmacist explained things clearly and showed my how to wrap and care for my burns. He was concerned about my allergy to tetanus and recommended that I see an allergist to determine if this was still the case (suggesting the tetanus compounds may have changed since 1976).”

“I appreciate Marge McCoy so much for taking care of me today. She came in on a Saturday morning and gently and carefully took care of my issue – shingles! She filled the prescription and recommended a lotion to ease the discomfort. My gratitude knows no bounds. This is a fabulous service and more people should be made aware of it.”

“Our Lopez pharmacists provide A+ service. They’re not the reason I moved here but they are definitely one of the reasons I’ve stayed. I’d choose them over waterfront property every time!”

07/30/15 Adventures in Paradise, sometimes it seems commonplace to us that many visiting our little corner of paradise seem to forget their routine health care until they realize that we are isolated. Dozens of times each week we seem to have any number of visitors seek our help, sometimes minor things, bump and bruises. Sometime major medication errors or worse no medications at all. Yesterday a young person presented with a bee sting, actually about the 4th one of the day. He took our advice and took some generic Benadryl and which point he admitted to being fairly allergic to bee stings in the past. In fact he had been prescribed and Epi-Pen for life threatening reactions. However he left it back home. He decided to sit in the pharmacy and cool down while waiting for his friends and seeing how he would do after taking the Benadryl. Well one thing lead to another and his reaction to the sting got worse. Marge then took over and quickly did a CDTA intervention and got him a new Epi-Pen which he administered right then, as well as some other medication. After sitting in the pharmacy for about an hour he decided he was good enough to cycle off and try to catch the ferry. He had about a 20 minute head start when we decided to follow us course to the ferry and just make sure he got there. Happily all was well and he arrived just in time to make the ferry with his friends. Just another day in paradise.

06/03/15  Helicopters and your healthcare – When you see the helicopters come and go on Lopez there are lots of things happening before they get here and after they leave.  First it’s not like the TV show M.A.S.H. where the helicopter lands and the patient is rushed into the helicopter and off they go.  First before the patient leaves Lopez there is an orderly hand off of his care and the patient is usually stabilized first.

What we do as soon as we know a helicopter is coming is to find out who the patient is, then if we have pharmacy records we quickly get an updated list to the clinic so they can give a copy to the flight nurse on the helicopter.  Then we also send a fax of the patents records directly to the emergency room of the facility they are flying to.  We have a list of all the faxes at all the hospitals we usually send patients to.  

We did this twice on Wednesday before noon.

06/02/2015  Using our CDTA (Collaborative Drug Therapy Agreement) 15 minutes before closing, and after the clinic was closed we treated a 2nd degree burn patient.  Diagnosing the burn and prescribing the appropriate prescription burn cream.  Everyone involved came away happy.

06/01/2015  We’ve started a program to heighten awareness of the dangers the mail-order pharmacies present, not just on a patient care level, but also on the dire situation their aggressive and questionable business practices cause us and our very ability to stay in business.

Here is just one example of what they do to a patients pocketbook, and the patient doesn’t even know it.  

We had a patient want to start getting their medications from our pharmacy instead of a mail-order pharmacy.  The patient had a $10 co-payment for their prescription and that is what they were paying at the mail-order pharmacy.  Now a little know fact is that on very inexpensive medications the mail-order pharmacy will reduce the $10 co-pay when we filled the the exact same prescription, in this case they reduced the patients co-pay by about $3.00, so we collected around $7, but when this same patient got the same order with the mail-order pharmacy they were charged the full $10.  

Now if we made an extra $3 on everyone of these prescriptions it would impact our financial health greatly.  So the bottom line is that this mail-order pharmacy charges the patient more and pays us less, hurting us on two fronts.

It will be interesting when we show the patient how they have been treated from the mail-order pharmacy.

05/07/2015  We have had some publicity as of late about how much patients using mail-order pharmacies has affected us, and our ability to keep the doors open.  Today a nice gentleman came  in and heard we needed some help in this regard.  He had a number of prescriptions and wanted to know how much they would cost him from us.  When asked this question we first need to know if there is any insurance, which he did have.  We knew his insurance very well and knew the price we would charge would be determined not by us but by the insurance company.  We also knew that our price to him should be exactly what he was paying elsewhere, at least within a few pennies. 

He never really understood why we couldn’t give him an exact number without getting some more information so we could submit it to his insurance, he told us that he gets a statement every month that shows the retail price from his current pharmacy, which we tried to tell him that often times that number is a made up number, much like the sticker price of a new car, and that it had no bearing on what he was ultimately charged.  Most insurance companies don’t care what amount we bill for, because they are going to pay what they want anyway.

When he left we knew he wasn’t satisfied with our answers, we think that since we couldn’t just provide him what his price would be right away, and how what we bill for has no affect on what he would pay,  he might have thought we were trying to evade what he thought was a simple question.  In reality we can’t give a quick answer in many cases and we need to explain how insurance billings work.

05/07/2015  A younger patient on Lopez has a chronic condition that can be hard to manage, in fact a recent flare-up hospitalized this person for quite sometime.  When they were released from the hospital they had a prescription for a specialized medication that the insurance did not cover.  We filled out the prior authorization and sent it along with 16 pages of supporting documents to the Dr. in Seattle.  They in turned filled out the rest of the prior authorization and today we received the approval.  Over $700 worth of medication we got covered. 

05/01/2015 Thanks for the kudos

In the last “Health Matters” newsletter there was an article on the pharmacy and how hard it is just to stay afloat.  One of our wonderful patients wrote this letter and sent it to one of our local papers.

A letter to the editor about the pharmacy

 04/30/2015  “It puffs no more”

A patient who for years has used an Albuterol Inhaler brought the unit back to us in hopes we could get it to work.  Marge tried all the tricks she knew, but to no avail, it was just a defective unit.  We quickly gave her a replacement at no cost, but then the fun begins.  Marge called the manufacturer to report the defective unit, and get a replacement for the one we gave the patient.  Now you can get me pretty fired up fairly quickly, but if you can get Marge fired up and angry, well you’ve done something.  The customer service ( or dis service) agent proceeded to argue with Marge and told her she didn’t know what she was doing.  As I’ve said many times Marge has forgot more than most people know about many things, this matter in particular. 

After about 15 minutes of a heated discussion with the manufacturer she finally hung up.  Not to let this slide Marge then looked up emails for the CEO and others in the company and fired off a letter of complaint.

Well the next day she heard back from the company and guess what we got a replacement,  and then found out the person Marge was arguing with had only been with the company a few weeks.

What these companies fail to realize when we make a product complaint is that we’re actually doing them a favor.  The ultimate course for a defective product or drug is to report the problem to the FDA, which we’ve done before.  Once we made a similar complaint and report to the FDA, and the company had to pull all their product from every pharmacy in the country. 

I got it, you take it, it’s mine!

04/27/2015 An insurance company decided to quit paying for a certain medicine for diabetes. One patient that had been well-controlled for many years on this medication was forced to switch meds. We tried to get a Prior Authorization, but it was denied. The patient decided to stay on this medication and had to pay for it himself.

Here comes the head-scratcher. Today this patient received a letter from his insurance company saying: “We noticed you are overdue to get your diabetes medicine. Taking medication properly is part of good health care.”

I don’t make this stuff up.

You know who they call when they really have a problem

04/19/2015  Sadly this is somewhat typical of handling emergencies after hours, in this case on a Sunday. Patient has an emergency in which they call 911, nothing wrong with that, however after the EMT’s reach the scene and speak with our Dr., then the Dr. calls us at home.  We have no problem with being called at home, what is a hard nut to swallow is when the call is for a patient that appreciates our service so much they continue to get their regular medications via mail-order, go figure!

 

The Bare Foot Pilgrim

04/15/2015 “The Bare Foot Pilgrim”  I once read an article about car salesmen, when they had a customer walk into the show room and pay full sticker price for a new car, they’d call that customer a “Bare Foot Pilgrim”, now what does that have to do with prescriptions.  In the 03/25/15 post below we mentioned how easily you can be taken advantage of when using an off island pharmacy.  This story will make you hair curl….

A patient from Lopez was vacationing in California and left their headache tablets at home, a generic medication.  This drug has been available as a generic for several years now.  The patients insurance company limits how much headache relief the patient can have in any given month to 12 tablets, nice of them isn’t it.  Anyway back to the story.  So they looked for a pharmacy around them and went into a Walgreen’s.  The Walgreen’s called us to get the prescription transferred, which we did, this kind of stuff happens quite often.  So later in the day the Walgreen’s called us back to tell us they were giving us the transfer back because the patient didn’t want the medication after all, the Walgreen’s told us that Walgreen’s didn’t accept the patients insurance plan down there and it was too expensive, and the patient refused to get the medication,thus they gave us the transfer back.  

When we heard this we bought the part about their insurance not working in California, you need to remember that some insurance is local or regional in nature and just doesn’t work everywhere.  The part that made all of us gasp, was the part about it being too expensive.  We knew the cost of the medication and for a patient without insurance we’d have charge around $45-50 for the 12 tablets.  Now seat backs in the upright position and tray tables up, we’re going to experience some turbulence.  The Walgreen’s charge to this patient without insurance remember was 

$460.00 for 12 tablets Walgreen’s vs $50 for Lopez Island Pharmacy

As we mentioned before most chain pharmacies will not let their pharmacist see the cost of the medication, so from their view-point the $460.00 is what it is,  they have no authority to over-ride the price and really have no skin in the game to take action to have management look at the pricing.

What more can we say….we don’t make this stuff up!

 

What me worry….Prior Authorizations

03/25/2015 Prior Authorizations OR how Insurance Companies limit care and create endless work for everyone in healthcare.  

So over the past week we had several patients have their regular medications denied by one insurance company or another because prior authorizations for medications they needed had expired.  The insurance companies latest attempts to NOT pay for medications is to require prior authorizations.  In the past we, the pharmacy, could do most if not all of the paper work required and get the medications covered.  Lately these insurance companies refuse to let us do the prior authorizations, instead requiring the Dr. to call.  Knowing full well that some Dr.’s won’t  or can’t call, then the insurance company wins.  When we did the prior authorizations we had a high success rate and they knew it, so they removed our ability to get the patients their medications.  

This week thanks to one of the nurses at our clinic we/she succeeded in getting several approvals, the really rotten thing is that these were all prior authorizations that had expired.  They should be a slam-dunk and easy to update, but the two she did took many days and many attempts.  Marge McCoy at the pharmacy today spent almost an hour to do one that we were allowed to do, which again was a renewal of a previously granted authorization.  Thankfully we keep all our worksheets and scan them in for later retrieval.  We had to pull up old documents that we had scanned, in order to get the approval granted again, had we not had these earlier documents Marge might still be on the phone.

Not the corner of happy and healthy!

03/23/2015   Don’t know exactly how to put this, but if you’re off-island and you need a prescription filled. be careful. If the pharmacy uses your insurance you and your wallet should be fine. But we just had another horror story over the weekend where a Walgreen’s didn’t accept the patients insurance.

The warning is this, without insurance you’re in the cross-hairs of getting charged a huge amount. In this case even without insurance we’d have only charge around $29. I don’t have the exact number, but  the Walgreen’s charged this patient over $100.

So if your insurance isn’t accepted or  the pharmacy is having trouble with the insurance, get just enough of the medication to get you back to Lopez, where you won’t be faced with these ridiculous amounts.

There are some caveats to only getting a few days of medications, such as SOME controlled substances can’t be transferred to us, so ask the pharmacist if the remainder can be transferred later to another pharmacy?

Big Box Stores

03/22/2015 Sure it’s a Sunday and the pharmacy is closed, but life goes on.  We answered two emergencies today after our EMT’s and Paramedics were called out.   Try to get Costco, Wal-Mart or a mail-order pharmacy to do this.

03/20/2015 A couple of years ago we upgraded part of the pharmacy computer to help patients analyze their Medicare Part D Plans, which you must do every year.  We did a quick report of patients turning 65 and sent them a brief note telling them we can help.  Two of the patients called back and asked us to help them.  So Marge and I each did a quick report that shows what plan would cover their medications and at what cost.  Time spent 45 minutes.

03/20/2015  Prior Authorization or how insurance companies, delay and deny until you give up.  Today several times either Marge and I or one of our techs, Megan and Kaylee got on the telephone to try and get a medications covered for a patient.  Today in at least two of the cases these were medications that the patients were ALREADY on, but the authorization from the insurance company expired.  OK, I get that these authorizations can’t go on forever, but when we call to renew a prior authorization shouldn’t it be fairly straight forward.  Is the the patient never going to have gout again, or is this patients chronic conditions just going to go away?  But we jump through the hoops and try to succeed, which we do quite a bit of the time.  Time spent today on this 60 minutes.

 

Drug to Drug Interactions

 03/19/2015  We were sent Rx’s for a new patient today from an off island provider, one of their medications had a contraindication with another of their medications.  Marge called the Dr. and got the medication changed to a safer alternative.  Later on she found out the the patient had been on this combinations for quite sometime, this was a textbook no-no and should have been caught ages ages, I guess someone was not paying as close attention as Marge.  Time Spent about 45 minutes.

03/17/2015 – Yesterday a patient who used to live on one of the other islands called us.  She spoke with Marge about some concerns she had about a relatives medications.  Now the person calling is not a patient of ours currently, but Marge took the time to listen to here concerns, and then Marge got a list of all the medications that this other person was taking.  Marge stayed after we closed for a good 30 minutes researching all the issues with the drug mix she was presented with.    After getting all the facts she could, Marge called the person back and went over all the issues.  Total time about 1 hour.

03/16/2015 – We received a written prescription from an off island prescriber where the mg dose was not as clear as we’d like, faxed off a medication clarification form to the prescriber just to be sure.  AFTER hearing back we filled the medication with the now confirmed dose.  Tablets were physically huge so we spoke to a family member and changed large tablet to two smaller ones, now not so hard to swallow.

03/16/2015 – BEFORE doing a number of vaccinations today we checked each and every patients on-line vaccination record before preceding, time taken-about 5 minutes per patient checking and another 5 minutes each to log the vaccinations we gave in their on-line records.

03/16/2015 – A patient had been getting a certain medication covered by their insurance, but now for some reason it wasn’t being paid for, and it is VERY expensive.  A quick check of our cheat sheet on who, what, or where to try and fix this had a happy ending.  Total time about 15 minutes. The score is patient 1 insurance company 0.

 Don’t break these tablets!

03/12/2015 – A mainland Dr. wrote a prescription for a time-release pain medication for a regular patient.  He wrote the prescription for a strength that didn’t exist.  Had the patient been given the higher strength and told to break the tablet in half, a serious overdose would have occurred.  Remember while it maybe possible to break most medication in half…but NOT all medications should be broken in half!