Sunday, February 26, 2006

First time driving in NY

I had my worst driving experience yesterday.

Thy and me went to a live CE in midtown yesterday and after it's finished Simon came to pick us up. While we were going towards Penn Station to drop off Thy, Vincent called and Simon were talking to him on the cell phone. I was chatting with Thy and didn't pay attention because he always talked on the cell phone in the car and never used the speaker function (he didn't have a hands-free). Then when we were waiting at the red light 2 poilcewomen came up and told Simon to roll down the window. I was like "oh-oh" as I remembered Milady told me she had to pay $130 for the same violation. One of the policewomen asked Simon for his driver's license while the other walked around our car and inspect from the outside. When Simon told her that he forgot his wallet and didn't have the license, I was like, another "oh-oh". I started to calculate how many hours of OTs I've to work in order to cover the fines and the raise in insurance premium. The 2 policewomen stepped aside and discussed for a while, then they came back and told us we were fine to leave but never talk on the cell phone while driving again. That's like the biggest relief and we just couldn't believe it! But then when they knew that I had my license on me they told us to switch place, that means I've to drive on the busiest streets in New York at the busiest time and I was so nervous. All the taxi drivers around me were like flying and I could only go slow because I didn't know when will they cut in front of me. I didn't remember how I got to Penn Station but we switched place again immediately after we dropped Thy off.

Now I'm like we've won a $200 lottery, maybe we can buy a Tivo?

Thursday, February 23, 2006

10 misconceptions in the pharmacy

1. Doctors are on call 24/7, including Friday nights, weekends, Christmas day, New Year, etc. They never get off and are there to wait for us to call for refills or questions anytime. If we fax the doctor office for your refill, they're supposed to refill it within 15 minutes or the pharmacy should to call them every 15 minutes until we get a respond.
Truth: Doctors are human and have a life too. That's why there're emergency rooms and urgent care clinics for people with true emergenies but couldn't reach their doctor in time.

2. Anyone who needs a refill but doesn't have a prescription is entitled some free pills until s/he gets to see a doctor, whether it's for a pain killer, tranquilizer, birth control, emergency contraception, antibiotic, antidepressant, cholesterol.........
Truth: Believe it or not, patients have responsibilities, too. Everyone who claims that s/he takes good care of herself/himself should keep track of their doctor's appointments, number of refills, etc. All the information was printed on the label, the prescription number, no. of refills, and the expiration date. New technologies such as automatic refills and express pay also simplify the steps to get a prescription. If you decide to call in a prescription with no refill on Friday afternoon and find out that it hasn't been authorized on Sunday, you can only blame yourself.

3. Everything should be covered by the insurance, such as over-the-counter drugs, nutritional drinks, nebulizers, blood pressure or glucose machines, band-aids, diet aids, botox, smoking cessation products, and health food cook books.
Truth: If you or your employer pay a $1000 monthly preium for your health insurance, then all of the above will probably be covered.

4. Drive-thru is for customer convenience, so it's reasonable to ask for a 12-pack pepsi, box of ibuprofen, diapers, or to drop off the negatives.
Truth: If we have absolutely nothing to do, then yes, we can go out and get you a bottle of cough syrup, or something pharmacy-related. But diapers? films? diet coke?

5. Whenever there's a problem with a prescription it's the pharmacy's fault.
Truth: No, we don't get a raise by selling you the more expensive medication. Nor do we want to be yelled at. We don't get extra paid for calling doctors and holding for 15 minutes just to get the strength that was omitted on the prescription, or to change the antibiotic the patient allergic to. There are problems in the pharmacy that are not within our control

6. Pharmacists set the copay.
Truth: Your insurance company sets the copay. It's an agreement between your employer and the insurance company. It should be clearly spelled out in the contract and every plan is different. Do not call and ask for a price with insurance because we won't know until the prescription is processed. If we possibily know the all the prices of all drugs with all prescription plans, we are not pharmacists, we are psychics.

7. Pharmacists know everything, such as which shampoo is best for your hair type, if the South Beach diet is better than the Atkins diet, or what is the difference between the baby foods.
Truth: We can't possible know every single drug in the world, just as a doctor wouldn't know all the disease state or a laywer wouldn't remember every law in a law book. We can try to look up the information but don't expect us to tell you a definite answer right top of our heads. We're not trained to diagnose, neither. So don't come in and show us your arm/leg/back/scalp and ask "what is it?" Go to see a doctor and get a diagnosis.

8. You can return a medication whenever you decide to, even it's a month after it was picked up, for whatever reason.
Truth: The pharmacy cannot accept return of medications once it's out of the pharmacy. Once it's dispensed we have no control on its storage condition, and we don't know what has been done to it. We can't resell the drug and it has to go into trash. Not knowing the price is not an excuse - why would you pay for something if you didn't know how much it costs? Just tell us at the register that you don't want it and call the doctor for a cheaper substitution so you won't get charged and we can reuse the medication.

9. Filling a prescription only takes 10 minutes or less because it's just count and slap the label on the bottle. While this can be true in some cases, there're other factors that affect the time to fill an rx.
Truth: I can fill an rx in 5 minutes provided that 1) the computer is not in "downtime", 2) the doctor fills in all the necessary information on the rx, 3) we have the medication in stock, 4) there's no interaction with other medications in the patient's profile, 5) the insurance covers this medication, 6) you're the only customer in the pharmacy (waiting or non-waiting). And chances for the above: 1) 99%, 2) 90%, 3) 95%, 4) 97%, 5) 90%, 6) 0%.

10. You can take advantage by yelling and screaming in the pharmacy, humiliating and intimidating the pharmacy personnel, or threaten to call the corporate and say you will take all your business to another store.
Truth: This is the truth, although we'd rather you take your business somewhere else.

Monday, February 20, 2006

"prior authorization" dream

"What do you mean my prescription is not covered?!?!?", woman screaming at the register.

"Your insurance doesn't cover this medication without a prior authorization, that means your doctor has to call insurance and explain to them why you have to be on this medication......"

She's getting more angry, "What do you mean my doctor has to call? He wrote the prescription that means I need it!"

We try to stay calm and explain patiently, "It usually happens when doctors write for expensive medication, especially if there's something similar, such as drugs from the same family, which is available in generic or over-the-counter."

"I don't care. I pay for my insurance they should cover everything!"

"We've already contacted your doctor but it takes time for them to call and the insurance will need to review the information before they decide to approve it or not." What else can we do?

"I need my medication. What am I supposed to do?"

* * *
Prior authorizations are big headaches for pharmacies. It's time consuming, frustrating, annoying. On one hand, I understand it's an attempt to cut the outrages drug costs. But on the other hand, it's no fun to call the doctor (we've more than 10 PA's to call everyday), explain to the patient, follow-up with insurance (sometimes), call the doctor again.....
?

My ideal scenario: When a patient receive a prescription at the doctor's office, there is an education pamphlet along with it explaining the possibility of requirement of a prior authorization and what will be done. Insurance companies can create websites with formularies, forms, instructions for doctors/pharmacists/patients, status update, and immediate help from representatives. Pharmacists and patients can check if the insurance has received the necessary information, if they're being reviewed, and if authorization was granted. When a medication is approved, the pharmacy and patient should be notified by email or fax. No confusion, no argument, everyone is happy.