whats up with the pharmacies lately?

[Glocktogo]

Thanks for the info Doc!

And HMFIC & smax... !

 

[Hedgehog1]

Another thing that is causing issues is some major medication shortages. (The spouse is a pharmacist, so it's grousing about pharmaceutical companies is sort of dinner table chat for us.) There are companies who cannot or will not produce enough of the older, well-established medications to meet the market demand. As a result, pharmacies (and hospitals) are left with a few options: 1) go without the meds that have been the gold standard for years 2) "upgrade" to the newer meds that the companies are making that cost more and are not necessarily more effective, 3) start using "gray market" sources (which has become very common in some places) or 4) raise prices. The retail cost of some medications has gone up by as much as a thousand percent since the beginning of the year. Trust me, the pharmacy staff are just as annoyed as you. My husband met with a rep from one of these companies not long ago and told the rep that unless he was there to give my husband the medications he needed to be able to care for his patients, any "new and improved" drug information was likely to wind up in the "folder of epic shame and failure" until the backorders were fixed since my husband regarded it as a glaring gap in continuity of care.
The issue of having phone queues and such opens up another can of worms that I think Doc did an excellent job of answering. Hope this helps some more...

 

[Sooner67]

Walgreens isnt accepting our insurance next year,so we gotta find a new Pharmacy..

 

[VitruvianDoc]

Walgreens isnt accepting our insurance next year,so we gotta find a new Pharmacy..

CVS will take it as will the local independents. Walgreens is shooting themselves in the foot with that move. (i suppose you have Tricare/Express Scripts of some form).

 

[vvvvvvv]

What's great is when your insurance provider is inconsistent with authorizing certain medications. When I worked a state job, Healthchoice was like that with a *routine* medication that most asthmatics have. One month it was a "yes", 3 months later (and still during the prescription period) it was a "no".

Another thing I've learned over the years is to not bother with Walgreens, CVS, Wal-Mart, and other chain pharmacies where the guy behind the counter has no say on the pricing of medication.

 

[LightningCrash]

Sucks to hear that.
I started going to a Walgreens and haven't had any issues. The CVS I went to before that was just as laid-back.

For anyone here in the Moore-Norman area, go to a West Norman pharmacy. They don't seem nearly as slammed as the other places I've seen.

 

[technetium-99m]

I'm not going to try to make excuses for pharmacies being slow but the breakdown posted above for filling timeline is spot on. I can't tell you how many times I left as an intern with the pharmacist staying behind to verify 50+ prescriptions that he/she didn't make it to that day. Every retail gig I went to ran 1/2 to 1 hour behind, no one got a meal break and restroom breaks were few and far between. Imagine doing a job that can really hurt someone if you screw up all the while you've had to visit the facilities for the last three hours. As far as authorizations go, once it's out of the pharmacies hands you are at the whim of your physician's office and your insurance company. I've seen them take a week from start to the patient getting medication.

The following are GT's three tips for avoiding most headaches at the pharmacy (not necessarily directed at the OP, but for general information).

1. Take the list of preferred medications (the one that's generally divided into three tiers) from your insurance with you to the doctor. Try to engage him/her about what they will write for coming off the preferred list, lowest tier, whatever they call it.

2. Call in refills before you are out. This goes double for when you don't have anymore refills left. The pharmacy will not hear back from the doctor's office that day, I promise and Oklahoma gives the pharmacist no legal standing to help you out.

3. Find a pharmacy that is as slow as possible (general rule, not absolute). Going to the 800 script a day place that is a mile closer to your house can be a bad idea for reasons already listed in this thread. In general the independents I have been with will be more apt to fill the scripts of the people who are waiting in the pharmacy right then and there with you getting your medication on the first trip there not the second. Chains could not care less about the actual volume of work the store has; unless you process an insane amount of scripts a day there will almost always be one pharmacist and two techs there, they may or may not have a cashier.

 

[adluginb]

I worked in various Pharmacies for 4 years as a Nationally Certified Pharm Tech and will be glad to provide some insight for you.

Alright, a good efficient tech (such as myself) can get a script typed into the system, medication counted and bottled, in a verification basket within 5 minutes of receiving the script. This is barring no interruptions such as phone calls, drive-thru, drop-off, etc. Reality has it, The phone never leaves my ear. I was always on the phone for various insurance issues typically "refill too-soon" or "Prior-authorization." Most insurance calls take between 30-45 minutes each between navigating menus and waiting in queues. Then on top of this phone call and script filling, you have to pause at least once every 2-3 minutes to answer a secondary phone call or help someone at drop off or pickup.

This results in a script taking 10 or so minutes from time of drop off to the approval queue (barring no insurance holds).
Approval takes however long the Pharmacist takes which depends on the amount of C-II (oxycontin, adderall, etc) drugs waiting to be filled as they and they only are supposed to count and fill those along with the other items waiting approval along with patients needing counseling. Typically it takes between 5-10 minutes to get a prescription reviewed and approved.

Total time ~20-25 minutes for 1 script. This is during an average day with an average work load at a store who does 350 scripts a day. Such a store typically has 2 techs on duty all day (typically overlap during the 3-5pm rush so have 3 techs then) with one pharmacist.

At CVS where I worked, we got no lunch break. We ate on our feet and typically had 15 minutes to eat. This is against OK State law, but it went on regardless. So those pharmacies that close for lunch are lucky because they actually get to sit down for a few minutes. What results from closing is you get behind a good 20-30 scripts and that puts you an hour behind worth of work and you have to double time to catch up.

NOW, as far as walgreens and the whole 24 hour thing. They have a new thing where unless you state that you are going to need your Rx the same day, they automatically bump it to tomorrows queue in order to keep up with those who will be arriving that day. That is walgreens policy. Thats why a simple phone call and change it can be done.



Pre-auths are a pain in the ass for us as much as you.

At CVS, we will have a pre-auth forwarded to your doctor within 10 minutes of receiving the pre-auth reject from the insurance. Then, its up to your doctor to call the insurance company and provide necessary documentation to get the pre-auth over-ridden otherwise they have to change the medication. If a Doc does have the necessary paperwork to over-ride a pre-auth, a good insurance company will take 48 hours for it to be approved and put into the system. Typically it takes the Doc 24 hours to respond to a pre-auth request because most do them before they open in the morning and start seeing patients. Total time is about 3 days.

What is a pre-auth?
Its when a doc writes for a medication that is NOT on your formulary of your prescription plan or is and is a Tier 3 or higher. Therefore you as a patient have all the access you need to take a list of drugs to your doctor and show them which ones your insurance doesn't cover or will typically require a pre-auth.

An example of this typically falls into the blood pressure or cholesterol medicine world. Any statin drug for cholesterol is going to work in a similar manner and are of the same drug group therefore in the insurance mind, everyone should be on the cheapest statin drug available. It increases their bottom line. However, in real world, different patients respond to different statins differently. Most docs will play around and find the best one for a person. Sometimes the newer statins that don't have a generic work best but the insurance doesn't like this since they cost a bundle. Therefore they slap a pre-auth on the newer, more expensive one stating that you must try the cheaper generic version before they will pay for the expensive one. A doc must then provide documentation that he tried the cheaper one and that it was ineffective. Then and only then will the insurance cover it.

And, you have the Gov't to thank for that as part of the medicare cost reduction act back in the early 2000's included provisions that allow insurance companies to do this.

This is all true except for it "being Walgreens policy " to bump it to tomorrow. Now maybe some techs are scanning the rx for tomorrow but its not policy. If you aren't waiting on it, 15 minute wait, it gets put in the (to be ready in 1 hour list.) If its not ready in 15 minutes call and complain. Walgreens really pushes the 15 minute wait time and Management needs to know if stores aren't keeping up with that. If you say tomorrow then and only then will it be ready tomorrow. How do I know?? Im a pharmacist for Walgreens. Yes I work the overnight shift at a 24 hour store. Come see me between 10pm and 8 am and your script will be ready in 5 minutes

 

[Oklahomabassin]

My longest wait at Walgreens was a month or so ago, when two older ladies pushed a full basket of small items that were from a clearance rack. They wanted everything price check to determine if they wanted it or not. Then they started 3 piles. One they didn't want and one for each of them items. They also had a prescription they were picking up. I was sick and in a bad mood and it ticked me off, the pharmacist was having to price check, and then check these ladies out, instead of filling my prescription.

 

[JB Books]

Well, you guys love the legislators that love the insurance companies....