Rx Wrecks

[fma_fanatic]

* We do not set the prices of your medications. Your insurance does. We're simply the messengers.

I know this and you know this, but you have no idea how many times I and my friend have been told by our insurance that it is the pharmacy that's setting the prices. She was complaining to me last night about getting a refill for her metformin and discovering that her 90 day supply was cheap, but her daughter's cost more. Same dosage, 90 day prescription - hers was $7, her daughters was $10. All the pharmacy could say was that it was the insurance and all the insurance could do was point fingers at the pharmacy.

[DGoddessChardonnay]

I know this and you know this, but you have no idea how many times I and my friend have been told by our insurance that it is the pharmacy that's setting the prices. She was complaining to me last night about getting a refill for her metformin and discovering that her 90 day supply was cheap, but her daughter's cost more. Same dosage, 90 day prescription - hers was $7, her daughters was $10. All the pharmacy could say was that it was the insurance and all the insurance could do was point fingers at the pharmacy.

Common practice, as I've recently discovered w/my antiinflammatory medication.

Perfect Drugstore wanted (w/out insurance paying on it) 52.99 for a 30 day supply

Wallyworld's price was 60.00 for the same medication (Etodolac 400 mg, 60 pills)

And my insurance didn't want to pay for it through either pharmacy (but they would gladly give it to me for 35.00 for 30 day supply through their mail order program.) Yet for a 90 day supply, it'll still cost me 35.00.

Great deal - I'd rather pay 35 every 3 months than 35 every month. Problem w/that: I can't seem to get my doctor to write the script for 90 day supply. I've requested this THREE times last month and each time he still sent it it for a 30 day supply w/one refill.

All because we no longer have any Litter Box pharmacies in my area (closest one is Raleigh, NC according to the website.) I was paying $10/30 day supply.

[Argabarga]

Our Pharmacy receipts had three lines at the bottom:


RX COST: $X

INS PAYS: $Y

YOU PAY: $Z (X - Y)

It didn't stop the grousing about prices, but, it was at least transparent enough that the customers knew it wasn't us or their insurance arbitrarily setting the price, it was both.

And the bitching about price pretty much stopped when I'd point out something like

RX COST: $876.55

INS PAYS: $866.55

YOU PAY: $10.00

Yeah, how much you want to complain about your plan now? Because you're on that stuff MONTHLY? Didn't think so.

[Sapphire Silk]

IDK if it's only referring to actual written records... But still, it's nothing to mess around with.

It's any communication, written or verbal. HIPAA covers paper records, electronic records, faxes, phone calls, and conversations in the hall. If medical information is being discussed, it must be HIPAA compliant.

You have no idea how frustrating this can be when people take it too far in the other direction. I used to be a hospice nurse. Sometimes our patients are hospitalized. When they're admitted or discharged, there is information the nursing staff either need to know, or that I need to know.

Unfortunately, I didn't have the ability to send written information if they were admitted on my shift; I worked from home and our software at the time didn't allow it (this has since been fixed I've been told). Getting the ER nurses to get on the phone and listen when I called to give them the patient's med list (for medication reconciliation) and history was a trial. Getting them to give me report when the patient was discharged from the ER was even worse. "We can't give information over the phone . . . HIPAA."

Except that they can. I'm the hospice nurse; I'm a care provider for the patient and all information can be discussed with me so I can document it and pass it on to the nurse who will be making the next home visit (usually within 24 hours). The case managers on the med surg floor never had a problem with this but no amount of education, explaination or complaints from our organization would make those dumb shits wake up and realize by NOT talking to me, they were making it difficult for us to make sure discharge instructions were followed up on correctly.

I know this and you know this, but you have no idea how many times I and my friend have been told by our insurance that it is the pharmacy that's setting the prices. She was complaining to me last night about getting a refill for her metformin and discovering that her 90 day supply was cheap, but her daughter's cost more. Same dosage, 90 day prescription - hers was $7, her daughters was $10. All the pharmacy could say was that it was the insurance and all the insurance could do was point fingers at the pharmacy.

I'll bet you didn't go to the same pharmacy. Different pharmacies use different suppliers, who cut deals with corporate on prices.

The pharmacy sets the price based on what they pay the supply company, based on the contract with the supplier and corporate. Markup is included.

The insurance company decides how much it will pay for the drug. Sometimes that price (often negotiated with pharmacy's corporate offices, meaning the same insurer will pay different rates at different pharmacies for different plans) gives the pharmacy a fat profit. Sometimes it doesn't cover the WHOLESALE price. This is why sometimes pharmacies will refuse insurance for some drugs (usually the independents, who operate on very thin profit margins as it is).

That's why some drugs cost more than the minimum co pay. Some drugs actually cost less than the co pay. Some considerably more (usually generics, but not always).

Great deal - I'd rather pay 35 every 3 months than 35 every month. Problem w/that: I can't seem to get my doctor to write the script for 90 day supply. I've requested this THREE times last month and each time he still sent it it for a 30 day supply w/one refill.

Ugh. Doctors have no FUCKING clue what medications can cost. They just write the script, often snowed by pharmacy reps who give them goodies and free trips to encourage them to write for Latest Greatest Drug when Good Old Standby would do just as well. They justify this to themselves by handing out free samples to patients, thinking "well, I'm saving them money by giving them the first few doses free." But it's not cheaper if the medication is Ungodly Expensive.

I used to use an app called ePocrates to check local formalary costs for meds, so I could give patients an idea how much the med would cost them. I remember one fellow who had an abscess and needed to go home on an antibiotic. The ER doc wrote Horribly Expensive Antibiotic. Patient asked me how much it would cost him. I looked it up, over $300! Patient said he couldn't afford it. He had no insurance. Wasn't there something cheaper?

I went to the doc and said the patient couldn't afford the med, and could he write for something else. Doc's response? "Does he want to die?"

I got mad. There was no reason not to write for Keflex: a solid, good, cheap broad spectrum antibiotic commonly used for these kinds of infections. I said, "Doc, he wants to follow your instructions. He has no money. He will take an antibiotic if you write for one he can afford. Isn't it better to send him out of here with something he will take, instead of something he won't?"

Doc grumbled, "It's not the best drug for this," and wrote for Keflex. I took the new script from him without another word, and went I talked to the patient, emphasized that he needed to take it exactly as prescribed because the doctor felt the Horribly Expensive Antibiotic was the better choice, and to come back if the infection got worse in any way. Patient promised to do so. I documented everything very carefully.

[DGoddessChardonnay]

Ugh. Doctors have no FUCKING clue what medications can cost. They just write the script, often snowed by pharmacy reps who give them goodies and free trips to encourage them to write for Latest Greatest Drug when Good Old Standby would do just as well. They justify this to themselves by handing out free samples to patients, thinking "well, I'm saving them money by giving them the first few doses free." But it's not cheaper if the medication is Ungodly Expensive.

Tell me about it. When I started on the Etodolac 2 years ago it was because I couldn't afford $160+ for a 30 day supply of Celebrex (which is what my doctor originally sent to the drugstore.)

One quick phone call to my drug plan's Customer Service while I was still at the drugstore and I found the Etodolac (which is generic for Lodine, which I've taken before years ago for inflammation and pain.)

Called the doctor's office back (it was after 4:30 but before 5 when they closed) and quickly explained the situation w/the meds and could the doctor switch the script?

Half hour passes, SCAT van shows up to pick up Mom and myself, so we had no choice to leave w/out the other med (had my pain pills - that was no issue.)

Got a phone call right after I'd gotten home just before 6 from my doctor - calling me from his personal cell phone and apologizing all over the place b/c he had gotten the message from me while I was still at the drugstore and had asked someone to send the script for the Etodolac electronically - and it wasn't done.

I told him if it wasn't for the fact that we had went to the drugstore (straight from his office, BTW) by SCAT van, I could have waited a few more minutes but as it was, we had to leave.

So that meant I had to go by after work the next day to pick it up . . . one more day of being stiff and feeling like my leg and hip were going to break off.

I explained the current situation to the nurse I spoke w/at the doctor's office last month when I called to get the medications set up for 90 days. Of course that went in one ear and out the other somewhere on their end . . .

Yet I can get 100 of my 50 mg Tramadol for $2.00 through mail order.

[Argabarga]

Ugh. Doctors have no FUCKING clue what medications can cost. They just write the script, often snowed by pharmacy reps who give them goodies and free trips to encourage them to write for Latest Greatest Drug when Good Old Standby would do just as well.

That was peeve #2, not inquiring about whether most plans in the area would cover it. Sometimes the reps would give out coupons, which were basically one-shot insurance cards that would cover the first Rx, but they had expiration dates on it.

Don't know who was doing it, be it rep, doctor or nurse, but, there was one office around here that would write for some expensive med, give them an expired coupon and blot out the expiration date with a marker.

That won't work, the insurance company computers know when it's expired, they're going to reject it. And they would. And I'd have a confused/pissed off customer wanting to know why I wanted $300 for a med they were promised free....

Never found out who was doing it, but at least they stopped, probably because of all the calls back to the office requesting a cheaper alternate.

[earl colby pottinger]

Until

No one is going to jail for allowing HIPAA protected information to be overheard at the pharmacy. Fines, hell yeah. Jail, no. Jail time is for the dumbasses who dump medical records in the dumpster, or who steal protected information to sell.

Unless it is time to set an example, then the one time you break the rules that you know everyone breaks and get away with it, only to find yourself going to jail to be that one example to all.

[AccountingDrone]

It's the same in Australia.

I'm very careful with my narcotics, because I know my doctor and pharmacist have strict limits on their ability to refill them early/replace losses/whatever.

But if I were to somehow lose them, it's not my pharmacist I'd go to first. It's my doctor. And if there was a provable reason for the loss (theft, fire, etc), I'd bring the police report information - if I were coherent enough to think of it, anyway.
I don't know for sure, but I imagine that a police report of a fire or something would justify an early refill. I also suspect that one would have to go to the doctor, not the pharmacist, first. At least out here.

I once brought the cracked bottle full of partially melted pills when the bottle got bashed and dropped into a sink of soapy water. No problem getting it replaced

And I called my insurance company to authorize an early refill to be sent through to CVS ... they asked why I needed it early, I was going to be traveling, but they have CVSs all over the country ... but not in Germany One authorization later, I had my meds early so I could go to Germany for a few months and not run out =)

[Catwoman2965]

Our Pharmacy receipts had three lines at the bottom:


RX COST: $X

INS PAYS: $Y

YOU PAY: $Z (X - Y)

It didn't stop the grousing about prices, but, it was at least transparent enough that the customers knew it wasn't us or their insurance arbitrarily setting the price, it was both.

And the bitching about price pretty much stopped when I'd point out something like

RX COST: $876.55

INS PAYS: $866.55

YOU PAY: $10.00

Yeah, how much you want to complain about your plan now? Because you're on that stuff MONTHLY? Didn't think so.

I don't get that either. Reading this post reminded me i needed to get my online access to my mail order pharmacy reset, pay a bill, and ask for a refill of my allergy eyedrops.

In doing so, i noticed that my "90 day" which for me lasts longer, supply of my one inhaler cost ME $85, but the full retail cost, was $425. I'd MUCH rather pay the $85 for a supply that will last me close to 6 months, than the full cost.

[Shalom]

Why your prescription takes so long to fill (a must read):
http://drugmonkey.blogspot.com/2006/...-done-you.html

Seriously, if you hadn't posted that, I would have.

[roxtar]

*didn't read the whole thread*

If you're on maintenance medication, don't wait until you're out to go in for your refill.
If there's a shortage, you may not be able to get it filled.
/once ended up running very low on insulin because I was lazy and waited until the last minute.

[KuariKaydrith]

I read the drugmonkey blog post and I nodded the entire way through it, and I'm not a pharmacist or pharmacy tech. But I have been the one waiting while some halfwit pulls some pretty shady shit trying to get refills too early, or is otherwise causing a scene. It probably doesn't help that the drug store I frequent (as it's a short walk from my place) also runs a methadone clinic and has an on-site doctors' office. I'd go elsewhere but the next nearest pharmacy is even sketchier :/

I have gotten to the point where I will drop off a prescription in the morning on my way to work and pick it up after work. Unless it's something I have to start taking right away, of course.

[Catwoman2965]

I've also learned, through experience, that prescriptions for certain kinds of meds, expire! i am terrified to fly. So much so that I need pharma help. I had to fly about 2 months ago, and called my dr. a good 2+ months in advance. Didn't know if I needed to go in and see him to refeill it, or not, so i figured I'd call then, in case I did.

Nope, and because of what it was, i could either pick it up, or they could mail it to me. My dr's office isn't that close, so I opted for mail. But then held onto it, until a few days before I was leaving. Ooops. its expired and they can't fill it. oh crap. I'm freaking out, thinking how can i go pick up a new one, and will they GIVE me one, i.e. can they tell that it hasn't been filled, both pharmacy and dr.

I was not happy, but as it turned out, the pharmacy had called his office, and when Icalled them, the nurse was on the phone, giving the ok to fill it. Phew.He gave me more than i needed, plus a refill! But now I know.

[sstabeler]

can they tell that it hasn't been filled, both pharmacy and dr.

probably. There IS communication between the two.

[Sapphire Silk]

Unless it is time to set an example, then the one time you break the rules that you know everyone breaks and get away with it, only to find yourself going to jail to be that one example to all.

Won't happen. A prosecutor could file the case, sure. But no judge would impose that kind of sentence for accidental disclosure.