Prescriptions and common sense - read the instructions....

Did you know that the average American can only read at about a 6^th grade level – this means an average of 7 words per sentence and 2-3 syllables per word.  Shocking I know – but also works into the idea that the average American has an IQ of 100 or less (though my friend in education says it is way lower – and she wasn’t talking about the students, mostly the administration).

Now, when I say all this – I am not talking about YOU because I know you are much brighter – but here are only a few examples of what people do with their prescriptions….and all of these are true stories.

• Story 1 - Customer gets an antibiotic prescription for a child’s earache – Instructions are  “Give one teaspoon by mouth twice a day”…Customer calls back later to ask how she can keep her kids ear from getting all sticky – and  says that she is having a hard time giving a whole teaspoon.  Pharmacist knows immediately he customer has been putting the medicine into the child’s ear.….

• Story 2 - Customer gets a prescription for a suppository.  Instructions are “Unwrap suppository and insert into rectum every 6 hours as needed”.  Customer calls back later to complain that the suppositories are very uncomfortable. Pharmacist knows immediately that the caller did not UNWRAP the suppository before inserting it into the correct place….

• Story 3 - And again - customer gets a prescription for a suppository.  Instructions are “Unwrap suppository and insert into rectum every 6 hours as needed”.  Customer calls back to complain about how bad “those pills taste” or “those pills you gave me are really greasy”.  In this case the pharmacist is clear that the customer unwrapped the suppository but ate it instead.  Perhaps the customer did not know what “rectum” meant…. 

In fact, story 3 has happened with ear drops, vaginal medicine and topical medicine etc. – when the customer failed to listen to or read the instructions, then ate the medicine rather than putting it where it should go.

Actually the most common failure of medication administration is the customer that uses a teaspoon or tablespoon from the silverware drawer to give one “teaspoon” or “tablespoon” - neither of which are accurate as both give about half the medicine that is supposed to be taken.  In most cases – an oral syringe or other accurate measuring device is given by the pharmacy along with the medicine – and some doctors have started writing in milliliters to force the customer to use an accurate device.  This however, does not stop some customers of doing it wrong. FYI – if you didn’t know, a teaspoon is 5 ml (milliliters) and a tablespoon is 15 ml (or 3 teaspoons). 

• Story 4 – Customer comes in to get a prescription filled.  Pharmacist tells the customer that insurance won’t cover the prescription.  Customer becomes irate – stating that the physician prescribed it, insurance has to cover it…becoming louder and more agitated.  Pharmacist again tells customer that the insurance will not cover it and that if medicine is wanted, they will have to pay cash.  Customer says “How do you know that MY insurance won’t cover it?” and squints eyes at pharmacist who (now exasperated) says “It’s called technology”.

Actually, some of the best stories have come from my nursing and paramedic students – which are truly gross and mostly involve “lost” articles and food such as a tuna fish sandwich “lost” in the folds, a sweet potato “lost” in an orifice resulting in leaves emerging from said orifice, or a “massaging device” lost in an orifice in the “on” position…really a subject for another time…believe me there is more where that came from.

In defense of the pharmacist

In case you didn’t know, your health insurance company doesn’t really want to pay for your treatment – of any type. One of the easiest ways for them to save money is to reject coverage for your prescription. Most often this is due to a “Non-formulary” medication.

A “Formulary” is a list of drugs which are approved for use in an insurance plan. These are medications they will pay for with no questions asked. There are also “prior authorization required” lists which they will pay for ONLY if your physician completes some certification documents that state that the medication in question is required. The problem comes in that the rules for why they might authorize payment vary widely from plan to plan….Sometimes they require documentation that you have “failed” on other therapies….Sometimes they require a letter from the physician…Sometimes they require the physician’s office to complete a specific form…Sometimes they require a medical review by their case manager…Sometimes they refuse to pay at all. In any case it is quite frustrating for both you and the pharmacist.

Essentially – they hope you will give up and go away or at least pay for it yourself.

Be assured - the pharmacist does not want to tell you that your prescription will not be covered. The pharmacist does not want to have to notify your physician or spend hours on the phone with the insurance company trying to find out exactly what information they need. The pharmacist does not want to make you wait for any of this. The truth is that a single pharmacist can and usually will spend hours each and every day negotiating the maze of insurance requirements to help you get your prescription paid for by your insurance company. The pharmacist is not getting paid for all of this extra effort. Most pharmacists are employees of a large chain and get paid a salary – no profit is included. The pharmacist who works for himself in an independent drugstore only gets paid what the insurance company will pay him – no matter what. Sometimes this means that the $250.00 prescription that you just received netted the pharmacy a whopping $8.00.
You might make it easier on yourself by contacting the physician’s office yourself – to help expedite the process. Occasionally, physician’s offices are slow in “getting back to” the pharmacy. When necessary you can also contact your benefits manager. It is actually their job to help you.

I guess the point is that the pharmacist really just wants to fill your prescription and give it to you. Try to take it easy on the poor guy (or girl). It is a really hard job – dealing with sick people and sick insurance companies all day.