The Confusing World Of Numbers

this is....an actual phone conversation....undoctored because, well there's just no reason to.

caller: "hi, i'm calling because i'm running out of medicine and i need a refill"

me: "okay great, well do you have the prescription numbers?"

caller: "sure, 403561 and 403562".................at this point i notice something wrong as our prescription numbers are 7 digits to begin with

me: "well, those aren't our prescription numbers, what's your name then?" she gives me her name and i'm searching in our system only to turn up empty-handed

me: "okay ma'am, those aren't our numbers and i can't find your name in our system, are you sure you're calling the right pharmacy?"

caller: "well, i'm not sure, they told me to call this number. this is springville pharmacy right?"

me: "no.............this is xxx pharmacy......"

caller: "well, what should i do? there's a phone number on the bottle, should i call that?"






uh, what?

So, How Much Will That Cost Me?

....I don't know. That's my honest and typical answer. I really don't know. I have an inkling, but one can never know for sure. I have a better idea than you do, but I don't know the finite answer. Why is that dumbfounding?

Here are some rhetorical questions that I ask in my head (while I'm attempting to process the claim so they go the fuck away) to allow me to cope:

Who let you out of your nursing home?
Where's your shower?
Does it really matter?
What is the monetary threshold that will make that horrible cough linger?
Do you have a better or cheaper way to get a hard-on?
What if I told you seven hundred dollars?
What if I told you three dollars?
Why would I be kidding you?
Do you think staring at me whilst typing will lower the amount owed?
Who do you think that toupee is fooling, honestly?
Why aren't you working?
When did you enjoy a "triple whopper" last?

I love the third tier. I really do. It's the most expensive and most confounding of all the tiers. It offers mesmerizing words such as "prior" and "authorization" in the same sentence often. It contains obsequious copays and dazzling drugs. Yes, the third tier is the shit. Maybe that's why doctors write prescriptions in the third tier. Then again, maybe the same asshole standing in front of me disagreed with the doctor's assessment. Then, the doctor, being human, wrote a prescription that s/he knew would be expensive. This concludes the third tier lesson.

The FDA is really starting to grind my gears.

Seriously. WTF with all the medguides? I can't give anything out now without some stupid question. It's bad enough that people think "metoprolol succinate" is pronounced mutupral succulent - oh yes they did. Now every douche with a fifth-grade education thinks their tendons are going to snap/burst or they're going to commit suicide. Look, you may grow a baboon ass for all I know, but if it's printed, then people are going to think this shit will affect them. As some dumb ass lady told me today: "I know my system." What the fuck ever.

FDA - stop it already, we get it. You are omnipotent and scary. You can make or break companies in a single pen stroke. Here's a thought: how about NOT APPROVING this shit in the first place? Oh, now that you have the money it's o.k. to fuck with people. Look, nobody's saying you're not the man, just ease the fuck up. Jesus.

There, I'm better (sort of).

Old Nurses: You're on Notice

Why is it that every bitchy, lazy, and condescending nurse is named Barb, Kathy, Pat(ty), Sue or Debbie? Well, if one goes to the Social Security website and fiddles with the decades ( http://www.ssa.gov/OACT/babynames/decades/names1950s.html ), you'll find your answer. Yes sirs, the old, crotchety nurses were born in the '50s. "Why is this important?," you may ask yourself. Phrustrated is such a douche. Yes, this may be, but I'm not nearly as douchetastic as the old guard. I genuinely despise this gaggle of former (or current) chain smokers with their smoker voices. They collectively sound like that creepy aunt who's always trying to kiss you.

Anyway, back to topic. This is important because I had a run-in today (and a few weeks ago). Yes, Barb the "nurse," I'm talking to you - so listen the fuck up. I'm only gonna say this once, so listen the fuck up, and listen the fuck up - but good. Here it goes: I HAVE MY OWN FUCKING JOB TO DO WARDING OFF THE DREGS WITHOUT DOING YOUR JOB TOO (YOU FUCKING WHORE). Okay, I don't know she's a whore. That's just the phrustration. She is, however, a grade A lazy douchebag. Here's a synopsis of the convo:

Me (after saying: who's on hold now? Oh, a doctor's office - again?....How long....Ohhh this oughta be good): Hi, sorry for the wait, how can I help y..

Barb (interrupting rudely): HOW LONG WERE YOU GONNA LEAVE ME HOLDING?

Me: Uhhh, I'm not sure what answer you're looking for..it's the day after the holiday, so I'm on quite a few calls today...sorry - I'm only one person.

Barb: Oh, fine...whatever. Look, what's covered?!?

Me: Uhhhhh, that's a bit vague, what are you pertaining to?

Barb: EYEDROPS!! (cough, clear throat of phlegm)

Me: Any particular ones, or just in general or any insurance, or wha...

Barb (interrupting): XALATAN, ON MEDICAID! UGH!

Me: How was I supposed to know what you meant simply by your tone?

Sidebar - all of Barb's lines will be capitalized. She was yelling and/or sighing the whole conversation - I was calm as a Hindu cow (as per usual)

Barb: THAT'S NOT IMPORTANT - I NEED YOU TO FIGURE OUT WHAT'S COVERED!

Me: Well, I don't have time right now. I cou..

Barb (Yes, interrupting - sensing a theme...) WHADDYA MEAN?!?...THIS IS WHAT I ALWAYS DO. I CALL AND YOUS FIGURE IT OUT...I DON'T HAVE THE TIME!

Me: What makes you think I have the time and money to waste time do your work? Isn't that a bit presumptuous?

Barb: NO! THAT'S WHAT I ALWAYS DO...WHAT'S YOUR PROBLEM?

Me: Well, it's the day after Memorial Day, and everyone and their brother has decided to NOW bring me their scripts and wait to have them filled. Since they are paying customers, they have first dibs. I would gladly give you the phone number to Medicaid's prior auth line and...

Barb: I'M NOT DOING A PRIOR AUTH, UGAHHH, GOD

Me: Now, there's no need for that.

Barb: NO NEED FOR WHAT?!? I'M JUST TRYING TO FIGURE OUT WHAT TO GIVE..WE GIVE SAMPLES, THEN THEY GIVE YOU THE SCRIPT AND, AND I DON'T KNOW....

Me: Yes, that is the normal cascade of events. As I was saying, I'll give you the number and you may speak with someone at Medicaid to tell you definitely what is and is not covered in that class. Then you may fax/phone/write/e-scribe/smoke signal the rx to me. I'm sorry, but that's all I can provide you at this time.

Barb: UGGGHHHHH...click.

Me: Fuck you too you fat fuck mouth-breather (she had hung up, but it still felt good)

Now, as frustrating as this was, there's more to the story. I know this is a long post, but hang in there. As it turns out, this office sucks at giving out eyedrops. Funny, since they are eye doctors. Don't you need a degree or some shit? Anyways, Barb and her legion of doom staff couldn't tell me if 'John Doe' was allergic to sulfa or if the doctor had a problem giving Azopt with that possible sulfa allergy. It took me three days and nine phone calls and countless hour(s) on hold to try to square this away. The patient is clueless and speaks phrases such as "I am eye drup" so no luck there. Finally I got to speak to Barb, who was dismissive and condescending - and never called me back. Well, I stored that in the "fuck you" sector of my memory. So, when I heard "this is Barb from Dr. Eyedrop's office" I went to the fuck you sector and pulled out a big ol' can of fuck you. I love it when a plan comes together.

So, what is all this rambling? Fuck you Barb, that's what. You're officially on notice and will get no favors from me - EVER. Funny thing is, I'm one of the most resourceful, helpful and respectful pharmacists you'll ever deal with. I have countless nurses that enjoy calling me and we will do favors for each other. You see, Barb, that's how it do. Like Patrick Swayze said in Roadhouse: "Be nice" That's all for now, I've got phones to answer.

Thanks FDA, You're the Best

No, really. I mean it; from the bottom of my ever-blackening heart. I love calling doctors to change people from ER metoprolol to IR metoprolol. I love telling pregnant women that their prenatals are going to look "a little different." Both of these acts are just asking for a bad time. Those of you who've dealt with this can empathize.

Let me ask you this FDA, have you ever had to deal with these things multiple times in multiple days for multiple months? It fucking blows, FDA. You don't call doctors. You don't talk to (pregnant errrr irrational errrrr hormonal) patients. Why you gotta be measurin' all the tablets, yo?

For those of you (and I mean both of you whom are loyal readers) who don't know, I'm referring to the FDA's utter demolishing of the drug company ETHEX. They seemed to be reputable enough, I don't know. All I know is they're gone and the FDA is the one who put them out of commission and we in the rank and file are left to clean up the wreckage.

What did they really do? Inconsistent tablet sizes are the reports I've most often seen. I'm not buyin' it. I'm not sure what higher-up told an FDA official to "fuck off," but it wasn't a good idea. Now the FDA knocks on your door with some calipers and a shit-eating grin. "Fuck off," you say, says the FDA, "well I don't fucking thing so," retorts the FDA. Now let me in so I can randomly measure all of your tablets.

This is an agency that has poetic license. I liken them to the scary old man with the brown slacks (yes, slacks) in the middle of August who steals your Frisbee because it happens to stray onto his lawn. He shakes his finger with pallor and says something like "now it's mine!" Well, friends this is the FDA. They are old, callous, and if you piss them off, they will take your Frisbee. Frisbee in this case being Metoprolol Succinate and Prenatal Vitamins.

I can't wait for the next round. I'm sure the FDA has something up it's (short) sleeve (with a yellowish pattern and a butterfly collar - remember the old man). Get fucked FDA, I've gotta go make some more senseless calls.

Actual Phone Call....

Me: Hello, may I help you?

Dumbass: Yeah, Uh, pharmacy....

M: Yes, you've reached the pharmacy.

DA: Uh, is this the farmist? (I like where this is going)

M: Yes, this is the farmist. (it's just easier)

DA: I've never been there before, is that going to be a issue?

Sidebar:

While I respect the fact that this waste of air was able to form a cohesive sentence/question, another piece of me has perished (again). Let's analyze the statement, shall we? "Is that going to be an issue?" It most definitely sounds to be "an issue" since you have no fucking clue how to communicate. I have no idea what my response should begin to sound like - seriously. After much silence and thinking, I came up with...

M: In what respect?

DA: I'VE NEVER BEEN THERE!

M: That much I ascertained from your previous statement, sir. We do indeed fill prescriptions for people whom have never frequented our location previously, however.

DA: Oh, aaaa, really?

M: Yes, really.

DA: Okay then....

I'll spare you the rest, but it turns out we don't take his insurance. Could have maybe just led with that question. Something like "I have BC/BS of East Bumfuck - do yous take it?" The answer is no. None of me dies this way.

I love the smell of forgery in the...evening...

ah, it's good to be back. okay, not really. but second day back after vacation and catching a user is just fantastic to me.

so, rx gets dropped off in the drive-thru, all torn up and whatnot, written today (it seriously looked like it had been in a washing machine) of course for...what else people...."hydrocodone 10/325." the first tip off was that there was already writing on it, date of birth and allergy, from another pharmacy. which, of course, means they took it somewhere first and they did not fill it. i can't imagine why. i ask if she had been to a store of ours before, the answer being no, and if she had insurance, and she said she was paying in cash. ah ha....second tip off.
so i go abouts my usual central search and find her name, but having nothing filled since 2005. i figured that can't be right, so i opened the search broader, and find a hyphenated last name for her, but no meds under that since 2007. so, for shits and giggles i look her up under the other last name and BANG, she's been going to a store near her house (a town over) regularly, and using a DIFFERENT last name that what is on the prescription. one, i'm assuming is her maiden name, and one her married name. and...hahaha, turns out she has an insurance. crafty ol' me. so, la la la, process said script under her insurance and...dun dun dun...reject! "similar medication quantity left on 1st rx" delightful. for me at least. so a quick call to the insurance reveals that she had received a months worth of tramadol yesterday, and was still finishing up some 7.5/500s from the middle of July. tee-hee, i'm on to her game. i find out where the script was processed before she took it to me, and i give the other pharmacist a call and turns out they found out the same thing from her insurance and refused to fill it.
then a smile creeps onto my face (not unlike the Grinch) as i start to write aaalllll over it, that she actually has insurance and she is getting medications under her maiden name AND her married name, some as cash some under her insurance. i get a warm fuzzy feeling inside when i do this. and, really, the icing on the cake is when i make a copy and write a little note and fax it to her doctor's office about the goings-on. ah, satisfaction.
i can't help but smile when i hand the script back, after explaining that we would have to call and verify the fill with the doctor. she, of course, wants the prescription back. and i get a little tingle when she frowns at the writing on it. sad for her.

what makes it worse is that she had two little kids with her. i mean, 2-year-old, and one maybe 8 months or so. i feel sad knowing they have to grow up with parents that lie and cheat the system to get narcotics which they either sell or use or both.

some days, i lose all faith in humanity.