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Tuesday, November 23, 2010

Patient vs. Customer

  I've been doing alot of thinking lately about what constitutes a patient and what constitutes a customer. The easy answer is that a patient is someone in need of medical assistance whereas a customer is just there to buy something. Easy, right...or is it? Patients buy medication so that makes them a customer as well. Should we include a caveat that says they are only considered patients if they are obtaining the medication for "legitimate" use? I know, we're only supposed to be filling the rx if it's for legitimate use but we are in the real world not FDA/DEA-land where everything is black or white. When there are drugs on the market such as Suboxone that are obviously for questionable patient to begin with, things get more into the grey area.
  What about people buying OTC products and asking your advise: patient or customer? How much time do we spend on this transaction? We all have encountered the "patient" who asks us a question about an OTC product and they only want us to agree with them they don't really want our advise. Our time is money. Do we waste time on these people or cut it off quick. They are, after all, only making a purchase of a few dollars anyway.
  How about the person on the other end of the phone, who doesn't fill their prescriptions with you but their pharmacy is closed/mail-order and they just have to ask this question now? About 30 seconds into the conversation you realise that they don't want to hear what you have to say, they just want to argue or they just want to talk. Once again, our time is money. Lately, I really don't have patients for these "patients"! I really don't have patients for these calls when I have people standing in line waiting for counseling on the rx that I just filled and they just paid for.
  I think as pharmacists we have given away our information for far too long. I know it started out as the mom and pop stores that knew all of their patients by name and were neighbors with most of them. Of course you'll give your neighbor advise for free when it's needed. Then this morphed into pharmacists working for corporations who used this free advise to "draw customers in". It was a form of public relations in both cases. These days with everybody and their brother on some kind of drug do we really need this kind of P.R.? The demand for our services is such that we should no longer have to give it away. The question is how do we change? After decades or even centuries of free advise how do we start charging? How do we set a price tag on our knowledge? Obviously the MDs have figured it out. Who will be the first pharmacist to say "You don't get your prescriptions filled here so I will not answer that question until you give me your credit card number."? The computer help desks do this why  can't we?
  So let me know how you classify a patient vs. a customer. I would really like to know. As for me, I'll continue giving away my knowledge because that's what my employer demands of me, but I won't like it and if it's not life-threatening, I may tell them to call their own pharmacy. I don't care if it is mail-order and you have to be on hold forever!

Saturday, November 13, 2010

Medicare Part D Rant

  OK, its that time of year. I'm not talking about open enrollment; I'm talking about the time of year when a larger majority of Medicare Part D recipients enter the dreaded "donut hole". I agree that its probably the most asinine way to manage this system and I really can't understand the concept, but its there and we have to deal with it. My biggest gripe about it is the people that act totally, completely surprised that there even is such a thing. Where have they been to not know about this? They act like the government is personally attacking them or, better yet, that the pharmacy is just trying to screw them. The majority of these recipients are over the age of 65 correct? Do they not remember the time before Medicare Part D when they had to pay full price for their meds every time? I mean, for God sake, I can remember when this plan started! Why can people not be grateful for what they have received instead of complaining about what they think they deserve? I guess I just don't get it. I really think that part of the problem is that they don't realise how much  their drugs normally would cost when they only have to pay $1.10 all year. Maybe we should start having our technicians point out to them how much their insurance saved them each time they check-out. Even my grocery store does that! Maybe it would make our patients a little more grateful. Not to mention the fact that they still get a discount even in the donut hole, its just not what they are used to. Every now and then I run into someone who gets it and is happy to hand over whatever money they have to because they either know how important the drug is to their health or they realise that things could be a lot worse for them without this insurance. Even when I point out to most patients that when they enter the donut hole they will get a $250 rebate check from Uncle Sam, they are still pissy with me. I had one lady say "If they are going to treat me this way then I guess I just won't take my medicine and die!" What is that about? Who are the mysterious they and how is dying going to teach them a lesson? I guess it just frustrates me because I do realise how much my insurance saves me. I personally use one medication that would cost me over $4000 per month if I didn't have insurance. And I take alot more than just one medication. Ingratitude annoys me. I can handle when people are not grateful for my services, that's just part of the job, but to not be grateful for a system that saves you hundreds or even thousands of dollars a month is crazy and more than a little selfcentered.
       On a more positive note I do encourage my patients to be, well...patient. The donut hole is going to close eventually. Also, this time of year, don't have them buy a 90 day supply when the plan year will start over at the first of the year. I also use this opportunity to teach them about their formulary and making sure they give a copy of it to their doctor. Let's face it, most drugs have a less expensive alternative. That's what formularies are all about. The docs are going to write for whatever drug they have samples for, and we all know that this translates into whatever drug is newer and more expensive. I mean really, do you have to give your patient Seroquel just because they don't sleep well?
   That brings me to another point. I would love to have a law passed that says the docs have to put on the rx what its being used for. Not only would it help us with proper counseling, it would help us to ascertain it there is a less expensive alternative that we could "lobby" the doc for. I think this may be a law in some states (California maybe?). With so many drugs being used off-label we often have a guessing game on our hands when counseling. How many of you have counseled a patient receiving Metformin that it is used to lower blood sugar, just to find out they are using it for poly-cystic ovarian disease?  I have a doc in town who is prescribing Victoza for weight loss!!  If the state boards think counseling is so important then how about making it easier for us to do it more effectively. How many times have you counseled someone on a med and they had no idea what they were taking it for? What did they go to the doc about anyway?
  Well, enough of my ranting. I do make a point of kindly pointing out how much a patient's insurance is saving them when they complain about prices. I personally  remember a time before rx insurance and I believe that the advent of insurance is what has driven prices so high. , but that's a subject for another post.