I've written posts recently discussing the problem with mental health and how many get into the medical field in general with a desire to help people get better.
And in a lot of cases, we succeed. People live longer, get healthier, and appreciate what everyone does, from the nurse, to the doctor, to the pharmacy tech, to the pharmacist, to their home health aid. They make changes and do what they can to get better.
How many times have you heard about someone surviving some horrible disease and making drastic changes so that they don't experience it again, or someone who is at risk for diabetes doing what they can to reduce that risk? It happens a lot and you praise people like that who recognize what they need to do.
Then there are those who don't learn, don't make adjustments. I've seen people get put on blood pressure and cholesterol medications who refuse to make changes to their lifestyle, thinking the medications alone were going to fix them. One guy even told us once that he shouldn't have to stop eating McDonald's all day since they have medications to control his issues. When told that changing his diet would make him healthier, he scoffed at us and said he was taking his business to someone who understands his position.
It's like the people who want a pill to lose weight. Yeah, you may drop a few pounds here and there, but you're not going to lose the weight like you want to if you're still going to sit on your ass and eat ho-ho's all day and night. You have to get up and move around and adjust your diet if you really want to lose the weight. No one wants to hear that though because we've become such an overly lazy society.
Then there are people like the guy who reveals he has mouth cancer because of his chewing tobacco and goes into detail of all the things he has to endure, all the medications he's taking, and how he has to fork over a ton of money for his nausea medication from his chemotherapy.
Then he admits he still uses chewing tobacco and seems indifferent about it.
Look, if I go through something, let's say soda cancer, and the chemo fixes it and I'm cancer-free, you can bet your ass I won't be drinking any kind of pop again, and that's saying a lot because I absolutely love Pepsi. It would be hard, but if I knew that avoiding pop of any sort would help me live longer, you can bet I'm doing it.
But some people just don't care. This seems to be most true of people who use tobacco of any kind. They can't kick the habit, even if it nearly kills them. Some will quit for a brief period, but most usually start back up again.
And that's the problem with people. You can know what the problem is, know how to fix the problem, but not do the things that you need to do to get better and stay healthy because it goes against what you want to do. It's like the stories you hear in pharmacies about the people refilling medications, but not taking them because they don't think they need them.
This seems to be most common with blood pressure medications. They see their levels go down to a normal level and think everything's okay, that they can stop taking the medication. Then they go back to the doctor's because they feel sick and it's because they're off their medications.
This gets into the whole compliance thing, which is something I do not feel like talking about at this point. It's been beaten to death how difficult compliance is to enforce and it just aggravates me to talk about it.
In the end, you can't make someone stop what they're doing to make themselves ill. If you could, drug abuse wouldn't be the problem that it is. But you can't, and it is.
If someone wants to continue to put their life in harm's way, there's really nothing you can do for them.
And that's the saddest part.
Monday, October 24, 2011
Thursday, October 20, 2011
the trouble with mental illness, part two
Not too long ago, I wrote about mental illness and why it's much more difficult to treat than other conditions we come across. I wrote about how some people respond to certain treatments better than others and how it's rare for people to find the right treatment.
My pharmacist and I had a conversation the other night that demonstrated more reasons why mental illness is so much more difficult to understand. This conversation was the end result of me discovering that I could look up people in the main software and see what was going on with them based upon nurses', doctors', and counselors' notes.
I discovered some of the more interesting clients we had were interesting for far more serious reasons than I had initially understood. The things that they had been through were far and beyond what I could've imagined, much less understood.
For example, people go through rough patches in relationships all the time, they go through custody issues all the time. Mostly it's just a simple case of two people no longer liking each other and trying to be spiteful towards one another. Well the case I was looking at was different in that the couple was engaged, but one was accused of felonious assault of a child and instead of seeing each other through the ordeal, they've been torn apart by it.
I don't want to get into too many details for a number of reasons, but this case shows how someone can appear to be better off than they actually are. I would never guess that the client was going through the things that they're dealing with.
What I learned from the discussion I had with my pharmacist though was how taboo mental illness is. You see/hear all the time with people dealing with cancer, or diabetes, or most other types of diseases how families band together, friends come to the person's side, and everyone hopes for the best. They send cards, they visit the person, they show all the support in the world.
Mental illness? They scatter. They disappear. They want NOTHING to do with the person, treating them as if they had the plague. They make fun of the person, or act like the problem can just be changed.
How many times have you seen someone tell someone suffering from depression "just don't think about it, or think happy thoughts." How many times has someone tried to make it seem like it was an easy problem to fix, that they just have to "think differently"?
The problem is, it isn't that easy. Someone who is depressed or mentally ill can't just flip a switch. Some can fight through it for the most part, but it can still catch up to them after a while.
Mental illness and treatment works the opposite of traditional diseases as well. Generally, if someone has high blood pressure, cholesterol issues, or diabetes, you can find a treatment relatively easy and implement it. In rare cases, it isn't easy and the person struggles through multiple treatments. If they fail, it's usually because they decide (rationally) they don't need the medicine.
With mental illness, it's rare that the solution is found right away. Usually several combinations of medicine and therapy are tried before the absolute right treatment is found (additionally, you generally won't need therapy for high cholesterol), and that's if it's found. Most people never find that combination and trudge through life, barely hanging on. It's sad and it's generally ignored.
One of our more troubling clients, who additionally is battling alcoholism (and losing badly), is an example of what happens to people when they start to lose control. Their own family abandoned them until recently. The client's sister hadn't seen her in years, yet had the nerve to yell at us for not doing more for the client. In my head, all I could think was "where were you for the last several years," but you can't say that. Instead, you have to bite your tongue.
That's what happens though. Family either disappears or become completely overwhelmed by having to take care of the client. Some end up devoting years upon years to take care of someone, but this is mainly because no one else wants to deal with it.
After going through some of the notes in the computer, it's become more and more clear to me that mental illness is an even bigger problem than I had already imagined, and I knew it was a big problem. These people need all the help they can get, but they don't get it.
In fact, the states are cutting funding for mental health treatment so much that people are being left behind because there aren't enough hours allowed anymore to provide people the help they need. Meanwhile, rich, healthy men and women are doing all they can to prevent tax increases on them so they can continue to live lavish lifestyles while those who need the money most continue to slip through the cracks.
Look, I'm not sitting here saying that throwing more money at the problem is going to fix it. Mental illness isn't just because someone goes through a rough patch and needs assistance. A lot of it is genetics and there isn't much you can do about that. But those that can be helped need more than they're getting.
It's a problem, but will anything happen to help change that?
My pharmacist and I had a conversation the other night that demonstrated more reasons why mental illness is so much more difficult to understand. This conversation was the end result of me discovering that I could look up people in the main software and see what was going on with them based upon nurses', doctors', and counselors' notes.
I discovered some of the more interesting clients we had were interesting for far more serious reasons than I had initially understood. The things that they had been through were far and beyond what I could've imagined, much less understood.
For example, people go through rough patches in relationships all the time, they go through custody issues all the time. Mostly it's just a simple case of two people no longer liking each other and trying to be spiteful towards one another. Well the case I was looking at was different in that the couple was engaged, but one was accused of felonious assault of a child and instead of seeing each other through the ordeal, they've been torn apart by it.
I don't want to get into too many details for a number of reasons, but this case shows how someone can appear to be better off than they actually are. I would never guess that the client was going through the things that they're dealing with.
What I learned from the discussion I had with my pharmacist though was how taboo mental illness is. You see/hear all the time with people dealing with cancer, or diabetes, or most other types of diseases how families band together, friends come to the person's side, and everyone hopes for the best. They send cards, they visit the person, they show all the support in the world.
Mental illness? They scatter. They disappear. They want NOTHING to do with the person, treating them as if they had the plague. They make fun of the person, or act like the problem can just be changed.
How many times have you seen someone tell someone suffering from depression "just don't think about it, or think happy thoughts." How many times has someone tried to make it seem like it was an easy problem to fix, that they just have to "think differently"?
The problem is, it isn't that easy. Someone who is depressed or mentally ill can't just flip a switch. Some can fight through it for the most part, but it can still catch up to them after a while.
Mental illness and treatment works the opposite of traditional diseases as well. Generally, if someone has high blood pressure, cholesterol issues, or diabetes, you can find a treatment relatively easy and implement it. In rare cases, it isn't easy and the person struggles through multiple treatments. If they fail, it's usually because they decide (rationally) they don't need the medicine.
With mental illness, it's rare that the solution is found right away. Usually several combinations of medicine and therapy are tried before the absolute right treatment is found (additionally, you generally won't need therapy for high cholesterol), and that's if it's found. Most people never find that combination and trudge through life, barely hanging on. It's sad and it's generally ignored.
One of our more troubling clients, who additionally is battling alcoholism (and losing badly), is an example of what happens to people when they start to lose control. Their own family abandoned them until recently. The client's sister hadn't seen her in years, yet had the nerve to yell at us for not doing more for the client. In my head, all I could think was "where were you for the last several years," but you can't say that. Instead, you have to bite your tongue.
That's what happens though. Family either disappears or become completely overwhelmed by having to take care of the client. Some end up devoting years upon years to take care of someone, but this is mainly because no one else wants to deal with it.
After going through some of the notes in the computer, it's become more and more clear to me that mental illness is an even bigger problem than I had already imagined, and I knew it was a big problem. These people need all the help they can get, but they don't get it.
In fact, the states are cutting funding for mental health treatment so much that people are being left behind because there aren't enough hours allowed anymore to provide people the help they need. Meanwhile, rich, healthy men and women are doing all they can to prevent tax increases on them so they can continue to live lavish lifestyles while those who need the money most continue to slip through the cracks.
Look, I'm not sitting here saying that throwing more money at the problem is going to fix it. Mental illness isn't just because someone goes through a rough patch and needs assistance. A lot of it is genetics and there isn't much you can do about that. But those that can be helped need more than they're getting.
It's a problem, but will anything happen to help change that?
Monday, October 17, 2011
the best intentions
People do things for different reasons.
Some people get into a profession because they have always had a thing for it. Some find it interesting and want to see what it's like. Some get into it because of the money. Some, well, they just want to help people or animals in some way or another.
Some do it to defend the life that we live every day.
In a lot of cases, we start off with good intentions. We want to do the best that we can and we adhere to rules and regulations as if God was going to come down and strike us down if we don't. As time goes on, we become lax with such things and in some cases, we become disenchanted with things. We suddenly don't care anymore and then end up hating the job after a while.
Pharmacy is no different. Many start off with the idea of keeping people compliant and hoping that we can help them become healthier. We call them after a few days to see how their new therapy is going, remind them that their refills are ready, and talk to them when they come in. We want to make a difference and so we try to go the extra mile to do so.
But something always happens along the way that causes us to lose that edge, lose that fire that drove us in the beginning. Sure, a lot of the patients are happy that we're there trying to help them out, but some just don't give a damn. Some just want to get in and get out. Some don't believe they need their medications; that we're just poisoning them and trying to fatten our pockets by getting them to buy more medication.
Eventually you start to realize it's a lost cause. For every person you convince to stay on their therapy, three stop taking a medication for a variety of reasons. Your best intentions are sometimes undone by the fact that some can't afford the medication that's saving them. Sometimes they don't care enough about themselves.
Eventually you stop trying so hard. You realize that it's hopeless, that most don't want to be helped. They just want to be left alone, and so you want to leave them alone. The ones that do want to be helped, you get mad at because they're wasting your time with stupid questions. You just want to slink in the back and ignore it all. You start to hate people and their neediness, their inability to take care of themselves.
Finally, you lose it. You can't do it anymore. If you're a tech, you change careers. If you're a pharmacist, you change pharmacies, maybe move into a hospital setting where you don't have as many people to deal with. You become reclusive. You hate people outside of work just as much as you do when at work.
The hospital setting doesn't make things easier and after a few years, you've ended up working at four different pharmacies trying to find something that doesn't make you extremely bitter.
If you're a tech, the path changes. The dream of being a pharmacist fizzles. If you've already entered school, you trudge along, but not for long since you already know the crap they're feeding you in class isn't true. Your professors decide they can't have the disturbances you cause continue and give you the boot. You can still change majors, but you don't care anymore because you've wasted all this time trying to become a pharmacist.
If you aren't in school, well, you have to decide what you're actually going to do. Are you going to force yourself to go? Swallow the bitter pill and hope it gets better? Or do you sit there and make the change into something else before it's too late?
The reality of it, and any job, is it can wear on you after a while. What seems like a great thing can become not-so-great with a little time. Everyone goes through it at some point. For some it isn't as severe as it is for others, but it happens. You start to dread going into work, the days drag more because you anticipate getting off more than you did before.
Everything changes.
For me, that moment occurred after 12-plus years in retail. The job itself still kept me satisfied, but the environment I was in didn't. It seemed like the job had changed so much from how it was when I was hired. The leeway we used to get was disappearing and it seemed like everyone was becoming more and more stressed with each passing day.
For me, the solution was to change environments. I kept the retail setting as a part-time gig but my full-time job became a closed-door pharmacy. We aren't spending every waking hour trying to cram in flu shots and adherence calls in the middle of filling prescriptions. Instead, we're doing what I think pharmacy should be about; making sure people get taken care of and receive the care they deserve.
While I don't see pharmacy as my future anymore, it's not something I dread either. I don't wake up dreading the trip to work.
No, my issues getting up stem directly from not wanting to leave the bed I'm sharing with my girlfriend, even if she has to get up for work as well. Once I get to work, I enjoy it. Sure, it stresses us at times and makes us want to bang our heads against the wall, but it isn't anything like it could be. I've seen what a burned out pharmacist/tech looks like and it isn't pretty.
The one thing I've talked about is once my girlfriend and I are settled in our own place together sometime next year is me possibly looking into law enforcement as a career. I've always had an interest in it and it goes along with the notion of me helping people, just in a different way.
Sure, I'd be putting my life on the line, but the way I see it, anything can happen at anytime. Someone could walk up to my window right now and demand drugs or money and my life would be in danger. At least if I were doing police work, I'd be putting my life on the line while attempting to help save others.
The realization is that I'm in my 30's and just don't really feel the best idea is to try and get through pharmacy school now, especially since I have minimal college experience behind me. It would take a long time and I feel there's a very good chance this line of work will burn me out in the next five years. To me, it makes more sense to look into law enforcement soon and see what opportunities lie there.
I don't want to become one of those horror stories of people becoming so scarred from their work experiences that they are shells of their former selves. I want to continue to be a productive human being who can still be fun to be around.
After all, I do only have the best intentions for myself, those close to me, and those I encounter in life.
Some people get into a profession because they have always had a thing for it. Some find it interesting and want to see what it's like. Some get into it because of the money. Some, well, they just want to help people or animals in some way or another.
Some do it to defend the life that we live every day.
In a lot of cases, we start off with good intentions. We want to do the best that we can and we adhere to rules and regulations as if God was going to come down and strike us down if we don't. As time goes on, we become lax with such things and in some cases, we become disenchanted with things. We suddenly don't care anymore and then end up hating the job after a while.
Pharmacy is no different. Many start off with the idea of keeping people compliant and hoping that we can help them become healthier. We call them after a few days to see how their new therapy is going, remind them that their refills are ready, and talk to them when they come in. We want to make a difference and so we try to go the extra mile to do so.
But something always happens along the way that causes us to lose that edge, lose that fire that drove us in the beginning. Sure, a lot of the patients are happy that we're there trying to help them out, but some just don't give a damn. Some just want to get in and get out. Some don't believe they need their medications; that we're just poisoning them and trying to fatten our pockets by getting them to buy more medication.
Eventually you start to realize it's a lost cause. For every person you convince to stay on their therapy, three stop taking a medication for a variety of reasons. Your best intentions are sometimes undone by the fact that some can't afford the medication that's saving them. Sometimes they don't care enough about themselves.
Eventually you stop trying so hard. You realize that it's hopeless, that most don't want to be helped. They just want to be left alone, and so you want to leave them alone. The ones that do want to be helped, you get mad at because they're wasting your time with stupid questions. You just want to slink in the back and ignore it all. You start to hate people and their neediness, their inability to take care of themselves.
Finally, you lose it. You can't do it anymore. If you're a tech, you change careers. If you're a pharmacist, you change pharmacies, maybe move into a hospital setting where you don't have as many people to deal with. You become reclusive. You hate people outside of work just as much as you do when at work.
The hospital setting doesn't make things easier and after a few years, you've ended up working at four different pharmacies trying to find something that doesn't make you extremely bitter.
If you're a tech, the path changes. The dream of being a pharmacist fizzles. If you've already entered school, you trudge along, but not for long since you already know the crap they're feeding you in class isn't true. Your professors decide they can't have the disturbances you cause continue and give you the boot. You can still change majors, but you don't care anymore because you've wasted all this time trying to become a pharmacist.
If you aren't in school, well, you have to decide what you're actually going to do. Are you going to force yourself to go? Swallow the bitter pill and hope it gets better? Or do you sit there and make the change into something else before it's too late?
The reality of it, and any job, is it can wear on you after a while. What seems like a great thing can become not-so-great with a little time. Everyone goes through it at some point. For some it isn't as severe as it is for others, but it happens. You start to dread going into work, the days drag more because you anticipate getting off more than you did before.
Everything changes.
For me, that moment occurred after 12-plus years in retail. The job itself still kept me satisfied, but the environment I was in didn't. It seemed like the job had changed so much from how it was when I was hired. The leeway we used to get was disappearing and it seemed like everyone was becoming more and more stressed with each passing day.
For me, the solution was to change environments. I kept the retail setting as a part-time gig but my full-time job became a closed-door pharmacy. We aren't spending every waking hour trying to cram in flu shots and adherence calls in the middle of filling prescriptions. Instead, we're doing what I think pharmacy should be about; making sure people get taken care of and receive the care they deserve.
While I don't see pharmacy as my future anymore, it's not something I dread either. I don't wake up dreading the trip to work.
No, my issues getting up stem directly from not wanting to leave the bed I'm sharing with my girlfriend, even if she has to get up for work as well. Once I get to work, I enjoy it. Sure, it stresses us at times and makes us want to bang our heads against the wall, but it isn't anything like it could be. I've seen what a burned out pharmacist/tech looks like and it isn't pretty.
The one thing I've talked about is once my girlfriend and I are settled in our own place together sometime next year is me possibly looking into law enforcement as a career. I've always had an interest in it and it goes along with the notion of me helping people, just in a different way.
Sure, I'd be putting my life on the line, but the way I see it, anything can happen at anytime. Someone could walk up to my window right now and demand drugs or money and my life would be in danger. At least if I were doing police work, I'd be putting my life on the line while attempting to help save others.
The realization is that I'm in my 30's and just don't really feel the best idea is to try and get through pharmacy school now, especially since I have minimal college experience behind me. It would take a long time and I feel there's a very good chance this line of work will burn me out in the next five years. To me, it makes more sense to look into law enforcement soon and see what opportunities lie there.
I don't want to become one of those horror stories of people becoming so scarred from their work experiences that they are shells of their former selves. I want to continue to be a productive human being who can still be fun to be around.
After all, I do only have the best intentions for myself, those close to me, and those I encounter in life.
Monday, October 10, 2011
The seeds of doubt
One of the more difficult things to achieve when working in a pharmacy is to remove doubt from a patient's mind. People are skeptical by nature to begin with, but it seems to be even more with anything that involves doctors and pharmacies.
How are they skeptical?
Let me count the ways.
This could take a while.
For one, they doubt that generic is as good as the brand name. This seems to be especially true of those on pain management (I need brand name Vicodin/Percocet/Demerol/Ultram) and those who come from the dentist with an antibiotic (but the dentist specifically said NO generic Amoxil!). We can preach to most of them the virtues of generics and win them over, but there's always one or two that just don't care.
They usually get whittled down when we run the claim to the insurance and it comes back with an excruciating high price (gotta love the old copay plus the difference in cost idea that insurances like to use), but isn't even foolproof. No, someone always invariably wants to pay or has such amazing insurance (they pay out their ass for their coverage) that it's covered.
This is particularly annoying when it's only one person who gets the brand name that hasn't been used in 3 years to begin with and we now have to keep it in stock so they can get their precious brand name every month. Then the real kick in the pants is when they get switched a week after you've opened a fresh bottle for them, thus rendering it impossible to send the crap back.
I'll admit, there are instances when they have legitimate issues with the generic. Sometimes people are allergic to one of the fillers. It happens. But those of you still stuck on "the brand name is holier than generic" bullshit, get a grip. It's not. Hell, a lot of times the generic is made by the same company that makes the brand version. How wild is that?
Open up a bottle of Adderall XR. Now open up a generic. One of the manufacturers uses the brand name in its bottle.
Try explaining that one to the masses. It's generic, yet it's brand. Understand? Good.
Another issue we receive doubt on is insurances in general. We spend more time trying to explain to people that we have NO control over their copays and what's covered than we do actually filling prescriptions.
Look, I am of the belief that it shouldn't be that complicated to get whatever treatment/service you need for a legitimate medical condition. I don't think doctors and nurses should have to jump through 17 hoops just so a patient who needs Abilify gets that medication (thanks Buckeye, by the way). All the same, we shouldn't have to explain 17 times over why your insurance doesn't want to pay for this.
I want you to get better. I want you to be stable/pain free and all that crap. I really do. I am not gaining by telling you that your insurance requires prior authorization, nor do I know specifically what they want the doctor to provide. Generally it's proof that a cheaper method didn't work for you, but sometimes it's just because they don't want to pay $500 to cover Abilify.
In the end, I do not know how anyone's insurance plan is structured. I do not know what's covered, what isn't, what requires prior authorization, why it's $47 this month when it was $39 last month, or why they only cover 30 instead of 90. I generally don't. Sometimes I can guess, but there's no guarantee.
You want to know what your plan is all about? You have to call to find out. I don't have a magic button on my computer that brings up everyone's insurance information. If I did, I'd probably go crazy because I'd be spending all my time at work explaining people's plans to them.
**Intermission**
On a side note, I am tired of reading/hearing people say we can't say prior authorization to patients, that it's too complicated for them. I've been a tech for well over 10 years and have yet to have someone so completely baffled by it that it took more than a couple minutes to explain.
Seriously, it's not that hard to sit and say "this requires prior authorization, which means the doctor or nurse has to tell the insurance company why they want to use this instead of generic option A." 95% of people have gotten it over the years and the rest are such lost causes that it doesn't matter what you say to them, they don't stand a chance of understanding.
People can be stupid, but a lot of them can have things explained to them relatively easily.
**End Intermission**
In the end, the only thing that we are assured is that insurances are complicated and we have no control over what happens with them. It is frustrating trying to explain to someone why they are paying $60 for their cholesterol meds a month, but we are usually more than happy to give their doctor a call and ask to try something cheaper.
What ends up being really frustrating is there's always that one doctor who will say no, he only uses that medication, that they'll just have to suck it up and pay for it.
People doubt us when we say a drug is on backorder. This is becoming one of the more frustrating situations, especially thanks to the generic Adderall shortage that's been going on for the entire year.
I had a woman one time tell me that I just didn't want her to have her medication when I tried to tell her the manufacturer wasn't supplying it. She said that was the most ridiculous thing she'd ever heard, that no drug company would EVER let that happen. I had to actually print out the screen on the ordering computer, then show her where it said long-term backorder, no release date available. Even then she was huffy with me, telling me to call her "whenever you bother getting it in for me."
Some people just can't believe that a drug can not be available.
But it happens. A lot in fact. More so now than in recent memory. I can remember a few years ago it was a huge surprise if something wasn't available. It's slowly becoming more commonplace as the years have gone by, almost to the point where people's common reaction is nonchalant because they've been hearing the same story all year long.
Yet there are those out there who can't understand it. They think we just don't want to give them their medication.
I can't do much about that perception and am not going to spend a lot of time explaining it to someone who just doesn't want to get it.
Some don't understand why it takes 15 minutes to fill a prescription. Well, a lot of times it doesn't take that long. More often than not, we can get someone out in less than 10 minutes. Yet sometimes, that's not fast enough.
Most in pharmacy have heard someone say "all you have to do is slap a label on a box/bottle. Why does that take so long?" Most have rolled their eyes at this question before going into the lengthy talk about having to enter it in, run it through to insurance, print the label, find the stock bottle, count out the pills (if applicable), pass it down to be verified, then finally be done with it.
Some get that it's not an instant process, but some think it is, or at least should be.
It's that old drive-thru mentality. People want it ready when they are, regardless if it's been 5 minutes or 5 hours.
In the end, doubt is a part of all professions and I guess we should be thankful it's not worse than it is.
I just wonder if the trust will ever come back like it used to be.
How are they skeptical?
Let me count the ways.
This could take a while.
For one, they doubt that generic is as good as the brand name. This seems to be especially true of those on pain management (I need brand name Vicodin/Percocet/Demerol/Ultram) and those who come from the dentist with an antibiotic (but the dentist specifically said NO generic Amoxil!). We can preach to most of them the virtues of generics and win them over, but there's always one or two that just don't care.
They usually get whittled down when we run the claim to the insurance and it comes back with an excruciating high price (gotta love the old copay plus the difference in cost idea that insurances like to use), but isn't even foolproof. No, someone always invariably wants to pay or has such amazing insurance (they pay out their ass for their coverage) that it's covered.
This is particularly annoying when it's only one person who gets the brand name that hasn't been used in 3 years to begin with and we now have to keep it in stock so they can get their precious brand name every month. Then the real kick in the pants is when they get switched a week after you've opened a fresh bottle for them, thus rendering it impossible to send the crap back.
I'll admit, there are instances when they have legitimate issues with the generic. Sometimes people are allergic to one of the fillers. It happens. But those of you still stuck on "the brand name is holier than generic" bullshit, get a grip. It's not. Hell, a lot of times the generic is made by the same company that makes the brand version. How wild is that?
Open up a bottle of Adderall XR. Now open up a generic. One of the manufacturers uses the brand name in its bottle.
Try explaining that one to the masses. It's generic, yet it's brand. Understand? Good.
Another issue we receive doubt on is insurances in general. We spend more time trying to explain to people that we have NO control over their copays and what's covered than we do actually filling prescriptions.
Look, I am of the belief that it shouldn't be that complicated to get whatever treatment/service you need for a legitimate medical condition. I don't think doctors and nurses should have to jump through 17 hoops just so a patient who needs Abilify gets that medication (thanks Buckeye, by the way). All the same, we shouldn't have to explain 17 times over why your insurance doesn't want to pay for this.
I want you to get better. I want you to be stable/pain free and all that crap. I really do. I am not gaining by telling you that your insurance requires prior authorization, nor do I know specifically what they want the doctor to provide. Generally it's proof that a cheaper method didn't work for you, but sometimes it's just because they don't want to pay $500 to cover Abilify.
In the end, I do not know how anyone's insurance plan is structured. I do not know what's covered, what isn't, what requires prior authorization, why it's $47 this month when it was $39 last month, or why they only cover 30 instead of 90. I generally don't. Sometimes I can guess, but there's no guarantee.
You want to know what your plan is all about? You have to call to find out. I don't have a magic button on my computer that brings up everyone's insurance information. If I did, I'd probably go crazy because I'd be spending all my time at work explaining people's plans to them.
**Intermission**
On a side note, I am tired of reading/hearing people say we can't say prior authorization to patients, that it's too complicated for them. I've been a tech for well over 10 years and have yet to have someone so completely baffled by it that it took more than a couple minutes to explain.
Seriously, it's not that hard to sit and say "this requires prior authorization, which means the doctor or nurse has to tell the insurance company why they want to use this instead of generic option A." 95% of people have gotten it over the years and the rest are such lost causes that it doesn't matter what you say to them, they don't stand a chance of understanding.
People can be stupid, but a lot of them can have things explained to them relatively easily.
**End Intermission**
In the end, the only thing that we are assured is that insurances are complicated and we have no control over what happens with them. It is frustrating trying to explain to someone why they are paying $60 for their cholesterol meds a month, but we are usually more than happy to give their doctor a call and ask to try something cheaper.
What ends up being really frustrating is there's always that one doctor who will say no, he only uses that medication, that they'll just have to suck it up and pay for it.
People doubt us when we say a drug is on backorder. This is becoming one of the more frustrating situations, especially thanks to the generic Adderall shortage that's been going on for the entire year.
I had a woman one time tell me that I just didn't want her to have her medication when I tried to tell her the manufacturer wasn't supplying it. She said that was the most ridiculous thing she'd ever heard, that no drug company would EVER let that happen. I had to actually print out the screen on the ordering computer, then show her where it said long-term backorder, no release date available. Even then she was huffy with me, telling me to call her "whenever you bother getting it in for me."
Some people just can't believe that a drug can not be available.
But it happens. A lot in fact. More so now than in recent memory. I can remember a few years ago it was a huge surprise if something wasn't available. It's slowly becoming more commonplace as the years have gone by, almost to the point where people's common reaction is nonchalant because they've been hearing the same story all year long.
Yet there are those out there who can't understand it. They think we just don't want to give them their medication.
I can't do much about that perception and am not going to spend a lot of time explaining it to someone who just doesn't want to get it.
Some don't understand why it takes 15 minutes to fill a prescription. Well, a lot of times it doesn't take that long. More often than not, we can get someone out in less than 10 minutes. Yet sometimes, that's not fast enough.
Most in pharmacy have heard someone say "all you have to do is slap a label on a box/bottle. Why does that take so long?" Most have rolled their eyes at this question before going into the lengthy talk about having to enter it in, run it through to insurance, print the label, find the stock bottle, count out the pills (if applicable), pass it down to be verified, then finally be done with it.
Some get that it's not an instant process, but some think it is, or at least should be.
It's that old drive-thru mentality. People want it ready when they are, regardless if it's been 5 minutes or 5 hours.
In the end, doubt is a part of all professions and I guess we should be thankful it's not worse than it is.
I just wonder if the trust will ever come back like it used to be.
Thursday, October 6, 2011
the trouble with mental illness
A lot of people probably remember when Tom Cruise jumped up on a couch and proclaimed that depression wasn't a myth, that it was a made-up disease so that drug companies could make money off of unsuspecting people who *thought* there was something wrong with them.
I remember watching the lunacy, then reading the follow-up remarks he made about it with a sense of disbelief, that someone as smart as Cruise would make those remarks.
Then I found out he followed Scientology, and it all came into focus.
This isn't about them though. I don't even like to acknowledge that they actually exist.
This is about the fact that mental illness is very real and a big problem, not just in this country, but around the world. This is about the fact that when people are treated properly for it, they stand a chance of getting better. This is about what happens when they don't receive proper treatment, or fail to follow their treatment plan.
This is also inspired by a client here.
When the pharmacy first opened, this client, we'll call him Mr. Kitty since he loves his cat so much, was in bad shape. He was ornery, he didn't like anyone, and if his meds weren't ready when he was, he was particularly cranky about it. It got to a point where I would dread seeing his name come up on the refill report.
He was one of those that demanded brand name, demanded three months at a time, and demanded that they be ready when he was ready to pick them up.
In short, he wasn't in great shape. You could tell from looking at him that he wasn't happy. When he wheeled by (Mr. Kitty is in a wheelchair), he wouldn't say anything to anyone who happened to walk by.
Then one day he went out and got a kitten. At the same time, some of his meds were changed up every so slightly, just enough to tweak his mood a little bit. Combine this with the kitten, with whom he reportedly played with constantly, and you could see his mood almost immediately start to change.
Fast forward more than a year and the change is incredible. He comes in and has a smile on his face. He says hi to everyone, making sure to stop by each pharmacy window to talk to all of us that are here. He and the courier have become especially buddy-buddy, sharing stories and talking about his cat.
One day he sat and played a card game with a little kid that was here for counseling, telling the kid about some of the things that he had endured. He then cracked jokes with us before heading back to his counseling session.
The other day, he stopped the CEO and said he had a suggestion for a group therapy. Now, the CEO is generally good at listening to all proposals to begin with, but you could tell that he was especially interested in Mr. Kitty's proposition. When Mr. Kitty was done with his proposal, the big boss said that he thought it was a great idea and that they were thinking of doing something similar to begin with. He then asked Mr. Kitty if he would be interested in leading the group session he suggested, saying that they wanted clients to take charge like that.
Mr. Kitty was ecstatic.
Now granted, this is a rarity. Most people don't turn around so dramatically as he has. Most, if they show any improvement, only show a slight bit of improvement. Some show no change whatsoever, and a few even regress further.
There are a lot of reasons, but very few solutions to that problem, which is what makes mental illness so difficult to comprehend.
Like all other things, what works for one person won't necessarily work for the next. This is especially true when it comes to medications. When you hear someone say that everyone responds differently to different medications, they aren't lying. It's just how it is. One person could take just Sertraline (Zoloft) and be fine. The next could take it and become worse. Sometimes it just takes adding one other drug to the mix, but on the other hand, that could make things even worse as well.
Treating mental illness is such trial and error that it's hard to come up with a simple solution, or "one size fits all" method of treating it. Some people respond really well to counseling just because they need someone to listen to them, others don't.
I had one mother-son combination in the facility today that demonstrates this. He was standing there, expressionless, while she dropped of his prescription. As I was entering it, she started to ask him why he was so silent, if something was wrong. He didn't react at all, not even a blink of his eyelids. There was no acknowledging that she had even asked him a question. I could look at him and tell something was amiss, but he was refusing to say anything.
She told him this was his problem; he had something bothering him, but he refused to talk to anyone about it, instead choosing to internalize it. She asked him if things were moving too fast for him, and he mouthed "Yes." I didn't hear the rest of the conversation because they started to walk away from the pharmacy, but she had at least received a response from him, which is often the most difficult part.
The most common thing I've seen amongst the kids that come in here, particularly the preteens and teenagers, is that they have the earbuds in either listening to music or playing a game on their phone/Nintendo DS/PSP. They've chosen to tune the outside world out, keeping everything to themselves for one reason or another.
Chances are, they've never tried to talk to anyone about what's bothering them, or if they have, whoever they tried to speak to just didn't care or listen very well, thus destroying any confidence they might have had in talking to someone about their problems.
**Column Intermission**
Every now and then, someone finds a way to surprise you, albeit in a not-so-satisfying way. Right now there is a client in the waiting room who looks like they are ready to let loose with the contents of their stomach. It happens to be one of the dependency clients, which makes me wonder just what's causing the queasy look.
One of the perks of having a job like this is being able to see what everyone is here for, not to make fun of them, but to understand better why they're here and why they're on the meds they're on.
**End Intermission**
The sad truth about mental illness is we still don't understand it well enough to properly get a handle on it. With many other conditions, such as high blood pressure or diabetes, you can find a way to effectively control the problem without too much of a hassle (of course this isn't always true, I know that better than anyone else). Try a couple different things and 90% of the time, you're good to go.
Not so with mental illness. First you have to figure out what the specific problem is before you can even start giving out meds, and even when you do, it's not likely you're going to nail it on the first try. In a lot of cases, it takes trials with a few different types of meds before you find the magic combination that makes a person feel better.
I dated a girl many years ago who epitomized this problem. When I met her, she was taking Cymbalta for her depression and Adderall for her attention issues. Of course, some of her problem was created by herself because she didn't take the adderall the way she was supposed to. She was on the extended-release capsule, which is supposed to last all day as long as you take it right. Well, she was opening the capsule and taking the contents directly, giving herself an immediate boost, but it didn't last as long.
This was directly related to the fact that she could NOT get up in the morning until she took her medication, which was only made worse by her reliance on the meds themselves. In essence, she took a minor problem and made a major one out of it, which ended up becoming worse because of her reaction to the Cymbalta.
She ended up developing severe bruising, which is one of the rarer side effects of Cymbalta, which combined with her developing Ovarian Cysts, made things rather testy for a while. She wasn't getting the help for her depression like she needed because the bruising made her uncomfortable, her ADD wasn't being treated properly because she wouldn't take her meds right, and she had cysts on her ovaries to complicate things more.
After it was determined that her Cymbalta was causing her problems, she was switched to Wellbutrin XL, which helped with her mood tremendously. She felt good and was more alert than she had been in a long time. This came with one drawback though; her libido didn't just go down, it completely disappeared (a common side effect amongst anti-depressants along with drowsiness and weight gain). In short, she had no desire to have sex, which ended up causing her depression to return.
Then shit hit the fan with her after that. She got into a fight with her mom's best friend, I ended up getting fed up with all the different things going on, and we went our separate ways and I figured that was the end of it.
A few months later we somehow ended up chatting again and she told me how she finally was on a medication that not only made her feel better, but didn't kill her sex drive or make her overly sleepy. She had started dating someone else and was finally starting to feel happy with life overall.
It took over a year of trials, tribulations, and errors for her to finally find a combination that worked for her, which is what my main point is.
Trial and error is such a big problem with treating mental illness and is why a lot of people never get the help they need. They give up because nothing's worked and they feel nothing will. They stop listening because everyone that's been telling them things will get better have been wrong to that point. They stop caring because, well, they don't care.
They feel lost and alone. Some end up angry, some end up sad, some end up some freakishly scary combination of both.
Now this doesn't apply to everyone. As I've said, everyone's different. Everyone's circumstances are different. What one person considers to be terrible, someone else might think "eh, that's not that bad."
In the long run, there isn't much a pharmacy technician can do. We can fill their scripts, answer their questions, and listen to them when they try to talk, but ultimately, we're just a person behind a counter. We don't have all the answers and we can't give them all the help they truly need.
Maybe one day we'll figure out a way to help people in a much easier fashion, but I doubt it.
Unless that day comes, all someone like me can do is fill their script quickly and hope they take it like they should.
I remember watching the lunacy, then reading the follow-up remarks he made about it with a sense of disbelief, that someone as smart as Cruise would make those remarks.
Then I found out he followed Scientology, and it all came into focus.
This isn't about them though. I don't even like to acknowledge that they actually exist.
This is about the fact that mental illness is very real and a big problem, not just in this country, but around the world. This is about the fact that when people are treated properly for it, they stand a chance of getting better. This is about what happens when they don't receive proper treatment, or fail to follow their treatment plan.
This is also inspired by a client here.
When the pharmacy first opened, this client, we'll call him Mr. Kitty since he loves his cat so much, was in bad shape. He was ornery, he didn't like anyone, and if his meds weren't ready when he was, he was particularly cranky about it. It got to a point where I would dread seeing his name come up on the refill report.
He was one of those that demanded brand name, demanded three months at a time, and demanded that they be ready when he was ready to pick them up.
In short, he wasn't in great shape. You could tell from looking at him that he wasn't happy. When he wheeled by (Mr. Kitty is in a wheelchair), he wouldn't say anything to anyone who happened to walk by.
Then one day he went out and got a kitten. At the same time, some of his meds were changed up every so slightly, just enough to tweak his mood a little bit. Combine this with the kitten, with whom he reportedly played with constantly, and you could see his mood almost immediately start to change.
Fast forward more than a year and the change is incredible. He comes in and has a smile on his face. He says hi to everyone, making sure to stop by each pharmacy window to talk to all of us that are here. He and the courier have become especially buddy-buddy, sharing stories and talking about his cat.
One day he sat and played a card game with a little kid that was here for counseling, telling the kid about some of the things that he had endured. He then cracked jokes with us before heading back to his counseling session.
The other day, he stopped the CEO and said he had a suggestion for a group therapy. Now, the CEO is generally good at listening to all proposals to begin with, but you could tell that he was especially interested in Mr. Kitty's proposition. When Mr. Kitty was done with his proposal, the big boss said that he thought it was a great idea and that they were thinking of doing something similar to begin with. He then asked Mr. Kitty if he would be interested in leading the group session he suggested, saying that they wanted clients to take charge like that.
Mr. Kitty was ecstatic.
Now granted, this is a rarity. Most people don't turn around so dramatically as he has. Most, if they show any improvement, only show a slight bit of improvement. Some show no change whatsoever, and a few even regress further.
There are a lot of reasons, but very few solutions to that problem, which is what makes mental illness so difficult to comprehend.
Like all other things, what works for one person won't necessarily work for the next. This is especially true when it comes to medications. When you hear someone say that everyone responds differently to different medications, they aren't lying. It's just how it is. One person could take just Sertraline (Zoloft) and be fine. The next could take it and become worse. Sometimes it just takes adding one other drug to the mix, but on the other hand, that could make things even worse as well.
Treating mental illness is such trial and error that it's hard to come up with a simple solution, or "one size fits all" method of treating it. Some people respond really well to counseling just because they need someone to listen to them, others don't.
I had one mother-son combination in the facility today that demonstrates this. He was standing there, expressionless, while she dropped of his prescription. As I was entering it, she started to ask him why he was so silent, if something was wrong. He didn't react at all, not even a blink of his eyelids. There was no acknowledging that she had even asked him a question. I could look at him and tell something was amiss, but he was refusing to say anything.
She told him this was his problem; he had something bothering him, but he refused to talk to anyone about it, instead choosing to internalize it. She asked him if things were moving too fast for him, and he mouthed "Yes." I didn't hear the rest of the conversation because they started to walk away from the pharmacy, but she had at least received a response from him, which is often the most difficult part.
The most common thing I've seen amongst the kids that come in here, particularly the preteens and teenagers, is that they have the earbuds in either listening to music or playing a game on their phone/Nintendo DS/PSP. They've chosen to tune the outside world out, keeping everything to themselves for one reason or another.
Chances are, they've never tried to talk to anyone about what's bothering them, or if they have, whoever they tried to speak to just didn't care or listen very well, thus destroying any confidence they might have had in talking to someone about their problems.
**Column Intermission**
Every now and then, someone finds a way to surprise you, albeit in a not-so-satisfying way. Right now there is a client in the waiting room who looks like they are ready to let loose with the contents of their stomach. It happens to be one of the dependency clients, which makes me wonder just what's causing the queasy look.
One of the perks of having a job like this is being able to see what everyone is here for, not to make fun of them, but to understand better why they're here and why they're on the meds they're on.
**End Intermission**
The sad truth about mental illness is we still don't understand it well enough to properly get a handle on it. With many other conditions, such as high blood pressure or diabetes, you can find a way to effectively control the problem without too much of a hassle (of course this isn't always true, I know that better than anyone else). Try a couple different things and 90% of the time, you're good to go.
Not so with mental illness. First you have to figure out what the specific problem is before you can even start giving out meds, and even when you do, it's not likely you're going to nail it on the first try. In a lot of cases, it takes trials with a few different types of meds before you find the magic combination that makes a person feel better.
I dated a girl many years ago who epitomized this problem. When I met her, she was taking Cymbalta for her depression and Adderall for her attention issues. Of course, some of her problem was created by herself because she didn't take the adderall the way she was supposed to. She was on the extended-release capsule, which is supposed to last all day as long as you take it right. Well, she was opening the capsule and taking the contents directly, giving herself an immediate boost, but it didn't last as long.
This was directly related to the fact that she could NOT get up in the morning until she took her medication, which was only made worse by her reliance on the meds themselves. In essence, she took a minor problem and made a major one out of it, which ended up becoming worse because of her reaction to the Cymbalta.
She ended up developing severe bruising, which is one of the rarer side effects of Cymbalta, which combined with her developing Ovarian Cysts, made things rather testy for a while. She wasn't getting the help for her depression like she needed because the bruising made her uncomfortable, her ADD wasn't being treated properly because she wouldn't take her meds right, and she had cysts on her ovaries to complicate things more.
After it was determined that her Cymbalta was causing her problems, she was switched to Wellbutrin XL, which helped with her mood tremendously. She felt good and was more alert than she had been in a long time. This came with one drawback though; her libido didn't just go down, it completely disappeared (a common side effect amongst anti-depressants along with drowsiness and weight gain). In short, she had no desire to have sex, which ended up causing her depression to return.
Then shit hit the fan with her after that. She got into a fight with her mom's best friend, I ended up getting fed up with all the different things going on, and we went our separate ways and I figured that was the end of it.
A few months later we somehow ended up chatting again and she told me how she finally was on a medication that not only made her feel better, but didn't kill her sex drive or make her overly sleepy. She had started dating someone else and was finally starting to feel happy with life overall.
It took over a year of trials, tribulations, and errors for her to finally find a combination that worked for her, which is what my main point is.
Trial and error is such a big problem with treating mental illness and is why a lot of people never get the help they need. They give up because nothing's worked and they feel nothing will. They stop listening because everyone that's been telling them things will get better have been wrong to that point. They stop caring because, well, they don't care.
They feel lost and alone. Some end up angry, some end up sad, some end up some freakishly scary combination of both.
Now this doesn't apply to everyone. As I've said, everyone's different. Everyone's circumstances are different. What one person considers to be terrible, someone else might think "eh, that's not that bad."
In the long run, there isn't much a pharmacy technician can do. We can fill their scripts, answer their questions, and listen to them when they try to talk, but ultimately, we're just a person behind a counter. We don't have all the answers and we can't give them all the help they truly need.
Maybe one day we'll figure out a way to help people in a much easier fashion, but I doubt it.
Unless that day comes, all someone like me can do is fill their script quickly and hope they take it like they should.
Wednesday, October 5, 2011
from the refill line
Mr. Husky: "I got a fucking answering machine...."
*click*
This indeed confirms this is one of those days.
*click*
This indeed confirms this is one of those days.
back away from the machine
One of my favorite moments during the day is when I hear someone beating on the vending machine because their snack was snuck.
Today, the first beating took place at approximately 8:38am after a woman's snack item became stuck.
Normally, all this entails is going over to reception to inform them of the problem and they either give the money back or have a guy come down with a key to open it up, but no one ever does that. They beat on the thing first, then come over to the pharmacy and complain.
This same woman was also *cheering* on my pharmacist as she opened the gate and keeps peeking into the window in the door to the offices to see if it's her turn.
I believe it's going to be one of those days today.
Today, the first beating took place at approximately 8:38am after a woman's snack item became stuck.
Normally, all this entails is going over to reception to inform them of the problem and they either give the money back or have a guy come down with a key to open it up, but no one ever does that. They beat on the thing first, then come over to the pharmacy and complain.
This same woman was also *cheering* on my pharmacist as she opened the gate and keeps peeking into the window in the door to the offices to see if it's her turn.
I believe it's going to be one of those days today.
Tuesday, October 4, 2011
changes, oh how I hate you
Before I say anything else, I have to make a big correction to my last post in which I talked about the changes since I started working. I omitted a very big, very important change that took place recently.
I forgot to mention how I am now involved in an amazing relationship with an amazing woman who absolutely completes my life.
The error is being corrected not because of pity, but because it was a huge one that should not have happened. My apologies to her.
Now then, back to the task at hand.
All of us who have worked in a pharmacy for any amount of time know that insurances often change things up at the beginning of the year, often throwing a huge wrench in things for the first month of the year as we try to figure who changed to what, what is and isn't covered anymore, and whether we want to reach through the phone to strangle the customer service rep, or just drive there instead to do the job.
To understand where the recent problems stem from, you have to understand a couple of things about my state's Medicaid system. Where I live, it's broken down into four different branches. There's Medicaid and 3 off-shoots, who up until 3 years ago, were processed by various insurance processors. One was processed by WHI, anothe by Express Scripts, and the third by US Scripts. 3 years ago, Medicaid decided to combine them all into one processor, thus creating the first set of issues we had, mostly with the Express Scripts one since that one let you get all kinds of OTC stuff that regular Medicaid didn't cover. For a few months, all we heard was people scream at us because their OTC ibuprofen was no longer covered because "MY INSURANCE COVERED IT BEFORE!"
Well after getting everyone used to that system and the formulary that Medicaid used, things were relatively fine.
Then about a few months ago, word started to spread that later in the year, Medicaid was going to split the three other versions off again. We didn't hear much else until my girlfriend received a newsletter telling her that her daughter's version was going to be processed under a new company and to be on the look-out for the new card (as of this writing, she still hadn't received and the changes took effect on the 1st).
It wasn't until right before the end of September that we started to see new cards. Much to my surprise, two of the three are back to their original processors, WHI and US Scripts. The other one was now going to be done by CVS/Caremark, and that's where things get interesting.
Before getting into that, a special shout-out to WHI for not notifying us or are insurance coordinator that we weren't contracted with your version of Medicaid. It was real nice going through half the day Monday getting the message "Pharmacy not contracted on date of service."
Now back to CVS/Caremark's Medicaid. This one was a spectacular fail, mostly because there was no consistency as to whether a claim was going to go through or not. The first couple went through like they should. I added the new plan in, put in their ID, the proper group, and voila! Success.
It was downhill after that.
First was the 25 minute phone call that ended in us adding a "1" at the end of the ID (that wasn't on the card), making sure the first name wasn't shortened, and adding their middle initial into their profile. Then it went through. After that, it was the double-bill debacle. See, we should be able to bill their primary insurance, then send the copay to whichever Medicaid they have so that their copay is $0. Well, it didn't work. It told us to submit to a different processor that CVS/Caremark uses for this reason, only to watch it reject again for non-matched cardholder/group reasons. After an hour and no resolution from the help desk, my pharmacist gave up and allowed the patient to try and take it somewhere else, where I'm sure they still had a ton of problems.
In short, it was a mess and we aren't very busy. The pharmacist at my retail job posted on Facebook how he was swearing the whole way home because of this particular version of Medicaid, thus confirming my belief it was the insurance's fault for all the problems, not ours.
Today has been better as we've discovered we can use the original Medicaid ID to run them through with less hassle than trying to use their new ID. I'm convinced this wasn't working yesterday and was implemented overnight because they got tired of all the phone calls they received.
Oh, and let's not get started on the formulary changes that have taken place now that the three Medicaids have split off. Stuff that was covered a month ago under the regular Medicaid is not covered anymore, even something as simple as Seroquel. Medicaid itself decided to kick us in the pants and change some of their formulary items just because, well, we don't know. I guess they think it's fun to watch doctors and nurses call in to request prior authorizations on things that had been covered for the last three years.
This is all taking place a month from open enrollment for Medicare Part D, which hasn't been as bad the last couple of years as it was when it was first introduced.
Then in January, a lot of pharmacies get to endure the "my insurance changed at the beginning of the year but I never got a card" circus.
Luckily in my job, we don't do a lot of private insurance so that's not too much of a concern. Most of our clients are Medicaid/Medicare recipients, so once we get past November, we're generally in the clear.
Except for the spenddowns.
I hate spenddowns.
I don't mean to sound bitchy about some of this stuff, but it's much more complicated than it needs to be.
Hopefully there are no more curveballs thrown our way.
I have enough trouble with fastballs.
I forgot to mention how I am now involved in an amazing relationship with an amazing woman who absolutely completes my life.
The error is being corrected not because of pity, but because it was a huge one that should not have happened. My apologies to her.
Now then, back to the task at hand.
All of us who have worked in a pharmacy for any amount of time know that insurances often change things up at the beginning of the year, often throwing a huge wrench in things for the first month of the year as we try to figure who changed to what, what is and isn't covered anymore, and whether we want to reach through the phone to strangle the customer service rep, or just drive there instead to do the job.
To understand where the recent problems stem from, you have to understand a couple of things about my state's Medicaid system. Where I live, it's broken down into four different branches. There's Medicaid and 3 off-shoots, who up until 3 years ago, were processed by various insurance processors. One was processed by WHI, anothe by Express Scripts, and the third by US Scripts. 3 years ago, Medicaid decided to combine them all into one processor, thus creating the first set of issues we had, mostly with the Express Scripts one since that one let you get all kinds of OTC stuff that regular Medicaid didn't cover. For a few months, all we heard was people scream at us because their OTC ibuprofen was no longer covered because "MY INSURANCE COVERED IT BEFORE!"
Well after getting everyone used to that system and the formulary that Medicaid used, things were relatively fine.
Then about a few months ago, word started to spread that later in the year, Medicaid was going to split the three other versions off again. We didn't hear much else until my girlfriend received a newsletter telling her that her daughter's version was going to be processed under a new company and to be on the look-out for the new card (as of this writing, she still hadn't received and the changes took effect on the 1st).
It wasn't until right before the end of September that we started to see new cards. Much to my surprise, two of the three are back to their original processors, WHI and US Scripts. The other one was now going to be done by CVS/Caremark, and that's where things get interesting.
Before getting into that, a special shout-out to WHI for not notifying us or are insurance coordinator that we weren't contracted with your version of Medicaid. It was real nice going through half the day Monday getting the message "Pharmacy not contracted on date of service."
Now back to CVS/Caremark's Medicaid. This one was a spectacular fail, mostly because there was no consistency as to whether a claim was going to go through or not. The first couple went through like they should. I added the new plan in, put in their ID, the proper group, and voila! Success.
It was downhill after that.
First was the 25 minute phone call that ended in us adding a "1" at the end of the ID (that wasn't on the card), making sure the first name wasn't shortened, and adding their middle initial into their profile. Then it went through. After that, it was the double-bill debacle. See, we should be able to bill their primary insurance, then send the copay to whichever Medicaid they have so that their copay is $0. Well, it didn't work. It told us to submit to a different processor that CVS/Caremark uses for this reason, only to watch it reject again for non-matched cardholder/group reasons. After an hour and no resolution from the help desk, my pharmacist gave up and allowed the patient to try and take it somewhere else, where I'm sure they still had a ton of problems.
In short, it was a mess and we aren't very busy. The pharmacist at my retail job posted on Facebook how he was swearing the whole way home because of this particular version of Medicaid, thus confirming my belief it was the insurance's fault for all the problems, not ours.
Today has been better as we've discovered we can use the original Medicaid ID to run them through with less hassle than trying to use their new ID. I'm convinced this wasn't working yesterday and was implemented overnight because they got tired of all the phone calls they received.
Oh, and let's not get started on the formulary changes that have taken place now that the three Medicaids have split off. Stuff that was covered a month ago under the regular Medicaid is not covered anymore, even something as simple as Seroquel. Medicaid itself decided to kick us in the pants and change some of their formulary items just because, well, we don't know. I guess they think it's fun to watch doctors and nurses call in to request prior authorizations on things that had been covered for the last three years.
This is all taking place a month from open enrollment for Medicare Part D, which hasn't been as bad the last couple of years as it was when it was first introduced.
Then in January, a lot of pharmacies get to endure the "my insurance changed at the beginning of the year but I never got a card" circus.
Luckily in my job, we don't do a lot of private insurance so that's not too much of a concern. Most of our clients are Medicaid/Medicare recipients, so once we get past November, we're generally in the clear.
Except for the spenddowns.
I hate spenddowns.
I don't mean to sound bitchy about some of this stuff, but it's much more complicated than it needs to be.
Hopefully there are no more curveballs thrown our way.
I have enough trouble with fastballs.
Monday, October 3, 2011
Memory lane
I read a post recently from Phat where he was thinking about things that have changed since he started up in the pharmacy and got me thinking about the same thing, but on a couple of different of levels.
First off, I'm proud to say that I've helped the pharmacy I work in become semi-successful. There have been bumps in the road since we opened last year, but it's been a rewarding experience overall and I feel I've contributed greatly to the success that has been achieved.
You never know how things will change from day to day, so the job being a success is a big deal to me at this point in time.
Of more interest is the fact that September was my 14 year anniversary working, 13 of which have been in a pharmacy. While it's still not long enough to qualify for a "back in the old days" kind of story, I still have unique perspectives on how much things have changed over the years.
First and foremost, when I started in a pharmacy, the computer systems weren't nearly as sophisticated as they are now. Back then, the labels weren't coming out of a regular printer like they do, they were part of a big sheet and you had to carefully separate things out.
The biggest difference back then was how much easier it was to process prescriptions in the aspect that there weren't prior authorizations, there weren't 18 different types of meds for the same illness, and everything was either $5 or $10.
Sure, birth control was rarely covered, but there weren't 76 different options either, and one of them was a cheap generic.
Zestril, Neurontin, Zoloft, Paxil, and many others didn't have a generic available. E-scripting wasn't even in the topic of conversation. Back then, we didn't have baskets, queues, immunizations, and telemarketing calls. There were no automated calls telling people their meds were ready, no automatic refills. Hell, we didn't even fax much back then.
When I started, the internet was still young and an uncertain thing for most people who had computers. Sure, I started blogging back in 1998, but for a few years before that, the only way anyone ever knew how to connect through the internet was AOL or Compuserve via a dial-up connection.
Cell phones still hadn't completely caught on and I don't even know if the original Playstation was out yet.
The world was a much different place, I was a much different person. I was wide-eyed and figured it would be a nice way to make some extra money while in high school. I didn't know it would stretch out many, many years down the road and entail so many changes in my life.
When I started, I was still living in my hometown. Shortly after starting, we were forced to move and I continued to make the trip to my store before finally transferring to my current location in 2000. Along the way I've dated a few girls, lived in a few different places, watched the house catch fire, and had people come and go.
There have been a few constants, for instance, my cat has been there for the ride since before I started working (she's almost 18 for those keeping score), and a few of my closest friends I've known for at least 9 years or more. So there has been some stability along the way.
Other things that have occurred since I began working:
* Myspace came along and took the social website title away from AOL's service.
* Facebook came and took Myspace's social website title away.
* Google+ is trying to take Facebook's social website title away.
* Twitter has become the most annoying way to communicate.
* Cell phone's destroyed the art of conversation (since everyone texts instead)
* Nintendo fell off due to the Playstation, Xbox came into the world, and Nintendo came back with the Wii.
* HD is now the standard in television with 3D attempting to catch up.
* Our cars talk to us
Sure, there have been a lot of other events that have taken place, but frankly, I don't care to sit and think about all of it at this point in time.
All I know is that in the 14 years that I've been working, I've gone from a shy, slightly neurotic guy to a boisterous, sarcastic, still slightly neurotic guy who's seen just about everything that can be seen.
The biggest thing working did for me was help break me out of the shell I had been in. Up until I had started working, I had trouble conversing with people, was incredibly socially awkward, and avoided opportunities to go out. Once I started working, it got better, but after transferring and a couple of my close friends were hired, it really started to come together for me.
I still have quirks with my personality, but overall I'm much different than I was back when I started working.
That includes a jaded view of the world since I've seen people at their worst a few too many times.
The one thing I've come to realize is that it's easy to whine about our jobs, easy to whine about what went wrong, and laugh at the expense of others just to make ourselves feel better. It's an entirely different thing to stop and take the positives out of life and what you've seen.
So while I've seen numerous people try to use fake scripts, try to get their meds early, try to scam us in any way they can think of, I've also seen a number of people go out of their way to help us, help others, and make working a little bit easier.
I've had customers buy us food and drinks, tell us funny stories, share with us why they are in a good or bad mood, and we've all had the occasional customer hit on one of us at any given time. For every person that pisses you off, there's someone who appreciates the effort that you give.
And that's what makes me think I can endure a few more years of this at the least.
14 years is a long time, but only if you think about it in the wrong way.
First off, I'm proud to say that I've helped the pharmacy I work in become semi-successful. There have been bumps in the road since we opened last year, but it's been a rewarding experience overall and I feel I've contributed greatly to the success that has been achieved.
You never know how things will change from day to day, so the job being a success is a big deal to me at this point in time.
Of more interest is the fact that September was my 14 year anniversary working, 13 of which have been in a pharmacy. While it's still not long enough to qualify for a "back in the old days" kind of story, I still have unique perspectives on how much things have changed over the years.
First and foremost, when I started in a pharmacy, the computer systems weren't nearly as sophisticated as they are now. Back then, the labels weren't coming out of a regular printer like they do, they were part of a big sheet and you had to carefully separate things out.
The biggest difference back then was how much easier it was to process prescriptions in the aspect that there weren't prior authorizations, there weren't 18 different types of meds for the same illness, and everything was either $5 or $10.
Sure, birth control was rarely covered, but there weren't 76 different options either, and one of them was a cheap generic.
Zestril, Neurontin, Zoloft, Paxil, and many others didn't have a generic available. E-scripting wasn't even in the topic of conversation. Back then, we didn't have baskets, queues, immunizations, and telemarketing calls. There were no automated calls telling people their meds were ready, no automatic refills. Hell, we didn't even fax much back then.
When I started, the internet was still young and an uncertain thing for most people who had computers. Sure, I started blogging back in 1998, but for a few years before that, the only way anyone ever knew how to connect through the internet was AOL or Compuserve via a dial-up connection.
Cell phones still hadn't completely caught on and I don't even know if the original Playstation was out yet.
The world was a much different place, I was a much different person. I was wide-eyed and figured it would be a nice way to make some extra money while in high school. I didn't know it would stretch out many, many years down the road and entail so many changes in my life.
When I started, I was still living in my hometown. Shortly after starting, we were forced to move and I continued to make the trip to my store before finally transferring to my current location in 2000. Along the way I've dated a few girls, lived in a few different places, watched the house catch fire, and had people come and go.
There have been a few constants, for instance, my cat has been there for the ride since before I started working (she's almost 18 for those keeping score), and a few of my closest friends I've known for at least 9 years or more. So there has been some stability along the way.
Other things that have occurred since I began working:
* Myspace came along and took the social website title away from AOL's service.
* Facebook came and took Myspace's social website title away.
* Google+ is trying to take Facebook's social website title away.
* Twitter has become the most annoying way to communicate.
* Cell phone's destroyed the art of conversation (since everyone texts instead)
* Nintendo fell off due to the Playstation, Xbox came into the world, and Nintendo came back with the Wii.
* HD is now the standard in television with 3D attempting to catch up.
* Our cars talk to us
Sure, there have been a lot of other events that have taken place, but frankly, I don't care to sit and think about all of it at this point in time.
All I know is that in the 14 years that I've been working, I've gone from a shy, slightly neurotic guy to a boisterous, sarcastic, still slightly neurotic guy who's seen just about everything that can be seen.
The biggest thing working did for me was help break me out of the shell I had been in. Up until I had started working, I had trouble conversing with people, was incredibly socially awkward, and avoided opportunities to go out. Once I started working, it got better, but after transferring and a couple of my close friends were hired, it really started to come together for me.
I still have quirks with my personality, but overall I'm much different than I was back when I started working.
That includes a jaded view of the world since I've seen people at their worst a few too many times.
The one thing I've come to realize is that it's easy to whine about our jobs, easy to whine about what went wrong, and laugh at the expense of others just to make ourselves feel better. It's an entirely different thing to stop and take the positives out of life and what you've seen.
So while I've seen numerous people try to use fake scripts, try to get their meds early, try to scam us in any way they can think of, I've also seen a number of people go out of their way to help us, help others, and make working a little bit easier.
I've had customers buy us food and drinks, tell us funny stories, share with us why they are in a good or bad mood, and we've all had the occasional customer hit on one of us at any given time. For every person that pisses you off, there's someone who appreciates the effort that you give.
And that's what makes me think I can endure a few more years of this at the least.
14 years is a long time, but only if you think about it in the wrong way.
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