Wednesday, March 12, 2008

I Thoroughly Apologize

A good deal of scotch and Sapporo later, I've come to the conclusion that it may, in fact, be time to post another work rant, because today officially made absolutely no sense whatsoever. As I've noted before, I don't typically post work rants, just because so many other pharmbloggers do it better than I do, but my egregious lack of content of late has me digging for things to post. I could honestly throw out some words of praise for the Purdue Pharmaceuticals rep I talked to today, or go into a long monologue about antibiotics, but I'll save that for a time when my blood-alcohol content is considerably lower.

The short story is that I dealt with the biggest jerk in the universe today.

The slightly longer story is that today I was "greeted" by a middle-aged man with salt-and-pepper hair, probably in his 50's or early 60's, presenting a prescription for prednisone. Sure. Easy. Prednisone. When do you want to pick this up?

"Right away," he says. "Also, I filled a script here two weeks ago for two weeks' worth of medication. I want it back."

"You want the prescription?" I was somewhat confused. "I want you to transfer it." "That's easy, just have the pharmacy call us." "Great," he said. "Transfer them to Canada."

Yes. Canada. The whole country.

"Er." As you may or may not know, once you fill a prescription, it is no longer yours. It is a legal document retained by the pharmacy, a contract between you, your doctor, and the pharmacist that you have been issued a specific medication for a specific purpose. You cannot get it back. It must be kept, filed, stamped, and otherwise notarized, presumably kept in a box somewhere in someone's pharmacy basement for at least seven years. Furthermore, there is no logical reason to want it back. Any other pharmacy can call for a copy and take your script. Canada, however, is apparently one big pharmacy and it can do whatever it damn well pleases.

At this point, the pharmacist noted that it was a matter of federal law that we had to retain his prescription. He was not happy about this, and the pharmacist suggested that he write his congressman.

There was a lot of shouting. I believe I was called a crook. I was told that I should be ashamed of myself for being part of the American pharmaceutical company's great scam, the price-gouging mafia of American drug stores, and all sorts of other general nastiness. I, apparently, am a terrible human being for charging this guy less than $20 for medications intended to prevent his blood pressure from skyrocketing and causing him to stroke out. Maybe we can blame the prednisone for his mental instability. Other customers joked about how nuts this guy was. The customer threatened to contact a lawyer unless we returned his prescriptions. We later noted, somewhat nervously, that it would have surprised none of us if he had jumped the counter or pulled a gun.

I quipped that should he have done so, a lawyer would've been provided for him, should he have been unable to afford one.

"Do you want THIS prescription filled here--and now? Not in Canada?" I wanted to make damn sure that he wanted his prednisone from an American pharmacy. He did.

The customer left the store, fuming. He came back five minutes later. "It's your lucky day!" he said, handing the pharmacist a slip of paper, a receipt from a Canadian mail-order pharmacy with a phone number and information for him. "Call this pharmacy and transfer my stuff there," he said. So the pharmacist called the number later. He was told to call a different number. He called that number and someone hung up on him. It was then that he noticed a number listed for a "United States Canada Mail-Order Service" at the bottom of the label. He called that number.

He got the patient. Apparently, the patient owns a company that imports and ships medications from Canada. GO FIGURE.

In any event, Canada wound up getting his prescriptions. Some specific Canadian pharmacy, that is, which is apparently legal albeit suspect, in the sense that the FDA has officially ruled that importing medications from Canada is "illegal." The Canadian pharmacy claims they do no billing, so none of us have any idea what the meds cost when imported. No one where I work plans to touch the situation with a ten-foot pole.

As an aside, physicians who read my blog? Don't sign your prescriptions "dispense as written." Just don't. Your patients want the cheaper generic. Your pharmacists want to dispense the cheaper generic. And don't refuse to permit substitution when we call you and tell you the patient wants generic, it's $10 versus $70. And for the love of all that is holy, don't sign antibiotics brand-name only. Do you really think there's that much variation between brand and generic Omnicef?

3 comments:

kath8562 said...

Last time I looked at the generic omnicef we have, (and I think it's the only one on the market) , it is Omnicef in the bottle- imprint says Omnicef!

whitecoatunderground.com said...

I've never prescribed Omnicef, but I pretty much prescribe generics whenever possible.

If a patient wants DAW, I warn them that they'll have to pay, and I'm not calling any prior auths.

That being said, see http://scienceblogs.com/terrasig/2008/03/are_generic_drugs_inferior_to.php

N.B. said...

Oh, I did see that. I intend to have my own thoughts on the issue relatively soon; I actually considered making an entry about the Wellbutrin issue a while ago and never got around to it. Looks like I'm due.