Support your Independent Pharmacy

... and I'm not just saying that because my brother's a pharmacist. Franchise, chain pharmacies... they are dumb sometimes. Unbelievably, how-can-you-be-that-dumb-and-have-received-a-degree, dumb. Yet they wonder why program integrity people want to take undeserved money away from them.

I worked with a pharmacist in Wichita two weeks ago on an access issue. Partially our fault, partially their fault for being lazy. So I tell them that I'll do all the paperwork for them, but the pills need to be dispensed. We're talking psychotropic and hypertension medications, folks. Not the kind you to can just ignore or use something over-the-counter in absentia .

So Pharmacist A says "no problem", and that they'll dispense the meds. I file the paperwork, and think all is fine.

Patient calls today -- "I still haven't received my meds. I've been trying to two weeks." WHAT?

I call the pharmacy -- Lab Tech says "oh yeah, Pharmacist B on duty called the next day, and they were told there is no guarantee of payment, so we reversed the scripts until we know we're going to get paid." This is their mistake Number 1.

I tell Lab Tech: "Well, that department tells everyone that by default. Until a claim is processed, we won't know what the exact reimbursement will be. But it's not like you don't know that you'll be paid, since the script wasn't early, didn't require prior authorization, etc."

Then I ask the obvious question: "So you did not dispense meds on the day that I put on your claim? The claim that you have now been paid for?" Their answer of course is "No. We didn't think we'd get paid." This is their mistake Number 2.

And just because I've had a Monday-kind of day, I feel like inflicting a bit more pain on them: "So why did Pharmacist B call another department for an answer (which conflicted with what I had already told them) on paperwork that already had my own contact information on it? Or why would Pharmacist B not think to call me for clarification once they heard an answer that conflicted with what I had already put in writing to [them]?"

Lab Tech: "uh.... I dunno." Mistake Number 3.

I was flummoxed. How could a medical professional be so counterintuitive? Editor's note: (Oh, how we did love using that word in debate rounds.) Now, I realize there are plenty of "dim" medical people out there. We see it every day. But it was astonishing all the same.

The pharmacy staff probably thinks I'm an a-one bioatch, but screw them. If they were so inconsiderate to not dispense the meds after they had already agreed to do so, THEN fail to go back to the paperwork origin to try and verify anything, and yet STILL not try and help the patient... well, they deserve it.

Oh, and here's the cherry. After hassling them for causing a patient access issue, I ask them: "So how are you going to display the dispense date on the meds you'll dispense today?"

Lab Tech: "We're sending them out with today's date."

Me: "Well, from a program integrity perspective, you're doing something unethical. You've already been paid for drugs supposedly dispensed on X date. To not have actually dispensed them, and now dispense them on a date that you're not actually billing for, that's not something a utilization review would overlook."

Lab Tech: "Can't I just put a note in the file of what happened?"

Me: [thinking to myself] Bwahahahaahhaha! I'd love to see that fly.

"Well, you probably ought to talk to your corporate program integrity people. That is the kind of question they should probably answer, since it is an issue that would come up in an audit."

All in all -- the patient got his meds, and hopefully everyone learned a lesson. I learned that you can't trust a provider to do the right thing, even when you try to help them. Hopefully the provider learned that they need not accept an answer at face value, especially if it conflicts with what they have in writing. And the patient should learn to not let two more weeks go by if their insurance isn't paying for something it ought to.

Not a wonder that full moon is coming. The psychos are starting early this week.