Why Independent and Small Chain Pharmacies are Better

 

   Tuesday morning a woman called the pharmacy. She had a prescription for her son called into Big Chain Pharmacy. She had just found out that BC didn't have the prescription ready, it was written for something they were unable to get. She was calling around to different places to see what she could do. It was an antibiotic and her son needed to get started on it.

   She didn't know what antibiotic was prescribed, but told me what her son had. I told her I was reasonably certain we had it, I asked her to call her MD and have the prescription sent to me. Normally I would call the pharmacy, but I was too busy to stay on hold with BC for 15 minutes. I was a little puzzled as to why BC wouldn't have it. They usually had everything.

   Half an hour later I realized why BC didn't have it. The liquid form of this particular antibiotic isn't used much and it is on backorder. I wasn't even sure if they made it anymore. I did what I usually do in such cases. I called the doctor and offered two options, a capsule or a liquid suspension in another strength. I had a small amount of the suspension, enough so that the boy could get started. I could order more that would arrive before the started supply ran out.

   I went on with the rest of my morning. It was busy as Tuesdays often are. I got a call back from the doctors office, they wanted the suspension. Due to the dose the boy needed, the capsule would not work. I had hoped they would choose the capsule it would be easier for everyone, but they were dosing by weight and I understood the problem.

   I filled the prescription and ran into my first snag. The insurance I had on file was expired. I did a query and found no information. I asked my tech to call the mother and get the right information. That was when I hit my second snag. The insurance didn't cover the liquid without a prior authorization. A  prior auth or PA as we call it means that the prescriber must provide additional information to the insurance company to justify use of the medication. While I understand that it can be a tool to control costs, if often feels like prescribing without a license. To me the prescriber who has seen the patient and knows what is most appropriate treatment should get to decide what medication a patient gets, not an actuary employed by the insurance company.

   I work with some really good technicians. My tech found the PA forms, filled out the pharmacy portion and faxed them to the doctor. Then she called the doctor's office to let them know the forms were coming and what needed to be done.

   While we were waiting the mother came in to get the medicine. I explained to her what was going on and told her we would call her when the medicine was ready for pick up. I felt bad that I didn't have it ready, but there was nothing I could do. 

   I went on with the rest of my morning and into the afternoon. By the time I left we still had not heard from the doctor. I was fairly certain that we would not hear back until the next day. I was hoping that we could have that ready so the boy could start it. I didn't want his infection getting worse. 

   I'm off until next week so I won't know what happened until my next work shift.

   This is the reason why I don't like Big Chain pharmacies. When they knew they could not get the medicine in, they should have called the doctor like I did. Instead they sat on the prescription and did nothing to help the patient's mother get the medication. I'm guessing they would not have taken time to do anything about the PA form if they had contacted the doctor. They most likely would have told the mother the med wasn't covered and leave it at that.

   I believe that independent and small chain pharmacies are better. We care  about customer service and patient care. Big chain pharmacies are owned by corporations and operate to maximize profit for shareholders. Small chains have independents have to make a profit to stay in business, but have more freedom to actually take care of their customers.  

   Later Tuesday afternoon I got a call from a woman who wanted her insurance information. She was waiting in line at BC pharmacy to get a dose of vaccine. I gave her the information and she asked me if we stocked the vaccine she needed. I told her that we did and that I was able to administer the dose if she wanted to come over. She said she was going to come right away. While I was waiting for her I billed the vaccine to her insurance and pulled all the paperwork needed. Everything was ready when she came to the counter. She was pleased that she would be able to get the vaccine she needed without a long wait. 

   I don't think that would have happened at Big Chain....