Due to the high competition in the pharmacy business, pharmacies are willing to come up with any strategies to steal each other's patients.  Even if that is for the price of losing some money initially, or permanently for that matter.  Sounds crazy, doesn't it?  The most common strategy now a days is issuing coupons for transferring prescriptions.  The best deal I have seen so far is getting a gift card worth $30 for every prescription you transfer from another pharmacy to their store.  That means, if you transfer 5 prescriptions, you make a grand total of $150.  Not bad at all!!  

Of course, where money is to be made, people become creative.  I have seen people have their prescriptions called to a pharmacy they have never been to so that they can transfer it to get the coupons.  I have also seen people transfering their prescriptions back and forth from one pharmacy to another.  Can you blame them?

So what does that mean to the pharmacists working in busy stores?  In one word, "PAIN".  Transferring prescriptions is a relatively lengthy process.  First of all, the technician needs to obtain some information on the prescription the patient wants to transfer.  Then, the pharmacist needs to call the other pharmacy.  After being on hold for a while,  the pharmacist finally obtains all the information of the transferee's prescription, such as the direction, first and last refill, all prescriber's information, prescription number and name of the other pharmacist he talked to.  Then, all this information needs to be entered in the system.  Trust me, it takes time. 

It is one thing to transfer a prescription for a legitimate reason, such as if you have moved to a new area, or if one pharmacy does not take a particular insurance.  It is another thing to keep transferring prescriptions back and forth, since you would like to make some easy money by abusing the system.  Just a few days ago, a very aggressive customer called me and asked me to call her doctor to get her a new prescription.  Of course, dear doctors do not bother calling the pharmacies any more, and simply ask their patients to have their pharmacies call them.  She then called back in one hour to check on the status of her new prescription.  As I explained to her that I had already faxed her doctor a request, she screamed at me "Why don't you also call my doctor."  So I called her doctor as well, as she demanded.  I finally got her the prescription; entered it in the system; filled it and had it ready for pick up.  Shortly after, my technician transfered me a phone call from another pharmacy.  Of course, that was another pharmacy calling to transfer the same prescription I had just spent so much time to get ready for my brilliant patient.  I told the other pharmacist, "But I just got this new prescription for my patient, and it is ready on the shelf for her."  She answered proudly, "But she has our coupon."

You will be the judge.  Is it really fair or right to go this far?  Have one pharmacy get a brand new prescription for you, so you could transfer it and cash your coupon?  At least, if you want your pharmacist to help you in your new business of cashing coupons, don't be too pushy.  Give her some time to first take care of more urgent prescriptions, and she eventually will take care of your business too. 

That is a question I was asked by one of my patients.  She just had picked up her antibiotic and had to pay $84 for it since that particular antibiotic was not part of her insurance formulary.  She then called me in couple of hours with so much disappointment asking why did we not check for her insurance formulary before we dispensed her medicine. 

The matter of the fact is, your doctor usually does not know whether the medication he is prescribing is covered by your insurance or not.  Your pharmacist does not know that either until he types your prescription and submits it to your insurance.  At that time, he gets prompted if your medicine is not covered.  If you are patient enough to wait for your pharmacist to enter your prescription before you leave the pharmacy, you get informed of your out of pocket cost.  At that point, you could decide whether you want to pay or ask your pharmacist to call your doctor for changing it to something cheaper.  Your doctor however, may refuse to change your medicine, since to his medical judgment nothing else would be as effective, or he may not mind changing it to something cheaper. 

If you leave the pharmacy before obtaining the price of your prescription though, you may end up with lots of disappointment.  By the time you come back to pick up your prescription, the doctor's office may already be closed leaving you no choice but paying a fortune.  You need to consider that due to heavy volume and your pharmacy's time constraints, it is really not practical for the pharmacist to call every single patient whose medication is not covered.  Plus, many patients decide to pay out pf pocket for the uncovered medicine anyway. 

The bottom line is, if money is an issue, and you don't want to end up paying a fortune for your medicine, ask your pharmacist to enter your prescription before you leave the pharmacy.  You could also call your pharmacy in half an hour to inquire about the price.  That way, you leave yourself with enough time to have your doctor contacted in case your medicine is not part of your formulary. 

Good luck, and be well.

So I was working last night at our super duper busy pharmacy.  We close the pharmacy at 9 pm, but we usually have to stay at least half an hour longer to finish all the orders of the day.  At 8:45 pm, as we were already swamped with all the orders, the phones, and the customers’ questions, this really not very pleasant lady walked in and handed us her new prescription for a pain pill, vicodin.  "We won't be able to fill your prescription now, but it would be ready first thing in the morning" we told her.  She said, "What?  You must be joking."  I told her, "I wish I could have this ready for you tonight, but we already have at least 30 more prescriptions to fill for tonight, and we are closing in 15 minutes."  She got even angrier and said "This is unheard of.  After all, there are not too many people waiting in the waiting area."  So to make a long story short, I figured it probably takes more energy convincing her to come back tomorrow than filling her prescription right then.  Even though we were already running out of time, the prescription was dated 2 weeks ago and nothing urgent, I decided to fill her prescription right then. 

Of course, as we inputted the prescription, her insurance prompted us that she had filled the same medication at a different pharmacy recently.   So I told her, "I am sorry, I cannot fill your medication now because this is a narcotic medication and cannot be filled early.  According to your insurance you recently picked this medication up."  She looked at me with so much anger and resentment that I literally felt I may turn into a frog or something.  Finally, after a couple of minutes of staring at me angrily with really open and angry eyes, she said, "I don't have insurance."  Oops, could I have made a mistake here?  So I double checked her name and address to make sure I am looking at the Right profile.  I said, "But there is an insurance listed here for you."  She screamed, "But I don't have any insurance."  By then, it was already 9 pm.  I told her, OK, I will call your insurance right now to clarify this.

Her insurance verified that she indeed had insurance and got the same medication not too long ago from another pharmacy.  They also informed me that she was listed under her husband's name.  I told that to her.  You would think by now she would be ashamed of herself and would apologize and hopefully leave the pharmacy.  Guess what?  She said, "I don't have a husband."  So to make a long story short, she finally left with her prescription as she was screaming at us.  That left me shaking for a few minutes.   I was wondering though, how someone who is trying to break the system by lying to you could be so mean, give you such a hard time, and ruin your night with such a straight, or more accurately, mean face.  Of course, there is a 0.0000005% chance that this really is a mistake by the insurance company and in fact there are two people with the same name, date of birth, and address in the city.  But trust me, this whole thing was an act; a mean act by a very mean customer to get her narcotic med earlier than she was supposed to.  

As a pharmacist, my biggest nightmare is to find out I failed to give the right medication to the right patient.  Even though there are many steps we take in the process of filling a prescription to avoid mistakes, and regardless of how competent, careful, and caring we are, it is utterly impossible to not make any mistakes throughout our practice as pharmacists.  So you, as a patient, need to also be more proactive in managing your prescriptions to avoid ending up with the wrong medication.  As a matter of fact, you can take 10 simple but smart steps to minimize prescription errors, and potentially save your life.  

1.  At the time of getting a new prescription form your doctor, always ask your doctor if you should discontinue any of your old prescriptions.  Quite often, I encounter a patient who was given a new dosage of a medication or a substituted medication, without being clear on what medication is being changed, and ending up taking the old and the new medications simultaneously.  This could cause overlapping side effects and potentially threaten patient’s life.  For example, it is very common for doctors to substitute a new blood pressure medication for an old one.  Taking the two medications together can drop the blood pressure too much or even affect the heart rate. 
2.  Make sure all your doctors and your pharmacies have a complete list of your current medications.  For example, a patient who is on a blood thinning medication such as Coumadin by the cardiologist may be prescribed an antibiotic for a simple strep throat by his internist.    However, there are some antibiotics that can significantly interact with blood thinning medications and cause bleeding.  So it is crucial that your internist be informed of your active medication list.  There are many tools available on the internet that allow you to create and manage your medication list.  One such tool, MedSort, lets you do just that. 
3. Also try to stick to one pharmacy.  This could assure you that the pharmacy has a complete list of your medications in their database, which allow them to check for any significant drug interactions.    
4. Make sure all your doctors and your pharmacies are aware of all your drug allergies.  There are some significant cross allergies among different classes of medications which patients are not aware of.  For example, a patient who is allergic to sulfa antibiotics could also be allergic to Celebrex which is an anti-inflammatory/anti pain medication.    
5. At the time of ordering your refills wheather through the automated phone service or manually by talking to someone in the pharmacy, be sure to mention both the name and the dosage of your medication.  Quite often, you may have been taking the same medication with a different dosage in the past, and if you don’t mention that on the phone, the pharmacist may end up filling the old strength of your medication.  It is not always that obvious to the pharmacist what the current dosage is unless we go into the details of your profile.   
6. If your pharmacist tells you that he needs to call your doctor to clarify your prescription, do not resist.  Let him do his job.  We know you are tired and can’t wait any longer, but waiting longer is better that having the pharmacist guessing the name or the dosage of your medication and you ending up with the wrong medication.
7. At the time of picking up your medication at the pharmacy, double check for your name on the medication bag.  This may seem obvious, but you will be surprised how often the wrong medication bag is handed to some one with similar first or last name.  Also cooperate with the cashier to verify your address at the pick up window, even if you are a regular customer.  Verifying the address is one of the best ways to ensure you are handed the right medication and is not because your business as a regular customer is not being acknowledged.
8. Always get consultation for any new prescriptions.  The most important information you need to obtain at the time of consultation is:            
   • Find out what the medication is for.  A very common mistake in filling a prescription occurs when two medication names look alike or sound alike. These kinds of mistakes can easily be caught at the time of consultation.  For example Lamisil is a medicine for fungal infection, and Lamictal is a psychiatry/neurology medication.  Thanks to the beautiful doctor’s hand writing, it is very easy to mistake one for the other on paper.  By getting a consultation, you will find out which medication you are getting and you can catch the pharmacist’s mistake in case you are being dispensed the wrong medicine.        
   •  Find out when is the best time to take your medication.   For example, oral corticosteroids, such as Prednisone, are best taken in the morning since they could cause insomnia. Water pills given for blood pressure such as Hydrochlorothiazide or Lasix should be taken in the morning since they make you urinate more frequently.
   •  Find out whether you should take your medicine with or without food.  For example, anti-inflammatory medications such as Motrin should be taken with food to avoid stomach pain and stomach ulcers.  Narcotic Pain medications such as Vicodin are better to tolerated with food to avoid stomach upset and nausea.          
   • Find out about your medication’s common or serous side effects.  For example, a common side effect of water pills such as Hydrochlorothiazide is dizziness, especially when you change positions, which over time your body gets used to.  A rare but serous side effect of Trazodone which is a psychiatry/sleeping pill is periapisam.  Periapism is prolonged penile erection, which is very rare but also very serious and requires immediate medical attention.
9. Before leaving the pharmacy, check all your medication bottles and be sure you got everything you ordered.  Quite often, we deal with frustrated patients who did not get everything they ordered.  This could be due to not using the automated phone service correctly, or being out of refills and having to wait for the doctor to approve additional refills. Patients may also be on two sound alike medications which could lead to mishearing the name at the time of ordering and dispensing the wrong medication.   By double checking your medications before leaving the pharmacy, you may save yourself from an extra trip to the pharmacy and lots of frustration.
10. Always call your pharmacist if you notice your medication looks different from before.  Most of the time, this is due to a change of manufacturer.  In this case, your medicine is exactly the same, but looks different.  Occasionally, though, the medication looks different because the wrong dosage or wrong medicine has been dispensed.   

I hope these 10 simple steps to avoid medication errors at the pharmacy will help you on your next trip.  Remember, we are all human and we need multiple checks and balances to avoid potentially serious mistakes.  You can be an integral part of this process.  Help your physicians and your pharmacists to help you. Good luck and be well.  .