The Dog ate my pills!

Life as a Pharmacist can be challenging especially as a rookie! Many of these problems are inherent in the way the health-care system currently operates and were not a surprise. However, there some which caught me by surprise—and these usually vary depending on the location of the pharmacy. One of the main challenges I have faced is prescription drug abuse and high costs of prescriptions for patients in my pharmacy. Prescription drug abuse normally hits you as a pharmacist in two dimensions.

First, we have patients who consistently finish all their medications and call in earlier than they should for refills. These are usually the most interesting ones since you get to hear all sorts of explanations for early refills. They range from vacation trips abroad, to my dog ate my pills, I accidentally threw away my bottle, I received less than the amount allocated on the bottle, my doctor told me to double up on the dose, am leaving town tomorrow and I don’t have enough pills to last me while am away and all sorts of other reasons. The challenge is figuring out who is telling the truth and those who simply try to get around the system and fill their prescriptions early. It usually gets easy as you get more familiar with patients and figuring out those who make it a habit. Sometimes patients will also try to call more than once to see if they get a different answer and therefore it helps to have staff that operates under similar guidelines. It is also important to understand that while insurance companies do a great job of alerting Pharmacies in case of early refills through claim rejects, it is worth taking the time to take note of prescription fill patterns (jumping from one Pharmacy to another) and patients who explicitly state that they want their prescriptions cashed out or billed to a different insurance.

Secondly, you have a category of forged or adulterated prescriptions. This is usually easy to identify as an experienced pharmacist and when in doubt it is always worth picking up the phone and calling a prescriber to verify the validity of a prescription. Sometimes you will also find patients traveling from different states and regions to fill narcotic prescriptions from un-authorized providers. As Pharmacists we are the last line of defense of the health-care hierarchy and it imperative that we do the best we can and use all the tools we have available to minimize prescription drug abuse. It is alarming how prescription drug abuse is continuing to spread with little or no publicity.

Prescription drug cost is the most frustrating aspect of life as a pharmacist. It is disheartening to look in the eyes of a patient and tell them it’s a $3 co-pay on their blood pressure medicine but they cannot afford it--- and walk away from the pharmacy knowing they are going to remain un-treated and non-adherent. Next in line you dispense prescriptions to another customer who is willing to pay $300 for their Viagra. This is where I believe we need to do more as pharmacists to advocate for affordable alternatives where possible. Sometimes patients will not share their financial struggles and continue paying for expensive brand name prescription drugs. There is a perception among many patients that brand-name products work better than generics. It is mostly the outcome of the overwhelming direct consumer advertising of prescription drugs which is often more misleading than informative.

It is frustrating when some patients shut their ears to any explanation a pharmacist can give, but I always make the effort and those who are struggling financially will often listen. We can’t solve every financial problem, but we have more knowledge and exposure to prescription drugs than most patients and therefore can make a big difference at a time where health-care costs are drowning many families.

© Kawuma