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PUBLISHER'S LETTER Guest Editorial
Bending Over Backwards Shouldn’t Have to Hurt (Financially)
By Erika Horstmann, PharmD
(Editor’s Note: Erika Horstmann is director of clinical services, MD Group Hometown Pharmacies, DeForest, Wis. Her article first appeared in the March/April 2010 issue of the Journal of the Pharmacy Society of Wisconsin, official publication of the Pharmacy Society of Wisconsin. It is reprinted here with written permission of the JPSW.) As pharmacists and technicians, we see examples of health care fragmentation on a daily basis. Unfortunately, these situations have become our normal. We have become accustomed to being frustrated and, consequently, have become experts at explaining complicated situations to our customers. Allow me to enlighten you with this experience which happened to me one Saturday while staffing one of the rural Hometown Pharmacies in Wisconsin. A new customer came in wanting to purchase a few pills of her two prescription medications (digoxin and atenolol); she had forgotten her supply at home and was traveling. Normally, this encounter would not be a problem; I would simply call her pharmacist, transfer the prescription and dispense the mediation. In this case, the patient received her medications from mail order and had no contact information for her mail order pharmacy with her. I Googled her mail order company, found a phone number, followed the automated options and explained the situation to the customer service representative (CSR). He connected me to another department. I followed the automated options and finally spoke with another CSR who informed me I had been transferred to the wrong department. She connected me to another department which promptly hung up on me while I was on hold, waiting for the CSR. I redialed, followed the automated options and spoke to a representative who explained I once again reached the incorrect department. By this time, I’ve been juggling patient consultations, checking and all the tasks our busy pharmacy life demands. I admit I raised my voice after she told me she would need to transfer me. Irritated, I explained this was the third department I had been transferred to and if she was going to transfer me again, I would appreciate it if she could be absolutely sure the number she was transferring me to was indeed the correct department! She hung up on me. (Man, I wish I had written down her employee ID number when she mumbled it to me at the beginning of our conversation.” By now, the patient feels horrible ¾ thinking she is causing me and my staff a headache. She quickly empathizes, explaining she experiences this same run around every month when trying to request her medication. She says “I’m Sorry! I’ll just skip my medication this weekend.” I reassure her this is not her fault, and one way or another, I will figure out a way to get her the medication she needs. Then, my technician has a brilliant idea! Let’s call a CVS pharmacy to see what phone number they call when they need to reach this particular mail order pharmacy. I agree this is the best way we will find the true phone number and so I put her plan into action. Success! I dialed the phone number and alleluia ¾ a pharmacist answers ¾ an actual pharmacist! I receive the transfers and thank the pharmacist. My technician inputs the prescription and you guessed it: Refill Too Soon! Se calls the company for an override, and after several minutes on the phone, she is allowed to dispense a 14-day supply. Total time spent: 1 hour Total revenue to our pharmacy: $3.00 ($1.50 per prescription) This situation I encountered is a perfect example of health care inefficiency and fragmentation ¾ all within the same company. How many times a day do we get a prior authorization for a medication or contact the prescriber for a formulary alternative? How many times a day do we deal with situations stemming from a PBM that causes us and our patients great frustration? All of these situations increase our cost, but where is the reimbursement to help offset the countless hours we spend decreasing their health care costs? Meanwhile, those of us who truly care about our patients and their well being provide service happily and wholeheartedly and continue to be reimbursed poorly for doing so. We all know these circumstances are sadly not uncommon in today’s pharmacy practice, but I wanted to encourage all of us to keep a log of the situations we encounter. For one month, record the date, the name of the PBM, the details of the situation and the amount of time it took you and your staff to resolve the problem. Finally, assign a dollar figure to those interventions. We can send our information on to each PBM requesting reimbursement or, at the very least, our information be forwarded on to the CEO so they can understand the dilemma we face daily. Perhaps if enough of us do this, we can make a difference. During this time of health care reform,, there’s got to be a better way! 04/04/10
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