Friday, October 17, 2008

Prescription Hassles in Medicine

I am currently out of town for a medical meeting and although I have been gone less than 24 hours I have received 7 phone calls or emails from patients and my office about pharmacy medication renewals. It is only 10:00 AM back home so that number will increase as the day goes on. If you query any primary care doctor, you will find that 9/10 will report pharmacy and drug renewals are one of the most annoying and time wasting hassles they have. (not a scientific study but if you doctors out there disagree, just tell me).

We deal with many different pharmacies, mail order drug companies and pharmacy benefit companies, each with their own rules, regulations, protocols and coverage. Patients have no idea what goes into getting them one simple medication. Here are just a few of the idiosyncrasies:
  • Controlled drugs (even common pain meds) and any drug for Medicaid patients needs to be written on a special tamper proof pad. They cannot be faxed or phoned in. They need to have the patient's address (making it impossible for an on-call doctor to help).
  • Pharmacies tell patients the drug has not been renewed when it has, prompting multiple phone calls back and forth and lots of finger pointing.
  • When I write for 12 renewals so I won't get a phone call each month, or the patient won't be hassled each month...the pharmacy ignores it and calls anyway.
  • If a patient needs more medication because they are going on vacation, the pharmacy will not allow more than one month..creating phone calls and angst.
  • Mail order pharmacies substitute different (cheaper for them) medications and patients are confused and call me.
  • Patients run out of medication or don't take their medicine on a trip and call frantic for the renewal "right now". Each of these calls requires the chart to be pulled and the doctor to get involved "right now".
  • I can't even begin to describe Medicare Part D.
This is the most inefficient and ridiculous way to practice medicine, provide good service to patients and insure everyone gets the right care and the right time.

Having electronic prescriptions will help but even that only works for the pharmacies that are hooked in on-line and it doesn't solve the mail order problems or the controlled substance problems.

I would write more but I need to go take care of pharmacy renewals.


ERP said...

I have to say that is one other reason I am glad I do Emergency Medicine. We don't usually do any refills and pharmacies only call us to confirm things. (and that is annoying enough!). I have to say I feel for you though. I can't imagine having my day continuously interrupted for that kind of crap as well as call backs, abnormal lab calls, and God knows what else. That sort of thing should be separately billable!

Anonymous said...

What a good reason for a national electronic system. Of course the VA ALREADY has one. With some tweeks (adding a billing progam)this could be instituted nationally. But God forbid this might be construed as SOCIALISM. Even though one system would work better than many (like say the military). Better to have the free-market of many different systems that don't talk to each other right? WRONG.

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