Thursday, December 31, 2009

More things that make me grumpy

When Dr. Cortex is out of town, I cover his patients.

I try to work within my patient's means as much as possible. If they have crappy (or no) insurance, I try to use the cheapest generic medication possible.

Dr. Cortex, however, uses a lot of brand-new, pricey Wonderdrugs, mainly because he has samples to give out. The problem here is that he also sees A LOT of Medicaid-subplan indigent patients, and once the patient runs out of samples there is NO FREAKING WAY the plan will pay for the prescription.

Normally, this is a problem between he and his patients. Except when he's out of town. Like now.

So Mr. Ictal runs out of expensive Wonderdrug samples for his epilepsy. Dr. Cortex's nurse calls in a script to Local Pharmacy. Local Pharmacy finds out Wonderdrug isn't covered by his Medicaid plan, and tells Mr. Ictal it'll be $400.

So Mr. Ictal calls Dr. Cortex's office. And his staff closed the office to take a 4-day New Year's weekend (which they weren't supposed to, but figured the boss was in Brazil, so who cares?). And so the answering service routes him to me (my office is closed for the 4-day weekend, too).

Wonderdrug won't be covered without a doctor begging, pleading, and filling out a 30 page form. I call the Medicaid subplan to at least beg. But I'm not contracted with that subplan myself, so they won't even talk to me.

The pharmacy (understandably) can't afford to take the loss on a $400/month pill that they know won't get reimbursed. And Mr. Ictal can't afford this at all. And he has 1 sample pill left, and it's pretty damn dangerous for epilepsy patients to stop their meds cold turkey. And he has no idea what he's taken in the past. And I really hate to change meds on a patient I know nothing about. And his chart is locked up in Dr. Cortex's office until next week.

I feel bad for Mr. Ictal. This insanity (mostly) isn't his fault.

What did I do?

Fortunately, I live close to my (closed) office. So I drove down there this morning to meet Mr. Cortex, and gave him enough samples of Wonderdrug so he won't run out before Dr. Cortex can get back and decide what to do. But this is me (and at least I had samples). In all honesty, most other docs wouldn't care, and say they can't help him. Or would tell him to put the pills on a credit card. Or say it's the pharmacy's issue and to call them. Or to go to an ER (I have no idea why he should go to ER for this, but it's amazing how many docs send patients there for stupid shit like this).

The bottom line here is that you should try to work within your patients' means as best you can. It prevents crap like this from happening, and your call partners will be grateful.


student dr. blaze said...

So, how do I nominate you for the doctor of the year award? You've definitely earned it.

At times like that, I might be awfully tempted to give the patient the drug rep's cell phone number.... *evilgrin*

Anonymous said...

Perfect example of why not to use samples for a new drug start.

moppie said...

My gosh, doctors opening up the office for just one truly deserve some type of incentive award. You were made to be a doctor :)

charmcity said...

This makes me nuts. Residents are notorious for discharging patients on meds that aren't covered.
Every uti gets Levaquin.
Everybody gets aciphex, or similar.
Who do they call...? Me.
Or worse, they come to the office for follow-up, not having gotten half their meds, when cheap, similar drugs are available.

By the way, how does one get invited to read Nurse K.'s blog?

Susan said...

Right on , Dr. G. You are a class act!!

GeorgiaRPh said...

Dr. Grumpy, you are my hero! (And Dr. Cortex better bring you back a nice souvenir from Brazil too)

Cheryl said...

Poor Mr. Ictal! What would have happened if you had not been there?
You are a sweetheart of a guy.

LilMsHppyPillz said...

Dr Grumpy, can we clone you, or at least have you write a handbook that other doctors are forced to follow? Me and every retail pharmacist would happily support that.

Pat F. said...

You'd be amazed (or maybe you wouldn't) at how many docs don't have the foggiest how much drugs (or tests) cost. Bless you.

Maha said...

You just earned some serious karmic points for that one Dr. G.

If I ever bump my noggin (which looks more and more likely as I hit my head against the desk whenever confronted by stoopidness), can you be my doc? I hear the local brain barn up north is hiring :P

Lipstick said...

Thank you Dr. Grumpy from Lipstick PharmD.

We pharmacists feel (and are) so helpless in those situations. Thunderous applause from everyone in the medical community with a big heart.

Grumpy, M.D. said...

Charmcity- she's not writing at present. She blocked off her blog to deal with personal issues.

terri c said...

Grumpy you may be but you have a heart of gold. Poor Mr. Ictal. I hope you left a tasteful message for Dr. Cortex.

Anonymous said...

Thanks, Dr. G. for explaining this thoroughly.

As a pharmacist, I'd probably opt to 'loan' out a few tablets to get through the next day, but only after I see the old prescription bottle (or, maybe the sample package). Unfortunately, sampling doesn't provide script bottles.

The local clinic absolutely refuses to see reps and handle 'samples'.

I work out of town and the clinic associated with the hospital where I work is small and 'poor' (at, least the patients are) and handles a lot of samples. We, in the hospital, serve as repository for expired meds, and it is a 'sin' to see how much expensive drugs have to be tossed due to expiration, but on the other hand, I do realize that we can't do anything ethically about drugs that have 'expired'.

If anything was emphasized in pharmacy schools thirty years ago, it was that one never dispensed expired drugs, drugs are always identified (unless the prescriber wrote 'Do not label' and something else that I don't remember because times have changed (something about generics and agreeing to substitute if it was okay among the three parties involved--patient, pharmacist, prescriber, or something like that).

Anonymous said...

I second Lipstick's comments. The pharmacy is at the bottom of the hill and all the crap slides straight down.

God bless you, Dr. G. for being kind and compassionate. And not an a$$ like other docs.

Nurse K said...

Or to go to an ER (I have no idea why he should go to ER for this, but it's amazing how many docs send patients there for stupid shit like this).

Wanna make out?

Anonymous said...

It's good of you to help him out. I work for a doctor who would do that if a patient was really in a bad way, so kudos to you. Happy New Year!

tottergirl said...

My primary care NP has the same idea as you. She mostly prescribes older, cheaper drugs. Of the 4 I take daily, I only have to pay full copay price for one.

I really appreciate this attitude. Thank you, I'm sure many of your patients appreciate it as well!

JimAtTheRez said...

Dr. G, as others have stated, that was awfully magnanimous of you. It certainly is above and beyond what most would have done. All I can say is you deserve a standing ovation. Kudos and God bless you for putting a patient's (not even yours) health first. Wow, just wow.

Anonymous said...

Amen!!! I mean is not that difficult to try to work within your patients' means. Thank you Dr. Grumpy. Other Docs should follow the same example.

Anonymous said...

Pristiq and Kapidex.

TiredRPh said...

I'm just in awe of how caring you are of other mds patients. I hope Dr Cortex sends you some appreciation for helping their patient stay seizure free over the weekend

Dragonfly said...

Maybe someone should pay you a bucketload of money to do a CME on good/rational prescribing? (But lots of those are drug company sponsored)

Negrrl said...

Thank you!
Us pharmacists are always on the recieving end of "I can't afford that!" Or my personal favorite " My doctor said this would be on the four dollar generic list."
You'd be suprised how many patients just don't take thier Levaquin, Bystolic, Trilipix, insert brand name here, until we get an angry MD on the phone even though we offered to call and see if we could switch to something cheaper.
I wish I lived where you practice!

Andrea said...

Tell Larry M. Ictal to move to New York- Medicaid covers the XR, and pretty much every other ridiculous drug here like Moxatag.

Silver said...

This post is now mandatory reading for all of the Silver clinic students on rotation.

50 points to Gryffindor for Dr. Grumpy's compassion in this situation!

Anonymous said...

Dr G you are awesome. I don't know any doctors who would go out of their way for their own patients, never mind someone they don't know.

Steph Pharmacist said...'re the MAN!

First and most importantly for trying to use the drugs with the highest value to the patient (not the drug company.)

Drug companies are using the same tactics as the local drug dealer here--first few doses are "free." There's a method to this generosity.

And secondly, but WOW, how awesome, for taking care of this patient. I hope you now have a new patient if you wanted one. You're a better doc.

Anonymous said...

Geesh, I wish my doc was like you. Four days before Xmas, I came down w/an ear infection. I call the doc's office for an appt. The staff says that the doc decided to take the week off and they are waiting for instructions from him. Say, what? I ended up in Urgent Care I had infection in both my ears!

Thanks for being a care doctor and human being.

Anonymous said...

I never comment on blogs, but I've been secretly reading yours for a few weeks now. I'm a new pharmacist in retail and sad to say I hate my job. My experience has not been great with the Dr's in my area, for the most part they ignore my warnings about serious interactions and throw insurance things like this back at me so I'm the one being cussed out by these patients. But this post gives me hope that there's still some Dr's that care.

Anonymous said...

I think you did a very kind caring thing. I also think this is a perfect example of why we need singer payer in this country.

Doctor D said...

Grumpy, you are awesome.

My former incompetent colleague used to give out meds from the closet like they were candy. All her patients were one hundreds of dollars per month of drugs and had never been tried on cheap effective generics.

Hello? They don't give out shiny new drugs for free out of the goodness of their hearts! They want granny hooked on the pricy stuff.

Usually a couple years later a well-designed study comes out showing that old generic is safer and more effective than shiny new wonderdrug. Opps!

Anonymous said...

Thanks for your efforts!

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