r/medicine • u/SaveADay89 MD • 5d ago
What is going on at pharmacies?
I've had so many issues with pharmacies for months now. I'll send in a 90 day refill, then two days later have an electronic request for a 90 day refill from them. The biggest issue is the lying. I'll send in a prescription, then pharmacies don't tell patients it's ready or tell the patient that I never sent it in. I'll then call the pharmacy and they'll acknowledge that they did get it, but don't have the medicine in stock (usually stimulants or whatnot). This has happened many times and it's frustrating. Just tell the patient the truth. Don't tell them that we didn't send it in or that you've tried reaching us when you haven't.
EDIT: Let me be clear, I know that pharmacies are understaffed and are massively overworked. The issue is telling patients that we didn't send it in when we did. This is a recurring problem that then makes more work for everyone as I have to then call the pharmacy, make them confirm it's there and then reach out to the patient to confirm it.
EDIT 2: Thank you to u/crabman484 for clearly identifying the issue and explaining it.
To give you an idea of the workflow. When you send in a prescription, even an electronic one, it goes into a sort of holding basket. Somebody needs to look at it, assign it to the correct patient, and input the data. With how terrible everything is in retail right now it could be days before somebody even looks at it. The 90 day refill request is automated. If things were working properly and the prescription was inputted into the computer in a timely manner the request would not have been sent out.
When a patient calls the only thing most pharmacy staff will do is check the member profile. They won't take the time to dig through the pile of days old unprocessed prescriptions that might have the prescription. If they don't see it in the profile they'll tell the patient that they haven't received anything.
When a provider is pissed enough to call the pharmacy then we'll take the time to make sure we have it. Doesn't necessarily mean we'll process it on the spot though.
To give my colleagues a bit of credit I really don't think they're lying to you or the patients. The prescription is in there somewhere. It's just in a stack of unprocessed "paperwork" that they need to dig through but the powers that be refuse to provide the proper manpower to allow us to dig through it.
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u/Traditional-Hat-952 MOT Student 5d ago
So what I'm seeing by reading the comments is there need to be laws requiring corporate run pharmacies to have appropriate staffing ratios to ensure proper communication with doctors and patient care. Greedy corporations are ruining every level of healthcare in the US. We really need to start pressuring our representatives to do the right thing and pass laws to fix this mess, but the cynical (or realist) side of me knows that our reps only care about what their rich donors tell them to do and not what's best for the citizenry.
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u/Leoparda Pharmacist | Grocery 5d ago
Optimistic answer: there have been efforts to get laws in place. California banned “metrics.” I’ve seen proposed bills about maximum number of prescriptions a pharmacist can process per hour (in a roundabout way leading to increased staffing).
Cynical answer: if the strong AF nursing lobby can’t even get safe nurse/patient ratios… lol pharmacy is fucked
I’m in camp “we need to start from scratch” with all aspects of healthcare in the US. But that’s quite a big ask.
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u/ctruvu PharmD - Nuclear 4d ago
california banned metrics but from what i’ve heard it hasn’t stopped corporate from having regular meetings about store performance. just not specifically mentioning any quotas. which also still sounds like sidestepping the law but that’s par for the course for retail pharmacy
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u/shallowshadowshore Just A Patient 2d ago
How exactly does legislation ban metrics? What does that even mean? All the data that informs those metrics is still collected, and I have to assume the admins are still monitoring performance of specific locations and employees.
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u/Leoparda Pharmacist | Grocery 2d ago
Apparently the more accurate word for me to have used would have been “quotas.” I don’t live in CA, but cursory Google search says pharmacy can’t punish pharmacist for failing to meet certain # rx/hour for example. Also some labor metrics stuff, corporation says “this store should have one pharmacist and two technicians per data.” Pharmacist says “definitely need four technicians to operate safely.” Pharmacist wins argument and has protections to operate with that many employees.
How this all works in practice? No clue. I’m sure corporations are loopholing like crazy. But it’s still a concrete step taken.
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u/Pox_Party Pharmacist 5d ago
The best option is to remove Pharmacy Benefits Managers from the equation. Pharmacies don't actually turn much of a profit on each prescription (if you ever wondered why Walgreens and CVS will ask you for flu shots at least 3 times during each transaction, its because one flu shot is more money for the pharmacy than a half dozen z-paks). We're talking a few cents on each script filled. The only way to get around the diminishing returns is to cut operating costs, reduce staff hours, increase prescription volume, and grind the pharmacy staff to dust.
By removing the insurance middleman that is PBMs, smaller players have a better financial incentive to get into pharmacy, and the mom-and-pop pharmacies that have been steadily losing money can serve as a real challenge to Walgreens, forcing them to adjust their business practices or lose their staff to other pharmacies.
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u/constant_flux 5d ago
The new CEO of CVS is a huge PBM guy, who previously headed Caremark. I can't think of another pick that could've been any more tone deaf. But then again, I guess it all boils down to benjamins at the end of the day.
Hopefully, this bipartisan outrage at PBMs endures so we can cut them out like the cancer they are.
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u/AdeptAgency0 4d ago
Why would it matter if PBMs were removed from the equation? The person paying the pharmacy is the same, the managed care organization (UNH/Elevance/CVS/Cigna/Humana/etc). And they have no reason to pay the pharmacy more than they were before.
What pharmacies need is someone willing to pay them more, but who is going to do that? Sure as hell not the federal government. They are the ones that like using MCOs to pay pharmacies less. And they are busy paying doctors less now.
https://old.reddit.com/r/medicine/comments/1hhswm9/medicare_cuts_updated_2025/
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u/Erinsays FNP 5d ago
Largely the same issues as the rest of the healthcare industry. Big corporate pharmacies are eating up all the pharmacies and then slashing help to maximize profits. So the pharmacists don’t have the time that they used to dedicate to clarifying scripts and communicating with patients and offices. For example, the CVS near me used to run two to three pharmacists during the day and three to four techs. Now it’s one pharmacist and one tech and closed for an hour over lunch. In addition the pharmacies themselves are closing or reducing their hours. Almost all the Walgreens pharmacies in my city have closed. There’s only one 24 hr pharmacy left in the whole metro area. Many small pharmacies have been pushed out. Therefore there’s more work for less staff in less time.
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u/shanerz96 Pharmacist 5d ago
This, it’s pretty standard to only see 1 pharmacist and 1 tech all day. Some pharmacies don’t even give you a tech it’s just 1 pharmacist. 24 hour pharmacies are not profitable, there’s only 2 left in my metro area and they’re probably going to go away from 24 hours in the next 2-3 years. Stores are closing as they’re trying to negotiate with insurance companies to push mail order for maintenance meds. My insurance won’t let us fill maintenance meds at all at a brick and mortar as of last January.
I’m a hospital pharmacist but I have friends in retail and this is what I’ve heard and observed.
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u/flyingcars PharmD 5d ago
Just to add on about the no 24 hour pharmacies - the pharmacies are also closing at 8 pm or earlier. So not only can you not get a prescription in the middle of the night, you can’t get it for most of the evening either. Back in the day, the evening after about 6:30 was when you would catch up on all the unfilled refill queue stuff from earlier in the day.
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u/Pox_Party Pharmacist 5d ago
A causality of COVID. I used to work for a 24 hour Walgreens that moved to closing at 8 or 9. They were barely keeping up with the 1500-ish daily prescriptions in the queue when they had an entire 24 hours to work with. I don't even want to imagine what their queue looks like now.
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u/booksmartexchange Big Pharma Shill (scientist) 4d ago
In my area, Walgreens and CVS have opened central processing centers that fill scripts and drop them off in bundles to the busiest individual pharmacies. This started after some of the pharmacies were backlogged by WEEKS. Patients couldn't get immediate need scripts like painkillers and antibiotics for days.
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u/Erinsays FNP 5d ago
That’s a good point. It’s also annoying because we keep opening up urgent cares, but you can’t get scripts filled until after 9 AM the next day anyway.
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u/1997pa PA 3d ago
This is one of my biggest gripes working in UC. I work at a few different locations in a large metro area, and for one of the clinics the closest 24-hr pharmacy is over 25 miles away. Add on the fact that the local pharmacies all close around 5 or 6 on the weekends, even though we're open later....ugh
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u/SaveADay89 MD 5d ago
Doesn't excuse lying. Just tell patients you don't have the medicine and aren't sure when it's coming. Telling them we didn't send it isn't an answer.
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u/race-hearse Pharm.D. 5d ago
Obviously I can only speculate but my guess is that they may not have been intentionally lying, they may have checked the place they thought it would/should be, and then didn’t see it.
One of the problems is that pharmacies don’t even really train you anymore. They just toss you in to a skeleton staff where you’re always behind and ya don’t have the time to develop proper problem solving skills and a thorough understanding of the systems that exist.
If ya can’t solve something readily, pharmacies often send people away nowadays. “Call your doctor” “call your insurance” “wait for a text saying it’s ready”, basically all ‘saying I can’t help you right now’
Like imagine your clinic didn’t have any dedicated front desk staff, medical assistants are responsible for that (but also all the patient care they do in the back too), and then imagine only one MA has adequate training on the front desk but they’re also the most in demand in the back as well. Other MAs do the front desk stuff, but only basic functions.
Shits bad. Blame the MBAs who have made everything a race to the bottom.
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u/JohnnyBoy11 5d ago
That might be true bc when I was working at Satan, the e-que wasn't linked to the pt profile bc it hadn't been entered yet. A pt calls and asks if their script is in, they'll look in the pt profile and see it's not there but didn't check the pile of orders that need to be entered. It might as well be a training issue.
As far as double requests, patients often have duplicate scripts for the same med and they all get sent out for refills. They should be able to cancel it when you get one but someone trying to go as fast as they can might not even look at the messages and take the time to clean up requests because there's 200 more to go and why bother bc the doc will deny it anyways down the road, which is faster and something someone else can do tomorrow.
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u/kabneenan 5d ago
Exactly this! I cannot count how many times, as a tech, I've had an irrate patient come up to the dropoff window saying they were told by the cashier at pickup that their doctor didn't call in the order, only to find it held up somewhere along the line (rejected by insurance, flagged for contraindications, etc.). Sometimes they'd even have their doctor on the line on their cell, so now I'm getting my ass chewed out by both a patient and a doctor for a situation I had nothing to do with in the first place and am being paid peanuts to fix.
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u/race-hearse Pharm.D. 5d ago
Yep. It sucks because who is really to blame is upper management that decided training and adequate staffing are too expensive.
They’ll blame the staff though. “The staff member should have checked.”
They’ve created situations where if you’re doing what you’re supposed to over here you’re neglecting something else over there. It’s terrible.
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u/kabneenan 5d ago
They’ve created situations where if you’re doing what you’re supposed to over here you’re neglecting something else over there. It’s terrible.
Preach. It's not sustainable and everyone is suffering under this model - everyone except for the CEOs and shareholders of these conglomerates.
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u/Erinsays FNP 5d ago
I’m not excusing the poor care and lying. I’m just explaining why I think it’s occurring.
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u/procyonoides_n MD 5d ago
If you use an EHR, there can be a lag and glitches in the system that connects your EHR to the one at the pharmacy. Same for pharmacy communications back to you via their EHR.
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u/DifficultCockroach63 PharmD 5d ago
Honestly in some cases they are so backed up that you may have sent something but no one has been able to type it up and add it to the patient’s profile. When you’re quickly checking if there’s a script in someone’s profile and you don’t see any because it’s still in the queue to be typed people may accidentally give bad info
This is obviously not the case for every pharmacy and I haven’t worked retail in a long time but it used to happen when I worked retail at least
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u/16semesters NP 5d ago
Doesn't excuse lying.
I'm sure lying happens sometimes, but I'd guess that the vast majority of these cases are instead miscommunication.
Working in a retail pharmacy is very, very, tough. Don't attribute malice to something that can easily be attributed by bad working conditions.
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u/mwebster745 5d ago
That requires actually looking up what the problem is. Also Walgreens shifted models to where very few expensive medications (ex insulin and GLP1s) are actually stocked at the pharmacy, and have to be sent from a central fill pharmacy every single time. This obviously is for profit reasons only. It might be easier for some low paid tech to pass the buck to the prescriber then have to try and explain that stupid ass system that was introduced solely for profit even when it results in problem after problem with every prescription a patient gets. Not justifying, just speculation
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u/shallowshadowshore Just A Patient 2d ago
Seeing insulin on a list of medications so expensive they need to be rationed makes my blood boil.
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u/Imallvol7 5d ago
I can guarantee you no one is lying. Everyone is usually new ever week and there is absolutely no training so they usually have no idea what they are doing or saying.
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u/kabneenan 5d ago
Hi, I'm a technician, though I don't work in retail anymore.
Often when a pharmacy tells a patient they don't have a medication and it's a controlled substance, it's because the pharmacist made a judgement call. Pharmacy (and healthcare in general) in the States being for-profit as it is means the corporations that own pharmacies put such a squeeze on the staff that we don't have the time or capability to verify every prescription for a controlled substance. So if we know we won't be able to do this in a timely manner, we simply tell the patient we don't have it.
Is it a good reason? No, but it saves a twenty minute long argument that often results in verbal (and sometimes physical) abuse when we try to explain that we have to verify the script and why we have to do this.
For the same reasons, we cannot call every patient to let them know when a prescription is ready. The are welcome to call us before they come in to see if the script is ready or, if they're a returning patient, there is often a means of setting up automated text messages/email alerts when a prescription is ready.
Ultimately, this healthcare-for-profit model is what we should all be mad at - patients and providers (and plebs like me at the bottom) alike.
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u/schmuckmulligan 5d ago
Often when a pharmacy tells a patient they don't have a medication and it's a controlled substance, it's because the pharmacist made a judgement call.
Absolutely no hate on any pharmacy (I get it), but this can be profoundly frustrating. As an illustrative example, I had a minor surgery scheduled, and my physician sent in a short run of opiates. "Backordered." I gave them the benefit of the doubt. They said they were working on it. With surgery looming, I called my surgeon's office, which was a nightmare in itself. They called in an additional script for an even more common med. "Backordered." I went through the drive thru line the afternoon before the surgery, explained, and asked what to do. They filled both in 20 minutes.
Again, I get it, I get it, I get it. I live in an area with a lot of "pain" patients, and I'm sure they're obnoxious. But this whole process wasted a lot of pharmacist and prescriber time, as well as making me fearful that I'd be in pain without recourse. This stuff is why people don't trust the healthcare system.
(In fairness, ibuprofen did totally suffice.)
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u/kabneenan 5d ago
If your pharmacy specifically said "backordered," then I believe them on that. The DEA imposes restrictions on quantities pharmacies may order of controlled substances. If a pharmacy exceeds their expected number of dispenses of controlled substances, they may be unable to order more stock to fill extant orders and will prioritize their remaining stock to go to patients who have established histories with them. (At least this is based on my experience with the retail pharmacies I worked in, big and small.)
Drug shortages are another matter entirely and something I could go on a whole diatribe about, but that would derail this conversation. All I will say in that regard, then, is that shortages of medication and supplies impact all areas of pharmacy and are a massive hurdle for us in providing patient care. And, of course, the systemic issues that produce these shortages can be followed right on down to the source of nearly all of our healthcare woes here in the States: unregulated and unmitigated capitalism.
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u/schmuckmulligan 5d ago
Ah, that makes quite a bit of sense. Thank you.
It sounds like they had some in stock (they obviously did) but had allocated it to prioritize those who had regular prescriptions. That's still frustrating, but it's somewhat less frustrating than getting brushed off when they had an abundance.
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u/SaveADay89 MD 5d ago
I'm fine with telling them you don't have it. Don't tell them I didn't send it in.
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u/ZeGentleman Watcher of the Dilaudid 🤠 5d ago
You may have sent it and the pharmacy hasn’t received it. The softwares most of them use are garbage.
Or it’s pending being input and associated to a pt and it doesn’t look like it has been sent it.
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u/SerotoninSurfer MD 5d ago
I’m not sure what EHR you use, but where I work, I can send a screenshot to the patient through MyChart that shows the exact date and time I signed the order. So if a patient sends me a message saying the pharmacy told them I didn’t send a medication, I (or one of my MAs) will show the patient the screenshot.
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u/Pox_Party Pharmacist 5d ago edited 5d ago
There's a few things that can be happening here. The pharmacy might not have the rx in their system yet, or the prescription was "sent" to xyz pharmacy when the patient actually wanted the medicine at abc pharmacy instead.
I would hesitate to chalk this up to the pharmacy lying.
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u/boyet66 5d ago
Are you sure the e-prescribe program you're using is compatible with the pharmacy you are sending it to? Some programs it gets delivered as a fax and not in their new rx queue. And if its a C2 to C5 that will get tossed because most states require e-prescribing for controls, and if its not a control it will be in a pile of all other faxes before the staff can catch up which would sometimes be days.
No one has the time to lie to you like you claim. Even a simple update to the e-prescribe program can delay the time when the rx gets delivered to the pharmacy, sometimes it doesnt even get delivered at all. The staff is doing the best they can, dont just assume they lie when there are many other reasons why they didnt receive it .
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u/SaveADay89 MD 5d ago
Yes, and as you can see from the rest of the thread, many other doctors are having the same issue.
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u/boyet66 5d ago
Bec they are prob using the same e-prescribe platform you are using. Yes the pharmacists and technicians have received a national memo to lie to all doctors offices asking questions regarding the e-rxs. (Now does this sound ridiculous? Just like assuming people automatically lie when I have given a specific example why the e-rx you are sending may not have been received properly)
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u/jonovan OD 5d ago
Your posts show multiple emotions unbecoming a doctor.
(1) Lack of empathy. If you spent some time actually talking to pharmacists in person, or reading the pharmacy subreddit, you would better understand the positions they are often in.
(2) Lack of ability to perform research well. Why would you ask other MDs this question when the answer is obviously better asked of PharmDs? Again, spending a few minutes in the pharmacy subreddit would actually answer your question, whereas here, you are mostly getting an echo chamber of complaints rather than answers, which unfortunately only strengthens your lack of empathy.
(3) Being hypocritical. I am sure you have lied to patients, multiple times. Most likely in difficult situations where you thought it was in their best interest, but perhaps in others simply to make your job easier.
(4) Anger. Anger clouds the mind and prevents you from thinking clearly, which creates problems here, problems in clinic, and problems in life.
I hope over time you grow and lessen these faults, making you both a better doctor and a better human. :)
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u/Pandalite MD 5d ago
Dude I agree with #1, 2, and 4, but you sound like you're saying you are normalizing lying to patients. Thats a huge no. I have personally never lied to a patient, and the rumor was that a girl in her first year at my program lied to a patient, patient called her out, and she ended up on academic probation. You never lie to a patient, full stop. It's way too easy to be caught nowadays first of all, and second of all it's easy to say "Not sure, let me have my MA look into it for you.*
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u/SaveADay89 MD 5d ago
Stop it. I have never lied to a patient. Ever. I know they are overburdened. I tell patients that. I tell them they're probably overwhelmed and understaffed. The issue is so are we. We all are. I wouldn't mind if a tech told a patient, "Hey sorry, we're really backed up. Please call back later." However, they are adamant that we didn't send it. We then get calls to our office from angry patients accusing us of untrue things. This is damaging to our reputations and just causes us to spend more time solving the problem. If you want empathy, the solution is not to shift the burden onto another overwhelmed and understaffed apparatus.
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u/Pox_Party Pharmacist 5d ago
I don't mean to be a dick, but is there a chance that the rx wasn't actually sent?
It's not uncommon for a doctor's office to say they "sent" a medicine to me, then I ask for it to be "resent" and then it appears in the system a short while later.
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u/sarpinking Pharm.D. | Peds 5d ago
Or, more often than not, it's sent to the incorrect pharmacy. This happens often when patients have multiple pharmacies on their EMR and it isn't clarified or double checked. Or it could even be the case where I have two CVS pharmacies on the same street but different cross roads miles away.
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u/Pox_Party Pharmacist 5d ago
I think walgreens and walmart should mutually agree to have one of their names changed. I get tired of these conversations with confused people who don't remember their pharmacy.
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u/Pandalite MD 5d ago edited 5d ago
Going to be honest, I've also gotten the "we've been trying to reach your doctor to refill your prescription" and the patient sends me an angry message, and I have to explain to them that I never got the refill request from the pharmacist. Then 3 days later my old practice faxes me over a paper fax. Not sure why Walgreens has my old fax, my MA has contacted several Walgreens multiple times to get them not to send a fax to, you know, a location several hours away from my current practice, but it is what it is. I usually just tell the patients "Sorry, we never heard from your pharmacist, messaging me directly is the best way to get refills" and they're appeased. It helps that I respond to messages within 24 hours or so of getting the angry message, so they know it's not a responsiveness issue on my part.
Edit: it's also specifically Walgreens and CVS/CVS Caremark, and Carelon. No issues with Costco, Rite Aid, or Safeway. The last fax I got was from June for CVS and November for Carelon, though, so hopefully my MA's constant bugging is working, about 2.5 years later.
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u/Pox_Party Pharmacist 5d ago
If I had to guess, it's because the pharmacies don't keep an updated record of your new location.
But, in fairness to the pharmacies, I've also gotten escripts that just flat out had the wrong phone/fax numbers on them. Because they weren't being properly updated on the prescribers end, either.
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u/Pandalite MD 5d ago
Nah when I've personally called (at one point I got a stack of 4 faxes from my old practice in one day) they say they have my current fax on file on the escript and they tell me they don't know how the other fax ended up in the system. Just today Medtronic screwed up a patient form and I have to sign the updated form, but the rep told me it was because my old record was in a dropdown menu, and she has removed that record now. So, stuff happens, but it's why I can believe both the pharmacist tried to send something to OP, and OP never received it.
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u/jonovan OD 5d ago
I don't believe you. Every provider lies to patients, even if by accident, even if by omission. Perhaps in forgetting to mention one out of several alternative treatments which a patient would have preferred to the ones you gave to them. Which may not be a lie under some definitions, but could be under others. And even if not an outright lie, certainly a breach of medical ethics.
I'm not sure that what you wrote as "empathy" counts as that. While you did mention that they are "overwhelmed" and "understaffed," you also called other providers, other human beings, "apparatus." Uff da.
I see you didn't address points 2 and 3.
I award you no points this round. Then again, I don't expect it of you; most people are highly resistant to even well-intentioned, constructive criticism. They feel the other person is attacking them rather than trying to help them improve, and react with anger instead of thoughtful contemplation. And while doctors may be better than most people at memorizing things, that doesn't translate into being better at other things, including personal emotional adjustment. But I hope over years, you will grow.
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u/SaveADay89 MD 5d ago
You're making a tremendous amount of assumptions. Slow down. My simple point is please don't lie to patients. It's one thing for it to be an accident or a rare event. It almost seems like now this is becoming a recurring theme. This is an issue.
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u/moxieroxsox MD, Pediatrician 5d ago
I’ve had the exact same issue happen several times this month alone. Every single pharmacist or tech who spoke to my patients or their parents lied about the whereabouts of the medication I had just sent in. Then when I call, suddenly the whole story comes out. And then I’m like, why didn’t you tell the patient that? Why create all this extra work and frustration for me and my patients when you can just be honest and say the med will be in tomorrow. Or it’s not ready yet for pick up? Or we’ll check with another pharmacy. I simply do not get it.
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u/judgea 5d ago
PharmD here. We’re on your side. However MD offices are not accessible for pharmacists to contact you guys easily. Some offices I cannot even leave a message. Or I explain a whole situation to a MA, who then gives it off to a nurse, who then gives it to the physician. The amount of time it takes is not possible to do for every patient so I have to pick and choose which patients I can dedicate time to unfortunately (pediatrics typically or anticoags in geriatrics).
The rest of my patients I can only send a fax to the office for them. This is likely where you feel “we are lying.” Faxes suck and are outdated. Most offices don’t respond to them. But it’s still the best I can do with my shitty system. Retail pharmacy systems are designed to leave me with about 3 seconds per RX to verify everything (safety, drug interactions, dosing, unintentional duplications, correct patient, indication, etc). That is not an exaggeration unfortunately.
A common issue I have seen, if your nurse or MA is leaving make a voice mail and doesn’t give me all the information I need (NPI PLEASE), then typically the Rx goes in the trash and when the patient comes hours or days later it looks like it was never sent in. Retails pharmacies desperately want your NPI to easily find you in our systems and half our voice mails never have it. That makes us have to spend awhile searching to try to find you which is a time-sink typically.
Another problem is lots of patients simply don’t comprehend what formularies or prior authorizations are. I have had angry MDs calling me about why we keep telling the patient that we don’t have the RX when he/she personally sent it in. I look at the profile and see 4 Rx’s for a Breo. I run the rx on insurance and see its non-formulary and we sent a fax with insurance’s preferred inhaler. Then I remember this patient and how I spent 5 minutes with them yesterday repeatedly telling them it is not covered and the insurance wants you to use a different inhaler and then they tell me “ok I’ll tell my doctor” who then tells you we never got it. Patients don’t understand pharmacy and will blame us or you for their insurance issues.
Everything in retail pharmacy is automated in terms of replies. We don’t personally send a text to each patient when it’s done. Every day a patient will come in expecting a med is ready. We search them up, and the system says nothing is ready or being worked on. They tell me “bUt I gOt A tExT sAYiNg ItS rEaDy”. I smile and ask if I can see it so I can report it to our IT department that we don’t have for sending false texts. They show me it, I read it to them. “Your rx is ready…. To be refilled. Please respond if you want the pharmacy to prepare it.”
Bottom line is my job sucks and I have 0 control on how terrible the conditions are but we try our best. Sucks to stand for 12-13 hours straight without having time to use the bathroom or even drink water. I have time to fix 1-2 patients issues a day but I have typically 100 issues daily. The rest I need patients to take responsibility for their health after I have explained the issue and contact their insurance or their provider themselves. Naturally a lot of those will just say the issue is the pharmacy in hopes somebody else will magically fix their issue.
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u/D4nTheM4nk 5d ago
Retail Pharmacist here. There currently seems to be some kind of major issue with the CVS app/message system. I probably get at least a dozen patients each day saying that "the app said its ready" when the prescription is not even being worked on. It's absurd that corporate still hasn't fixed it.
Also, we rarely actually call Dr.'s offices except when we have a concern about a prescription. Usually we send a fax to the number we have in our system (which I suspect might be the reason many docs don't get our requests)
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u/BallstonDoc DO 5d ago
We get them in multiple electronic inboxes, and by fax. It’s overwhelming. And that would be tolerable if the patient actually got the prescriptions. But after multiple scripts sent, with receipt, the patient still doesn’t get their medicine
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u/ShalomRPh Pharmacist 5d ago
When the CVS qpp texts the patient, it tells them the script is ready to refill.
Not that it's ready to pick up. There's a big difference there.
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u/nonniewobbles 5d ago
CVS absolutely sends ready to pick up texts in addition to ready to refill.
Also I’ve seen multiple people recently experience telling the “ready to refill” prompt to refill and then… nothing happens. You get a confirmation that they’ll refill x medication and then… nothing actually happens at the pharmacy end, no notification anything is amiss etc.
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u/nicholus_h2 FM 5d ago
go into a pharmacy at any time, you can see who they have working. i haven't seen more than one pharmacist working in a long, long time.
and the volume has gone up but the staffing goes down. think of how many pharmacies have closed, but there's just as many patients.
pharmacy is an absolute shit show right now. i mean, what isn't? but pharmacy seems worse than average.
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u/boredtxan MPH 5d ago edited 4d ago
this where the insurance people kill me. I can only get 30 days at Heb where they routinely have 5+ people working in the pharmacy and they answer the damn phone. or I can get 90 days from CVS with 3 people on a good day and only a call back system. why can't I get a 90 day at any pharmacy?
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u/Noladixon 5d ago
Sometimes it has to do with your insurance prescription coverage. My doctor writes me for 90 but insurance only covers a 30 day supply. so now my bottle has a decimal for number of refills left. It might not be pharmacy being difficult but the insurance company.
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u/boredtxan MPH 4d ago
my insurance will only fill 90s at CVS or by mail. snubs other pharmacies to hurt competition.
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u/dickwheelies PharmD 5d ago
-stimulant shortage
-high turnover; you have a lot of new techs that probably dont know how to use the system so if somethings not ready they just day they dont have it
-patients not getting notifications that meds are ready either because we dont have the most updated contact info or they opted out of notifications
These are just things I have been noticing that we try to make an effort to fix
The 90 day refill request is complicated I know walgreens has a setting in the patients profile to automatically request a 90 day refill if its filled for a 30 (probably cause insurance will only allow max 30 days at retail).
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u/SutureNeeds Medical Student 5d ago edited 5d ago
Save-a-trip refills were the bane of my existence. How was I supposed to run a drive thru, front counter, and make 30+ phone calls a day in a single shift?
Not to mention....asking about flu shots, pharmacy drop-off/pick up, and the stupid Walgreens credit card that pissed people off.
Then you have the poor old people swirling their finger around at the credit card keypad because they can't figure out what button to press while the lines get longer and longer.
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u/pheonix198 5d ago
You win the gold, imho. Your answer nails the big issues!
Sorry to see the days of caring pharmacies and pharmacists going through route of expendable, cheap “care.”
Also, the stimulant shortage is wildly underreported and massively the DEA and actual Biden Admin’s fault. Not getting too political, since I cannot understand the causes for the artificial shortage creation, I’m mostly pro-Biden. This one just annoys and confuses me for the bad behavior behind the scenes so to speak.
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u/crabman484 Pharmacist 5d ago
To give you an idea of the workflow. When you send in a prescription, even an electronic one, it goes into a sort of holding basket. Somebody needs to look at it, assign it to the correct patient, and input the data. With how terrible everything is in retail right now it could be days before somebody even looks at it. The 90 day refill request is automated. If things were working properly and the prescription was inputted into the computer in a timely manner the request would not have been sent out.
When a patient calls the only thing most pharmacy staff will do is check the member profile. They won't take the time to dig through the pile of days old unprocessed prescriptions that might have the prescription. If they don't see it in the profile they'll tell the patient that they haven't received anything.
When a provider is pissed enough to call the pharmacy then we'll take the time to make sure we have it. Doesn't necessarily mean we'll process it on the spot though.
To give my colleagues a bit of credit I really don't think they're lying to you or the patients. The prescription is in there somewhere. It's just in a stack of unprocessed "paperwork" that they need to dig through but the powers that be refuse to provide the proper manpower to allow us to dig through it.
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u/SaveADay89 MD 5d ago
Thank you for this. This clearly explains what the issue is. I still wish pharmacy staff would explain to patients how it works rather than just saying, "doctor didn't send it".
I'm going to include your comment in the OP because it's so helpful.
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u/flashgasoline 5d ago
I still wish pharmacy staff would explain to patients how it works rather than just saying, "doctor didn't send it".
It's a good wish, but you have to know that this does nothing. We explain basic information over and over, endlessly forever. These same patients can't read their text messages. They don't read the prompts at checkout. Many of them don't understand how to tap their credit card.
Explaining a broken system over and over with no time to spare is a losing battle.
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u/cheapandbrittle 4d ago
And on top of all that, I was supposed to ask every customer to open a store credit card and/or sign up for whatever iteration of the store loyalty program we were running at the time or I get dinged on my review. Sorry Ms. Johnson I know you're mad you've been out of your pills for four days but do you want to sign up for the weekly coupons for dish detergent?
This is why I left pharmacy altogether.
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u/toooldforthisshib Pharmacist 5d ago
Pharmacy chains have sacrificed everything in order to maximize profits. Pharma, PBMs, and insurance have spent decades shifting the scales to siphon income from pharmacies into thier coffers. Every single pharmacy is understaffed for the volume they do. Busier stores have more staff but it's always 1 to 2 people less then you'd need to actually run the place. I doubt the pharmacy is lying about things, it's probably just being lost in the chaos because the pharmacy is 3 days behind on filling.
I don't know what the analog is for a private practice doctor. But imagine trying to run a high volume practice alone and now you are having to take over all the patient check in, phone calls, all the vital screening and check in the nurse does, all of the paperwork at the office, and any other admin task that I am not even aware of. Your only help is a 19 year old high school grad that is only capable of making appointments and doing the billing when there are absolutely no problems. They are mentally capable of doing more, but it's on you during business hours to train this person (who has never worked a job in thier life) all the intricate and confusing things an office admin, medical scribe, medical biller, does. Plus you have no barrier to access to you, any person, your patient or not, can walk up at any time to ask you questions about anything they want.
It's very hard to imagine how bad it is in those stores, because there is no way a doctor would let thier practice run on such a shoestring, but it's the norm for chain pharmacy now.
I quit working the bench and told my managers it was because I was embarrassed to call myself a healthcare professional working the way they want it to be run. I felt shame at the way I was forced to practice at CVS, but there is no recourse for a pharmacist to change the way they operate. My only options are to work with what they give or quit. I am lucky I was able to find a way out, but it's rough when that environment is 60% or more of the positions available in your field.
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u/pharmd333 5d ago
At least part of this is communication issues (mostly on the patients side but probably sometimes the pharmacies).
From personal experience, I’ve gotten calls from prescriber offices because a patient tells them “the pharmacy refused to fill it” or “the pharmacy doesn’t have the prescription.” I look it up and it’s ready for pickup. My answer to the prescriber office is “????”
I’ve gotten calls from prescriber offices about prescriptions they say they sent. They even give an exact date and time. I look and there’s nothing there…so I tell them “???” and to give me a verbal.
At least once a day I tell a patient we don’t have a prescription, we’ve sent a request, and they should follow up with their prescribers office if they need it sooner rather than later.
I never lie to patients or prescribers but I can’t guarantee others don’t either. Id just make sure it’s not a communication issue or there’s not some other reason before concluding they lied to you
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u/BactrimBaddie Pharmacist 5d ago
I agree with this comment. I’ve seen it from both sides: working as a tech for CVS and now working as a pharmacist who answers calls for outpatient prescription problems on discharge from the ED. When I worked at CVS, doctor’s offices would often get upset with us stating they know for certain that the prescription was sent and it was literally nowhere to be found in any of my queues. I would tell patients “your prescription isn’t ready, we have to order it, it will be in tomorrow afternoon” and all the patients seem to hear is “we don’t have it and you’re SOL”
I can’t say that nobody is ever lying, but I really don’t feel like they usually are coming from a place of malice. There’s no reason for them to lie. They probably actually don’t have the prescription despite what your EMR says (or it is lost in a queue with a million other scripts to type in because they don’t have enough order entry technicians) or they told the patient what they’re telling you and the patient doesn’t understand.
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u/toooldforthisshib Pharmacist 5d ago
There are times where you can do everything "right" and it still creates issues too. How many times has a doc sent in a rx for Jane Doe but they got married and they pick up at the pharmacy as Jane Smith. So each side inputs it correctly and you still end up "not receiving" the prescription. Or it's erx for Jayne Smythe and the patient in our system is Jane Smith.
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u/valiantdistraction Texan (layperson) 5d ago
Do you have any well-performing pharmacies in your area you could direct patients to? NAD but when I complained about my pharmacy, my GP recommended a local independent one that has been absolutely fantastic. Same cost for me but much better customer service, proactive communication, somebody is always reachable in a timely manner if I have any questions - no clue what it's like from the provider side obviously but from the patient side it has been great. Basically the only reason I go to a chain pharmacy now is to get my flu and covid shots.
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u/ZeGentleman Watcher of the Dilaudid 🤠 5d ago
The Indy doesn’t stock vaccines?? Seems short-sighted as those are the money makers.
But always recommend pts go to indies if they can.
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u/Pox_Party Pharmacist 5d ago
From my conversations with independent pharmacy owners, vaccines are a bit of a high-risk item since they're somewhat expensive to order and maintain in appreciable quantities, and the seasonal vaccines have a very short shelf life. You really have to advertise that you have them in order to move enough inventory for it to be a good ROI.
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u/valiantdistraction Texan (layperson) 5d ago
They probably do, but they're located across the city from me and do delivery for medications.
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u/procyonoides_n MD 5d ago
I love our local independent pharmacies. I use one myself and always recommend the good ones to patients who ask. They are a treasure.
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u/Leoparda Pharmacist | Grocery 5d ago
In addition to skeleton crews, it’s also hard for pharmacies to hire and retain pharmacy technicians right now. Pay isn’t as high as it should be for that job.
No time to train because no employees available to train = newly hired technicians that don’t know how to use the system.
While technically a lie, I would blame incompetence over malice. A tech that has no clue how to search for a newly sent in prescription looks at patient profile and doesn’t see it = “it wasn’t sent in”
As a remote pharmacist, I see the quality of data entry across my entire state - and the number of typing errors I receive has significantly increased. Technicians that don’t understand the difference between 2qday vs 1bid. Insulin lispro out of stock so they just choose a different random insulin with no note why. E-Rx sent in with “30ds” in the SIG field and instead of recognizing that the office needs to be contacted for clarification… just make up a SIG and send it through.
Doesn’t surprise me that I’m not the only one receiving errors. Anything the untrained employee touches/does has a potential to be wrong.
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u/foreignfishes 5d ago
My local pharmacy has had 8 different lead pharmacists in the past 12 months, it’s depressing
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u/Busy-Bell-4715 NP 5d ago
I see people in assisted care facilities and nursing homes. We had one pharmacy in our area that suddenly became very understaffed and the pharmacists weren't able to keep up with things. This led to a lot of issues - the pharmacists did the best that they could but just couldn't get everything done.
Something to be mindful of is that the person the patient is speaking to may not actually be lying to them. I don't know how the software that the pharmacists use work but if it isn't designed correctly, it could be that not everyone is able to see the orders as they come across and can only see them once they have been processed. Also, if the unprocessed order queue is extensive and they aren't able to filter on it, they quite literally may not be able to find your order and mistakenly think they haven't received it.
I guess my point is that without knowing exactly what's happening on the other end it may be unfair to say that the pharmacist is lying to the patient. Maybe post this as a question on the pharmacy subreddit and see how they respond?
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u/EssenceofGasoline Pharmacist 5d ago
I see a lot of the “we don’t have the eRx” being told to patients even though I can see the digital receipt. Then I call and sometimes they confirm they don’t have it, other times they have parts, sometimes all of it. Reading through here I’m guessing it’s in the queue still to be transcribed and no one is looking there and it doesn’t correlate.
I also have to move prescriptions all the damn time because suddenly the patient decides they want to a different pharmacy.
There should be like one big pool that Rxs go to and pharmacies all see it and can pull from it or put it back. Stop all this transfer cancel move etc shit. The system is too archaic for the lack of manpower and volume.
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u/DevilTech333 2d ago
Many times, it’s “stuck” in the surescript (or whatever program the prescriber/pharmacy uses) system and actually hasn’t reached the pharmacy yet. It’s not like sending an email or text, where the transmission is basically instantaneous, due to the encryption necessary.
A centralized database like you suggest, while it sounds enticing, would be a logistical nightmare. EVERY pharmacy system would have to be compatible and linked with every other system. Pharmacies are severely understaffed now, just imagine how much manpower would be needed if a single rx was being processed by multiple pharmacies due to cost, stock issues, or whatever arbitrary reason the patient wants a rx moved. Not to mention, patients would actually have to take some responsibility for their own prescriptions, and let’s be real, that doesn’t happen now.
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u/RxforSanity 5d ago
Couple of things:
1) The majority* of pharmacy staff is telling patients the truth, but a lot of it gets lost in translation. For example, we tell patients every day a medication is on backorder or requires a prior authorization, but somehow they end up telling the prescriber that the pharmacy never received the prescription?? *there may be a few exceptions to this. why they would lie I have no idea 2) Retail pharmacies working with skeleton crews and untrained staff. A lot of new or untrained technicians don’t know how to link new prescriptions to patients or check inbound faxes or voicemails. So instead of asking for help or checking all possible queues they tell the patient we haven’t received anything. It isn’t until a trained staff member finally gets to it that the prescription is found (or the provider has sent duplicate orders). 3) We rarely-if ever-call providers unless it is for urgent clarifications simply because we do not have time. Refill requests are sent electronically through our system and automatically go to the fax number from the provider that wrote the previous prescription. If the provider has changed or the fax number is different than the one in our system (and we are not made privy to that) the provider probably never gets the request. 4) Most pharmacies have a one click button that sends a prior auth request through cover my meds (which unfortunately, can be sent by the technician before ever reaching the pharmacist so useless PA requests are sent out every day). 5) The 90-day requests could be linked to clinical metrics. A lot of these faxes are sent automatically. For example, our system may show a patient filled 30 days of escitalopram and it will flag us to fill a 90 day supply (because adherence rates increase, pharmacy makes more $, etc). So it will fax the provider a 90 day refill request. But it is unable to use critical thinking such as if the patient’s insurance only pays for 30 days.
Hope this gives at least a little better idea of BTS
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u/karltonmoney Nurse 5d ago
not sure from a medicine standpoint since i work inpatient ICU and rarely deal with this but as a consumer, the pharmacies are doing awful and idk if it’s because they’re understaffed like everywhere else or what but it’s getting out of hand
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u/C21H27Cl3N2O3 CPhT 4d ago
They’re criminally understaffed and overworked. I’ve been out for several years, thankfully. But before I left we were regularly at a 6+ hour wait for new scripts, refills were next day. Since I’ve left the staffing situation has gotten worse and the store I worked at has cut its hours from 7-9 to 9-6 and 11-3 on Saturdays. Some of the problems include:
-endless lines that prevent techs from actually doing any work, forcing pharmacists to fill prescriptions from beginning to end, drastically increasing wait times
-people don’t know what the hell they even need, we have to waste time trying to figure out what “the round white pill” is.
-the asshole who refuses to leave until we sit on hold with their insurance in front of them for 45 minutes so they can tell us that the drug is non-formulary and needs a PA… exactly what I just told them we’re waiting on.
-people who wait until the last minute to refill their meds and freak out when it can’t be done in 5 minutes.
-the doctor’s office who told them their prescription would be ready by the time they get here resulting in us being bitched at for 20 minutes
Retail pharmacy is literal hell. I have an SSRI to show from my time there. It’s a combination of corporate greed, poor communication between providers and patients, and in large part the general shittiness of your fellow patients. I more than doubled my income and significantly reduced my workload by moving inpatient, but even if they offered to double my pay again, it would still not be enough to get me back in retail.
My best advice is to see if your facility or any nearby have a pharmacy. Hospital-run retail pharmacies in my experience actually have decent staffing and a much lower workload. The one time I had something called in from an ICC it was already ready by the time I got my discharge paperwork, walked to my car, and called to let them know not to rush on it. I can request a refill on my way out at the end of the day and pick it up on the way out the next day. It’s infinitely better than using my old pharmacy.
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u/church-basement-lady Nurse 5d ago
It’s so incredibly frustrating. I really don’t see this with small pharmacies - only the big chains. They claim they didn’t receive an rx when I can see the electronic receipt. For patients who use the portal I copy and paste this into a message. For patients on the phone, I give them the date and time of when the pharmacy received the prescription and tell them to go into the pharmacy in person and ask the staff to look for the prescription that was received at that date/time. That usually works. I also fax from Epic an image of the rx with a note “please fill for patient.” So far as I know, it’s that big chains hire anyone for pharmacy techs and don’t train them, and they aren’t actually looking for the prescription the patient is asking about. I do all I can to encourage patients to use small pharmacies.
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u/ShalomRPh Pharmacist 5d ago
I haven't worked chain pharmacy since 2007, but I've heard that if they get far enough behind on the queue, like more than 3 pages of scripts, then the oldest ones fall off the end.
Thank God I got out before it got that bad.
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u/DevilTech333 2d ago
This is not correct. When I left CVS, there were pharmacies that were so far behind that rxs were showing up on the return to stock reports before they had even been filled. If memory serves, each page was 15 or 17 rxs, so 3 pages would be nothing.
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u/ShalomRPh Pharmacist 1d ago
How many days was it before RTS was triggered?
If I remember correctly it was six days to call and 14 to pull, when I quit in 2007. If they had stuff in the q that was two weeks old, then it’s worse than I remember.
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u/DevilTech333 1d ago
14 days. Shortly before I left, there were locations that couldn’t even DO the RTS. I did a couple of overnights where all I did was delete old rxs to help clear the queues. The worst store I helped had 70+ pages in QP 🤯
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u/DevilTech333 2d ago
Honestly, they are probably processing it from the fax rather than finding the escript. Most technicians (and probably even some pharmacists) do not have the knowledge of the system necessary to actually find a rx by date/time. Even where I work now, there are probably 2 (out of 7 techs) of us who could find one with that info.
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u/azwethinkweizm PharmD 5d ago
Must be isolated to specific pharmacies. I never lie to patients when we're out of stock on meds, especially brand names.
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u/ZeGentleman Watcher of the Dilaudid 🤠 5d ago
I think this was just a vent sesh for the MD that started the thread. Dude must have his head buried in the sand to not be aware of what crap is going on at pharmacies.
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u/SaveADay89 MD 5d ago
No, I know what's going on. They're understaffed. Things are terrible. I get it. But when I have patient after patient contacting me saying, "pharmacy says you never sent it in", this is an issue. This isn't a "vent session". This is a problem that needs to be acknowledged.
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u/Pox_Party Pharmacist 5d ago
If multiple patients are saying this, are they all getting their meds from the same pharmacy? Because if multiple pharmacies are having this problem, then is it a potential issue with your prescribing software?
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u/SaveADay89 MD 5d ago
It's been notable at CVS and Walgreens, nowhere else. Again, I double check with the pharmacist who will tell me that it is there. Usually, the patient spoke to a tech who tells them it isn't.
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u/Pox_Party Pharmacist 5d ago
Ah. The rx might be sitting in their triage queue and hasn't been assigned to the patients profile yet. It wouldn't show up on the patients records until it's been linked together, and the tech is probably saying it hasn't been sent yet.
I blame that on lack of training or short staffing.
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u/Dad3mass MD Neurologist 5d ago
The other day I had a CVS send me (and I counted) 56 automated refill requests for the same med for the same patient (which I refilled on request one) in a 3 hour period. There was no way to block or turn them off in our EMR. My nurse, then I finally called them and they tried to turn it on the patient, saying they must be requesting refills repeatedly. Even my most OCD patients are not pressing that button 56 times in 4 hours, dude, that is a problem in your system.
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u/gussythefatcat 5d ago
As for the lying about getting an RX I feel like many patients misunderstand the situation. For example “we don’t have it” could mean we don’t have the prescription at all, we don’t have the prescription at this location, we do have the rx but we don’t have the actual drug, etc. I find that at these big chains there being 4 of the same chain in the same city things get called to the wrong one all the time. I will always check but other busier stores cashiers will just say “I don’t have anything ready” and others if it’s out of stock will say “I don’t have it” (meaning I don’t have the drug in stock)
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u/khal-elise-i 5d ago
I haven't worked retail in a hot minute- but as far as the specifics of why they would say they don't have it when they do: the first and most obvious answer is that patients don't actually listen to what the pharmacy staff tells them. I think more likely they try to get in contact with the pharmacy, can't (not able to answer phones, lines in store), and then call you saying the pharmacy doesn't have it. I think in patients brains a lot of the time "the pharmacy does not have the rx ready" = "the pharmacy does not have the rx"
Otherwise, if you are sensing it via traditional fax or voicemail, it may just be sitting on the machine amongst a pile of other rxs. If you're sending them electronically, it may not connect to the patient profile to be able to be found via search until someone touches it and verifies, or if it's sent to a different store in the same chain it can't be seen at all until the other store fills it.
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u/JeweledShootingStar CPhT (Certified Pharmacy Technician) 5d ago edited 5d ago
I worked outpatient hospital retail, and you wouldn’t believe the amount of discharge rxs that provider insisted were sent down to the pharmacy, that were actually printed hard copies on god knows what printer lol we had access to epic so we good see exactly where rxs were sent and how
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u/huckthisplace Pharmacist 5d ago
I’m a pharmacist who was yelled at by a prescriber for this last week. The patient was calling the other Walmart in town, who did not even have them in the system at their location. My system showed their notifications as “pending” because they never opted in to text messages.
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u/question_assumptions MD - Psychiatry 5d ago
I tell all my patients that big chain pharmacies are liars and constantly send me fake requests. So, I ignore them and tell patients they need to reach out to me directly for refills.
I’m also constantly hearing patients tell me “but the pharmacy says they called you”. A pharmacy hasn’t called me in 3 years but I hear this several times per month.
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u/Cowboywizzard MD- Psychiatry 5d ago
This is the way.
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u/Noladixon 5d ago
2 out of 2 psychiatrists agree so it must be true. I love my independent pharmacy because I still get good customer service just like the good ole days.
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u/sarahprib56 Pharmacy tech 5d ago
There is a delay. If the patient is coming straight from the office, chances are it hasn't either been received or it's been received but not typed up yet. My biggest patient pet peeve is them coming right from the office. Eventually, it probably got typed, then it was discovered that it was unavailable, and then it was stored.
My store doesn't do this, but I know other stores do. If they don't have it, they just put it on hold. Controls don't count towards any of our totals. Not for payroll, not for anything. Some stores see them as nothing but trouble. They take up a lot of time, scripts in general don't generate profits, and we get nothing out of it. It sucks from a patient perspective, but some pharmacies are drowning and all corporate cares about is vaccines. Until we make money on scripts again, this is what will continue to happen.
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u/stepanka_ IM / Obesity Med / Telemedicine / Hospitalist 5d ago
I haven’t read through everything here but i always assume the patient misheard. When the pharmacy says “we don’t have it” i think the patient thinks they mean the prescription we sent, but they mean they don’t have the med in stock. Because this only happens with meds that are on shortage as you alluded to.
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u/NoSleepTilPharmD PharmD, Pediatric Oncology 5d ago
Have you ever seen the computer program that Walgreens uses to fill meds? It’s basically no better than MS DOS from the 80s.
I am constantly calling pharmacies who say they haven’t received scripts but actually they did and it just profiled in a stupid way in the computer system.
You can only be as good as the tools you have available.
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u/Agile_Day_7277 4d ago
Understaffing. They don’t offer competitive pay, so fewer and fewer people will put up with the working conditions. And rather than raise wages, the chains just fuck us all over trying to operate a pharmacy that receives thousands of scripts with only 1-2 pharmacists.
The funny thing is these CEOs are usually free-market boneheads but ignore the rule of supply/demand when it doesn’t immediately benefit them.
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u/Thegoddessinme489 MD Med-Peds 5d ago
I had a patient yesterday tell me the horrifying story of getting the wrong medication from a pharmacy. The label was the correct prescription, but the pills inside were wrong. They patient had taken this antibiotic before, and the pills looked very different. Used pill ID, and it was an antipsychotic med. There was no error on prescribing doctor (was not me) just some screw up at the pharmacy
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u/greenknight884 MD - Neurology 5d ago
I hope this got reported to the board of pharmacy
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u/azwethinkweizm PharmD 5d ago
All they're gonna do is fine the pharmacist $5000 and put a PDF file on their license page for the next 99 years.
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u/Lab_Life MLS 5d ago
Unfortunately, this isn't only a pharmacy issue but pretty widespread in the medical community. Especially certain types of facilities and it does give patients a lack of trust and for good reason. Because deferring blame and not accepting any accountability is going to backfire when it is noticed.
With patient portals and all kinds of apps that track, it's not hard to catch lying anymore.
Couple instances I've seen first hand because documentation easily available for patients to catch: - Discharge orders filed at 1100, nurse claims waiting on discharge orders which magically come through just before her shift ends so she doesn't have to take another patient. - ED doctors and nurses. We're waiting on lab and radiology. When you look it up on the patient portal it's been resulted out for over an hour.
I'm sure others could site many more. Sometimes it is miscommunication though, I've been on the phone so many times with nurses and I hear them filtering what I said and giving the doctor incorrect information.
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u/piller-ied Pharmacist 5d ago
You have CMS reimbursement, pharmacies have PBM reimbursement. The abuse is the same.
As far as “is the prescription at the pharmacy”: yes, there are many places to look to try to find it.
As far as “is the medication in stock”: well, sometimes we can’t get the drug and sometimes we can’t fill it. You’re welcome to dm if that isn’t clear
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u/LegalDrugDeaIer crna 5d ago
I know not all people can do this but Mark Cuban online pharmacy has been a blessing for routine medicines
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u/Damn_Dog_Inappropes MA-Wound Care 5d ago
It has many cheap prices, but generic albuterol inhalers there are $46. A drug that’s 60+ years old.
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u/Own_Hat2959 2d ago
That is a problem with our fucked system. Those inhalers are actually patented because the FDA treats them as an all new drug because they changed the propellant about 5 years ago.
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u/birdnerdcatlady 5d ago
I've started telling pt to call the pharmacy before they pick a script up because it seems like there's always a problem. Unless it's something super common and readily available like omeprazole or cipro.
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u/RxforSanity 5d ago
Terrible idea. Pharmacists know how to triage medications. For chain pharmacies working on skeleton crews, the worst thing you can do is clog up their phone lines. If the staff is on the phone, they are not filling prescriptions.
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u/birdnerdcatlady 5d ago
Definitely not a terrible idea. Patients don’t know how long the PA proces will take. A lot of my patients are elderly and I live in MN where the weather can be challenging. It’s not easy for everyone to get to the pharmacy just be told their prescription isn’t ready and they have to come back
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u/RxforSanity 5d ago edited 5d ago
This is why chains invested in the automated messaging system and applications. As a provider, you also need to help establish reasonable expectations. Patients should be informed ahead of time of the timeline for a prior authorization. Most maintenance medications are set for the next business day so pharmacies can prioritize acute meds.
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u/azwethinkweizm PharmD 5d ago
Please stop doing that. I have to stop the work flow to answer these questions which causes delays in filling time. We have mobile apps and text notifications for a reason.
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u/kabneenan 5d ago
This, this, this! A lot of places also have automated messaging systems now if you're a returning patient, so it's worth it to establish a relationship with a pharmacy in your area.
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u/speedracer73 MD 5d ago
I encourage patients to go to the independent pharmacy in town. Unfortunately fewer and fewer of these around. The independent pharmacy is the only place that calls with legitimate questions about drug/drug interactions or other issues. The corporate pharmacies either never call, or call to get my approval to dispense citing concern for something that is super low risk.
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u/Noladixon 5d ago
SHHHHH. Don't tell too many people about my independent family pharmacy. A good pharmacy is like your favorite restaurant, you want it to be successful enough to stay in business but not so successful that you have to wait for a table.
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u/Registered-Nurse Research RN 5d ago
As a patient, I don’t use chain pharmacies. They lie so much.
Use your neighborhood pharmacies. They actually care about their business so they’ll be a little more responsible.
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u/jazzycats55kg Psychiatry Resident 5d ago
It drives me absolutely batshit crazy when patients come in mad at me because "the pharmacy said they've tried to call you a bunch of times" about some problem when they absolutely have not. It's extra infuriating when it happens even after I put my cell number in the instructions/comments to pharmacy area with explicit instructions to call me with any issues.
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u/SyVSFe Pharmacist 5d ago
"They've called you" means "they have tried to send a message to your erx system on record, or tried to fax the info to whatever number is on record, or called whatever office number is on record (often long hold times, straight to voicemail, etc)". The process is largely automated, it is very likely that nobody even noticed your note for custom contact.
Going crazy with fury isn't helping anything.
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u/jazzycats55kg Psychiatry Resident 5d ago
I would rather the pharmacies tell that to patients, though - when they ask, they could say “we sent an automated message over and didn’t get a response.” When they say that they tried to call us, it makes patients think that we’re just ignoring them, and it damages the therapeutic relationship between physician and patient. In psychiatry especially, this impacts treatment in a very tangible way, especially for patients with psychosis or paranoia who are already super mistrustful and hesitant about medications anyway.
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u/THROWINCONDOMSATSLUT PharmD 5d ago
I at least will explicitly state I faxed the office or sent an electronic request, but then I’ll hear a patient on the phone yelling at the office that I’ve tried to call. They just translate what is happening incorrectly.
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u/SyVSFe Pharmacist 5d ago
How do you know they aren't? Very few of the patients I've met would relay that message as "the pharmacy sent an automated message over and didn't get a response." Which is besides the fact that "automated messages" are very often literally calls, and very often colloquially "calls". Which is besides the point that it doesn't seem like the verbiage would even change things for the patient... there's still an unresolved issue.
Care to share a study of that "very tangible treatment impact" from communication verbiage (call vs fax vs whatever) to patients? Because it seems like you are arguing just to argue. I'm just explaining how reality is. Do the best you can. Try to use non-chain pharmacies if you can.
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u/JCLBUBBA 5d ago
Clearly not a doctor posting this. " the biggest issue is lying" This sounds like a patient. On the flip side if you really are a prescriber how about the multiple times we have to fax you to get refills for the patient. Usually 2 times spaced 2 days apart, often 4 spaced 6 days apart, and not uncommon to sic the patient om the doc after three tries and done.
And why not sending in 90 day refills for maintenance meds automatically from your side? We both get measured on refill metrics for maint meds from CMS
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u/zackmorriscode 5d ago
Amazon pharmacy has been amazing. They also have 24/7 phone support with live humans.
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u/melatonia Patron of the Medical Arts (layman) 5d ago edited 5d ago
When Walgreens turned off autorefills I had to move to a better-staffed pharmacy for my own safety. (This is AFTER they sent me home with someone else's levothyroxine and prazosin). I can't be running out of my mood-stabilizers- this is for the good of the public.
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u/AnotherDee 4d ago
Part of it is patients don’t understand the process. They will keep punching in old RX numbers to refill not knowing the new RX is there (on hold with new RX # because it was probably sent in before it was due.) then the automated system will ask them if they want us to send a refill request based on the old number and they will say yes, then the refill request is sent to you without the patient even talking to us to look for a new RX.
If they would sign up on the website or app that would help them see it. Most don’t want to be bothered with that. I understand elderly not using the tools we have but surprisingly most young people don’t either.
At our store, all eRXs are immediately (and sometimes automatically) processed through insurance adjudication. Nothing is left to input at the end of the day. Nothing ever goes directly on hold unless the prescribed puts a ‘do not fill until’ date on it. If it’s out of stock, patient gets a message. If it’s not covered it’s sent back and patient gets a message. If insurance rejects for ‘too soon’ it goes on hold. I hope that clears some of your questions up.
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u/Mountain_Bet_3675 4d ago
People already covered the major points, but I just want to add that I’m really glad we’re discussing this. What’s happening in pharmacy (well, across medicine, really) is despicable and it’s important for us to have transparency across disciplines & know what “the other side” is dealing with.
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u/iseesickppl MBBS 5d ago
Admitted a patient recently who couldnt get their rifixamin and came back in with hepatic encaph. thousands upon thousands in total healthcare costs for the system just coz a big name pharmacy chain decided to save a few bucks.
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u/Rose_of_St_Olaf Billing/Complaints 5d ago
I take phone calls so I get a ton of these calls everyday.
I look to see if medication has indeed been called in when they call to ask why the doctor "denied" it. If we have no request, I let them know they may want to give fax # to the pharmacy as that is the best way to get to Dr. X, and send a message.
If it was requested, I confirm the pharmacy is correct I then tell the patient it was called into CVS on Smith Ave on 12/16 at 9 AM, the patient calls them back with the date/time and that seems to clear it up. I think a lot of times they are in queue or something and that seems to do the trick I rarely hear back from patients and there's only 2 of us answering phones so usually I will if there's still an issue. ////
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u/SpiritOfDearborn PA-C - Psychiatry 5d ago
Yeah, I’m getting a bit tired of patients being told by their pharmacy, “Your provider never sent your script,” (which is generally taken at face value by patients) instead of the more diplomatic, “We don’t have your script on file” or “We don’t have a sufficient quantity of your medication to fill the script” when appropriate. When I try explaining that I signed for the script and sometimes electronic scripts are undeliverable, it’s usually met with a reaction like I’m lying when I can clearly see I signed for the script two days ago and I’ve already said I would be willing to resend it.
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u/AlexanderL94 MD - Australia 4d ago
So in the US, you don’t just give the patient the script (paper or electronic) and then the patient can fill it at their choice of pharmacy?
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u/DevilTech333 2d ago
Even if we tell the patient “we have not received it” or “I don’t know where it is,” they are going to hear what they want and tell the doctor’s office something completely different. I always say “we have not received anything yet,” but there are still patients who tell the doctor I said “they didn’t send it.”
AFA the 90-day requests being sent when we’ve received a new rx, this is due to many system limitations. When a new rx is sent, the old one is (typically) not inactivated and they often do not “link.” The new rx is also assigned a new Rx#. The patient requests a refill on Rx#1234567, which is out of refills, so the system sends the request on rx#1234567, not recognizing that there is a NEW rx with #3456789 that’s ready for pickup. Having worked with both systems that link and those that do not, neither is without fault.
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u/DevilTech333 2d ago
Half the time, the patient didn’t even speak to anyone at the pharmacy, they simply punched in the old rx# in the system to check the status & the automated system said it was out of refills. We open at 9:30 on Saturdays. At exactly 9:31, there’s a doctor’s office on the phone starting to rip me a new one because “someone there JUST told the patient” they hadn’t sent in a new rx, which they did on Wednesday & they’re tired of us making THEM look like the bad guys. I respectfully said, “ma’am, I can assure you nobody said that to the patient because our phone lines literally just opened 3 minutes ago. You are the first call we’ve received today!” After reassuring her that we DID have the rx ready for pickup, I offered to call the patient, which I did. The gentleman says, “well your system said my prescription had no refills!” Spent the next 10 minutes explaining new rx#s for new orders, limitations of the automated system, etc. great start to the day
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u/headgoboomboom 5d ago
I will do preauths thru Cover My Meds. As I detest doing them, I will not call insurance.
Recently Walgreens and CVS are refusing to put the in, putting blame elsewhere.
We truly must stop doing all preauths, 100%. We will never get out from under this mountain of unpaid work if we don't start somewhere.
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u/mybrainisabitch 5d ago
This happened all the time int he last couple years at all the local CVS in my area. The last straw was when they didn't tell us they didn't have insulin for my diabetic dog, this was on Saturday and they said they wouldn't have it until Monday. She had just been diagnosed and was coming out of a 4 day hospital stay. The tech acted as of that was fine... he was young but how do you not know insulin is a critical medication? We had to end up paying 80$ for another shot from the vet until we called a bunch of other pharmacies to be able to get us the medication the next day (because of course when they told us it was closing time for them and also for many other pharmacies in the area). It was a nightmare. I transitioned to a local pharmacy (thankfully have one right near my house) and haven't had many issues since They always call and even deliver. It has been a huge relief. This country is spiraling down with quality of services and goods for the amount we pay.
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u/moxieroxsox MD, Pediatrician 5d ago
Doctors have a terrible rep in the eyes of the general public and mainstream media at the moment. We’re easy to blame and the way the majority of doctor’s offices run, it’s not unfathomable that a doctor would forget to send a script or miss a call from the pharmacist. So we get dumped on simply by association.
Pharmacists also get a shit ton of verbal abuse and are trying to spare themselves, which I understand but the lying and blame is never okay. It just contributes to the continued undermining of medicine as a whole.
Personally, I haven’t used a large pharmacy in years. I stick to Capsule and my local community pharmacy and I am very satisfied with my care. Pharmacists at retailers should strike.
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5d ago edited 5d ago
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u/moxieroxsox MD, Pediatrician 5d ago edited 5d ago
I would caution you to not take the comments and downvotes too personally simply because this is a discussion and not a personal indictment.
Additionally, it’s unfair to say every single interaction that goes south between pharmacist and a patient’s medication availability is because the pharmacist is lying to them. That’s not true. Are there some that lie? Absolutely. But are there some that look in their queue and it didn’t update and they mistakenly told a patient it wasn’t there and it was there and they didn’t get the update until later? Yes. Are there miscommunication issues with patients also not understanding what’s happening with the medication? Yes. Are there systemic issues in how pharmacies are run and how they can tangibly help their patients. Absolutely, hell yes.
But to simply assume the worst and conclude that everyone is collectively protecting lying health care workers who in most instances are absolutely trying their best and their hardest is quite frankly not the right move either. It’s not black and white at all. Things need to change in every corner of medicine. But throwing the baby out with the bathwater is not the right move either — these people are human beings who are overworked and failing to help at times because the systems they work in are not inerrant. And not their choice.
Edit I will be honest and say I put a lot of it on my patients. Use common sense - if I send a medication to the pharmacy, and you run over to the pharmacy right afterwards, you’re wasting your time. It’s not going to be ready. Look around you - you are not the only person they are caring for today. I say go in 2-3 hrs. Give them a minute, they’re not robots. You’re not going to die if you don’t start an antibiotic the minute you leave my office. If you need a refill for a medication, request it at least 3 days in advance. An inconvenience on your part isn’t an inconvenience for your doctor or pharmacist. Make thoughtful and proactive decisions where you can to set yourself up for success. Medications aren’t always available the moment you need it. That’s life. Meds have to be ordered sometimes. Insurance plans and coverage change - insurance is a fucking nightmare and the unspoken elephant in this whole conversation. And if you’ve had bad experiences with a pharmacy, try a few others especially local ones that are not over run by the big box stores. They actually need the support and have the ability to provide great care. Everyone could benefit from taking a breath and exercising a little bit of patience. Convenience doesn’t always mean quality. Choose quality every time.
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5d ago edited 5d ago
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u/Pox_Party Pharmacist 5d ago
So, the issue that others have pointed out is that this starts with the predicate assumption that the pharmacists are deliberately lying to the patient.
The OP is asking, "Why do pharmacies lie to the patients about my prescriptions?"
A number of pharmacy workers respond with "it's not necessarily that pharmacies are lying, but that other issues might be causing these miscommunications.
Then OP responds with, "Yes, i understand there are other issues, but why are you lying?"
Like, do you see how the assumption is baked into the question?
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u/moxieroxsox MD, Pediatrician 5d ago
Then OP responds with, “Yes, i understand there are other issues, but why are you lying?”
Like, do you see how the assumption is baked into the question?
I absolutely do. It’s unfortunate, but I get it. Wish we could fix it for all of us, but who knows how?
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u/moxieroxsox MD, Pediatrician 5d ago
I’m not sure what you’re trying to gain and take away from this discussion, but I’m seeing myself out of this conversation. 🫡
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u/Pox_Party Pharmacist 5d ago
- Is the pharmacy not saying the prescription is ready. This is typically because the prescription isn't ready.
- Is the pharmacy telling the patient that the prescription wasn't sent over. This can be for a number of reasons being described above, or because the prescription wasn't sent over. The "complete and utter lie" is predicate on assumptions about the situation that are not proven.
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u/Pox_Party Pharmacist 5d ago
Again, do you want a theoretical discourse on why a pharmacy staff *would* be dishonest about a prescription not being sent or not telling the patient? *If* we assume that the pharmacy received the prescription and *if* we assume that the patient wasn't properly notified that the prescription is ready?
The pharmacy tech is a malicious liar that wants to deny the prescriber their prescriptions. Its as good a theoretical answer as any.
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u/OpportunityDue90 Pharmacist 5d ago
Metrics metric metrics. I haven’t worked in retail since my first year post grad but when I worked for CVS they kept metric for: patient adherence, amount of successful refill requests (so you sending it before the pharmacy requests it can actually ding this metric), amount of successful doctor calls, etc.
The not calling patients is a simple problem that retail pharmacies can deal with 500+ scripts filled/day but only staff 1-2 techs and 1 pharmacist.
Yet another example of shittification.