What takes pharmacists so long?
March 29, 2008 2:26 PM Subscribe
Why does it take 20 minutes for the pharmacy to fill my prescription, even when there's no other people in line? I assume they're doing something, but what else is there besides putting my pills in a bottle?
They're submitting your claim to the insurance company and waiting for an approval or denial to come back. Assuming you have health insurance
posted by junkbox at 2:32 PM on March 29, 2008
posted by junkbox at 2:32 PM on March 29, 2008
You're talking about bringing the scrip in and waiting for it to be called? Um, IANAP, but 20 minutes is the standard wait time. I've had them say 20 minutes and do it in 3, or 5 minutes.
I think a few things are in play. If you're bringing in a scrip for a drug which is under the controlled substances act, there are a few more safety checks before they give you the medicine. For example, I think schedule IV drugs require a physical scrip (the doctor cannot call it in and cannot send it to the pharmacist via his scrip-writing program on his computer) with three copies, one of which the doc keeps, and the other two go to the pharmacist.
I'm pretty sure the pharmacist can get in big trouble if they make a mistake with schedule I-IV substances, so I assume there is some double-checking involved.
Also, there may not be anyone in the pharmacy, but other people might have had prescriptions called in for them that are being filled and are prioritized before yours.
Also, they could be trying to run your insurance to make sure that they've got everything straight before they charge you.
Finally, they could just not know where to find the particular medicine that you wanted. My doc prescribed Tamiflu to me a few months ago for the flu and a) the people working at the pharmacy hadn't heard of it (huh? don't people remember the BIRD FLU scare?!) and b) wanted to give me the pills rather than the mist, which it took them 5-10 minutes to locate. Also, I once waited for twenty minutes while the person working looked for nuvoring on the shelves. She told me they didn't carry it, and I suggested she check in their fridge, where, of course, nuvoring is stored.
Other than that, I don't know! Interesting question.
posted by arnicae at 2:36 PM on March 29, 2008
I think a few things are in play. If you're bringing in a scrip for a drug which is under the controlled substances act, there are a few more safety checks before they give you the medicine. For example, I think schedule IV drugs require a physical scrip (the doctor cannot call it in and cannot send it to the pharmacist via his scrip-writing program on his computer) with three copies, one of which the doc keeps, and the other two go to the pharmacist.
I'm pretty sure the pharmacist can get in big trouble if they make a mistake with schedule I-IV substances, so I assume there is some double-checking involved.
Also, there may not be anyone in the pharmacy, but other people might have had prescriptions called in for them that are being filled and are prioritized before yours.
Also, they could be trying to run your insurance to make sure that they've got everything straight before they charge you.
Finally, they could just not know where to find the particular medicine that you wanted. My doc prescribed Tamiflu to me a few months ago for the flu and a) the people working at the pharmacy hadn't heard of it (huh? don't people remember the BIRD FLU scare?!) and b) wanted to give me the pills rather than the mist, which it took them 5-10 minutes to locate. Also, I once waited for twenty minutes while the person working looked for nuvoring on the shelves. She told me they didn't carry it, and I suggested she check in their fridge, where, of course, nuvoring is stored.
Other than that, I don't know! Interesting question.
posted by arnicae at 2:36 PM on March 29, 2008
Best answer: Speaking as the one who counts the pills, I can tell you that we can get things done in under 5 minutes, providing that your insurance isn't giving us a problem, you're the only one waiting, and you're just looking for a refill.
If you're not the only one there or you're bringing us a brand new rx, then we've got to enter your script(s) into the system, find your drug (not really all that difficult, really), count the stuff out, etc. Then it's up to the pharmacist to make sure that us techs put everything together properly, that the doctor didn't make any sort of mistakes (happens more often than you'd expect) and that there isn't going to be any sort of interactions with your other medications or medical conditions. Plus, we've got some doctors that we call and verify scripts on because there's been fakes going around from that particular office.
Oh, and we're gossiping about your medical conditions.
posted by chickygrrl at 2:47 PM on March 29, 2008 [11 favorites]
If you're not the only one there or you're bringing us a brand new rx, then we've got to enter your script(s) into the system, find your drug (not really all that difficult, really), count the stuff out, etc. Then it's up to the pharmacist to make sure that us techs put everything together properly, that the doctor didn't make any sort of mistakes (happens more often than you'd expect) and that there isn't going to be any sort of interactions with your other medications or medical conditions. Plus, we've got some doctors that we call and verify scripts on because there's been fakes going around from that particular office.
Oh, and we're gossiping about your medical conditions.
posted by chickygrrl at 2:47 PM on March 29, 2008 [11 favorites]
Best answer: I work in a pharmacy sometimes. I have an answer.
Pharmacy is generally staffed with one pharmacist and one, maybe two techs. When a new prescription is presented at the window, the following steps get taken.
1. We make sure that the person actually exists in our system.
a. If the person exists, we can continue.
b. If the person doesn't exist, then we have to get their name, address, phone, dob, and any allergies, and insurance information, then enter all of this information in manually.
c. If someone comes up to the window to pickup, we have to drop everything and ring them out.
d. If the phone rings, then we have to drop everything and answer it.
2. The prescription is scanned in at one terminal.
a. Only one of our three terminals has a scanner, so if it's occupied, I have to wait on whatever the other person is doing.
b. The terminal is free or becomes free, then I have to manually enter all the information in.
c. The prescription contains an error such as missing quantity, incorrect strength, it isn't signed, missing directions, or is written by a doctor that doesn't exist in our system. Fixing these requires a call to the prescriber to fix. We can't just fill it anyway.
d. Your insurance rejects it. Insurance cockery and fixing is too long to go into here.
e. If someone comes up to the window to pickup, we have to drop everything and ring them out.
f. If the phone rings, then we have to drop everything and answer it.
3. Once the prescription is entered in, the label and monograph are printed and we pull the drugs from the shelf.
a. The label printer fucks up again.
b. It's printed for a drug that is out of stock or the wrong manufacturer. One of the brilliant things about this is that it arbitrarily picks a manufacturer for a generic instead of going on what you have in inventory, even though it does have an inventory function. This requires starting over to fix.
c. Drug is pulled from the shelf and the label is scanned so that drug and prescription match.
d. The scanner terminal is taken and we have to wait for that to open up.
e. If someone comes up to the window to pickup, we have to drop everything and ring them out.
f. If the phone rings, then we have to drop everything and answer it.
4. We fill it and hand it to the pharmacist to verify.
a. The pharmacist has disappeared somewhere.
b. The pharmacist is on the phone with his wife and or kids for the 100th time today.
c. The pharmacist is too busy bugging out over inventory issues and running reports to verify the script.
d. The pharmacist scans the bottle, and McKesson ERX doesn't check for interactions until the last step instead of the first, so it turns out your Medicine Drug interacts violently with other Medicine Drug and we have to call the prescriber to change it.
f. The pharmacist scans the bottle and gives it back to me and THEN I can ring it out.
posted by pieoverdone at 2:52 PM on March 29, 2008 [47 favorites]
Pharmacy is generally staffed with one pharmacist and one, maybe two techs. When a new prescription is presented at the window, the following steps get taken.
1. We make sure that the person actually exists in our system.
a. If the person exists, we can continue.
b. If the person doesn't exist, then we have to get their name, address, phone, dob, and any allergies, and insurance information, then enter all of this information in manually.
c. If someone comes up to the window to pickup, we have to drop everything and ring them out.
d. If the phone rings, then we have to drop everything and answer it.
2. The prescription is scanned in at one terminal.
a. Only one of our three terminals has a scanner, so if it's occupied, I have to wait on whatever the other person is doing.
b. The terminal is free or becomes free, then I have to manually enter all the information in.
c. The prescription contains an error such as missing quantity, incorrect strength, it isn't signed, missing directions, or is written by a doctor that doesn't exist in our system. Fixing these requires a call to the prescriber to fix. We can't just fill it anyway.
d. Your insurance rejects it. Insurance cockery and fixing is too long to go into here.
e. If someone comes up to the window to pickup, we have to drop everything and ring them out.
f. If the phone rings, then we have to drop everything and answer it.
3. Once the prescription is entered in, the label and monograph are printed and we pull the drugs from the shelf.
a. The label printer fucks up again.
b. It's printed for a drug that is out of stock or the wrong manufacturer. One of the brilliant things about this is that it arbitrarily picks a manufacturer for a generic instead of going on what you have in inventory, even though it does have an inventory function. This requires starting over to fix.
c. Drug is pulled from the shelf and the label is scanned so that drug and prescription match.
d. The scanner terminal is taken and we have to wait for that to open up.
e. If someone comes up to the window to pickup, we have to drop everything and ring them out.
f. If the phone rings, then we have to drop everything and answer it.
4. We fill it and hand it to the pharmacist to verify.
a. The pharmacist has disappeared somewhere.
b. The pharmacist is on the phone with his wife and or kids for the 100th time today.
c. The pharmacist is too busy bugging out over inventory issues and running reports to verify the script.
d. The pharmacist scans the bottle, and McKesson ERX doesn't check for interactions until the last step instead of the first, so it turns out your Medicine Drug interacts violently with other Medicine Drug and we have to call the prescriber to change it.
f. The pharmacist scans the bottle and gives it back to me and THEN I can ring it out.
posted by pieoverdone at 2:52 PM on March 29, 2008 [47 favorites]
What chickygrrl said. At the pharmacy I work at, the workflow is something like this:
- scan script into computer, type it in (30-60 seconds, if the tech is fast, and there aren't any problems like an illegible doctor name, ambiguous directions, insurance problems, etc.)
- wait for pharmacist to validate the data entry (this can be the biggest holdup if the pharmacist is busy or something requires correction)
- physically fill the prescription (usually takes a minute or two, but there are probably other scripts ahead of yours)
- wait for pharmacist to verify that it was filled correctly and bag the prescription (again, depends on how busy the pharmacist is at the moment, and how many scripts are ahead in line)
So, if the tech(s) and pharmacist(s) aren't too busy and have an interest in expediting your prescription, and there aren't any holdups or interruptions, the above only takes a few minutes. The pharmacy business however, like retail, is pretty unpredictable and we could get tied up for awhile on something else, so we like to add a safety margin. (It works similarly in a one-hour photo lab -- it really only takes about 20 minutes to develop and print a roll of film, about 2 minutes of that being actual work, but that assumes nothing goes wrong and there are no interruptions.)
arnicae is wrong about the controlled substances thing. Only Schedule II drugs (the most restricted; Schedule I drugs are illegal for any use) require a written script, and are strictly controlled. III-V are only somewhat more controlled than regular drugs.
And the insurance claim only takes a few seconds to run, actually, if the insurance information is entered correctly (that's a big if sometimes, and knowing how to do this correctly is one of those black magic things that's the difference between an experienced tech and a newbie).
posted by neckro23 at 3:05 PM on March 29, 2008 [1 favorite]
- scan script into computer, type it in (30-60 seconds, if the tech is fast, and there aren't any problems like an illegible doctor name, ambiguous directions, insurance problems, etc.)
- wait for pharmacist to validate the data entry (this can be the biggest holdup if the pharmacist is busy or something requires correction)
- physically fill the prescription (usually takes a minute or two, but there are probably other scripts ahead of yours)
- wait for pharmacist to verify that it was filled correctly and bag the prescription (again, depends on how busy the pharmacist is at the moment, and how many scripts are ahead in line)
So, if the tech(s) and pharmacist(s) aren't too busy and have an interest in expediting your prescription, and there aren't any holdups or interruptions, the above only takes a few minutes. The pharmacy business however, like retail, is pretty unpredictable and we could get tied up for awhile on something else, so we like to add a safety margin. (It works similarly in a one-hour photo lab -- it really only takes about 20 minutes to develop and print a roll of film, about 2 minutes of that being actual work, but that assumes nothing goes wrong and there are no interruptions.)
arnicae is wrong about the controlled substances thing. Only Schedule II drugs (the most restricted; Schedule I drugs are illegal for any use) require a written script, and are strictly controlled. III-V are only somewhat more controlled than regular drugs.
And the insurance claim only takes a few seconds to run, actually, if the insurance information is entered correctly (that's a big if sometimes, and knowing how to do this correctly is one of those black magic things that's the difference between an experienced tech and a newbie).
posted by neckro23 at 3:05 PM on March 29, 2008 [1 favorite]
on post, looks like pieoverdone beat me to it with a more complete answer.
posted by neckro23 at 3:05 PM on March 29, 2008
posted by neckro23 at 3:05 PM on March 29, 2008
Oh, one other thing, if it's written for any Class II Narcotic, such as percocet, methylphenidate, etc - these are kept in a locked cabinet that only the pharmacist has access too and techs are by law not allowed to count them. I believe the pharmacist is also required to double count them.
posted by pieoverdone at 3:10 PM on March 29, 2008
posted by pieoverdone at 3:10 PM on March 29, 2008
This is something I've always wondered, I have the same problem in the UK - there's no insurance issue and my pills come preboxed and in foil-fresh blister-packs. Its not like some guy has to count them out into a bottle. As far as I can tell, all he does is print a sticker out to put on the box.
posted by missmagenta at 3:35 PM on March 29, 2008
posted by missmagenta at 3:35 PM on March 29, 2008
You already have your answers from people in the business, but as a regular Joe I can tell you that I've never been to my pharmacy when the pharmacists were sitting around doing nothing. Even when nobody else is actually in line, they always have someone else's scripts on deck, always have phone calls to make, always have things to be done that were put in the queue before I showed up.
It's just like when I'm at work: sure, I can get this done for you in not-much-time, but I also have several other jobs to do, too, so you're going to have to wait. (And if it is a rare time when I have nothing else to do, it's not in anybody's best interest for me to get the new job done in no-time-flat because that just conditions everyone to think that they can always get it done that fast. Future tension ensues.)
posted by iguanapolitico at 3:54 PM on March 29, 2008 [1 favorite]
It's just like when I'm at work: sure, I can get this done for you in not-much-time, but I also have several other jobs to do, too, so you're going to have to wait. (And if it is a rare time when I have nothing else to do, it's not in anybody's best interest for me to get the new job done in no-time-flat because that just conditions everyone to think that they can always get it done that fast. Future tension ensues.)
posted by iguanapolitico at 3:54 PM on March 29, 2008 [1 favorite]
The REAL question is....why do the pharmacists need to be a foot higher than everyone else? Why isn't that blocked off area the same level as the rest of the pharmacy?
posted by Flying Squirrel at 6:09 PM on March 29, 2008 [3 favorites]
posted by Flying Squirrel at 6:09 PM on March 29, 2008 [3 favorites]
All the above and...because I'm a marketer, I have a strong suspicion that telling you to wander around for 10 or 20 minutes results in many impluse buys. Instead of standing around for 3 minutes, you wander around, pick up some milk, a magazine, razors, shampoo, chocolate, etc.
posted by acoutu at 9:37 PM on March 29, 2008
posted by acoutu at 9:37 PM on March 29, 2008
The REAL question is....why do the pharmacists need to be a foot higher than everyone else? Why isn't that blocked off area the same level as the rest of the pharmacy?
It's a holdover from the days when the pharmacist was also the owner of the store, and the only employee on duty. When he was in the back filling prescriptions, it was too easy for someone to help themselves to items and leave without paying. Standing on a raised platform allowed him to keep an eye on the rest of the store.
posted by Oriole Adams at 10:06 PM on March 29, 2008 [4 favorites]
It's a holdover from the days when the pharmacist was also the owner of the store, and the only employee on duty. When he was in the back filling prescriptions, it was too easy for someone to help themselves to items and leave without paying. Standing on a raised platform allowed him to keep an eye on the rest of the store.
posted by Oriole Adams at 10:06 PM on March 29, 2008 [4 favorites]
Pieoverdone's answer is entirely correct, and deserves all of the acquired "favorites" the answer has acquired.
I was a pharmacist from 1987 to 2002, with several years of hiatus in the early 1990's.
I believe the question was posted in good faith, but the undercurrent still stings. I remember a comment years ago from a store manager (not one of the pharmacy staff) to me to the effect of "gee, I wish I could stand around all day like you people in the pharmacy". It's a little bit like the other question that pharmacists get; "do you people have to go to college?"
But enough editorializing. Please consider the following analogy. If you watch two people playing chess, it doesn't look like much is going on. If you don't know the game of chess, it looks like they are "just sitting around".
Like chess, the practice of pharmacy is a great deal mental. Instead of game strategy as in chess, the pharmacist, and pharmacy staff, are engaging in a continuous, highly focused supervisory process.
This is not a bullshit, corporate, self-congratulatory, boast. The pharmacist and pharmacy staff are engaging in a continuous, highly focused supervisory process because if you don't YOU COULD KILL SOMEONE.
In chess, a mental lapse may cause you to lose the game. In pharmacy, a mental lapse could kill someone.
On a positive note, I see on preview that why are pharmacy counters so high... was correctly answered...
posted by Tube at 12:15 AM on March 30, 2008 [4 favorites]
I was a pharmacist from 1987 to 2002, with several years of hiatus in the early 1990's.
I believe the question was posted in good faith, but the undercurrent still stings. I remember a comment years ago from a store manager (not one of the pharmacy staff) to me to the effect of "gee, I wish I could stand around all day like you people in the pharmacy". It's a little bit like the other question that pharmacists get; "do you people have to go to college?"
But enough editorializing. Please consider the following analogy. If you watch two people playing chess, it doesn't look like much is going on. If you don't know the game of chess, it looks like they are "just sitting around".
Like chess, the practice of pharmacy is a great deal mental. Instead of game strategy as in chess, the pharmacist, and pharmacy staff, are engaging in a continuous, highly focused supervisory process.
This is not a bullshit, corporate, self-congratulatory, boast. The pharmacist and pharmacy staff are engaging in a continuous, highly focused supervisory process because if you don't YOU COULD KILL SOMEONE.
In chess, a mental lapse may cause you to lose the game. In pharmacy, a mental lapse could kill someone.
On a positive note, I see on preview that why are pharmacy counters so high... was correctly answered...
posted by Tube at 12:15 AM on March 30, 2008 [4 favorites]
The REAL question is....why do the pharmacists need to be a foot higher than everyone else? Why isn't that blocked off area the same level as the rest of the pharmacy?
posted by Flying Squirrel
I used to be a tech, and I always thought it was for a few reasons:
1. So that customers or thieves can't easily reach over the counter and grab stuff.
2. So that customers can't easily see what's really going on up there.
3. So that the pharmacy staff can see customers coming and going and be aware.
4. So that people wandering around shopping won't accidentally wander behind the counter thinking it is a part of the sales floor.
And probably a couple other reasons, too, involving psychological advantage when speaking to the patient. Although most pharmacists I worked with liked to come down to the patient's eye level when speaking privately with them.
posted by vewystwange at 7:19 AM on March 30, 2008
posted by Flying Squirrel
I used to be a tech, and I always thought it was for a few reasons:
1. So that customers or thieves can't easily reach over the counter and grab stuff.
2. So that customers can't easily see what's really going on up there.
3. So that the pharmacy staff can see customers coming and going and be aware.
4. So that people wandering around shopping won't accidentally wander behind the counter thinking it is a part of the sales floor.
And probably a couple other reasons, too, involving psychological advantage when speaking to the patient. Although most pharmacists I worked with liked to come down to the patient's eye level when speaking privately with them.
posted by vewystwange at 7:19 AM on March 30, 2008
Pharmacies don't make money for stores. After it's been done, pharmacies basically make only a couple of bucks from the transaction. They're basically a loss-leader service to draw you in every month and browse and hopefully purchase some goods to make up for it.
It's in the store's best interest to keep their RPhs and techs busy and occupied because waiting time = browsing time, and their workers are getting paid for the time they're there, not the number of fills they get done. Otherwise, they could just buy another scanner or some simple efficiency step, and ease these folks' lives.
posted by jsmith77 at 10:39 AM on March 30, 2008 [1 favorite]
It's in the store's best interest to keep their RPhs and techs busy and occupied because waiting time = browsing time, and their workers are getting paid for the time they're there, not the number of fills they get done. Otherwise, they could just buy another scanner or some simple efficiency step, and ease these folks' lives.
posted by jsmith77 at 10:39 AM on March 30, 2008 [1 favorite]
Then why does it take them a matter of minutes to fill two prescriptions at my local mom and pop? The price is the same.
There is some benefit in having a "pipeline" process to these sorts of things, and that is keeping the wait time the same for everyone. It allows time for the above mentioned bits of recordkeeping and whatnot to get done at their own pace and the end "product" gets completed at the same time, every time.
And very often people working in these types of professions like to build a bit of a backlog as a barrier to push against and as a buffer to the maddening highs and lows of "busy" and "slow". Same thing happens in government offices- how in the world can the line ALWAYS be 20 people long? Clearly, they can handle the traffic flow, or the line would keep getting longer. It's just that it's easier to mentally deal with a line that goes from 17 people to 22 people multiple times a day than a line that goes from 0 to 5.
In the pharmacy example, it's probably easier from a self- and department-management standpoint to not move the "while-u-wait" people to the head of the line. Might be better from a customer service perspective, but it's more stressful and more likely to cause error.
posted by gjc at 7:37 PM on March 30, 2008
There is some benefit in having a "pipeline" process to these sorts of things, and that is keeping the wait time the same for everyone. It allows time for the above mentioned bits of recordkeeping and whatnot to get done at their own pace and the end "product" gets completed at the same time, every time.
And very often people working in these types of professions like to build a bit of a backlog as a barrier to push against and as a buffer to the maddening highs and lows of "busy" and "slow". Same thing happens in government offices- how in the world can the line ALWAYS be 20 people long? Clearly, they can handle the traffic flow, or the line would keep getting longer. It's just that it's easier to mentally deal with a line that goes from 17 people to 22 people multiple times a day than a line that goes from 0 to 5.
In the pharmacy example, it's probably easier from a self- and department-management standpoint to not move the "while-u-wait" people to the head of the line. Might be better from a customer service perspective, but it's more stressful and more likely to cause error.
posted by gjc at 7:37 PM on March 30, 2008
Then why does it take them a matter of minutes to fill two prescriptions at my local mom and pop?
And very often people working in these types of professions like to build a bit of a backlog as a barrier to push against and as a buffer to the maddening highs and lows of "busy" and "slow".
The second biggest holdup to getting anything done is the pharmacist.
This is retail, the biggest holdup to getting anything done are the customers. You know how long it took you to read my massive answer up there? Multiply that by several people dropping off written prescriptions.
If someone comes up to the window and needs a pickup, I cannot tell them to wait on me to finish something. I have to ring them out. A lot of our clientele is old people. Not newly retired old people, but one foot in the grave old people. They argue, they ask 100 questions, they whine about Medicare Part D, they forgot to have something filled, they don't understand they need a prior auth, they don't understand that when they're out of refills, I can't just fill it anway, they write effing checks to pay for things, etc. Now multiply that by the 10 other centenarians in line behind them and it's like that scene from Shaun of the Dead where the zombies are trying to bust into the windows at the pub.
You can drop off a written prescription and want to pick it up in 20 minutes, but if I have 20 minutes of customers to ring out, I'm stuck doing that.
We never sit on prescriptions just so we have something to do when it's slow. We don't send you out in the store for 20 minutes to make impulse purchases. We really do try to get your water pills and your beetus pills and your boner pills packaged up asap and get you out of there.
posted by pieoverdone at 10:39 AM on March 31, 2008 [4 favorites]
And very often people working in these types of professions like to build a bit of a backlog as a barrier to push against and as a buffer to the maddening highs and lows of "busy" and "slow".
The second biggest holdup to getting anything done is the pharmacist.
This is retail, the biggest holdup to getting anything done are the customers. You know how long it took you to read my massive answer up there? Multiply that by several people dropping off written prescriptions.
If someone comes up to the window and needs a pickup, I cannot tell them to wait on me to finish something. I have to ring them out. A lot of our clientele is old people. Not newly retired old people, but one foot in the grave old people. They argue, they ask 100 questions, they whine about Medicare Part D, they forgot to have something filled, they don't understand they need a prior auth, they don't understand that when they're out of refills, I can't just fill it anway, they write effing checks to pay for things, etc. Now multiply that by the 10 other centenarians in line behind them and it's like that scene from Shaun of the Dead where the zombies are trying to bust into the windows at the pub.
You can drop off a written prescription and want to pick it up in 20 minutes, but if I have 20 minutes of customers to ring out, I'm stuck doing that.
We never sit on prescriptions just so we have something to do when it's slow. We don't send you out in the store for 20 minutes to make impulse purchases. We really do try to get your water pills and your beetus pills and your boner pills packaged up asap and get you out of there.
posted by pieoverdone at 10:39 AM on March 31, 2008 [4 favorites]
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posted by autojack at 2:28 PM on March 29, 2008