Why does the pharmacist take so god damn long?
November 25, 2011 4:19 PM   Subscribe

Why does the pharmacist take so god damn long?

(Honest question, I'm not being snarky, or at least that snarky)

I genuinely want to know why dispensing prescriptions at every single pharmacy I've ever been takes so bloody long. Even for a very simple, pre-portioned prescription, it seems to take an indorinate amount of time relative to what is actually dispensed.

E.g. every time my wife goes to get a birth control refill, it takes forever. All they need to do is take three smaller boxes from a bigger box. That's it! But even if it's like 8 PM on a Tuesday night and the store is quiet a tomb, it still takes 15-20 minutes. The other day she tried to pick up an Rx and they said it would be between 45 minutes and an hour. Sure, there were a few people around, but it's not like there was a dozens-deep wall of people waiting around the pharmacy counter.

Are there controlled substance checks that need to be performed? Ensure there are no dangerous interactions? Some other kind of pharmaceutical sorcery?

I'm in Canada if it matters, but this is definitely something I've seen when I lived in the US too.
posted by Nelsormensch to Health & Fitness (21 answers total) 7 users marked this as a favorite
My guess is so it gives you time to shop in the store...that's always been my impatient and cynical take on it.
posted by murrey at 4:27 PM on November 25, 2011 [2 favorites]

Best answer: Previously.
posted by mullacc at 4:32 PM on November 25, 2011 [6 favorites]

My guess from the pharmacy related people I know (a pharmacist and a pharmacy auditor) is that there is a lot of paperwork involved in filling even benign seeming prescriptions, and also that even though the pharmacy techs do a lot of the work back there, the pharmacists themselves are doing a lot more work, and different kinds of work.

The pharmacist is the one whose license is at stake, so they have an interest in things being accurate over fast. (each degree of speed probably adds the risk of an uptick in errors, which you would not want!)

the pharmacy auditor is always appalled at the kinds of errors that get made anyway.
posted by bilabial at 4:32 PM on November 25, 2011 [2 favorites]

They probably have to follow very strict instructions, regardless of the complexity of the prescription. If they mess the tiniest thing up, they could be in huge trouble.
posted by jozxyqk at 4:32 PM on November 25, 2011

Interesting, there was just a sign up at my local pharmacy explaining some of this. It turns out that who's in line is not the whole picture-- they're often filling prescriptions called in by doctors/hospitals that have more urgency. In fact, the whole process is like triage-- and your prescriptions might not be the most urgent in their queue, and you can't see that whole queue because not everyone's on the premises.

This is why I always call in refills. Everything's ready to pick up right away!
posted by mireille at 4:37 PM on November 25, 2011 [5 favorites]

In the U.S., my pharmacy takes 5-10 minutes to fill in person. If there's a paperwork issue, that takes longer. But, you know, call ahead.
posted by Eyebrows McGee at 4:59 PM on November 25, 2011

My prescriptions in Australia only take 5 minutes to fill. Maybe try another pharmacy?
posted by dave99 at 5:06 PM on November 25, 2011

Mostly insurance billing issues. Quantity restrictions, refill too soon, formulary status change and the ever-loving "needs a prior auth now" requires the staff to contact the PBM to figure this out.

The software is designed to cross check drug-to-drug interactions; if there is one then that will take time. This is designed to not kill you.

Verifying prescriptions takes time also; and of course making sure the meds are in stock.

Pharmacies will receive faxed and called in prescriptions all day long.
posted by Bun Surnt at 5:15 PM on November 25, 2011 [2 favorites]

** go to the same pharmacy, be kind and respectful and it'll get faster.
posted by Bun Surnt at 5:16 PM on November 25, 2011 [1 favorite]

My pharmacy is pretty quick; on the order of 5-10 minutes most times; I switched from another (they are both big chains) because they were as slow as you describe. It can help a lot if you use all the things like online refills but even with a new prescription they are reasonably quick.
posted by TedW at 5:50 PM on November 25, 2011

Somewhere I explained what I had to do to make salt water of pharmaceutical release testing back in the day. It was a significant effort for something that was unlikely to be value added 99.9 times out of 100. But somewhere on high, someone decided if it made sense to record all kinds of data for a lot of custom biological reagent that might go bad if you looked at it funny, the by God, it made sense to do it for salt.* My guess is that this is the intersection of that and typical retail crap.

*Just to be clear, this is not salt water that was to be used in a drug where contamination could be a serious issue. This was just a wash buffer for an ELISA plate. But put quality in some manager type's job title and it's amazing what minutia they would be fascinated by and what issues become totally irrelevant to them.
posted by Kid Charlemagne at 5:56 PM on November 25, 2011

I worked as a pharmacy tech, and we definitely triaged the prescription filling.

"All they need to do is take three smaller boxes from a bigger box"

Not really. Some steps may be missing from my list, because this was a while ago:

1. Enter prescription into computer. If some kind of issue comes up, deal with that. Could be insurance, could be note about prior interaction with customer (i.e. fake scripts), could be anything. This slows down other prescription filling.

2. Print off prescription sheet and stickers. Put in queue.

3. Tech grabs prescription and fills it - IF it's not a controlled drug. If it is, go bug pharmacist until they have time to fill it. Trust me, if it's one where they only have to put in a couple of bc boxes, the techs love those. Often, they have to fill others first - yep, triage.

4. Get pharmacist to initial that prescription is correct.

5. You get your prescription.

There's a lot of little delays in the process - you get stuck on the phone with an insurance company, or talking to a customer about a new card, or someone called something in 5 minutes before they got there and can't understand why it isn't ready, etc.... That's why they always, always, ALWAYS say 15-20 minutes minimum.
posted by HopperFan at 5:59 PM on November 25, 2011 [2 favorites]

Response by poster: Thanks mullacc, I tried searching but I guess I couldn't find the right constellation of terms (or it was pages and pages back in the results).

FWIW, even when my wife is just refilling her BC Rx, it still takes a long time. But I guess it's the triage plus everything else. Thanks!
posted by Nelsormensch at 6:17 PM on November 25, 2011

I see two weaknesses in the "hoping you'll buy stuff" theory (which would otherwise be pretty attractive). One is that they always have chairs to sit in. Sure, maybe you'll have to give your chair to someone elderly or who's not able to stand around for twenty minutes, but, if it's not busy, there's no reason not to just sit there. The other is that the pharmacy I go to is a pharmacy and only a pharmacy. They've maybe got a couple of boxes on bandaids and some cough syrup, but there's no opportunity for impulse buys. It still takes them twenty minutes. I kind of doubt they've formed a conspiracy with the grocery store across the street that everyone wanders over to (you can only read the local gay mag so many times while waiting before you go insane).
posted by hoyland at 6:40 PM on November 25, 2011

I am a pharmacist. What most people don't realize is that a pharmacist may do in excess of 300 prescriptions in a single day. In many cases, the day begins at 8 AM and ends at 9 PM.

That's 13 hours to do 300 things--perfectly. 13 hours/300 prescriptions = 2.6 minutes per prescription. That's not a lot of time to make sure each prescription is perfect. In addition to that, we have other responsibilities including:

1) Calling insurance companies
2) Calling doctor's offices
3) Getting calls from doctor's offices to receive oral orders for preparing new prescriptions
4) Compounding (more limited, these days but there are still a few orders per day)
5) Insurance overrides when people go on vacation
6) Ordering medication
7) Helping customers find over-the-counter products
8) Explaining important directions for taking certain medications

All of those tasks take very little time, but when they happen they need to be done immediately. Meanwhile, the prescription queue continues to grow. Remember, each prescription only gets a couple of minutes of a pharmacist's attention.

Certain medicines can be very harmful to people if there are even very small errors in the way the directions are written.

In spite of all of those things, I remain very sensitive to the amount of time it takes to prepare a prescription--so much so, that it racks me with guilt. I don't want pharmacists to be percieved as middlemen who are taking money from innocent people who need medicine. I want them to be perceived as people who are truly a part of the health care system and who truly do good things for people.

Running a pharmacy is a very difficult job, even though it may seem easy. I had to leave the field because the stress was too much for me.
posted by candasartan at 8:05 PM on November 25, 2011 [19 favorites]

Most pharmacists seem to be pretty phlegmatic sorts, but to add to what candasartan said: one of the pharmacists at my local Shoppers' fills prescriptions about as quickly as any other pharmacist, but she always seems very fast-talking, flustered and anxious.

I dropped off a script the other day, wandered around to get some planned shopping done, and picked it up at the expected time, about 15 minutes later. She had printed out an annual checklist about my active prescriptions, took a couple of minutes to go through it with me even though other customers were there (making notations on the sheet in handwriting almost as bad as mine), and made sure I knew how to take the new prescription she had just filled. So she is obviously very conscientious. and what she did fits in with what others have described as a lot of background responsibility that we customers generally don't see.

But while her intensity and rushing may have made things slightly faster, the way she behaves around me doesn't make me comfortable at all. I really hope someone working with her can convince her to breathe a little bit, slow down a little and project a more confident and competent attitude. Sixty extra seconds per customer interaction would be a good thing.
posted by maudlin at 8:14 PM on November 25, 2011

I work at (undisclosed national pharmacy chain that should not be allowed to track me). I'm in a management position, so I fill in a lot in the pharmacy when we're backed up. So I am not your pharmacist, but I bet I know the situation they're in.

It takes 20 minutes because we're busy and we don't want to kill you. I know it doesn't seem like we're busy because when you look behind the counter you see just three people standing there on the phone and ringing a couple people out. But what you don't see is the 23 voicemails we have on the machine that arrived overnight from people waiting to pick up their prescription when the store opens because they "called in it the night before so it should be ready," or the three faxes we have to get the doctor's office to resend because they're repeatedly sending the wrong prescription to us, or the list of phone calls we have to make to the insurance company because Grandma doesn't understand that she needs prior authorization. Or the patient that is waiting for us to convince the insurance company to authorize a medication for all three of her triplets when they're only going to cover one medication per birthdate, so her co-pay is $300 more than she can really afford. Or the medication that "on second thought Jimmy really doesn't like bubblegum flavoring, do you have anything else?"

Not to mention the face that the medication doesn't really just get shoved in a bag and put on the counter. First we have to check to make sure we have all the medication in stock, and then we have to scan your prescription into the computer. Then we file the prescription and type it into our database so we have an electronic copy. ((This is often the part that takes the longest when we have a back-up- although it only takes 2 minutes to do, when you have people waiting in line you don't have that kind of time to waste)) Then the tech fills it, and counts it out again. Then the pharmacist counts it and double checks it against the drug interactions and the allergies you have on file. Then we have to file it in one of the medication bins for pick-up.

What we have back there is a complicated system of checks and balances that can really easily go out of whack. All it takes is one customer coming in and taking more than the 5 minutes we can allot them and everything gets slowed up. We try our best to get every prescription out as soon as we SAFELY can, which at best is 5 minutes. But if we tell you 5 minutes you're going to stand at the counter staring at the clock, so to buy us the time in case something goes wrong we tell you 15 or 20 minutes.

It doesn't help that across the country pharmacies are cutting the number of hours that pharmacy techs are scheduled, leaving the pharmacist with less and less help and an increasing work load. Half of my day is spent simply ringing people up in the pharmacy because the pharmacist is shorthanded.

Sorry for the textwall, it's just kind of aggravating when people don't understand the extend of the work that we do behind the counter. I mean, I'm sure very few people here understand exactly what medications are covered in which way under their insurance policies- what do you think we have to spend so much time on the phone counseling people about? I bet we spend more time counseling people on insurance than their providers do.
posted by shesaysgo at 8:34 PM on November 25, 2011 [8 favorites]

In addition to everything else, there are the 20 people who came in, one a minute, over the previous 20 minutes, and are now wandering around the store waiting on their prescriptions. The customers ahead of you in the queue are often invisible.
posted by looli at 11:32 PM on November 25, 2011 [1 favorite]

This is a US thing, in my experience.

When I lived in the US it was one of the things that baffled the hell out of me. In the UK I was used to handing in my prescription, waiting maybe two minutes at most and then getting my stuff. The first time I had a prescription in the US I handed it in and waited by the desk, as usual. When the pharmacist looked at me with a "What the hell are you still here for?"look and told to come back in an hour I could hardly believe it. There was no one else waiting and I wanted to say "Why? Can't you do it, you know, now?" I didn't, of course, because I felt very culturally-shifted right then.

I don't really get why this takes so long in the US. Prescriptions come in via computer and so on in the UK now too, but I still get my stuff with only a short on-the-spot wait. The only clue I can offer is based on my experience in a US hospital, which involved so much paperwork and keyboard-tapping I couldn't believe it. I suspect there must be something similar going on in the pharmacies too.
posted by Decani at 2:37 AM on November 26, 2011

Decani: North American drug insurance coverage goes across a lot of private companies, requiring more database digging and phone calls and masses of rules to follow, versus the NHS (I believe) covering all drugs directly. I have heard more people are going to private clinics in the UK, but aren't drugs still covered by the NHS only?

And in US hospitals: yeah, insurance company pixelwork there, too.
posted by maudlin at 7:40 AM on November 26, 2011

I recently had to fill a scrip for pain meds immediately after a bad dental appointment. I could barely talk because my mouth was so swollen. Based on that and what the scrip was for, the tech kindly pushed me to the head of the line and got everything done in about 10 minutes. I'm sure this happens all the time, accounting for at least some of the delay.

Also, having volunteered in a hospital pharmacy, there is a lot of double-redundancy checking and counting to reduce errors-- a good thing.
posted by charmcityblues at 11:15 AM on November 26, 2011

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