I recently saw the new Tom Cruise Mission Impossible movie. It’s called Mission Impossible— Dead Reckoning Part One. It’s a lot of fun.
Throughout the movie, Tom Cruise is chasing after the bad guy. About halfway through the movie, I realized that Tom Cruise would never catch him. That’s because this was only part one. If he catches the bad guy, there won’t be a part two. Part two is supposed to come out in June 2024.
A few months ago, I wrote an article about my girlfriend’s difficulties with a Dexamethasone liquid prescription. In the article, I discussed the problems that my girlfriend and I encountered in obtaining the medication. When I originally wrote the article, I only had enough material for that one article. I never dreamed that I would have more stories for a second article. But I do. So that was part one— this is part two.
Just to refresh, my girlfriend is taking Dexamethasone liquid. She will be on it for a long time. She is taking 5 milliliters (MLS) four times a day. I’ve had problems with how the physician wrote it and the quantity he requested to be dispensed. I’ve had issues with the number of refills that he prescribed.
I’ve had problems with one pharmacy not wanting to obtain the medication. I’ve had another problem with one pharmacy’s misinterpretation of the directions— 5 mls every day (QD) vs. 5 mls four times a day (QID).
I’ve had several refill issues with the pharmacy. I refilled my girlfriend’s Dexamethasone prescription approximately every two weeks and then picked it up at the pharmacy. Originally, I dreaded picking up her prescription— anticipating what would go wrong. Now, I actually look forward to the prescription pick-up day. After all, the more that goes wrong— the more stuff I have to write about.
Requesting A Refill
It was time for my girlfriend to get a refill of her Dexamethasone liquid. She was almost out of it. I called the pharmacy and spoke to one of the staff members. (It was probably a pharmacy tech who answered the phone.) I felt it was better to speak to a person rather than enter the prescription number to request a refill.
“I’d like to refill my girlfriend’s prescription,” I said. I gave the pharmacy tech all the necessary information. “Does she have any refills?”
“Yes,” replied the pharmacy tech. “She has one refill left. We will fill it out shortly. When would you like to pick it up?”
“I will be there after 3 p.m.,” I said.
I arrived after 3 pm. I approached the counter when it was my turn.
“I’m picking up a prescription for my girlfriend, ” I stated. I provided her name and date of birth.
“One moment,” replied the pharmacy tech. She then turned to a rack to retrieve the prescription. She returned with the bag of medication and addressed me.
“The cost is $2.45,” she replied. “Will that be cash or charge?”
I froze. The prescription normally costs about $47.00. But $2.45? Really? I was dumbfounded.
“$2.45??!!” I exclaimed. “What did she get?”
“We dispensed 10 mls of Dexamethasone liquid,” she answered.
“10 mls??!! I asked if she had a refill.”
“She did,” replied the pharmacy tech. She continued, “Her last prescription was for 250 mls. We dispensed 240 mls. So she had a refill of 10 mls.”
I couldn’t believe what I was hearing. I continued, “ But she takes 5 mls four times a day. If she takes a dose after supper and a dose at bedtime, she’ll be out of it tomorrow morning!”
“You can speak to the pharmacist if you want. Maybe she can call the doctor and get another refill,” said the pharmacy tech.
I went to speak to the pharmacist.
Defining A Refill
I explained to the pharmacist that I had called earlier that morning to get a refill on my girlfriend’s prescription. I had thought it was successful until I arrived at the pharmacy today. I told the pharmacist that I, too, am a pharmacist. I further told the pharmacist that my definition of what constituted a “refill” was very different from what the pharmacy considered a “refill.”
The pharmacist checked her computer. She repeated what was told to me previously— how the prescription was originally written for 250 mls and 240 mls was dispensed. Thus, there was a refill of 10 mls left on the prescription.
I said nothing and stared at the pharmacist. Finally, I said, “You’re kidding me, right? A refill of 10ml constitutes two doses! What kind of refill is that?”
I continued, “Suppose a person has high blood pressure and they are taking one tablet a day to control their high blood pressure. Imagine if they called for a refill and you dispensed only two tablets. Does that make sense?”
The pharmacist tried to explain to me that this was how the computer figured out refills. In some cases, the quantity of medication dispensed is less than the actual quantity prescribed. When this occurs, regardless of how small the amount may be, the computer states that the medication can be refilled and balance is given. I stated that the pharmacy is misusing the term refill since the public expects a refill to be additional doses dispensed for a longer period of time.
I have an issue with computers. Sometimes, I feel people have lost the ability to think. In this particular case, I blamed three people who worked in the pharmacy:
- The technician who took my initial call about the 10 mls refill,
- The technician who filled the 10 MLS refill, and
- The pharmacist checked the 10 MLS refills.
These three people saw a 10 MLS refill and didn’t think to question it because that’s what the computer said. What were these people thinking?
Battling With The Insurance Company
I asked the pharmacist if she could contact the doctor and get another refill. A full refill, not just a couple of doses. I knew it was late in the day, but maybe the doctor (or his nurse) would call back and authorize the refill. The pharmacist said she could call the physician, but she wouldn’t be able to refill the prescription until tomorrow.
“Why is that?” I asked.
“Because the insurance won’t pay for it,” replied the pharmacist, “because you already received a refill today.”
“But I only received a refill for two doses. My girlfriend will be out of it by tomorrow!” I exclaimed, “In fact, she won’t have anything for her morning dose.”
“I’m sorry, but that’s the best I can do,” answered the pharmacist. I turned, exasperated, and left.
Obtaining Extra Doses
I’m a pharmacist. I know many things about prescriptions that the average person wouldn’t. So, when I got to my car, I decided to go back into the pharmacy and speak to the pharmacist.
When I first started my career, I worked as a pharmacist in a retail setting. Every so often, a customer would come in and ask for a refill. Some of these customers waited until the very last minute when they were completely out of their medication. This usually happened late on Friday or the day before Christmas or Thanksgiving. At those times, it would be impossible to get the physician or anyone to authorize a refill.
Rather than have the customer go without their medication, our pharmacy would give the patient two or three pills to hold them over. Sometimes, we wouldn’t charge them for these doses. Other times, we’d deduct the tablets from the next prescription.
I asked the pharmacist if I could get about 20 mls of Dexamethasone— which would get provide enough medication to get my girlfriend through the day. The pharmacist said “no,” stating that the computer wouldn’t allow it.
I’ve encountered this before. This is another example of not doing the right thing because the computer won’t be happy.
The next day, the pharmacist contacted the doctor. The doctor prescribed a refill. A full refill. Not one of these 10 MLS things.
The last two prescription refills that I picked up were perfect. I telephoned the pharmacy, and the automatic system allowed me to request two individual refills on separate days. It was amazing how easy it was.
Hopefully, there won’t be any more problems with the prescription. But if there are— there will be a part three.
Daniel Shifrin, R.P., M.S. is a recently retired pharmacist who enjoys sharing his insights about hospital pharmacy. He is proud to own one of the largest collections of Pharmacy Stamp First Day Covers.