No One Can Change How You Practice But You

Today a woman in her mid-70s made her way to the out-window of which I was manning. As I brought her name up on the work queue, she started by saying that she recently transferred to us from Walmart due to "those swarmy bastards."

I liked her already.

Since she was a new patient, I went through the usual round of intel gathering to update her file. It was when I arrived at the question regarding insurance that things became interesting.

She initially stated she would be paying cash for her prescriptions. I asked her if she was sure because her prescriptions totaled nearly $900 at the cash price. She was taken aback at first, but reiterated that she was paying the cash price.

After a minute she pointed at one of the scripts and said, "This isn't right, Walmart's been selling this one to me for just $373, not what you have listed there."

Now one of the drawbacks of WAGs system is that you cannot override cash prices, at least from what I've been told. The price we had was, to say the least, ridiculous in it's own right and I wasn't going to make this elderly woman fork over hundreds of dollars extra because of it.

I turned to my pharmacist and said I was going to take her over to our consultation area so I could work with her and see if I can find some way to fix this. He looked a bit perplexed at first, but allowed me to continue on.

I begin to try various filling combos to fix the price. There was changing it to two different prescription strengths, halving tablets, taking more of a smaller dose, etc. I had gotten it knocked down to just a shade over $400, and she was content with that.

It was then that she began fumbling around in her wallet for her credit card when I noticed her Medicare card. And it dawned on me; she has to have Part D coverage and, if she doesn't, she has to have some sort of supplement.

I ask her if she's enrolled in Medicare Part D and she replied yes. Next I ask her why she didn't mention she had any coverage at first and she said it was because she had lost the card several weeks ago so she didn't know how to get us the information. Naturally she was surprised when I said I could look up her information simply by using her Medicare number.

As she hands me her Medicare card she then states, "I don't know how much good this insurance stuff is gonna do me." I ask why and she goes, "Well they don't cover that spendy one right there cause I've been paying cash for it all year. And I'm in the donut hole so Walmart told me it's better to just pay cash for everything."

Are the alarm bells going off in your head? Because they were going off in mind.

First, I explained to her that I would be very surprised if they did not cover the drug in question. It's not an uncommon generic drug and I'm not sure if I've ever seen someone not pay for it since it went generic.

Second, I then explained to her that when you're in the donut hole you don't really pay the 'true cash' price. The price given, if you will, is more of a discounted cash price and is usually less than what WAGs or Walmart can match.

Of course she asked why her Walmart pharmacy had never explained to her, of which I had no answer.

I proceeded to input her Part D information and rebill. Suddenly that almost $400 medication she had been paying for at Walmart was now just $40.

She was shocked. Utterly and completely shocked. By the time I re-ran everything, the total bill was around $280, down from the $900+ originally. She thanked me several times for helping her as she left, while I sat wondering how in the world another pharmacy could be so inept at helping a patient.

Then I remembered that Walmart employs more of a profits before patients policy, similar to what I alluded to in my last post. Their pharmacies are often overworked and understaffed. A corollary to this is they have a tendency to hire 'cheap' techs who may not know as much as they could otherwise.

To make things even more interesting, my pharmacy manager pulled me aside and said he hadn't seen anyone do anything like that here in the eight years he's been working at WAGs. It reminded him of working in his pharmacy back home.

I told him there's no reason you can't practice like that, even in a WAGs-type setting. It's how I decided to practice long ago and where I work won't change that.

Ultimately, I think this is the moral to the entire story. It doesn't matter where you work, what you do on a daily basis or what corporate wants you to do. We still have an opportunity to take some time with our patients to help them.

We choose how we want to practice, no corporate decree can change that. It doesn't matter how busy or how swamped you are, I did this entire exchange during the 5pm rush on a Friday afternoon.

And if I can do it, so can you. All I ask is that you try...