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  #1  
Old 07-20-2010, 04:34 PM
The Hamster King The Hamster King is online now
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Why are pharmacies so slow?

I've got bronchitis. Today I went to the drug store to pick up the drugs to treat it: an inhaler, antibiotics, and cough syrup.

I handed the pharmacist my prescription and she went and pulled all three drugs off the shelf. She didn't have to count pills or measure anything out. Everything was already packaged in the proper dosage.

"Okay," she said "Come back in 20 minutes and we'll have them ready for you."

I came back in 20 minutes and they weren't ready. It actually took 45 minutes.

They weren't particularly busy. Why did it take so long? I understand they have to type up a label and stick it on, and enter the transaction in their computer system ... but, seriously, 45 minutes? What am I missing here?
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  #2  
Old 07-20-2010, 04:36 PM
KneadToKnow KneadToKnow is offline
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Do you have insurance? Were any of the drugs on the controlled substances list? Either of those might have necessitated double-checking information with either the insurance company or the prescribing doctor.
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  #3  
Old 07-20-2010, 04:40 PM
The Hamster King The Hamster King is online now
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I got antibiotics, an antihistamine inhaler, and cough syrup with codeine. Nothing exotic.

I do have insurance.
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  #4  
Old 07-20-2010, 04:47 PM
KneadToKnow KneadToKnow is offline
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Wikipedia says codeine is a schedule I controlled substance when not combined with at least two other active ingredients. Maybe that's it?
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  #5  
Old 07-20-2010, 04:52 PM
Tom Tildrum Tom Tildrum is online now
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Maybe there were others in a queue that you weren't aware of. Many pharmacies enable people to call in refills via an automated phone line, for instance.
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  #6  
Old 07-20-2010, 04:53 PM
Slithy Tove Slithy Tove is offline
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The classic blog post addressing this
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  #7  
Old 07-20-2010, 06:18 PM
AmunRa AmunRa is offline
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Quote:
Originally Posted by The Hamster King View Post
codeine. Nothing exotic.
I'd call codeine pretty exotic.
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  #8  
Old 07-20-2010, 06:25 PM
Joey P Joey P is online now
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Originally Posted by KneadToKnow View Post
Wikipedia says codeine is a schedule I controlled substance when not combined with at least two other active ingredients. Maybe that's it?
Ya know, I looked at that list and for the life of me I couldn't figure it out...then I realized it's the Canadian Controlled Substance list. In the states I believe codeine is CIII.
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  #9  
Old 07-20-2010, 06:32 PM
GilaB GilaB is offline
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The regulation of codeine is weird. In the US, it's a controlled substance, more regulated than your average prescription drug, but in the UK, it's available without a prescription.
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  #10  
Old 07-20-2010, 06:44 PM
Joey P Joey P is online now
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Originally Posted by AmunRa View Post
I'd call codeine pretty exotic.
I wouldn't. In fact I think most people would consider it pretty mundane.
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  #11  
Old 07-20-2010, 06:59 PM
ChrisBooth12 ChrisBooth12 is offline
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Other people are in front of you..there is probably only 1 guy actually filling the bottles. They count and recount you pills and make sure it does not interfere with other meds your on. Doctors prescribe conflicting meds a lot more than you would think
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  #12  
Old 07-20-2010, 07:03 PM
running coach running coach is online now
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Quote:
Originally Posted by AmunRa View Post
I'd call codeine pretty exotic.
It's not exotic, it's narcotic.
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  #13  
Old 07-20-2010, 07:24 PM
Markxxx Markxxx is offline
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I recall one time at Walmart I left my prescription for my blood pressure meds and an inhaler. She said, "About 45 minutes," which was fine as I had to shop anyway.

I came back in 45 minutes and the pharamacist says, "Oh I didn't put you in, just a minute." She types some stuff into a computer, it prints out two labels, she slapped them on an inhaler and a bottle of sealed pills, (she didn't have to count them) and handed to me. Time total about 3 minutes.

So I am thinking the pharmacy has a lot of back orders from the day, plus they probably have a standard time for everyone in the place. Like 20 minutes or 45 minutes.

I guess you have to think of it like this. When the pharmacy opens, they probably have back orders off the Internet and phone refills and if they have say 30 that came in over night and you're first in line in the morning, you're really 31st in line but you wouldn't see that.
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  #14  
Old 07-20-2010, 07:43 PM
Moonlitherial Moonlitherial is online now
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Originally Posted by GilaB View Post
The regulation of codeine is weird. In the US, it's a controlled substance, more regulated than your average prescription drug, but in the UK, it's available without a prescription.
Depending on the dose it's OTC in Canada too.
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  #15  
Old 07-20-2010, 08:05 PM
apollonia apollonia is offline
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The blog Your Pharmacist May Hate You addresses this and many, many, many other questions about the pharmaceutical industry in a sort of tongue-in-cheek manner. He's done a post about this very thing.

Why Your Prescription Takes So Damned Long To Fill.
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  #16  
Old 07-20-2010, 08:38 PM
lazybratsche lazybratsche is offline
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Psst, apollonia, check post #6.

It's ok, I've done the same thing myself more times than I care to tally up...
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  #17  
Old 07-20-2010, 08:45 PM
dogbutler dogbutler is online now
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Quote:
Originally Posted by ChrisBooth12 View Post
Doctors prescribe conflicting meds a lot more than you would think
Doc: Take X.
Me: I'm on Y, if I take X, my liver will reenact the lunchroom scene from Alien.
Doc: OK, don't take X.

I worked in a pharmacy for 10 years, and my mom's a pediatric nurse, I know more than average about drugs.
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  #18  
Old 07-20-2010, 08:46 PM
Guinastasia Guinastasia is offline
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Originally Posted by Joey P View Post
I wouldn't. In fact I think most people would consider it pretty mundane.
Well, it IS a morphine derivative.
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  #19  
Old 07-20-2010, 09:26 PM
Hirka T'Bawa Hirka T'Bawa is offline
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There is a lot that goes into filling a script when we get one, it isn't as simple as "slapping a label on a box". First we need to decipher what the doctor wrote, sometimes it is easy, sometimes it involves calling the doctor's office. Then it gets typed into the computer system, then we need to run it through the insurance. This again could be easy if you've been there before and the drug is covered, or it could be hard if your insurance company doesn't want to cooperate. Once all that is done, we can finally print the label, and count or slap it on the box.

Once the script is counted, labeled, etc, it needs to go to the pharmacist to check. Most of the time, this is the actual bottleneck in the process. There is only one pharmacist (most times), and every prescription has to be checked by him/her. This is where the pharmacist does a drug interaction check to make sure none of the drugs interact with each other, or with anything else you are taking, or if they do interact, the interaction isn't clinically significant. The pharmacist also has to make sure the prescription was typed and filled correctly by the techs. If there is any errors or if the pharmacist wants something changed (wrong verb, change 5 mL to 1 TSP, etc) , they will most of the time the pharmacist will send it back to a tech.

Now, during all of this, the phone is still ringing, there are other patients in front of you, a tech will ask you to decipher a script, or ask what the generic is for a brand. You'll have patients asking the pharmacist a question on a drug, a doctor calling in a new prescription, a patient wanting to know if the doctored called in their medication, so the pharmacist has to check the voice mail, or even just some customer asking you where the trash bags are kept.

If someone drops off a prescription in person, I will tell them a minimum of 15 minutes, if they drop it off in the drive thru, it's a minimum of 30 minutes. That is even if I'm going to do it right away. If I rush a script through without distractions, I can get a new script done in about 5 minutes, a refill in about 2 to 3 minutes.

Oh, and Codeine is a C-II if by itself, C-IV if mixed with another medication (like acetaminophen in Tylenol #3), and a C-V if used as an anti-tussive (Like with Robitussin AC).
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  #20  
Old 07-20-2010, 10:40 PM
Washoe Washoe is offline
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Originally Posted by The Hamster King View Post
Why did it take so long?
‘Cuz they just don’t get no respect.
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  #21  
Old 07-20-2010, 11:20 PM
njtt njtt is online now
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Isn't this all just yet another example of the fucked-upness of the American health care system, and the inefficiencies generated by the lack of centralized health records, and the need to check on people's insurance, figure out which set of rules and payment obligations apply for each particular patient, and then double-check, and often sort out insurance related errors made by insurance companies or (because they also have to handle all these absurd complexities) doctor's offices?

In my experience, 20 minutes seems to be the default or minimum wait time for American pharmacies (so long as nothing goes wrong). It is a long time since I have had occasion to use a pharmacy in Britain, and I may be looking back through rose-tinted NHS spectacles, but it is my impression that typical or minimum wait times were much shorter (and this would be before the days of widespread computerization). It was not as quick as buying something over the counter – prescriptions still had to be counted out, labeled and checked for correctness, and, presumably, recorded – but I think I would have considered myself to be having a particularly bad day if they were so backed up that it all took 20 minutes or more. Can anyone currently living in Britain or another UHC, single-payer country confirm or disconfirm my memory here?

Last edited by njtt; 07-20-2010 at 11:21 PM..
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  #22  
Old 07-21-2010, 12:13 AM
Alessan Alessan is offline
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Here in Israel the whole process takes maybe 30 seconds more than a normal over-the-counter purchase. Everything is computerized. Doctors don't write anything by hand - they enter the scrips into their computers (which are linked to the HMO's site) and hand the patients a printout with a barcode on top. The pharmachist scans the printout , compares it to what he sees on the screen, clicks to print the stickers, and hands over the meds. No wait, no hassle.
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  #23  
Old 07-21-2010, 01:35 AM
suranyi suranyi is offline
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Quote:
Originally Posted by Alessan View Post
Here in Israel the whole process takes maybe 30 seconds more than a normal over-the-counter purchase. Everything is computerized. Doctors don't write anything by hand - they enter the scrips into their computers (which are linked to the HMO's site) and hand the patients a printout with a barcode on top. The pharmachist scans the printout , compares it to what he sees on the screen, clicks to print the stickers, and hands over the meds. No wait, no hassle.
That's interesting. Don't the pharmacists have to count the pills out into individual bottles for the patient?
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  #24  
Old 07-21-2010, 01:49 AM
Alessan Alessan is offline
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I've never gotten a pill that wasn't in a foil sheet. Prescriptions are usually by the box.
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  #25  
Old 07-21-2010, 02:11 AM
Shinna Minna Ma Shinna Minna Ma is offline
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Originally Posted by Alessan View Post
Here in Israel the whole process takes maybe 30 seconds more than a normal over-the-counter purchase. Everything is computerized. Doctors don't write anything by hand - they enter the scrips into their computers (which are linked to the HMO's site) and hand the patients a printout with a barcode on top. The pharmachist scans the printout , compares it to what he sees on the screen, clicks to print the stickers, and hands over the meds. No wait, no hassle.
I get mine at the local clinic on my yishuv, so I have you beat. I walk in, tell the nurse (a neighbor of mine) that I'm there for my refill, she pulls it out of the drawer, I pay the receptionist, and I'm out - about 2 minutes, tops.

--SMM
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  #26  
Old 07-21-2010, 02:17 AM
Maastricht Maastricht is offline
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In the Netherlands I have never had my prescriptions take more then 5-10 minutes. Maybe it is an USA thing, indeed.

Quote:
Originally Posted by suranyi View Post
That's interesting. Don't the pharmacists have to count the pills out into individual bottles for the patient?
Nope, foil sheets. Sometimes you get part of a foil sheet.

What the Dutch pharmacy does do, is mostly give you the generic version of the medicine you have been prescribed. To cut costs.

Last edited by Maastricht; 07-21-2010 at 02:19 AM..
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  #27  
Old 07-21-2010, 05:11 AM
sandra_nz sandra_nz is online now
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My local pharmacy (here in the UK) has a robot that takes the medicines off the shelves out the back. It's all done with bar codes, I think. They have a tv screen showing it working busily so you can play the 'are those my pills? those look like my pills' game.

It seems to take about ten minutes for me to get my pill prescription, that's the only thing I get on a regular basis.
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  #28  
Old 07-21-2010, 05:25 AM
Westrogothia Westrogothia is offline
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sweden here. Usually it takes me around 30sec*. Even if its codein pills. But of course this is in socialist state. I suspect waiting for your pills is the price of freedom.

*Unless obviously they have to call the doc an ask if he really ment to give me that particular drug.

Last edited by Westrogothia; 07-21-2010 at 05:28 AM..
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  #29  
Old 07-21-2010, 06:36 AM
BleizDu BleizDu is offline
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Yup same here in France. I went to the pharmacy this morning and I had to wait maybe a minute or two before it was my turn, then it took two or three minutes at most for them to go get my meds, swipe my health card and give me back my stuff.
Like in Israel or the Netherlands, pills or gel caps most often come in boxes, with foil sheets inside.
Having to wait, once at the counter, 15min or more to get meds would be really really unsual.
I might wait this long for my turn in a busy pharmacy though.
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  #30  
Old 07-21-2010, 07:11 AM
hogarth hogarth is offline
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Originally Posted by Maastricht View Post
In the Netherlands I have never had my prescriptions take more then 5-10 minutes. Maybe it is an USA thing, indeed.
And maybe Canada, too. I find that 15-20 minutes is the standard wait for prescriptions.
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  #31  
Old 07-21-2010, 07:25 AM
njtt njtt is online now
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Just so we are not comparing apples and oranges, I should say that in the U.S.A. now, if the prescription has been sent well in advance to the pharmacy, picking it up may take no more than a couple of minutes (so long as you don't get stuck in line behind someone who has an issue, usually concerning their insurance coverage). In the last two or three years, my doctor has started using a system whereby he can send my prescriptions from his computer straight to the pharmacy, and if I need to get a refill on a prescription that the doctor has already approved for refilling, I can call that in by phone myself, via a voicemail-type system, and when I go in to pick it up, the process is quick.

HOWEVER, this ordering has to be done well in advance. One time, after my doctor, had sent a prescription for me to the pharmacy from his computer, I made the mistake of going straight to the pharmacy to get it after leaving his office. It took about 10 or 15 minutes to get there, but they were nowhere near ready when I got there – in fact I do not think they had even got around to looking at the relevant message yet. When I arrived and asked, they checked and found the doctor's message, and then it took about another 20 to 25 minutes before I got the stuff (even though there were not many other customers around). If I had gone in the next day, I think I might have got it immediately.

Likewise, when I phone in for a refill, the automated system gives me a pickup time that is usually about two days on from when I call. If I go in after that assigned time, I will normally get the stuff in a minute or two, but if I go in before, I will be dealing with that 20 or more minute wait again.

So, for the most part the system that I (with fairly decent insurance coverage, knock on wood) use in the U.S.A. rarely keeps me waiting around for long at the pharmacy itself. However, from when they actually receive the prescription to actually having it ready for me behind the counter, it takes them somewhere between 20 minutes (if they are prioritizing my prescription, because I am actually there, drumming my fingers, and if they don't hit any unusual bureaucratic or other snags) to two days.

Last edited by njtt; 07-21-2010 at 07:26 AM..
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  #32  
Old 07-21-2010, 07:55 AM
Capt. Ridley's Shooting Party Capt. Ridley's Shooting Party is offline
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I've never spent longer than 5 minutes in a pharmacy in the UK picking up a prescription. I go in, hand over the script, they ask me to read the back of the script to make sure I'm not exempt from paying and sign it, hand it back, the clerk passes it to the pharmacist who fills it, I pay the prescription fee and leave. 20 minutes, never mind 45 minutes, to fill a prescription is insane.
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  #33  
Old 07-21-2010, 07:58 AM
SanVito SanVito is online now
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Originally Posted by Capt. Ridley's Shooting Party View Post
I've never spent longer than 5 minutes in a pharmacy in the UK picking up a prescription. I go in, hand over the script, they ask me to read the back of the script to make sure I'm not exempt from paying and sign it, hand it back, the clerk passes it to the pharmacist who fills it, I pay the prescription fee and leave. 20 minutes, never mind 45 minutes, to fill a prescription is insane.
Another Brit concurring with this. Maybe ten minutes if there's a queue of old ladies.
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  #34  
Old 07-21-2010, 08:04 AM
gotpasswords gotpasswords is offline
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From experience, probably 95% of the time is eaten up with sorting out insurance issues.

Years ago, I was with Kaiser Permanente. It's a large HMO and essentially, if you're able to get into the building, you're covered. Everyone in line at the pharmacy has the same insurance company, so to speak, and everyone's doctor knows what the standard meds are and what the standard quantities are, so there's not going to be any calling around to the insurance company to beg them to cover a non-formulary prescription.

More often than not, you could drop off a new prescription, then immediately get into the pickup line and your meds would be ready by the time you got to the counter. (This pharmacy was seriously busy - 20 people in line was a "slow" day.) I believe Kaiser was a pioneer of standardized pre-packs, so the pharmacist only had to reach into a bin right there at the counter for the most popular meds and pull out a sealed bottle or foil pack.
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  #35  
Old 07-21-2010, 08:13 AM
Mops Mops is offline
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Originally Posted by suranyi View Post
That's interesting. Don't the pharmacists have to count the pills out into individual bottles for the patient?
Which looks curious to me, Like stated above for Israel, the Netherlands and France and probably in most other countries, prescription medication in Germany is sold factory-packed with the pills on foil sheets or occasionally a sealed plastic bottle. Usually there are standard package sizes referred to as N1, N2 or N3.

For example the process of getting a prescription drug for me is:
  1. Doctor selects drug on his software's menu. The software tells him whether the drug is covered by statutory insurance (most drugs) or not (things like sleeping pills etc.), and he prints out the prescription on a light red or light blue form accordingly.
  2. I hand over the prescription (computer printed so no question of reading handwriting) in the pharmacy. Pharmacist looks in their computer system on whether it is on stock and whether insurance requires a particular generic version to be used (the major statutory insurances have contracts with drug manufacturers for rebates on popular drugs, so they require that that manufacturer's version be used). Whether the drug is covered by insurance has already been determined at the doctor's office.
  3. If the drug is not on stock (rare) I get a slip to come back and collect it in a few hours.
  4. Pharmacist collects package from storage (or asks robotic storage to convey it), asks questions on whether you are already familiar with it, on possible other medications, gives advice (e.g. with my father's opiate painkiller: to also get a laxative). If precription mentions specific instructions e.g. "1/2 - 1 - 1/2 - 1/2", copies these to a label to stick on the package. Collects copay if any from me in cash.

The whole thing rarely takes more than a minute.

Is there a specific rationale for prescription pills to be repackaged in the pharmacy in the US?
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  #36  
Old 07-21-2010, 08:25 AM
njtt njtt is online now
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We do sometimes get given prescription meds on foil-backed plastic sheets or in what appear to be factory-pre-packed bottles in the U.S. But pills counted out and custom bottled at the pharmacy for you are still very common, the norm even, in my experience.
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  #37  
Old 07-21-2010, 08:25 AM
Cliffy Cliffy is offline
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Originally Posted by The Hamster King View Post
Why are pharmacies so slow?
In addition to all the interesting information so far in this thread, there's a simple reason, too: When they screw up, people die.

That's not typically the case at Burger King.

--Cliffy
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Old 07-21-2010, 08:56 AM
jayjay jayjay is offline
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In addition to all the interesting information so far in this thread, there's a simple reason, too: When they screw up, people die.

That's not typically the case at Burger King.
Well, on a good day, anyway.
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  #39  
Old 07-21-2010, 10:06 AM
kspharm kspharm is offline
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I was a pharmacist at Walgreens (the largest U.S. pharmacy chain) for 5 years. The main reasons the wait time for prescriptions is that high is:

1) Insurance issues. We spent an unbelievable amount of time trying to resolve issues with denial of service. Insurance companies can and do reject prescriptions that are submitted to them online for a myriad of reasons - refill too soon, quantity, therapeutic duplications, drug-drug interactions, non-formulary drug, cost of the drug, brand name vs. generic, non-participating pharmacy, non-network physician, etc., etc., etc. Each plan has its own rules and formulary (and there are thousands of plans). If a patient brought in a script that was not covered, we would have to contact the physician's office and try to have them get a prior authorization for the drug or change it to something that was covered. When we would get a rejection for other reasons (e.g. the doctor wrote for 30 pills but the insurance will only cover 8 pills per month), we would try to fix and re-submit online. If that didn't work we would be forced to contact the insurance plan - then you're talking about 10-15 minute hold times.

2) Volume of prescriptions to number of staff. A typical Walgreens pharmacy filled about 300 prescriptions per day with 2 shifts (8-4 pm and 2-10 pm). Each shift would be staffed by 1 pharmacist and 2 or 3 technicians. The pharmacist is responsible for verifying that the prescription has been entered correctly, that the correct drug has been filled, checking for drug interactions, therapeutic duplications, duration of therapy, appropriateness of therapy (this was limited to how much information you had on the patient); as well as counseling (or offering counseling) to each and every patient, fielding telephone calls and questions from both patients and physicians; checking the voice-mail system for new and refill prescriptions; and finally contacting physicians offices directly if there were problems with a prescription (illegible writing, incorrect strengths, or even if there were questions regarding the validity of the prescription - sad to say but forgeries and fake prescriptions are a very common occurrence in retail pharmacies in the U.S.). Pharmacist liability and fear of mis-filling a prescription always looms large as well. The pharmacy technician is responsible for receiving the prescription, typing it in, adjudicating it through the insurance, counting and labeling, ringing it up at the cash register, and also is responsible for the drive-thru window. If it is a particularly busy day or one of the technicians is on break or out, the pharmacist is responsible for all the duties of the technician. The pharmacy has a certain workflow to it, and if all goes as planned then it usually runs smoothly - however, any problem whatsoever (e.g. one patient's prescription gets rejected by their insurance) will immediately disrupt everything and can cause a very large ripple effect that will create long wait times for everyone.

3)Cost-cutting measures by the chain drug stores. The obvious solution to most of these problems would be to have extra staff working - however, in most states, there can only be 2 technicians per each pharmacist (or 3 technicians if you have permission from the state Board of Pharmacy) - the technicians are working directly under the pharmacist's license, and the pharmacist is ultimately responsible for each and every prescription that leaves the pharmacy. Because of their salaries, Walgreens would not justify having 2 pharmacists on shift at the same time (unless the store was exceptionally busy). The major problem as I saw it, though, was that they would pay their pharmacy technicians a horribly low hourly wage (in 2005 they were paying $8.50 an hour to start) which would leave you with a low candidate pool to begin with, and then extremely high turnover amongst pharmacy technicians (they usually lasted between 3 to 6 months). This means constant re-training of the technicians and a very inefficient system. This is the main reason independent pharmacies in the U.S. have much higher customer service, I believe.

So these 3 major problem areas all combined to create a vortex of inefficiency and delays. On a slow day at the pharmacy, our standard default waiting time was always 30 minutes - you have to give yourself a buffer to try to deal with problems as they arise. If nothing goes wrong, we would usually have a new prescription ready within 5 minutes (and refills even less time than that), and we would let the customer know as soon as it was ready. In case of a true urgent issue, I would always bump that person up to the head of the queue and could usually fill the prescription within a minute or two. (FYI if you speak to the pharmacist directly and ask them -nicely- to prioritize your prescription they will usually almost always help you out).

Quote:
Originally Posted by Capt. Ridley's Shooting Party
I've never spent longer than 5 minutes in a pharmacy in the UK picking up a prescription. I go in, hand over the script, they ask me to read the back of the script to make sure I'm not exempt from paying and sign it, hand it back, the clerk passes it to the pharmacist who fills it, I pay the prescription fee and leave. 20 minutes, never mind 45 minutes, to fill a prescription is insane.
Quote:
Yup same here in France. I went to the pharmacy this morning and I had to wait maybe a minute or two before it was my turn, then it took two or three minutes at most for them to go get my meds, swipe my health card and give me back my stuff.
Like in Israel or the Netherlands, pills or gel caps most often come in boxes, with foil sheets inside.
Having to wait, once at the counter, 15min or more to get meds would be really really unsual.
I might wait this long for my turn in a busy pharmacy though.
Oh, how I wish we had an NHS-like system in place in the U.S. Not even talking about the full socialized medicine aspect (although I do support that) - I would have been perfectly happy if we could have standardized insurance information cards. I envisioned something like a credit card with your insurance information on it that the pharmacy could just swipe instead of having to hunt for the information in a database or online. Standardized insurance would cut your wait time by a lot.

As far as pre-packed or blister-packs go, there are quite a few drugs that come that way in the States, however it is cheaper for the pharmacy to buy massive bulk bottles (say a thousand count) and package it themselves. That is the main reason it is still done this way.
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  #40  
Old 07-21-2010, 10:20 AM
suranyi suranyi is offline
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Originally Posted by Mops View Post
Which looks curious to me, Like stated above for Israel, the Netherlands and France and probably in most other countries, prescription medication in Germany is sold factory-packed with the pills on foil sheets or occasionally a sealed plastic bottle. Usually there are standard package sizes referred to as N1, N2 or N3.

For example the process of getting a prescription drug for me is:
  1. Doctor selects drug on his software's menu. The software tells him whether the drug is covered by statutory insurance (most drugs) or not (things like sleeping pills etc.), and he prints out the prescription on a light red or light blue form accordingly.
  2. I hand over the prescription (computer printed so no question of reading handwriting) in the pharmacy. Pharmacist looks in their computer system on whether it is on stock and whether insurance requires a particular generic version to be used (the major statutory insurances have contracts with drug manufacturers for rebates on popular drugs, so they require that that manufacturer's version be used). Whether the drug is covered by insurance has already been determined at the doctor's office.
  3. If the drug is not on stock (rare) I get a slip to come back and collect it in a few hours.
  4. Pharmacist collects package from storage (or asks robotic storage to convey it), asks questions on whether you are already familiar with it, on possible other medications, gives advice (e.g. with my father's opiate painkiller: to also get a laxative). If precription mentions specific instructions e.g. "1/2 - 1 - 1/2 - 1/2", copies these to a label to stick on the package. Collects copay if any from me in cash.

The whole thing rarely takes more than a minute.

Is there a specific rationale for prescription pills to be repackaged in the pharmacy in the US?
The only rationale is that it's cheaper for the pharmacy to buy drugs from the wholesaler in jars of thousands of pills, and count them out into individual doses themselves. Sometimes we get prescriptions in which the pills come in the foil, as the postings from other parts of the world mentioned. And in that case the pharmacist really does only have to slap on the label. But it's the exception.

Last edited by suranyi; 07-21-2010 at 10:21 AM..
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  #41  
Old 07-21-2010, 10:36 AM
jjimm jjimm is offline
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Originally Posted by SanVito View Post
Another Brit concurring with this. Maybe ten minutes if there's a queue of old ladies.
And another. Longest I've ever waited was about 10 minutes. This afternoon it took 3 mins.

And my local pharmacy has a robot with a pill chute which is awesome.
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  #42  
Old 07-21-2010, 10:41 AM
Rumor_Watkins Rumor_Watkins is offline
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Medical profession protectionism + Incentive to make you wait around so you browse the store's aisles some more = wait.
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Old 07-21-2010, 11:21 AM
crazyjoe crazyjoe is offline
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At my local pharmacy, many of the folks behind the counter recognize me by name and it rarely takes longer than 5 -10 minutes to get my prescription filled if I am dropping it off right then. Even less if I have called it in ahead of time.

And it's a pharmacy chain.

I get my pills in allotments of 180 for a month, and they are not small pills. I would need a mule to haul them out of there if they were in foil packs.
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  #44  
Old 07-21-2010, 11:25 AM
Turble Turble is offline
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I don't see how it's possible that having a tech count pills from a large bottle then having the pharmacist also count them – and having to purchase, ship, and store a large number of assorted empty bottle could be more cost effective than for the store to buy pills that have been counted and packaged by a machine doing several hundred or several thousand per minute.

If the cost of the machined packaged pills is indeed higher than the cost of hand-counted when the labor cost is included … something wrong with the picture … higher cost, slower service, more prone to errors … hmmm … so why do they do it that way in the USA? … somewhere in there somebody somehow is managing to make more money than they would by doing it the right way.
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Old 07-21-2010, 11:28 AM
Rumor_Watkins Rumor_Watkins is offline
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Originally Posted by Turble View Post
I don't see how it's possible that having a tech count pills from a large bottle then having the pharmacist also count them – and having to purchase, ship, and store a large number of assorted empty bottle could be more cost effective than for the store to buy pills that have been counted and packaged by a machine doing several hundred or several thousand per minute.

If the cost of the machined packaged pills is indeed higher than the cost of hand-counted when the labor cost is included … something wrong with the picture … higher cost, slower service, more prone to errors … hmmm … so why do they do it that way in the USA? … somewhere in there somebody somehow is managing to make more money than they would by doing it the right way.
it's not - it's an excuse to justify/maintain the role of the pharmacist.
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  #46  
Old 07-21-2010, 12:43 PM
robert_columbia robert_columbia is offline
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A few years ago, I filled a prescription at a pharmacy where I had some insurance information on file, but I knew going in that I would not be covered*. I told the tech in NO UNCERTAIN TERMS not to file a claim because it WOULD BE DENIED, and that I would pay cash, and then told them that I would be hanging around the area and would be back in 20 or 30 mins or so to pick it up and pay cash. I then wandered to a nearby store at that mall for a little bit. I then got a phone call on my cell phone from the pharamacy, telling me that my insurance claim had been DENIED and what do I want the pharamacy to do about it.

I went back to the pharmacy to tell them about their problem in following instructions, and was told off and told that their procedures do not permit bypassing insurance on file such as I had requested, and that in order to not file a claim, I have to formally request my insurance information be removed from my file.

I thought about filing a privacy violation lawsuit, but decided it wasn't worth it.

Stupid pharmacies.

*(I think my insurance may have been expired)
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  #47  
Old 07-21-2010, 01:23 PM
grimpixie grimpixie is offline
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South African here - although we have a state sponsored healthcare system, anyone who can afford to will generally choose a private medical aid scheme. If I have been to a particular pharmacy before, they will have my details on file, and filling a prescription will take 5 min unless there is a problem (out of stock, can't read the doc's handwriting, etc).
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  #48  
Old 07-21-2010, 01:33 PM
brendon_small brendon_small is offline
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I had this same question the other day when I went to the pharmacy. I read the post linked in the earlier part of the thread and I get it, but this is the way it went down. I went to the doctor and got my prescription for the same antibiotic I have had the last four times for an upper respiratory infection. I took this to the exact same pharmacy and waited on them to open (I was 10 minutes early) and as I handed it to them they explained it would take about 20 minutes. Not so bad, I guess. I wandered over and sat down on the bench nearby. 20 minutes later, no medicine. 40 some minutes later, I walked up to the counter and asked for my meds again. They explained it would be ready in just a minute, but I watched as the lady walked over, picked up the pre-packaged six pills I needed, placed the label on them, stapled them inside two different bags, put them in a hanger bag, walked back over and asked what my name was again, got them back out of the bag, and handed them to me. I'm not sure why this would take so long, but apparently it does.

This is the same pharmacy where I may call in a prescription at noon and they say it will be ready in an hour, leave my house and get there by 1:15 (it is near my doctors, which is rather far away) and when I get there they will say it will take an hour. This seems to be a common thing, and my assumption is that it takes two hours to prepare prepackaged pills because they wait till you show up to start, not when you call in the refill. This gives a buffer of time where they assume that because you are stuck there anyways, you will go shop. If there is a reasonable explanation of why call in refills never are ready when you get to the store, I'd love to hear it, but more and more I hate going to the doctor because I hate dealing with all the sitting at the pharmacy afterwards. It takes less time to drive to the doctors office, be seen (after waiting) and drive to the pharmacy than it does to sit in the front and wait on my pills. My insurance company keeps offering mail order crap so I don't have to deal with this, but the program seems pretty much only for maintenance drugs (my inhaler) and not one-off drugs (antibiotics and whatnot).

Brendon Small

Brendon Small
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  #49  
Old 07-21-2010, 02:52 PM
control-z control-z is offline
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The CVS in my area has 5 or 6 people running around and it takes forever to do anything. The Walgreen's across the street has 2 or 3 people and is more sedate, yet they're much faster.
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  #50  
Old 07-21-2010, 03:57 PM
JerseyFrank JerseyFrank is offline
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You're still missing the most important reason:

Pharmacies are in retail outlets that sell much more than prescription and OTC medications. These retail outlets virtually (or possibly actually) mandate that there's a wait long enough for someone to buy more stuff.
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