Why are pharmacies so slow?

Factual Questions
21

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?

22

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.

23

That’s interesting. Don’t the pharmacists have to count the pills out into individual bottles for the patient?

24

I’ve never gotten a pill that wasn’t in a foil sheet. Prescriptions are usually by the box.

25

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

26

In the Netherlands I have never had my prescriptions take more then 5-10 minutes. Maybe it is an USA thing, indeed.

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.

27

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.

28

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. :slight_smile:

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

29

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.

30

And maybe Canada, too. I find that 15-20 minutes is the standard wait for prescriptions.

31

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.

32

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.

33

Another Brit concurring with this. Maybe ten minutes if there’s a queue of old ladies.

34

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.

35

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:

[ol]
[li]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.[/li][li]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.[/li][li]If the drug is not on stock (rare) I get a slip to come back and collect it in a few hours.[/li][li]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.[/li][/ol]

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?

36

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.

37

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

38

Well, on a good day, anyway.

39

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).

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.

40

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.