Alot of pharmacies have pill counters. They don’t work on all size pills, but they do on alot of them. As for who shows the missing pill (customer or store), even if it’s the customer, if you’re the 3rd person to call this week about it, they might believe you or at the very least start investigating people.
By the way, the paperwork requirements on scheduled drugs are a pain. They track them more closely than you might imagine, and an overdispense can mean trouble…
I belong to one of the largest HMOs in California. I have to take phenobarbital for seizures. It’s one of the older prescription drugs around. It’s been off patent for decades.
Nevertheless, the HMO pharmacy often tells me that they don’t have enough around to fill my prescription. One time they told me they were out all together.
I get 300 at a time (my doctor wants to make my $5 copay be worth it since the drug is so cheap). Once, they gave me an odd amount. Something like 189. So I’m really wondering what inventory control is like in a busy pharmacy.
It wouldn’t suprise me. About 15 years ago, my husband had outpatient surgery. The doctor met with me just afterward to let me know how it went, and to give me a scrip for pain medication (Percocet, I think). I figured I’d get it filled while my husband was still in surgery. So I started calling around to the local People’s Pharmacies (only place that took our plan) to make sure they had it and got “Nope, No, Sorry” and one horrified-sounding “That’s a Category II Drug!!!” (IIRC, Cat2 meds are not especially high in street appeal, they’re not nearly as controlled as some stronger stuff). Made me feel like a junkie for even asking about the stuff. I finally found one local shop that had the meds in stock.
Of course things may have loosened up since then. While on vacation, I broke my arm and got a scrip for Vicodin. I walked into a drugstore to get it filled and said “Oh, I don’t need all 20 tablets, just give me 8” and the pharmacist said “Go ahead and get them all, it won’t really save you any money to get fewer”.
As far as meds in general - I’ve occasionally had to wait 24 hours for an out-of-the-mainstream medication, but never any longer than that and even that’s unusual.
Mamma Zappa, Schedule II drugs include things like pharmaceutical cocaine as well as strong painkillers. They are prized on the street. Schedule I drugs are illegal, like heroin and crack. A doctor’s DEA certificate will typically cover schedules II through V, although it’s possible to request a more limited range of schedules. 
Ah - then perhaps it was a schedule III drug - I remember looking it up in the PDR some time later and thinking “well, this isn’t that bad!!” This was a long time ago and I have trouble remembering what I ate for breakfast
A couple of things from a former pharm tech (and former occasional pill popper…I’m better now, though. I swear)
Vicodin, Lortab, Xanax, Valium, etc. are all schedule III drugs…meaning basically they require a little more paperwork than normal scripts and are supposed to be pretty closely monitored as far as inventory goes. However, there are so many different kinds of Sched III’s that its not feasible to give track of every pill. IIRC, an audit number of the pills have to be within 10% of the number reported to the FDA. As you can imagine, over the course of the year that could be a difference of 30,000 pills. (Once, and I’m not proud of this, I stole an entire 1000 count bottle of Xanax and nobody noticed.)
Sched II’s are the big ones- Oxys, Percs, Morphine tabs. And they are monitored super closely. However, again, every single pill is not tracked.
On the Viconden miscount thing, I would not worry about it. Call and get your pill. A single pill missing is not going to raise any eyebrows with the staff. Over the course of a day, when you’re counting 10,000 pills out, there’s bound to be a mistake made. It happened at my pharmacy at least 3 or 4 times a week. Its when it happens every other day with certain customers calling and complaining about missing pills and those pills just happen to be painkillers; thats when the eyebrows get raised.
I live in NH and have a similar experience. Those signs are at most pharmacies.
When my husband had surgery a few years ago, prior to those 24 hours signs and near the beginning of the robberies, he was prescribed Oxycontin. We brought the prescription to our grocery store pharmacy (our usual place), and were told they would not even fill Oxycontin. I went home with a husband in a great deal of pain, and decided to call some pharmacies to find one that would fill it (instead of driving around, as I live in the sticks). I soon discovered that no one would even tell me over the phone whether or not they had it, and lectured me for even trying to find out.
Well if you think about it, if someone called up asking for that, it would seem like they’re casing the pharmacy so they can rob it later. That’s probably a good rule to have.
However, I have a big problem with pharmacies not stocking the medication. Its not like its a rare prescription and its usually needed for extreme pain. You don’t want to be dicking around looking over the place for a pharmacy that carries it, all the while dealing breakthrough cancer pain or whatever.
Man, that really roils me up when pharmacies do that. Especially in rural places.
[QUOTE=tiny ham]
I currently work at a local chain pharmacy, in the pharmacy (I’m a Drug Cashier, in training to be a tech). We keep a large supply of diffrent medicines in stock, but we don’t keep every single one. Some of the less common medicines, or brands that have a generic we normally don’t carry. However, we can get most medicines in the store in 24 to 48 hours (depending on if we get it from the wholesaler or the chain’s wharehouse).
Oh and Tiny Ham in my state (Georgia) you can transfer a controlled substance one time, and one time only. I don’t know if its the same in your state, but I don’t know why it wouldn’t. You might want to ask someone else if you can transfer the perscription if you want to.
Many hospitals have outpatient pharmacies and will definitely have it in stock, makes it alot easier especially if you are already there for hubbys discharge.
Also you can have his nurse call in the script to a nearby pharmacy, they will not recieve the attitude you will. If a local phamacy starts giving attitiude to acute care RN’s relaying discharge medication orders its a good way to guarantee you will be losing tons of business.
Less, if they order from the company I work for (albeit in a far-removed branch).
I work in the central pharmacy at Johns Hopkins Hospital. We have every medication known to modern medical science, at hand, or available within 8 hours.
Re: Oxycontin and other narcs, there are often safe-style machines which can only be opened by specific codes. Pyxis is one of them.
[QUOTE=gotpassword
As for pharmacies being able to predict that a given medicine will be needed on an ongoing basis to cover refills, [/QUOTE]
It’s easily possible to do so, though whether it’s actually done depends on the pharmacy’s desire to implement it.
Where I work, we don’t have refill prediction, but if you use the automated refill system, it’s (supposed) to be ordered if necessary.
I live in a rural area, and my wife has a condition that requires meds “as needed”
Once we failed to keep an eye on the supply, and the local pharmacy was out, as it was not a common thing. The Pharmasist called a place in bordering state, and got it delivered in a few hours. Igot nothing but good to sat about them here. They care more than the doctors.
We have our prescriptions filled at a big chain grocery store. We’ve been using the pharmacy there pretty much since the day we moved into town (almost 9 years ago), and while I tried other pharmacies (Walgreens and CVS are also close by), it’s just super convenient to use the grocery store where I shop every week. I am so well known there that a couple of the pharmacy assistants know me by sight, and will pull the prescriptions while I’m still waiting in line.
Our son did take a compound prescription that had to be mixed in the pharmacy, and for that, we had the pharmacy at the doctor’s office mix it, since the doctor knew he could do it correctly, and the office was less than two blocks from my husband’s office.
However, one of the meds that my son takes (Concerta) is not always stocked at the grocery pharmacy. The first few times that we brought in the script, they told us they would have to get some from another store, and that it would take two days to fill. Even now that he’s been on the same dose of the same medicine for nearly a year, they have to check their stocks when I drop off the script.
Since I fill the script the first week of every month, and since I have done so for more than a year, I think it would be reasonable for them to make sure that they have that particular medicine in stock. However, I’m sure that there is a cost issue involved. Once the pharmacy buys the medication, they are stuck with it until they sell it. They can pre-buy things like antibiotics and pain meds easily, because they can be sure that those will be sold before they expire. However, they have moved to a centralized refill system, so when I call in a refill, the central office fills the prescription and sends it to the store where I plan to pick it up.
Concerta, though, is a controlled substance, that can only be filled with a written prescription (no phone-in orders are legal) and that cannot include refills as part of the prescription. I actually plan the first week of each month so that I can call the doctor’s office to prepare the script, pick up the script in person, then drop it off at the pharmacy with at least a three-day grace period, just in case the pharmacy doesn’t actually have it in stock. My Outlook calendar always reminds me of this the last Friday of each month.
When I was picking up another prescription a couple of days ago, I was behind a couple who were having a long conversation with the pharmacist about a medication their son had just started taking. Apparently, the cost of this medication was $9,000 per month, and if the pharmacy ordered it, they would have to pay for it. Since it isn’t prescribed often, they don’t stock it on a regular basis, so the pharmacist was trying to emphasize to the parents that they needed to give them at least a week’s notice if it needed to be refilled next month.
The only time we’ve had problems was when my mom was visiting us and she needed to get some Imitrex in case she had another migraine. She travels with it, but had used it up on a bad migraine once she got here, and although her pharmacy in Quebec will basically give it to her on demand, pharmacies in Ontario are not allowed to accept an out-of-province prescription. So we took her to the ER to treat the migraine (the Imitrex she had wasn’t sufficient) and we convinced a doctor there to write a script for 2 injections. Thing is, apparently it’s not that common a migraine med around here - this R2 had never even heard of it! My mom’s been taking it for over a decade, and in Quebec, I know a few other people using it too. Lucky for him we had the box and injector with us, so we could show him the exact product we wanted.
Anyways. we get the script and go to a pharmacy and they say they didn’t have it in stock either, and that they’d never had to dispense it before. They told us they could get it in by 5pm the next day, so that’s what we did. My mom didn’t have another migraine on the trip, which is good, but it’s always best to have some injections around just in case!
[busts out the inventory pet peeve]
One of the things that always baffled me about the medical world is slowly but surely changing in the last 10 years or so. Many aspects of medical support and infrastructure are horribly neglected because in a nutshell a pharmacist isn’t a specialist in inventory management and product usage forecasting. Computers are helping out there much of the medical world is not focused on heavy computer use outside of a few specialties. There are plenty of people out there who are great at that type of thing and could probably do wonders for the levels of service in many aspects of medicine. The downside of course is hiring additional bodies to perform tasks that are generally seen as secondary or easily performed by licenced staff during slow times. Problem being what RN wants to sit down and start checking to see if percocet stock levels are staying within safe levels based on historical usage padded to 2 standard deviations above peak usage, that would probably be none.
What many businesses fail to realize is how much money they have tied up in inventory that is not being utilized or worse being bulk ordered to save a few minutes potentially tying up hundreds of thousands of dollars on product/drugs that would take months to use up when new stock can be had in 24 hours if needed.
Nowadays some major manufacturers are running inventory levels so tight that raw materials for tomorrows work is arriving no more than a day or two before it is needed on the production lines. Medical needs a little more of a buffer than that IMHO but just goes as an example. When many hospitals are looking to cut costs, proper forecasting of many of the products a hospital consistently uses can make a huge difference not just in cost but the headaches associated with storing, tracking, and investigating shrinkage on those items.
A 10% margin of error in almost every manufacturing and distribution operation I have heard of would be considered atrocious. My last job doing supply chain work 2% variance was the maximum acceptable. 5% errors would inspire visits from regional management for spot audits and ass kickings if called for.
[passes out and falls of soapbox]
Sorry, Qadop I don’t remember the name, or purpose, or the medication, and it’s been over 10 years. I just remember because I got pissed at the doctor.
Bob
We should have thought of that. At the time my husband just wanted to get the heck out of Dodge City Hospital, and not hang around waiting for a prescription to be filled. It did not even occur to my that our trusty grocery store wouldn’t have it (as I said, this was just when the robberies were beginning). When ValleyGirl was born, they gave us her prescription a few hours before discharge so my hubby could go get it filled before we got all bundled up to go, which made sense to me.
Good advice, thank you.
And, JPen, I agree now that it put them in an awkward position for me to call, but at the time I really was discombobulated and at a loss for what else to do.
Here is an explanation of the FDA drug schedules
As far as the count being off on a particular perscription, most community pharmacies use techs, who type the label for your pill bottle, get the container off the shelf & count out the prescribed # of pills. The container, and the counted pills still in the tray, along with the labeled bottle with the patient’s information, and the perscription are left for a pharmacist to check. The pharmacist is supposed to count the pills, check them against the shelf supply, then against the perscription.
In many busy pharmacies it isn’t done as thoroughly as it should be. I’ve gotten a perscription with my first name, wrong last name, wrong DOB right doctor, right generic name, wrong proprietary name, and wrong drug. The tech who handed it to me said every thing was right when he filled it, that the pharmacist must have changed it. Unfortunately, a pharmacist never checked it because they were “too busy.”
Luckily, this isn’t too common place, but it happens more often than it should. When ever you pick up a perscription, check your information, be sure you know the name of the drug you’re to get. If you’ve had it before, look at the pills to see if they are the same. If they aren’t ask to speak with the pharmacist. It could be they look different because they are using a different generic brand, but it could be they were incorrectly dispensed.