I am not seeking medical advice. I have a question having to do with the current health care system in the US.
Every now and then I have a medical issues that requires me to make a visit to my primary care physician. After a thorough examination he usually prescribes a drug that I can then get filled at my local pharmacy. I assume it works the same way for most people in the US. And like most people, I have medical insurance that is provided by my employer.
Recently, for the second time in 6 years, I contracted Bell’s Palsy, a fair rare condition that causes paralysis of half of my face. I marched down to my PCP and he prescribed the usual two prescriptions, a corticosteroid and a antiviral. Since they have no idea what causes it there isn’t much they can do about it, and last time it cleared up after about 5 weeks. This time around I am having pain that I didn’t have previously, so the doctor prescribed Gabapentin for ‘neuropathic pain’. Once again I went down to my local pharmacy and filled the prescription.
We’ll see if this new drug helps, but as I was walking out of the drug store I started thinking that in all my life I have never gone to the drug store and had them say sorry, we don’t have that drug. How is that possible? There must be thousands of possible drugs that can be prescribed, yet they always seem to have what is ordered by the doctor.
So do doctors limit their prescriptions to drugs that are likely to be stocked by most drug stores, or are drug stores required to stock a certain amount of everything just in case someone happens to walk into their store with a prescription? I live in a small town (<1000 people) so I doubt it would be the same as a pharmacy in a large city.
I asked this question once here a long time ago. It didn’t seem like it was possible for them to have every type of drug available usually in multiple sizes especially since their shelved usually look half empty. It turns out that there aren’t as many drugs as you think there are and there are some things a pharmacy won’t have if you show up and want it right then but they can get it quickly.
Bell’s palsy is not all that rare, but, in any event, the drugs your doctor prescribed can be used for many different problems. Corticosteroid and antivirals are quite obviously used for many illnesses. Gabapentin is, as you said, used for “neuropathic pain,” which can have many causes. A pharmacist can also construct a prescription from medicines he has on hand, if necessary.
Yes I’ve had situations picking up medicines for my wife that they didn’t stock and had to order. Once they were even out of stock of a fairly common thyroid medicine in the right dosage. They gave me a temporary supply of half dosage pills and siad to take two.
Walgreens and my local supermarket chain pharmacy have both been “almost” out of the drug I take for my migraines which is also used to treat other conditions. Multiple times they have only been able to fill a partial when I was out (and I cannot stop taking so I could not just wait) and had to come back a day or so later when they got the rest in. So they did not even have 1 month on hand for 1 person. They only had like 3 days worth, and it’s not a short-term like drug, AFAIK, since you have to taper on and off.
You have been lucky then, it has happened to me more than once (in both the USA and the UK).
Also, about 90% of the times I order a prescription I phone it in first, and am usually told it will be ready in two or three days time. No doubt this is usually because they like to count out the pills reeeeeaaaaallllyy sllllowwwwwwllly (when I don’t phone in advance it usually only takes USA pharmacists about 20 minutes, or British ones about 3 minutes), but in some cases they may be needing the time to bring in the stuff from somewhere else.
My wife and I used to get our prescriptions filled at a small neighborhood pharmacy, and it wasn’t at all unusual for them to be temporarily out of what I assume were pretty common medications (for high blood pressure and high cholesterol). When that pharmacy folded a few years ago we transferred our prescriptions to a local CVS and they have never been out of those same medications.
It’s happened to me once or twice, and happened fairly often to my son when he was at school in a small town. They were usually able to find some at a pharmacy nearby, or, worst case, get it overnight.
My wife has a rare autoimmune and all the Pharmacies never had the medication she was using. It was always ordered from the manufacturer, but this was a rare drug, $4000 a shot and a short shelf life.
Perhaps the most widely known case of the the pharmacy having something for years and then not having is quinine sulfate. It was discontinued everywhere in the US a few years ago.
Who cares about Heroin? DARVOCET is the critical drug that is no longer available! My friends and I (all with chronic pain) soon expect to be encountering shady people in parking lots, waiting to hear, “Pssst. Wanna buy some Darvocet?”
My ENT once prescribed me an antibiotic for a persistent sinus infection that I couldn’t get anywhere. I live in a mid-size city (~400K) and called close to a dozen chain and non-chain pharmacies and nobody had it in stock. I finally called back the ENT and got him to prescribe something else. If I recall correctly, it may not have been the drug that was the issue as much as the dosage and number of pills.
As mentioned above, just as grocery stores will generally have the two or three hundred commonly purchased foods, and bookstores will generally have the most commonly requested books, pharmacies try to keep the most commonly prescribed medications. There are probably about two hundred medications that are commonly prescribed, with a few dosage sizes of each. Gabapentin, certain steroids, and certain antivirals are among these.
Sometimes you need to go to an old fashioned pharmacy that compounds their own prescriptions. I needed it once when the doctor prescribed an unusual dosage on a particular prescription.
My comment was probably more snarky than needed. But I am bitter. I am just getting over a particularly excruciating episode of lower back pain. I went to the urgent care they gave me a shot of something I forget what but when I looked it up online it was said to be related to heroin. It did nothing for me. I got the Vicodin it made me nauseous but did not result in pain relief.
More on topic I was listening to an NPR story about pharmacies no longer providing Oxycodone because they were getting robbed over and over by people looking for Oxycodone.