Pharmacy Rant Re: Eliquis - But not Entirely About Eliquis

[Aspenglow]

We’ll agree that the pharmacist was in the wrong, and agree to disagree on how to approach letting the pharmacist know that.

[Ellecram]

@Hari_Seldon

Just for the record, I take Apixaban (the generic name for Eliquis) and I just looked at the receipt. The pharmacist paid (all prices in CAD) $24 for 60 pills (5 mg) plus $1.56 to the wholesaler and their fee of $10.50, for a total of $36.06 of which insurance (from the province) paid $24.52 and I paid $11.54. I take it twice a day so that is a 30 day supply..

Thank you for sharing that. I am happy to hear your medical needs are taken care out with minimal effort because you have humane systems in place. You live in a country that treats its citizens with respect.

I’ve always had excellent health insurance and never encountered anything like this. So I guess my many years of feeling cared for and protected are a thing of the past. It also makes me even more wary of retiring and having to deal with the nightmare of Medicare.

I’ve been watching both Eliquis and Xarelto and their slow slide towards generic availability.

Xarelto started it’s rollout this year and it has been exceedingly slow. A bit like watching ice cubes get smaller in the freezer.
The helpful Rite Aide pharmacist explained this slow rollout protocol to me on one of my last visits to that pharmacy.

Eliquis is due to be generic in 2028 which probably means 2030 in real life.

[puzzlegal]

@Ellecram

Or at the very least take me to the back of the store or somewhere more private. This happened at the store counter in full view of all of the workers and customers behind me in line.

If i had been a customer being you in line, i can assure you that i would have been appalled at the pharmacist. She embarrassed herself far more than you.

I’m fact, there’s a pharmacy near me that i won’t go to because last time i was there:

1. the customer looked for their loyalty card, but couldn’t find it, so they asked the cashier to ring it up without that.
2. the cashier refused to do so, and insisted the customer keep looking.
3. i asked to get free covid tests (which were available then, with some paperwork) and the cashier and the pharmacist got into a fight about who was going to carry the tests from the front (where there were stacked) to the back (where the pharmacist needed them to do the paperwork). The idea that i would be happy to carry the damn things apparently didn’t cross their minds.
4. as i was waiting for the pharmacist to fill out that paperwork, the customer from (2) complained to the manager about being bullied by the cashier. And the manager sided with the cashier, and also bullied the poor customer.

That customer did nothing wrong. She just wanted to buy something and get out.

The pharmacy is broken, though. As best as i can tell, they all hate each other and their customers.

It’s a CVS. The other CVS is town seems to be fine. Really weird. But i think this one is just really badly managed.

Anyway, your transaction sounds intensely unpleasant. But i bet the customers behind you in line are thinking they don’t want to go back, too. And I’m certain that not one I’d turn blames you.

[susan]

@Aspenglow

Say the word, “HIPAA!” in a very loud voice. Turn around and look the closest next-in-line person right in the eye and ask, “Is there anyone in this line who didn’t hear this pharmacist disclose my private health information?” Turn back to the pharmacist and say, “Would you like to continue violating HIPAA law and have me report you to your regulatory agency for doing so, or would you prefer to treat me with some common respect and decency as we conclude this interaction?”

So sorry. This ^^^.

[Ellecram]

@Aspenglow

The reason I consider this an important part of the exchange is to establish that the pharmacist is already speaking in a voice loud enough to involve other patients. You say you’re not listening to any of my transaction, but based on the scenario outlined by the OP, is that true? Aren’t you already uncomfortably listening to the loud pharmacist complaining about the cost of my Eliquis prescription to the pharmacy?

I recognize this approach is far more confrontational than most people are comfortable with, but the work I do regards PHI as inviolate. I would want to remind the pharmacist of this. I’m sure it’s not an approach many would take, including you. But I would.

Yes that pharmacist was way out of line. I’ve learned to be professionally confrontational in my line of work but this hit me out of the blue. Wasn’t expecting such an attack over a routine transaction. I appreciate suggestions for future conversations should the need arise.

I work in county government and had a brief conversation with my Human Resources Director just to make her aware of this incident. She told me that this pharmacy is sponsoring a flu shot clinic at the courthouse in a few weeks and that she would have a word with the main pharmacist/owner about the situation. I told her I was fine with that.

I thought about this a bit more and decided that once I get my prescriptions safely transferred to Walmart I plan to escalate this a bit. I have to research the pros and cons of how to go about doing this for maximum impact.

All my life I’ve fought back on more issues than I care to remember for my brother, my father, my son and various other family members.

I guess I am going to have to put those skills to work for myself and possibly my coworkers.

[Aspenglow]

@Ellecram

I guess I am going to have to put those skills to work for myself.

Sadly, I fear we are all in this boat now.

[Pork_Rind]

Just another data point from my recent experience…

I’m currently taking Zepbound, which would be $1100 a month but a manufactured discount card gets it down to just about $500 a month for me. After I got fed up with the poor service at my CVS I switched my prescription to a local independent pharmacy. The pharmacist there sat me down quite apologetically and explained that because they have less buying power, they are actually paying more to their wholesaler than they are are allowed to charge me under the discount program. As I recall, basically what he told me was that they would continue to fill the prescription, but they would genuinely prefer if I go back to CVS for it.

[Aspenglow]

@Pork_Rind

The pharmacist there sat me down quite apologetically and explained that because they have less buying power, they are actually paying more to their wholesaler than they are are allowed to charge me under the discount program. As I recall, basically what he told me was that they would continue to fill the prescription, but they would genuinely prefer if I go back to CVS for it.

This is the way to handle it, seems to me. I assume the discussion was private and not engineered to embarrass you with your own private health information.

[susan]

I’ve been pretty happy with CostCo pharmacy. They’re indifferent to me, but they fill my scrips very quickly and clearly have giant buying power. I also liked Postal Prescription Services for the samr reasons, but as delivery services have eroded, I’d get my FedExed injection medication warm in the sun on the porch a day late.

[Ellecram]

@puzzlegal

Yikes! That CVS pharmacy sounds like a madhouse and I would not feel comfortable going there at all.

[Pork_Rind]

Yeah, it was a totally appropriate conversation, handled professionally. The weird thing though was that I didn’t actually get the prescription transferred immediately, so the next month when I called for my refill, the answer was almost instant, “It’s out of stock at the warehouse.” I got the same answer the next two or three times I called. To be clear, in no way where they looking that up. It was just the stock answer. So essentially they did decide to decline my refill. They just wouldn’t own up to it.

[FinsToTheLeft]

@Aspenglow

Say the word, “HIPAA!” in a very loud voice. Turn around and look the closest next-in-line person right in the eye and ask, “Is there anyone in this line who didn’t hear this pharmacist disclose my private health information?” Turn back to the pharmacist and say, “Would you like to continue violating HIPAA law and have me report you to your regulatory agency for doing so, or would you prefer to treat me with some common respect and decency as we conclude this interaction?”

Being Canadian, we don’t have HIPAA but we do have similar privacy laws.

I have a pituitary tumour which has messed up my endocrine system and is treated with a medication that I will be on for life. I went to my usual chain pharmacy to get my refill and the regular pharmacists were either not there or helping another customer. They had a new pharmacist who demanded to know why my endocrinologist had prescribed this medication for me, with a line up full of people standing behind. Rather than replying loudly that it was to help treat my lack of testosterone production and resulting impotence, I explained that my Dr. felt it was required and I was not discussing this with her. I ended up firing off a written complaint to the head pharmacist.

[JRDelirious]

@Aspenglow

@Pork_Rind

The pharmacist there sat me down quite apologetically and explained that because they have less buying power, they are actually paying more to their wholesaler than they are are allowed to charge me under the discount program. As I recall, basically what he told me was that they would continue to fill the prescription, but they would genuinely prefer if I go back to CVS for it.

This is the way to handle it, seems to me.

Quite so. There’s no need to figuratively slap the patient.

And ithis is reflective of another of the many issues with the US health care system. Independent and small providers get screwed by the insurers and payment processors who will negotiate deals with the large chains and large hospital systems who in turn can negotiate deals with the suppliers. The economies of scale of the Big Customers get baked into what the insurer is willing to pay regardless of what it actually costs the small or individual provider who can’t get a discount deal from the Pharma companies, but are bound by the network contract to deliver on the insurer’s terms.

[scotandrsn]

The 90-day thing about the previous refill is sn insurance company thing. My own insurance sprung this one on me a couple of years ago. Anything you’re on regularly long-term is designated a “maintenance medication” and insurance will only cover it if a 90-day supply is prescribed. I’ve suffered endless nonsense between my pharmacy and my Dr.’s office over this.

Bristol-Meyers-Sqibb offers a discount card to help with the steep co-pays.

Savings and FTO | Rx ELIQUIS® (apixaban) | Safety Info

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@scotandrsn

Bristol-Meyers-Sqibb offers a discount card to help with the steep co-pays.

Very useful to know. Thank you!

[BippityBoppityBoo]

@scotandrsn

Bristol-Meyers-Sqibb offers a discount card to help with the steep co-pays.

Those discount cards never work with government insurance like Medicare or Medicaid so keep your hopes proportional.