Solving a mystery … one clue at a time

There is this mysterious section of many of our grocery stores, and similar mysterious places that seem to be cropping up on every street corner.  When we enter these places it may seem that the employees are speaking in some special slang or perhaps another language altogether.  If we don’t need anything from this mystery area there seems to be no one waiting in line, but the moment we need something, there is a line a mile long.  Sometimes the wait for your order feels like half of an eternity.  You may also feel embarrassed to ask about what was just handed to you.  There are sometimes methods for pre-ordering what you need to make pick up quicker, but it can be challenging and there are still lines to the cashier.  The staff is competent but obviously overworked.  They also often have several accessory items on shelves and displays in their section.


No, I am not talking about a coffee chain.


I am talking about your local pharmacy.


When Grandpa came to live with me I found myself tossed into the deep end of a lot of things I’d never dealt with before.  One of those things was dealing with prescriptions.  I was suddenly responsible for making sure Grandpa’s prescriptions were filled on time, for making sure he was taking all of his medications correctly and keeping track of it all.  I also had to deal with figuring out things like Medicare (parts A, B, and D), supplemental prescription coverage and the donut hole.


I had a wonderful resource that not many people do, my sisters.  They are both pharmacy techs and when I had questions I knew I could turn to them.  They helped me make sense of what seemed to be the biggest convoluted mess I’d ever seen.


I can’t exactly share my sisters with everyone else and much of the advice they gave me for Grandpa was very specific to his situation with his insurance(s).  What I can do is ask my sisters about some of the more general mysteries of your local pharmacy and pass on the information to you.


One of the first things my sister mentioned when I brought this up was regarding seniors with memory problems.


Going to the pharmacy can be a confusing experience for many seniors, especially when they have memory issues.  When a senior with memory issues goes to the pharmacy they need someone to go with them who can ask the pertinent questions and understand the answers.  This person should also be willing to help this person in making sure they are taking their medications correctly.  When a senior with dementia doesn’t have assistance with their medications they may; forget to take the medication, overdose on the medication; take the medication the wrong way; or take the medication at the wrong times.


I need a shot, should I get it at my pharmacy or doctor’s office?


I had quite a surprise the first year Grandpa was with me.  We were at his doctor’s office and discussed with his doctor about Grandpa needing a tetanus booster shot.  The doctor wrote up the order and a few minutes later his nurse came in and gave Grandpa the shot.  A few weeks later we received a bill from the doctor’s office for that shot.  Between Medicare and supplemental insurance Grandpa never even had a co-pay, so I was shocked.


I found out from one of my sisters that some shots are covered by part A or B (ER part or doctor part) of Medicare and others are covered by part D (the prescription part).  It all tends to get rather convoluted as to who covers what.  The best advice I can give you is to contact whoever is your prescription coverage and ask them about the shot you need to get and if you should be getting that shot at your doctor’s office or at your pharmacy.  Basically, for billing purposes, if your prescription plan covers the shot you should do it at the pharmacy.  If it doesn’t, then check with your Medicare part B to see if they cover it at your doctor’s office.


Here’s a helpful link to further clarify what Medicare part covers what:


I wonder if my prescription plan will cover … ?


If you are asking your pharmacy to check into coverage for something specific; like shots, diabetes supplies, or other disposable medical supplies, be patient with the staff.  They will need some specific information from you before they can look for the information you need.  You will need to have a doctor’s prescription for the item, and your insurance information.


The best way to figure what’s covered would be to go to the website for your insurance plan.  Here’s another website that may help you navigate plans.


Every year insurance companies change what they cover and how much they cover, so the pharmacy staff have no way of memorizing this information.  Each time a request is made they have to research it like it was the first time.  Again, the fastest way to find out specific coverage information would be to use the above link to the Medicare website.


My doctor wrote me a prescription and when I got to the pharmacy I got a generic …


Most insurance companies will prefer generic drugs to be used whenever possible.  If your doctor feels that you really need the brand name version of a drug he/she can specify that on the prescription.


Keep in mind that if brand name medications are specified your insurance may decline to cover, or your co-pay will be much higher.


I got a letter from my insurance company to bring all the medications I take in to my pharmacist for a consultation, why?


If you have been seeing multiple doctors or visiting multiple pharmacies without sharing your full medication list you may want to inquire at your primary pharmacy to ask if you could schedule a consult with the pharmacist to go over all of your medications to check for therapeutic duplications.  This is a service that most pharmacies offer.


A good preventative measure to make sure you avoid therapeutic duplications as much as possible is to stick with just one pharmacy to fill your prescriptions.  The other is to always carry a current list of all your medications (including over the counter) with the dose and what it is being used to treat.  Show your list to every doctor at every office visit.


My doctor has prescribed me a new medication, how do I make sure I know what I need to about it?


While in your doctor’s office, ask them about the medication.  Ask them how they want you to be taking the medication.  Ask them what condition specifically this medication is supposed to be treating and how this medication is supposed to cure or treat the condition.  Ask them about potential side effects and how to respond if you have any.


Also ask your doctor if this medication is to be replacing another medication.  If it is, ask which one and request to have those instructions included on the prescription.


When getting your prescription filled speak with the pharmacist about any specific details of taking the medication, such as; best time of day to take, if you need to take the medicine with or without food, and if there are any further side effects to be concerned about.


If this new medication is replacing an existing one, let your pharmacy staff know so they can mark your old prescription as being inactive.


An important additional note is that if you are getting a new prescription or a change of dose you should never leave the pharmacy without speaking with a pharmacist face to face.  In some states this is actually required by law.  This ensures that for each new prescription or change of dose you have the opportunity to receive the counseling from the pharmacist to help you make sure the medication is taken appropriately.


My doctor has changed the dose of a medication I’m already taking, does he need to send anything to my pharmacy?


Yes, even though it’s the same medication this is considered a new prescription and your doctor will need to send it to your pharmacy just like any other new medication.  Make sure this is done the same day as your doctor makes the change, regardless of how much of the medication you have at home.  Ask your doctor to include the fact that this is a dose change on the prescription instructions.


I am concerned about running out of my medication, how soon can I put in a refill request?


While this varies based upon your insurance company and the medication in question, the general rule of thumb is that most insurance companies want you to have gone through 75 to 90% of the last fill.


My pharmacy says I need a prior authorization from my doctor before my insurance will cover my medication.  What does this mean?


Basically your insurance company has a list of medications that they will agree to help cover for your specific plan, this is referred to the formulary list.  If the medication in question isn’t on this list that may be the reason for them to need a prior authorization.


The insurance company is looking for the doctor to tell them why you need the medication.  What specific condition is being treated and why another, approved medication won’t do the job.


In the end, if your insurance company chooses to deny coverage, you can still pay cash for the medication to get it.


Final information for a happier pharmacy experience:


Please remember that your pharmacy staff are busy all the time.  Even if there’s no one lined up at the counter they’re dealing with filling prescriptions, making and receiving calls and tying up tons of paperwork.


Be patient with them and try your best to plan ahead for your needs.  If you know something is coming up where you need additional assistance give them a few day’s heads up.  This will give them time to find the answers you need – and make sure they’re the right answers.


If your pharmacy has a phone-in or web based refill system consider using it to reduce wait time while at the pharmacy.


To be perfectly honest, from my own experience in dealing with Grandpa’s pharmacy I found that by being patient and planning ahead I received excellent information and help.



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