In pursuit of prescriptions: cultivating an effective, productive rapport with the pharmacy

One of the downsides of (1) getting older and (2) having a chronic condition is that you have to take a lot of medications.  Depending on your health plan, some of the drugs can be costly.  Even if the prices are reasonable, it can be time-consuming to keep track of ordering refills before they run out.  I am also finding that sometimes I have to play Nancy Drew to get to the bottom of prescription mysteries.

It helps to establish a good rapport with the pharmacist at your local pharmacy and with the customer service representatives at your mail order pharmacy.  Trust me, you may need to contact them if something goes awry in in the mail order process.  I always keep in mind that whatever the issue is, the person answering the customer service number did not cause the issue.  In other words, stay cool and pleasant with that person.

My insurer encourages clients to order long term prescriptions through the mail order pharmacy.  I have about 6 medications that I get via mail order at this point.  I have to get my beta blocker (carvedilol) through the mail.  This is because I needed to order the product made by one specific manufacturer as my retail pharmacy does not get carvedilol from this manufacturer.

I have used the mail order side of my prescription plan for 18 months now. I always find the representatives and the pharmacists I have talked with at the prescription plan website to be very efficient, pleasant and helpful.  This is a good thing because I have had to make a number of calls in the last 6 months.  I was beginning to wonder if I had a black cloud over my head.

The first issue arose in February with a renewal of my carvedilol prescription.  Because the initial prescription had expired, I received an e-mail stating that the pharmacy had sent a request for authorization to my cardiologist.  The authorization was provided promptly to the plan – all good so far.

Normally once the prescription is filled, it is picked up and transported by a private mail carrier to the city where I live.  But instead of bringing it directly to my residence, the carrier takes the prescription to the local United States Post Office.  I am not sure why there are two layers to the delivery, but up until February 2017, it seemed to work fine. 

I received a notice on a Friday afternoon that the Post Office had delivered a package to my mailbox.  I thought this was strange because normally any package is left at the front desk of our building.  So I went to my box and checked it, and there was no package waiting for me.  I checked at the front desk and there was no package waiting for me.  I also learned that the regular mail carrier was off on that Friday. 

I called customer service and reported that the package appeared to have been misdelivered.  They could not issue a replacement prescription until it had been lost in the mail for a month.  Alas, by that time I would have been out of my beta blocker for a while.  Fortunately, there was another alternative that allowed them to issue a second prescription.  That prescription arrived within about 5 days. 

With respect to the lost prescription, I reached out to the Post Office supervisor.  She instructed my regular mail carrier to check all the boxes in my building with no luck.  Finally 11 days after the original notice of delivery, the package was left on the front desk at my building.  It appears it was put in a post box at another high-rise building in my neighborhood but eventually found me. 

Around this time, my insurer approved my doctor’s request to prescribe Prolia, an injectable osteoporosis drug.  Initially, my doctor believed a local hospital’s injection center could get the drug and administer it. But we learned that the insurance company had only approved for me to get the drug from a pharmacy.  So I would have to get the drug on my own and bring it to the doctor’s office to get the injection.

I went to my retail pharmacy.  The pharmacist was not familiar with the drug (I guess he hasn’t seen the Blythe Danner commercials).  He said he could order it but told me I should check with my insurance to see how much my co-pay would be before I ordered it.  I used my plan’s on-line calculator to try to figure out the cost.  The problem was that I thought I only need it twice a year, but the calculator questions did not fit that scenario.  So I called customer service. 

I found a representative who could answer the cost question, and a pharmacist who could provide information about the drug as well as storage instructions.  Fortunately, while the drug is very costly, my co-pay is quite reasonable.  I also learned that the drug has to be refrigerated.  Given my recent experience with lost drugs, I decided to forego mail order and get it from the local pharmacy. 

My retail pharmacist was able to get the Prolia within three days.  I picked it up and drove to the doctor’s office for an injection.  When I was there, I learned from the nurse that some patients had to pay a co-pay five times the cost I had to pay.  I was grateful that my co-pay was so reasonable and that I found such helpful people to guide me at both the mail order pharmacy and the retail pharmacy.     

In April, I was running low on another drug.  It is not a heart drug, and I take a very small dose and I do not take it every day.  Because I was out of refills, the mail order pharmacy needed to contact the doctor’s office.  I advised my doctor’s office that the request for authorization. 

About 5 days later, I received an e-mail from the mail order pharmacy that said the prescription was in the process of being shipped and they would update the information shortly.  Then I received another e-mail saying that the prescription was under review.  I e-mailed customer service asking which advice was correct – was the prescription being shipped or was it under review, and if so, why?  I received a response two days later stating that the original prescription was shipped and that they had also sent an early refill.  I have no idea why they did this, but since it was in the mail, I couldn’t stop it.

A few days later I received the initial prescription.  Then I got an e-mail from the mail order pharmacy stating that there was a prescription that was about to be filled.  I was confused because I had no outstanding prescription requests to my knowledge.  I looked at my on-line account.  While there was an indication that a new prescription was being processed, it did not list a drug name or quantity.  I called customer service.   The representative also could not figure out what the drug was or the quantity.  He connected me with a pharmacist.  She found that it was yet another prescription for the same drug that had just been both filled and refilled.  So I asked her to cancel the order.

The next day I received an e-mail stating that the early refill prescription had arrived at my local post office.  But it was immediately sent to a post office in another city about 10 miles away from me.  I have no idea why. 

In the meantime, I looked on the prescription plan’s website and saw that another prescription pending for the same drug under review.  It had been a long day and I was a bit frazzled.  So I sent a brief e-mail to customer service stating that I did not ask for another prescription refill.  I went to bed hoping that the system would update overnight and reflect a cancellation.

But of course, that did not happen.  On the upside, I had a really good night sleep, so after exercising and getting a cup of coffee in my system, I called the mail order pharmacy and was connected to a really pleasant representative.  I told her my tale of woe of the Zombie prescription that would not die.  She assured me that she would cancel this order. 
 
The customer service representative said it appeared that the pharmacy continued to receive orders from the doctor’s office.  So I advised I would call the doctor’s office and let them know what was happening.  I did this as soon as I got off the phone with customer service.
 
Happily, it appears that the Zombie prescription has taken her final breath.  I don’t know if a technology glitch was corrected, or whether it was just my persistence.  But it was an overall good experience because I was able to find out that there are some very nice and friendly people at my doctor’s office and at the mail order pharmacy.  So I will continue to use mail order, but will monitor each prescription closely until I get it.

Oh, and my early refill prescription traveled for just a day or so more.  Then it got tired of seeing America and showed up on my doorstep.