I don’t understand how it can possibly take 2 hours to count a couple dozen pills, throw them in an orange tube, and slap a label on it. Maybe a pharmacy tech can enlighten me here.
Beyond that systemic problem that adds delay, actually dispensing the prescription is not the rate limiting step. When you get a prescription there’s a whole list of things you need to do before it can be dispensed. In no particular order:
Select the right drug which seems easy but the prescriber may have used an old brand name, or misspelled it, or put in something that doesn’t exist.
Calculate days supply (easy for pills, not so much for insulin, creams, eye drops, etc.)
Find the correct doctor in the system
Find the right patient’s profile and see if they really fill at your store
Transcribe the directions in a way that makes sense in less than ~200 characters to fit on the bottle.
Check to see if the patient already has another prescription on file they are in the middle of the refills for so you don’t have two active prescriptions.
Check to see the prescription has all the required information on it to be filled based on state requirements
Send the finalized prescription to the patient’s insurance which inevitably is rejected because of some minor issue with any of the above, or it is expired, or requires prior authorization, or they changed their name, or it is too soon, or it’s not the proper moon phase.
Actually fill the prescription which requires finding it on the shelf which is a mess because you fill ~500 prescriptions a day
Scan the bottle to make sure it’s the same as what you billed the insurance, but if you picked the wrong generic brand on the first step you get to start over.
Clean the counting tray
Count the pills
Get the right vial and label everything with the stickers, and if you need more you need to print more out but someone else has a 50 page print job ahead of you and it’s out of labels
Answer the phone
Answer the drive through
Answer the patient at consultation
Answer the patient at the cash register
Send it to the pharmacist for review which is a huge process on it’s own which requires looking for interactions, appropriate dosage, correct drug for the disease indication, and simply reviewing you got everything transcribed correctly which if it isn’t you get to start all over. Plus there are 50-100 prescriptions already waiting for review.
Process a vaccination patient
Add water to a reconstitutable (powder) medication
If Poseidon wills it, the prescription is approved and then you get to bag it, then put it in the right spot in the bins so it can be found.
If it’s a controlled substance you need the pharmacist to do about 50% of the steps above and access the safe which is a whole process. In the meantime they are on the phone with a doctor or some insurance trying to get something clarified or approved. Or compounding someone’s diaper cream. Or doing vaccinations. Or counseling someone on their antibiotic. Some drugs have mandatory monitoring programs you have to enter information from the doctor before they can be dispensed. Some drugs require a dosage syringe, or intramuscular syringes, or needle tips.
Wow, that is a lot more manual work than I expected. You have to rewrite the directions too? I imagined the prescribing doctor would do that, then all you have to do is look up the order on the computer and print out the label.
Thank you for the explanation, the whole process seems like it could be made more efficient.
Last prescription I got was antibiotics and steroids for an ear infection. The doctor indeed did give me dosage and schedule. Then the pharmacy also gave me instructions, and they were different. Seeing how each Doctor hopefully keeps up with their field and most likely can’t really with others, I’d say the pharmacy instructions are usually safer unless the patient has specific circumstances only the prescribing doctor is aware of.
Sometimes the doctor will write something in latin abbreviations so you have to translate that and write it out in plain text but you typically want to make sure the entire directions can fit on a single label. If you just say “see attached directions” then you may not get paid for the prescription if their insurance audits it they will take back any payment they gave to the pharmacy because you dispensed incorrectly. They may also just write something unhelpful like, “as directed in discharge paperwork” or “to be dosed by pharmacy” or something really long that can’t easily fit.
That said it’s been several years since i have been there so there may have been more enhancements.
All the other people who have ordered meds before you. Also where you told a two hour wait time in person? That’s a little suspect if it’s not a huge order. I worked a very busy pharmacy, and if you are waiting in store we rarely had to ask more than a half hour. In fact a half hour is rare, but a rush when we are short handed…
But if you call ahead or order online, that yea you are just in the line of a few hundred people who needs rxs filled.
My CVS went through a period at one time where even in person prescription, they would ask me to come back later to pick it up. CVS treats its employees like trash, but apparently customers got mad enough that they finally hired some more people because that hasn’t happened in a while.
Corporate CVS is absolutely terrible, to the customers and employees. As a pharm tech, my supervisors (the pharmacists) were awesome. The company was shit to work for and I understand completely how customers feel. Unless you live in a city with like a thousand CVS locations and the multiple locations makes a big difference to you, avoid them.
If you live in a small town type area and that one CVS is all you have? Ask to talk the pharmacy manager. They are one of the two or three pharmacists you see all the time. They cannot stop all the robo calls. But they can make sure that most of the time (that one person is not there every day)that your shit is ready when you want it. Again, CVS sucks but they are forced to hire real people.
I can walk to CVS from my house. That’s the main reason I stay at this pharmacy. The staff there know me and I like them. But fuck the corporation for real.
I can’t understand that you guys are at an (probably minimum wage) employee’s mercy to put the right pills into the right container to get the drugs you actually need and not something that kills you.
In Germany virtually all medications are brought to the pharmacy pre-packaged and (as of this year) stamped with a batch number on the outside and on each inner container, so you can be absolutely sure what’s inside really is what it says on the outside.
I mean, filling the tubes could be done so much faster and securely by a machine.
Pharmacy techs actually make a pretty average salary (40k median), closely supervised by a pharmacist with a doctor of pharmacy degree who makes a pretty decent salary (136k median).
I don’t work anywhere near pharmacies or healthcare but I’m sure they do all the same stuff you described. I’m not really sure what suggested to you that they didn’t tbh.
In Germany virtually all medications are brought to the pharmacy pre-packaged and (as of this year) stamped with a batch number on the outside and on each inner container, so you can be absolutely sure what’s inside really is what it says on the outside.
Are you saying the individually dispensed medications are all sent to the pharmacy pre-filled? That sounds wildly inefficient and inflexible in terms of transport/logistics/packaging tbh.
Sorry. I thought you were talking about bulk medications that the pharmacy uses to fill prescriptions as they get them.
I’m sure there are insane repercussions to filling a prescription wrong, especially if someone is injured. There’s also usually a description on the printed label of what the pill should look like; shape, color, unique printings, etc. Though I’ve had a medication or two that came in factory packaging cause its prescribed less often and really predictably. Tbh though, it’s just not a worry that I’ve ever had cross my mind or heard of being an issue.
Are you saying the individually dispensed medications are all sent to the pharmacy pre-filled?
This is what a box of Paracetamol (a pain killer and anti-inflammatory drug) looks like when you buy it at the pharmacy (this particular image seems to be from a different country, but they look similar).
That sounds wildly inefficient and inflexible in terms of transport/logistics/packaging tbh.
Well, yes. I get that point. It would save some deliveries to store 5kg of the drug at the pharmacy and have the containers separate. There are instances when they tell you they only have the 100-dose package on hand and need to have the 25-dose package delivered. That usually happens when you first start a long-time medication. The pharmacy will then deliver the medication to you for free (at least ours, I don’t know if that’s usual).
repercussions to filling a prescription wrong, especially if someone is injured
The trouble is, repercussions don’t help any injured person. And they require you to notice that you’ve taken the wrong medication. If you simply don’t feel better, your first instinct might not be “the drugs are wrong”.
There’s also usually a description on the printed label of what the pill should look like
We have that, to, but with a gut estimate of around 10,000 different drugs in circulation, that doesn’t really help with distinguishing them safely.
I’m very aware. I was asking why the process takes longer than the steps I described, not for people to passively aggressively state the obvious. An ex pharmacy employee gave a very well written explanation above.
I don’t understand how it can possibly take 2 hours to count a couple dozen pills, throw them in an orange tube, and slap a label on it. Maybe a pharmacy tech can enlighten me here.
I have worked in a CVS so I can answer this first hand. The main reason is every CVS is critically understaffed to the point of danger to patients.
Beyond that systemic problem that adds delay, actually dispensing the prescription is not the rate limiting step. When you get a prescription there’s a whole list of things you need to do before it can be dispensed. In no particular order:
If it’s a controlled substance you need the pharmacist to do about 50% of the steps above and access the safe which is a whole process. In the meantime they are on the phone with a doctor or some insurance trying to get something clarified or approved. Or compounding someone’s diaper cream. Or doing vaccinations. Or counseling someone on their antibiotic. Some drugs have mandatory monitoring programs you have to enter information from the doctor before they can be dispensed. Some drugs require a dosage syringe, or intramuscular syringes, or needle tips.
Suffice it to to say it is an involved process.
Wow, that is a lot more manual work than I expected. You have to rewrite the directions too? I imagined the prescribing doctor would do that, then all you have to do is look up the order on the computer and print out the label.
Thank you for the explanation, the whole process seems like it could be made more efficient.
Last prescription I got was antibiotics and steroids for an ear infection. The doctor indeed did give me dosage and schedule. Then the pharmacy also gave me instructions, and they were different. Seeing how each Doctor hopefully keeps up with their field and most likely can’t really with others, I’d say the pharmacy instructions are usually safer unless the patient has specific circumstances only the prescribing doctor is aware of.
Sometimes the doctor will write something in latin abbreviations so you have to translate that and write it out in plain text but you typically want to make sure the entire directions can fit on a single label. If you just say “see attached directions” then you may not get paid for the prescription if their insurance audits it they will take back any payment they gave to the pharmacy because you dispensed incorrectly. They may also just write something unhelpful like, “as directed in discharge paperwork” or “to be dosed by pharmacy” or something really long that can’t easily fit.
That said it’s been several years since i have been there so there may have been more enhancements.
Probably because they’re counting pills and throwing them in bottles for a lot of other people, too.
But I’m the only person that matters here.
Are you a Target executive?
All the other people who have ordered meds before you. Also where you told a two hour wait time in person? That’s a little suspect if it’s not a huge order. I worked a very busy pharmacy, and if you are waiting in store we rarely had to ask more than a half hour. In fact a half hour is rare, but a rush when we are short handed…
But if you call ahead or order online, that yea you are just in the line of a few hundred people who needs rxs filled.
My CVS went through a period at one time where even in person prescription, they would ask me to come back later to pick it up. CVS treats its employees like trash, but apparently customers got mad enough that they finally hired some more people because that hasn’t happened in a while.
Corporate CVS is absolutely terrible, to the customers and employees. As a pharm tech, my supervisors (the pharmacists) were awesome. The company was shit to work for and I understand completely how customers feel. Unless you live in a city with like a thousand CVS locations and the multiple locations makes a big difference to you, avoid them.
If you live in a small town type area and that one CVS is all you have? Ask to talk the pharmacy manager. They are one of the two or three pharmacists you see all the time. They cannot stop all the robo calls. But they can make sure that most of the time (that one person is not there every day)that your shit is ready when you want it. Again, CVS sucks but they are forced to hire real people.
I can walk to CVS from my house. That’s the main reason I stay at this pharmacy. The staff there know me and I like them. But fuck the corporation for real.
I can’t understand that you guys are at an (probably minimum wage) employee’s mercy to put the right pills into the right container to get the drugs you actually need and not something that kills you.
In Germany virtually all medications are brought to the pharmacy pre-packaged and (as of this year) stamped with a batch number on the outside and on each inner container, so you can be absolutely sure what’s inside really is what it says on the outside.
I mean, filling the tubes could be done so much faster and securely by a machine.
Pharmacy techs actually make a pretty average salary (40k median), closely supervised by a pharmacist with a doctor of pharmacy degree who makes a pretty decent salary (136k median).
Read all about it: https://www.bls.gov/ooh/healthcare/pharmacy-technicians.htm https://www.bls.gov/ooh/healthcare/pharmacists.htm
I don’t work anywhere near pharmacies or healthcare but I’m sure they do all the same stuff you described. I’m not really sure what suggested to you that they didn’t tbh.
This is an excerpt from the comment I replied to:
This is an excerpt from the comment I replied to:
Are you saying the individually dispensed medications are all sent to the pharmacy pre-filled? That sounds wildly inefficient and inflexible in terms of transport/logistics/packaging tbh.
Sorry. I thought you were talking about bulk medications that the pharmacy uses to fill prescriptions as they get them.
I’m sure there are insane repercussions to filling a prescription wrong, especially if someone is injured. There’s also usually a description on the printed label of what the pill should look like; shape, color, unique printings, etc. Though I’ve had a medication or two that came in factory packaging cause its prescribed less often and really predictably. Tbh though, it’s just not a worry that I’ve ever had cross my mind or heard of being an issue.
This is what a box of Paracetamol (a pain killer and anti-inflammatory drug) looks like when you buy it at the pharmacy (this particular image seems to be from a different country, but they look similar).
Well, yes. I get that point. It would save some deliveries to store 5kg of the drug at the pharmacy and have the containers separate. There are instances when they tell you they only have the 100-dose package on hand and need to have the 25-dose package delivered. That usually happens when you first start a long-time medication. The pharmacy will then deliver the medication to you for free (at least ours, I don’t know if that’s usual).
The trouble is, repercussions don’t help any injured person. And they require you to notice that you’ve taken the wrong medication. If you simply don’t feel better, your first instinct might not be “the drugs are wrong”.
We have that, to, but with a gut estimate of around 10,000 different drugs in circulation, that doesn’t really help with distinguishing them safely.
Imagine having medication that doesn’t already come prepackaged by the manufacturer
Ok, we’ll be able to get you a response in two hours, do you mind waiting here?
Because the world doesn’t revolve around you and there are other people as well.
I’m very aware. I was asking why the process takes longer than the steps I described, not for people to passively aggressively state the obvious. An ex pharmacy employee gave a very well written explanation above.
My country also has multiple people. Here they fill prescriptions when we arrive at the register. It’s almost as fast and easy as buying cigarettes.