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30 Responses

  1. Russell Scott
    Russell Scott October 8, 2010 at 6:08 am | | Reply

    I don’t think I have ever talked to a pharmacist it is always the counter person or a tech. they do fill a 90 day script but they chare 3 co-pays instead of the 2 co-pays that the warehouse charges. My ENDO is always willing to write 90 scripts for all my meds and I ask him to do that once a year.

  2. Scott Strange
    Scott Strange October 8, 2010 at 6:22 am | | Reply

    You know, I’ve never had any type of “relationship” with my pharmacy or pharmacist. Despite the fact that I run two or three thousand dollars thru their registers every year (and that’s just my co-pays), the only comment I get is “Do you have any questions about your medications”.

    Any other “local” store I spent that much at every month would at least know my name when I walked in…

  3. Faye
    Faye October 8, 2010 at 6:22 am | | Reply

    My husband is a pharmacy student who used to work at CVS, and he’s the one who actually encouraged me to do mail order. He said it’s cheaper, you don’t have to keep going back to the pharmacy every month, AND you don’t have to deal with the idiots at the pharmacy (mainly the clerks you mentioned).

    I for one haven’t had a single problem with CVS/Caremark delivering my insulin. The bottles are in a ziplock bag, packed with one of those Nordic ice packs, and both packages are in a foam mailer looking envelope. One shipment arrived at our apt building while we were away, and the ice pack was still cold when we returned a few days later, despite having been in our building’s basement. Since moving, I’ve been getting my scripts delivered to work.

    I’m going to show your post to my husband and get his thoughts :)

  4. Cary
    Cary October 8, 2010 at 6:30 am | | Reply

    Mail order is a very simple economic benefit. I get 3 months of supplies for the cost of 2 months from the local pharmacy. Guess what I pick? Refilling the same script 4x a year, that means I save 4 months worth of copays. Cash in my pocket. If some insulin gets baked on my doorstep, all you have to do is call up and they’ll overnight you a new batch (for free).

    I think the bills they are trying to pass are good — it will let local pharmacies compete (could be huge for warmer climates).

  5. kdroberts
    kdroberts October 8, 2010 at 6:30 am | | Reply

    I have mixed feelings and I use both types or pharmacy. Personally I would like to use a retail one, and I did/do when there was no price difference but for most things it’s now cheaper to use mail order. However, I don’t like dealing with the mail order ones. My latest gripe is that my prescription for a 90 day supply of Lantus that clearly had 3 boxes written on it was turned into 1 box by the mail order company because the number of units per day didn’t add up. So, I get to pay $75 for one box every 90 days from mail order or $50 from a retail pharmacy where I can get it filled every 30 days. No amount of “discussion” would make them change their mind.

    On the flip side, my local pharmacy (Target) has given me needles (no charge, no claim to insurance) when I ran out and forgot that I had no refill on my prescription, has given me a lot of help plus a lot of other little things that add up. Just like the Cheers theme tune said, it’s nice to go somewhere where everybody knows your name rather than having to give your ID number, name, address and date of birth.

  6. Scott S
    Scott S October 8, 2010 at 6:42 am | | Reply

    The issue seems to be that pharmacists are being disintermediated by third-party pharmacy benefits managers like the big 3 (Medco, CVS Caremark and Express Scripts). I did not have any bonding experiences with big chain pharmacies like Walgreens or CVS, but in many parts of the country, especially rural areas, that’s not the case at all. Pharmacists (even at big chains) are very much a part of the community, and are likely to remain in the same store for years and years. While the convenience of mail-order for patients with chronic medical needs is apparent, its not perfect for all scenarios. Many healthcare plans today are forcing patients to use mail-order for 100% of their drug needs, which isn’t good when you’re sick and need cough medicine and cannot fulfill it locally; at best you can use overnight delivery for shipping costs of $17.95 or more. The reality is that our existing “system” does have many flaws.

  7. Karen
    Karen October 8, 2010 at 7:03 am | | Reply

    I grew up with a hometown pharmacy – the owner went to high school with my mom – and it was a lifesaver after diagnosis. As a 16-year-old girl, I don’t know what I would have done without those guys staying open past closing time because I’d failed to call in a refill or had dropped a bottle of NPH on the floor.

    But now, living in Brooklyn and using those chains? Mail-order is infinitely easier, and certainly cheaper. I have had to get everything delivered to work, though, and if you’re trying to fly under the everyone-else-knows-about-my-D radar, that’s not an ideal situation.

  8. Brian P
    Brian P October 8, 2010 at 7:05 am | | Reply

    The retail pharmacy industry is a massive waste of talent in this country. These pharmacists go through years and years of education to do what a vending machine can do — count and sell pills. Let’s bite bullet and replace pharmacists with vending machines, and let the aspiring pharmacy students go medical school where they can actually USE their talents and gifts to HELP PEOPLE, not count out their pills.

    I patronize my local pharmacy out of the goodness of my heart. They constantly screw up my meds or run out of them so I have to come back multiple times. They do know my name, so they can say “Brian, can you come back tomorrow, we’re out of that insulin?” I’m sure they are charging a more than the mail order guys.

  9. Leighann of D-Mom Blog
    Leighann of D-Mom Blog October 8, 2010 at 7:57 am | | Reply

    I get our prescriptions at one of our local Walgreens stores. Before we moved across town, we literally walked to our neighborhood pharmacy. We now live nearer to a different Walgreens, but we are sticking with the other one.

    Why?

    Because it’s 24 hours.

    And?

    Because of Dave the pharmacist.

    Dave teases me every time I come in and there is an issue with the insurance company (not the pharmacy). He recognizes me. When I call and he answers, he often already knows what I am going to ask. He works with us to try to get the insurance to approve more test strips per day or to cover all of our prescriptions written by an out-of-state doctor.

    Granted, Dave does not work every minute of every day. But he is knowledgeable and helpful.

    AND we do purchase 90-day supplies at Walgreens. I would never do mail order if I could help it because there is nothing better than being able to go into a store and talk face-to-face with someone who knows your (child’s) name and wants to help you.

    In fact, a couple of weeks ago we were going through the annual issue of getting an override for 900 test strips for 90 days (blame this on the insurance, not the pharmacy) and Dave was concerned that we would have enough strips to get us through the weekend and was going to front us a box. What mail order company is going to do that?

  10. David
    David October 8, 2010 at 7:58 am | | Reply

    I agree that locals should be allowed to fill for 3 months. But, I can’t beat the mail order for convenience. I’ve never had an error via mail-order. A local pharmacy once gave me pens instead of vials. If I don’t pick up insulin right away, they put it in their “back” fridge and require 15 minutes before I can pick it up. With mail order, I never wait in line and there’s no way I’ll accidentally leave a scrip in the shopping cart. I briefly used local for my insulin to avoid the waste of insulin being shipped in big boxes with ice packs, but I’m over that eco-friendly phase.

  11. Bennet
    Bennet October 8, 2010 at 9:05 am | | Reply

    We have had multiple orders of insulin shipped by CVS Caremark in the dead hot dog days of summer without anything to keep it cool. It came like it had been in a metal box in the sun all day. When you think about it that what a delivery truck in August is. CVS Caremark customer service insisted they had studies that said it was safe. I am not a fan.

  12. Michael Ratrie
    Michael Ratrie October 8, 2010 at 10:02 am | | Reply

    Amy,

    I I had the option of getting my 90-day supply of insulin and test strips from any other source besides the mail order idiots @ CVS Caremark, I would do it in a heartbeat.

    I am sure it is just me AND the fact that I only “come back” to the US to get meds and pump supplies, but I have RARELY received the proper amount of insulin in the time frame “promised”. In addition, the pharmacy techs and pharmacists I speak to while trying to get the script corrected are virtually clueless about T1 diabetes.

    I always make a point of getting to know my local pharmacist, and while I agree that the “value” is not as great as their lobbyists would like to make it, there IS value there.

    Fair Winds,
    Mike

  13. Kate
    Kate October 8, 2010 at 10:10 am | | Reply

    I have been encouraged to do the mail pharmacy thing, but I truly love the peeps at my Target pharmacy. I don’t like their hours, but I appreciate the fact that they greet me by name (even if I’m close by picking up some Advil), know what my Omnipod is, and have helped me make some decisions about my meds. I walked out of that pharmacy armed with my first bg monitor and $500 worth of prescriptions when I got out of the hospital, and I will always be their customer!

  14. Mike
    Mike October 8, 2010 at 11:48 am | | Reply

    I think this issue is related to a larger issue of how does one save on the expense of diabetes. I think it would be a great blog article to think of ways to make prescriptions, medication, etc. last longer, without sacrificing management. A lot of people have insurance plans with percentage co-pays, which is very expensive with some drugs without generics.

  15. Stuart
    Stuart October 8, 2010 at 5:03 pm | | Reply

    I have CVS Caremark for prescription insurance coverage. I’ve been able to do 90 day prescriptions at my local CVS for all of this year. I love it.

  16. Chris
    Chris October 8, 2010 at 7:27 pm | | Reply

    Hello all, I’ll preface this saying that I’m a pharmacy student who has worked retail (CVS), an independent store (in PA), and currently working inpatient at a major teaching hospital.

    First, the mail order debate…I was the one that encouraged Faye (above) to go mail order for her medications simply for economic reasons. My old CVS was 24-hrs and did 4000+ prescriptions per week, we were a well oiled machine. There is no functional difference between a prescription verified and delivered by mail vs. waiting in line at the store to pick it up. Trained eyes are monitoring your medication record & fixing prescribers’ mistakes (MD, PA, NP, etc…) along the way. Chances are, if you’re on a maintenance med that qualifies for mail order, you really don’t need counseling for it each time. I’ve seen patients come in almost DAILY because their 20 medications were started and billed at different times and we were unable to sync them up due to insurance restrictions.

    Second, in terms of pharmacists & ancillary staff helping you out because they “know you,” be careful here. Corporate policies are such that giving an emergency insulin bottle to a long time patient can get you fired. Plus, with staff turnover, it’s never a sure thing. Independent pharmacies have more leeway, but because of dropping/changing reimbursements, their numbers will be severely restricted going forward.

    And to whoever said pharmacy students need to go to med school because all we do is count pills…your opinion would have been correct 30 years ago. The field has grown more clinically oriented and complex as medication use/development has expanded. It’s mostly behind the scenes…when you go to a hospital or your physician’s office, it’s still the same nurses, physicians, and assistants giving you care. What’s different now is when that physician walks out of your room, they’ll call the pharmacist for a clinical consult for your MRSA infection to make sure it doesn’t mess up the other 20 drugs coursing through your veins at that moment. It’s why the profession went from a ~3yr bachelor’s degree to a 4 year doctorate degree (requiring 3-4 years of undergrad). So, while your comment makes sense, you should probably update that view. Though I agree retail chains have yet to take advantage of new graduates and move the profession forward.

    It’s all personal preference, these laws referenced above are special interests trying to protect their piece of the market by killing off competition. It’s all about money, not patient safety/choice. Hope I didn’t ramble too much, Faye says I should turn this into a blog post, haha.

  17. Badri
    Badri October 8, 2010 at 11:36 pm | | Reply

    Amy,

    I’m from India and our medical care system and delivery is very different from the US and hence i choose not to comment on this particular post. But what caught my eye was your parting sentence “diabetes being a chronic problem”. By chronic i assume you mean ‘everlasting’ and if this is what you feel, then i want to take a couple of minutes to dispel that myth.

    That diabetes is a life-long disease is a story that has been fed to us by knowing or innocent doctors and we can choose to accept it or examine its veracity like a scientist. I choose to be a latter and when i look at diabetes (atleast Type II), I see it as a metabolic disorder or condition (not a disease) caused by wrong lifestyle choices and hence is something that is reversible if we correct the source that caused it in the first place!!

    Allopathy assumes (wrongly) that our pancreas has lost its ability to produce the sufficient quantity of insulin that is required for our body and hence takes the route of substitutes like oral medication or insulin injections. In my research, I came across several systems of medicine and therapies that firmly believe that our body is highly intelligent and is capable of healing itself given the stimulus. Do visit http://www.HealthierDiabetic.In especially the section on Treatments and Therapies to get a glimpse of what is possible.

    Please believe that you can say good-bye to Diabetes!!

  18. Laura
    Laura October 9, 2010 at 8:50 am | | Reply

    I love the mail order except when they had no more of my brand of test strips on the shelf and substituted another brand then charge me for a new glucometer as well!! ?? However, Costco pharmacy is fine for most things and they even recognize me when I go to get “need it right now scripts”Except for the time they sent me home with the wrong meds which I promptly gave to my son….No problem for him but scared the heck out of me.
    seeing as neither choice is perfect I would prefer much much prefer to have the chronic meds mailed to me

  19. Corinna
    Corinna October 9, 2010 at 12:10 pm | | Reply

    This debate was so volatile here in Hawaii that the State of Hawaii’s employee benefits department backed away from requiring their patients to use mail order. Too bad too, because it would have saved the State millions.

    The primary argument was that independent pharmacists would go out of business and rural communities would loose out.

    The secondary argument was that the medicines would come from the mainland (and not a distribution center in state) so locals would loose jobs.

    The third argument was that people couldn’t count on their medications getting here from the mainland in time and might run out.

    Not that I necessarily want to side with the insurance companies, but I think the economic benefit (all the way around) of mail order refills far out weighs the (questionable) convenience of going to Longs.

  20. Ann Gann
    Ann Gann October 10, 2010 at 6:44 am | | Reply

    I use both mail order and local CVS. My pump supplies come regularly from Medtronic – that is if I call and make sure all is in order every 3 months. I am very thankful for the pharmacists and the techs who work my local CVS pharmacy. Yes, I live in a small town and know most of the workers by name and they know me, greeting me by name, asking about family and trying hard to help me. No problem is too small for them to solve. The pharmacists will often come from behind the counter to help me look for the best over the counter medications. If I am out of a long standing medicine and the doctor has not returned a new script, they often “loan” me a few days worth of the meds until the script comes in. Then they reduce the number of pills I get. I have been able to get 3 months of meds for 2 months co-pay (a few months ago I got 3 months for 1 month copay!).
    I see from the other posts that my experience is not the norm, but I do try to be friendly with the staff (even if it is the first time I have seen them) and to always have a positive experience with them, even if something goes awry. They work in a hectic, life or death situtaion and I am just ONE of the many customers they see in a day. I want the encounter to be friendly and for them to take the time they need to get it right. I also want good service the next time I see them at the counter.
    I agree with the earlier post, that times have changed. I often need a consultation with the pharmacist in terms of my meds or those of my mother in law. I trust their knowledge more than most other doctors. I have several friends who work in hospitals and I know from them the constant consultation between pharmacists and the other doctors. We need more vigilance over our meds not less.
    Both services are needed. Each person has different needs. The meds that are standard and we have used them for years, mail order is probably great. New meds and new medical situation could benefit from quality service from a pharmacists.

  21. Steve
    Steve October 10, 2010 at 12:55 pm | | Reply

    I guess if you don’t live close to a pharamacy the mail ored is way better then visiting the retail store.

  22. dargirl
    dargirl October 10, 2010 at 2:55 pm | | Reply

    Your benefit plan controls everything. For an antibiotic, I am sick today medication I go to the local pharmacy (Walgreens). For my maintenance prescriptions the insurance company has control over that. Mail order. Having T1 for 38 years I do remember the neighborhood pharmacy. But look around closely they have disappeared. Mail order is very convenient. I get an email reminder. Time to order! I rarely have situation that I go without.

    What freaked me out recently was the statement from CVS.
    3 months supply, insulin, test strips, maintenance everyday drugs total cost $1875.00. My co pay was $125.

    If I did not have insurance I could not afford to stay alive. Now that is a real issue!

  23. dargirl
    dargirl October 10, 2010 at 2:57 pm | | Reply

    Amy,

    Great post and Great comments. Definetly an issue that effects all of us with Diabetes and other health issues.

  24. T1 in Boston
    T1 in Boston October 11, 2010 at 7:26 pm | | Reply

    “Thoughts, anyone?”

    I guess so!

    I loved mail order when I had Express Scripts. They had a great on-line system and rarely missed a beat.

    Then my insurance plan switched me to Bioscrip. Whoa! Completely different experience! You get a robo-call about insurance problems, requiring a call-back with a 7-digit “code,” which then gives you a recorded message. I am still trying to resolve a generic v. name brand issue that has delayed an important routine med for me for over 18 days. Yikes! So for me, the Q isn’t mail-order or local pharma, it’s which mail-order company works well? (Looks like I may be going back to CVS, savings be danged, rather than deal with Bioscrip, alas.)

  25. Type 1 Tuesday 10.12.10
    Type 1 Tuesday 10.12.10 October 12, 2010 at 4:09 am |

    [...] Tenderich of Diabetes Mine: Face-Time with a Pharmacist vs. Mail Order Meds (Personally, I use the local Walgreens. Dave the Pharmacist, as I lovingly call him on Twitter, is [...]

  26. Karen
    Karen October 12, 2010 at 8:13 am | | Reply

    I wish the local pharmacy would keep a list of all the medicine you take in order to check for interactions with new short-term meds like antibiotics or pain killers. Earlier this year, I was prescribed a medicine for an infection that interacted with the statin I take. After starting the medicine, I felt awful so my doctor did bloodwork only to find that my liver function results were alarmingly high. I believe this interaction could have been avoided if my local pharmacy knew about the statin which is filled my mail.

    In my opinion, this disconnect between mail-ordered med and pharmacy meds has potential to be dangerous especially as you age and require more meds.

  27. Chris
    Chris October 12, 2010 at 11:26 am | | Reply

    Karen — This is where your pharmacy benefit (insurance) comes in handy. We have interactions built right into the claims software so if we’re being billed for a statin and an interacting antibiotic pops up, the computer automatically rejects it. This is called a DUR (drug utilization review) reject.

    I don’t know what statin and what antibiotic you were on (not all of them interact), but some statins should be suspended during antibiotic therapy, others simply require monitoring. If the latter is the case, then everything went right…you were (probably) experiencing muscle pains, you called your physician, and he/she took a look at your LFT’s (liver function tests) and went from there.

    But yes, lack of information is generally an issue with retail pharmacies. We’re years away from meaningful electronic medical records. Ideally, like in the hospital setting, every pharmacist should have access to your full record to ensure optimal treatment. The best thing one can do now is to request to speak to the pharmacist, many states mandate an offer to counsel on new prescriptions.

  28. Scott K. Johnson
    Scott K. Johnson October 13, 2010 at 7:29 am | | Reply

    Great post and great discussion – very hot issue for many people, and it is good to see all of the different perspectives.

  29. tmana
    tmana October 14, 2010 at 4:45 am | | Reply

    At my local (chain) pharmacies, most of the prescriptions are filled by techs or interns, nominally with the pharmacist’s oversight. A new script goes into the computer where the intake person checks for insurance coverage and (at least in theory) drug interactions. (A number of drug cautions and interactions appear not to have made it into the major interaction databases because they are considered to be “anecdotal” rather than proven by some major pharma-paid-for published study.)

    I’d love to know whether or not my patient record at my pharmacy mentions the drugs and classes of drugs to which I’ve had adverse reactions — there’s a real need for that, just in case the specialist tries to prescribe something the PCP knows you’re allergic to (or vice-versa), or in case a new drug shows off-label effects similar to a class of drugs to which one has adverse reactions.

    That being said: this past May I had an adverse reaction to a drug which the info flyer said was serious enough to “call your doctor or pharmacist immediately”. The doctor’s office wasn’t open at that hour, but my pharmacy was. The “pharmacist” who answered the call told me I should see my PCP the following day. WTF?! Since the drug was a pain reliever and I’d only had three regular doses of it, I discontinued on my own and wanted a reasonable washout period before starting up something theoretically equivalent. It took me three calls back to the pharmacy to get a tech to give me a number that I knew was the t-1/2 period (the amount of time needed for half the drug to leave one’s system), not the washout period (the amount of time needed for all active traces of the drug to leave the system). Is it naïve of me to expect my local pharmacist, or pharmacy technician/intern, to provide short-term advice for a “serious-adverse-reaction” report, to understand what a washout period is, and to advise me appropriately (even if that is “get to your PCP as soon as s/he’s open” or “get to the ER immediately”)?

  30. Midas Craft
    Midas Craft January 8, 2013 at 4:06 am | | Reply

    Diabetes or Diabetes Mellitus refers to a class of metabolic disorders characterized by high blood sugar content. This situation results either due to the body’s incapability of producing insulin or due to the unresponsiveness of the body cells to the produced insulin. The increased sugar content, thereby, results in the state of Polyuria, Polyphagia and Polydipsia characterized by increased urination, increased thirst, and increased hunger respectively. The state of diabetes mellitus is characterized by the body’s inability of controlling the sugar level in the blood. The condition of high blood sugar in the human body is referred is hyperglycemia and this condition is controlled by a hormone referred as insulin. Thus, in a nutshell, diabetes simply disturbs the secretion of insulin in the human body, thereby resulting in the state of hyperglycemia.

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