After this latest bout of cholangitis, the doctors decided to switch Adam's preventative antibiotic from Septra to Augmentin. The theory is that he might be getting resistant to the old drug and that this new one could do a better job of warding off cholangitis.
I went down to the pharmacy the day after we were released to fill the new prescription. The first hurdle to clear was the fact that the paper prescription they had given me at the hospital didn't match the strength of the prescription entered into the computer for our pharmacy. I waited about twenty minutes while the pharmacy tech sorted things out, and when I came back to the window she proclaimed that actually the prescriptions were the same--just written differently.
I received the bottle, filled with a white liquid, and the pharmacist came over to give me the rundown on how to use it. "It needs to be refrigerated, and it only lasts 14 days after it is mixed together, so even though your prescription is for a thirty day supply, you'll have to come back and get another prescription filled in two weeks."
"Will I have to pay for the next bottle?"
Blank stare.
I explained that my normal copay is $15 or 50%, whichever is greater, for a thirty day supply of medicine. If I was already paying $15 for this half-filled-prescription, why should I have to pay $15 again for another half-filled-prescription two weeks later?
"Oh, I understand. I guess I can mark that you have already paid for the next bottle."
"Thanks."
Later that afternoon I got a phone call from one of that pharmacist's associates. "The pharmacist you spoke to earlier today made a mistake. The medicine actually only lasts for 10 days once it is mixed up, so you'll need to come in after 10 days to get another bottle."
Anyone who has ever waited in line at a pharmacy with three kids two and under in tow will know that this is not a consummation devoutly to be wished.
I tried to troubleshoot the problem and avoid more frequent trips to the pharmacy. "When you say 'mixed up' is this some sort of technical pharmaceutical term, or does it just mean 'mixing up the medicine' in a normal way?"
"The medicine is a powder and it has to be shaken up with an exact amount of water."
"So, could you just give me three bottles of medicine when I come in each month and I can mix it up myself every ten days?"
"Are you sure you would feel comfortable doing that?"
I thought back on the countless bottles of infant formula that I mixed up during the twins' first twelve months of life? "Yes, I think I can handle that."
"All right, but when you come in again, make sure you bring your receipt for the first batch. We need to refund you the $15 and then charge you the new amount $22.63 for the month's supply."
I'm pretty good with math. I can even do it in my head sometimes. Why should a thirty day supply broken into (roughly) two batches cost $15 when a thirty day supply broken into three batches costs $22.63? It's the same amount of medicine, right?
I asked about the price discrepancy. She answered in a foreign language--possibly Klingon? It soon became apparent that a face-to-face conversation would be needed to sort this out, so I said my good-byes and resolved to address the problem later.
After ten days elapsed from my first pick up, I returned to the pharmacy to get the next two batches. I was delighted to see that they had the powder and water (93 ml carefully measured out in each bottle) all ready for me. It was time to broach the subject of payment. I explained my confusion to the pharmacy tech; she tried to explain it away, but ended up with, "Now I'm getting confused myself. Let me get the pharmacist and she can explain it."
"You're getting more medicine now, so that's why it costs more."
"Why am I getting more medicine? He's still getting a thirty day supply."
"Yes, but you have to get it every ten days, so you are getting three bottles instead of two."
I looked at the bottles. Mixed together, the water and powder would make 100 ml. Adam's dose was 2.5 ml per day--25 ml in ten days. He would only be using a quarter of each bottle before it expired.
"Why can't you put 25 ml in each bottle instead of 100 ml?"
"Because that's the way it comes from the manufacturer. We can't divide up the powder."
"So, you're telling me that I have to pay extra for medicine that I can't use?"
The pharmacist shrugged. "It's the only way we can do it. Just throw out what you can't use."
If this was the first time I had encountered this disregard for thrift at the pharmacy, I might have gotten upset. But as it was, I simply slid my card and punched in my pin number. It's only eight more dollars a month. It's only a hundred more dollars a year. It's only one more example of how money is invisible to those in the medical profession.
I went down to the pharmacy the day after we were released to fill the new prescription. The first hurdle to clear was the fact that the paper prescription they had given me at the hospital didn't match the strength of the prescription entered into the computer for our pharmacy. I waited about twenty minutes while the pharmacy tech sorted things out, and when I came back to the window she proclaimed that actually the prescriptions were the same--just written differently.
I received the bottle, filled with a white liquid, and the pharmacist came over to give me the rundown on how to use it. "It needs to be refrigerated, and it only lasts 14 days after it is mixed together, so even though your prescription is for a thirty day supply, you'll have to come back and get another prescription filled in two weeks."
"Will I have to pay for the next bottle?"
Blank stare.
I explained that my normal copay is $15 or 50%, whichever is greater, for a thirty day supply of medicine. If I was already paying $15 for this half-filled-prescription, why should I have to pay $15 again for another half-filled-prescription two weeks later?
"Oh, I understand. I guess I can mark that you have already paid for the next bottle."
"Thanks."
Later that afternoon I got a phone call from one of that pharmacist's associates. "The pharmacist you spoke to earlier today made a mistake. The medicine actually only lasts for 10 days once it is mixed up, so you'll need to come in after 10 days to get another bottle."
Anyone who has ever waited in line at a pharmacy with three kids two and under in tow will know that this is not a consummation devoutly to be wished.
I tried to troubleshoot the problem and avoid more frequent trips to the pharmacy. "When you say 'mixed up' is this some sort of technical pharmaceutical term, or does it just mean 'mixing up the medicine' in a normal way?"
"The medicine is a powder and it has to be shaken up with an exact amount of water."
"So, could you just give me three bottles of medicine when I come in each month and I can mix it up myself every ten days?"
"Are you sure you would feel comfortable doing that?"
I thought back on the countless bottles of infant formula that I mixed up during the twins' first twelve months of life? "Yes, I think I can handle that."
"All right, but when you come in again, make sure you bring your receipt for the first batch. We need to refund you the $15 and then charge you the new amount $22.63 for the month's supply."
I'm pretty good with math. I can even do it in my head sometimes. Why should a thirty day supply broken into (roughly) two batches cost $15 when a thirty day supply broken into three batches costs $22.63? It's the same amount of medicine, right?
I asked about the price discrepancy. She answered in a foreign language--possibly Klingon? It soon became apparent that a face-to-face conversation would be needed to sort this out, so I said my good-byes and resolved to address the problem later.
After ten days elapsed from my first pick up, I returned to the pharmacy to get the next two batches. I was delighted to see that they had the powder and water (93 ml carefully measured out in each bottle) all ready for me. It was time to broach the subject of payment. I explained my confusion to the pharmacy tech; she tried to explain it away, but ended up with, "Now I'm getting confused myself. Let me get the pharmacist and she can explain it."
"You're getting more medicine now, so that's why it costs more."
"Why am I getting more medicine? He's still getting a thirty day supply."
"Yes, but you have to get it every ten days, so you are getting three bottles instead of two."
I looked at the bottles. Mixed together, the water and powder would make 100 ml. Adam's dose was 2.5 ml per day--25 ml in ten days. He would only be using a quarter of each bottle before it expired.
"Why can't you put 25 ml in each bottle instead of 100 ml?"
"Because that's the way it comes from the manufacturer. We can't divide up the powder."
"So, you're telling me that I have to pay extra for medicine that I can't use?"
The pharmacist shrugged. "It's the only way we can do it. Just throw out what you can't use."
If this was the first time I had encountered this disregard for thrift at the pharmacy, I might have gotten upset. But as it was, I simply slid my card and punched in my pin number. It's only eight more dollars a month. It's only a hundred more dollars a year. It's only one more example of how money is invisible to those in the medical profession.
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