A Tale of Two Pharmacies

violadad · October 10, 2009, 2:10pm

I’m going to throw out a recent experience, and am a bit more interested in the opinions of those who may be professional pharmacists, or in managerial positions at the store level and above corporately in a major national name brand retail environment. My purpose is to pick the collective brain, and determine just how far I may pursue this up the chain of command.

I was given a prescription for an anticipated next level of treatment for a canine disorder. The prescribed drug is not experimental, but not normally on shelf at many pharmacies. It is typically administered in clinical situations. It is a dry powder injectable, and requires the knowledge and training to administer. Circumstances allow this to be done by a family member who possesses the requisite background. It is also used cross-species in both humans and canines.

The cost of the drug is fairly steep, in the 100’s of dollars, given the number of required doses. I have a personal friend who is a licensed pharmacist who can acquire the drug through normal channels at the chain he works for. I have an extremely attractive price from this source, but it is a logistics issue. At his suggestion, he advised me to seek out some alternative sources locally, including national chain drug stores and pharmacy departments at different retail chains. His industry knowledge allows him to pinpoint similarly priced competition.

I inquired of the availability and cost at a local chain pharmacy within a major retailer. The tech provided me with a printed quote, and assured the drug could be on hand 24-48 hours after entering the 'script. I returned 10 days later with the quote in hand, wanting to enter the 'script. The registered pharmacist on duty informed me the drug was not available; they could not order it. When I asked as to why or if the info I had in hand was erroneous, the pharmacist could not enter an explanation. She spent no time confirming the information that the printed quote was either valid or invalid. I offered the opportunity for her to take a copy of the printout and address this with the tech that printed it. She refused to do this. She replied she would address this issue with her store manager. (Personally, I doubt this will be the case.) I left confused and disappointed.

The chain has a second store locally. I went there yesterday, explained the needs and a bit of the conflicting background from the other store to the pharmacist on duty. The pharmacist took the info, called me an hour later, confirmed the pricing and availability of the original quote, and went so far as to give me the National Drug Codes for both the prescribed medication and an alternative. He was a consummate professional. Circumstances dictated that I needed to place the order, and I had already done so through my personal source. I informed him of this. The price differential was so inconsequential that I would have ordered it through the chain locally. I thanked him for both his time and professionalism.

I am clearly looking at poor customer service by the first pharmacist at the very least.

My questions are these:

-were professional or ethical standards at all violated in any way by the pharmacist at the first store? I need to know this, because I will pursue this to the highest level if there is any indication that they were.

-For those at the store or corporate management level, what would be your hypothetical reaction to a complaint letter addressing just the customer service aspects demonstrated by the two pharmacists? I realize that a reaction to an ethics or professional standards violation may be moot as there may be legal ramifications involved. In the interest of fairness, I’d prefer not to entertain any legal comments.

-At this point, I will not identify the chain involved. Please don’t ask.

member · October 10, 2009, 2:20pm

I really have to ask whey you choose to go to a chain store over a small mom and pop pharmacy. I always choose the latter, I never trust chains. Chains mostly hire poor pharmacist’s, whom have low grades and are willing to take a pay cut to get a job. I suggest you go to a small personal pharmacy, where customer service is the survival of the store itself.

violadad · October 10, 2009, 2:31pm

member, the reason was purely pricing. The treatment may be long and costly. Our vet suggested seeking the best possible pricing. I have a pharmacist I trust implicitly. He is godfather to my son. Your comments are sound, I typically agree. I would urge anyone with drug specific questions to address them to a trusted pharmacist who by training can provide the most informed answers.

I think your comment does a disservice to the many fine pharmacists who for any number of reasons ply their trade within retail chain environments.

My purpose was not to turn this into a debate over the career options of those employed in the profession.

cottonwood513 · October 10, 2009, 3:05pm

I am listening, I have also had issues with chain pharmacists.

ncmentor · October 10, 2009, 3:18pm

violadad - I am neither a pharmacists, or in a managerial positions at the store level and above corporately in a major national name brand retail environment. And I would not normally respond to a posting like yours, but given your extensive contributions to this community I will share with you some advice that I often give to a loved extended family member. They have ongoing issues that require complicated medical interpretations and often find themselves in situations not unlike yours.

I believe you would be best served by making sure that you get the medications you need , at a reasonable price, as conveniently as possible. For now I would let the corporate climate correct itself by voting with your wallet and feet and shopping only at the place that wants your business and provides you with the best service. There are Way Too Many places that provide bad service to spend your precocious energy correcting the world. Give your money to the service providers that care about you as a customer.

I know it would be more satisfying to point out a problem and have it corrected to everyones satisfaction but that’s not usually the way the world works. As long as pharmacists are in short supply, overworked, and essentially chained to a countertop then customer service will not be as important as a licence. Don’t expect that large chain will fire their licence to operate, to satisfy a customer. Ordinarily I would advise you to look for a smaller independent pharmacy that depends on return business but it sounds like you already found a pharmacy that will help you. So now you just need to let go of your first experience and just take care of yourself. I’m sorry for your pain.

violadad · October 10, 2009, 3:39pm

ncmentor, thank you for your comments. I have held managerial positions, and I know how I would have dealt with a scenario similar to this if it involved an employee under my jurisdiction. My professional experience does not include managing licensed professionals. My outside source who has managed those within this specific field is also researching some of the ethics and professional issues involved for me.

My single largest concern is the potential violation of regulated statutes or common industry specific practices. My feeling is that those so licensed operate under mandates. Violation of those mandates need to be brought to the attention of those who need to know, and be subject to the appropriate actions and or penalties. It is a case where one should not have to suffer fools lightly.

It may seem like tilting at windmills. I am not Don Quixote. ;)

Your concern is appreciated. The condition being treated is correctable, and is not life threatening. And some may say it is just a dog. Perhaps that was the first pharmacist’s reaction, which had also crossed my mind. But that is not a factor in my thought processes.

teriwtt · October 10, 2009, 4:03pm

I ALWAYS go to a chain store because they will have my entire history in their computer (including allergies/bad reactions, etc.), should I be traveling and need to get prescription meds. My daughters both attend(ed) schools very far from home, and were able to continue to refill their own prescriptions via the chain. They will also most likely have 24-hour pharmacies somewhat convenient to wherever I am, if by chance, I were to lose the medication, or even something simple such as drop some down the sink (have done that a couple of times by accident when trying to juggle things in a small hotel bathroom). I never want to be away from home and worry about how I might get my meds refilled at a moment’s notice, when the mom and pop store’s data base is not available to the pharmacy I’m at.

violadad · October 10, 2009, 4:06pm

A bit too late to edit the prior post. I had written in an attempt to add

Edit: I have also considered that the second pharmacist’s superb service MAY have been the result of a corporate policy or professional courtesy in possibly doing a “cover your (collective) arse” in heading off a disgruntled customer.

And for the record, I typically will pay more for exemplary service and more personal attention. In this case, it made sense to seek out a more cost effective means, which could if required extend the length of necessary treatment.

teriwtt · October 10, 2009, 4:18pm

Sorry to go off track with my previous post. Last month we had a terrible experience being left waiting in the waiting room of my daughter’s pulmonologist for 2 1/2 hours, despite my frequent complaints (she was leaving to go out of the country for the semester and had to see him prior to going for some med refills) who basically blew us off. When we had to leave to get to another doctor’s appointment (also, for some med refills), I made quite a scene and told them we’d never be back at this doctor’s office again, hoping (and pretty sure) that our next doctor would refill the asthma meds when told of the situation (which he did). I wrote a letter, addressed it personal and confidential, to the pulmonologist, explaining everything that had happened. The afternoon of the morning they received my letter, I received a phone call from the practice administrator (the office administrator told me there was no one above her for me to complain to that day) who told me they’d already had a staff meeting that morning, just to deal with this situation and he apologized profusely for their errors. Frankly, I had implicitly suggested an incident report go in this office administrator’s file for the mistakes she made, and the manner in which she treated us, but I don’t know if it went that far. Again, he apologized profusely, saying that it was a total fail on their part, and hoped we would give them a chance again.

He also told me, several times, thank you for bringing this incident to their attention, for writing the letter so that they could address it. He said most people would just never come back again, and they’d never know why, but he was thankful that I’d taken the time to put the incident down in writing so that it could be appropriately addressed by the entire office. My daughter only sees this doc once a year, so I don’t know what we’ll do this time next year, when she’s due again, but I appreciated his phone call, and affirmation that they had indeed been very wrong.

Just my two cents.

lamom · October 10, 2009, 7:44pm

I am so sorry your dog has a need for the med. The last two years of our dog’s life he had a controlled substance that was $225/month from the vet. He tied low cost alternatives that didn’t work. I understand that the dog is family. 
While not a retail pharmacist, some of my peers have told me horror tales of working for some chains. Having quotas and lights to time your work. Management telling the public one thing and the employees another. One chains hires pharmacy students, gives them $10k and has them commit for 2 yrs after graduation. The cash can be a reason why some chose to stay. I heard things changed a bit his past year with the economy. 
Recent years the chains gave huge bonuses/loan payoffs in addition to higher wages than those to clinical hospital pharmacists. I use the local independents, unfortunately my past three were bought up by chains. In general I hate chains and see techs in chains seem to do more than is legal. Chains don’t care about you or your health.
I would get next refill from the local nice guy. If you feel you should report crummy customer service, report. It is very possible the mean guy will be complimented for avoiding a costly sale. You should also report your good experience.

violadad · October 10, 2009, 8:48pm

lamom, thank you for your insights and your thoughts. I appreciate them.

Nova10 · October 11, 2009, 6:57pm

Actually chain pharmacies pay the most of all the major sectors.

When you order a medication from McKesson, Cardinal, etc, it should tell you the price and whether or not the drug is on backorder. Most drugs you can get within one business day. When given a quote for a drug, it is only valid for that day.

Independent pharmacies are being squeezed out. The general expectation is that almost all of them will be gone in another 5-10 years. Independents cannot get as good of a price on drugs as chains. Insurance reimbursements are constantly decreasing. The federal government wants pharmacies to accept reimbursements below acquisition costs. In general, it is the independent pharmacies which get into more legal trouble.

Some pharmacies will not order dry powder injectables as a rule. They are afraid the person will not administer it correctly. It is a liability issue. To order it, you would have to get the pharmacy manager to override the block.

violadad · October 11, 2009, 8:21pm

Nova10, thank you for that info. I was not aware of the potential block. I will keep that in mind for potential future needs. My d is certified in the field, administration is not an issue (and she works for our vet as well).

violadad · October 14, 2009, 8:15am

My thanks to those who responded.

The 'script has been filled, and treatment has begun. There are already signs of improvement.

In discussing professional/ethical issues with my pharmacist friend, he confirmed what a few of you had said. Nothing the first pharmacist did violated any professional or ethical industry practices by refusing to look up or confirm the original price quote I received from a tech at that same store. The customer service aspects are a different issue. He did seem perplexed by the disparity of service standards apparent in two stores of a national retailer within the same zip code. His personal view is that this type of behavior would have carried risk of termination if it occurred within an operation he was managing. For reference, he has been licensed and practicing for 30 years, in “mom and pop’s”, hospital environments (both as a pharmacist and administrator/manager), and in regional and national chains.

Just to give a cost summary based on my experience, the prices for 30 doses ranged from
$20 per dose to about $12. The differential allows us to effectively double the treatment
(if required) at about the same out of pocket cost.

The higher price included direct from vet, national pharmacy chains, and a local pharmacy.

The lower end included national retailers with pharmacy departments, and a regional grocery chain with a pharmacy department.

In this case, it made sense to do some price research. Those with deeper pockets are welcome to disagree.

I will not pursue a complaint against the poor service offered by the first pharmacist. I will write to the store manager of the second store commending the pharmacist there that went out of his way to exhibit a higher standard of service.

Again, thanks to those who offered insight and good wishes.

A Tale of Two Pharmacies

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