The Pharmacist Who Tries Not to Judge You by Your Prescriptions

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Photo: Brad Wilson/Getty Images

Anonymous, 31
Retail Pharmacist

Massachusetts

This particular Rite Aid is pretty low-volume compared to others, meaning we process about 100 scripts a day. Luckily, we don’t have a drive-through. Isn’t a drive-through pharmacy a crazy concept? It makes sense from a business POV, like, Let’s make it easier for customers to pick up their meds. But it really does help when you can see the person you are about to give drugs to.

We don’t get any training in how to spot a drug user; it’s just through experience. A definite red flag is when they bring in a prescription for a narcotic — say, Percocet — and tell me, “I want to pay full price in cash.” Usually, you can tell if someone is questionable by their demeanor: They act overly confident. You have the typical sociopath who comes in with a poker face. That guy will get upset at me when I call him out because the date of the prescription is a year old. He believes his story: that he is innocent. You also see people who clearly don’t need the 90 tablets of Vicodin a week early. Then there’s the standard college student who is obviously a newbie, trying to make a pass to get this Adderall.

In a drugstore, there are pharmacy technicians, clerks, and then a pharmacist. The pharmacist deals with any customer-related issues, insurance problems; they sign off on the medications and make sure customers are given the right dose. By law, there has to be one pharmacist on-site, and the staffing ratio — how many technicians can be under a pharmacist — is state-regulated.

There are cameras everywhere. We usually do an inventory each month. They’re not as strict about the inventories for nonnarcotics, and it’s not that unusual for a count to be off. But we do manual inventory once a month for narcotics. There’s a manual log of what goes in and comes out. It’s usually a miscount, or someone dropped a pill, or the bottle arrived with 99 pills instead of 100. The manufacturer weighs pills rather than counting them, so there could be errors. It’s treated with so much scrutiny that it would be hard to steal — but not impossible.

In New York, it’s now mandatory for scripts to be sent electronically. It costs a lot of money for pharmacies to invest in the technology for electronic scripts, but it’s harder for people to tamper. It’s usually pretty obvious when they do. They change the number — a six becomes an eight. When that happens, I call the doctor’s office to verify the quantity. The customers usually don’t argue because we tell them that, by law, we have to go with what the doctor says. That often ends it. They’re busted. If it has been significantly tampered with, then I would void it. Depending on how serious the tampering is, we report it.

I saw some really bad tampering by a woman wanting Oxy. I told her it was void, and she bitched at me for a while and then left because there was nothing she could do. She looked like she was from the street. The script was all crumpled and stained. I gave it back to her because she wanted it, but it was void. She looked at me and said, “Why did you do that?”

Different branches have different clientele. One branch I worked at was near lots of colleges. The most common medications I prescribed were birth control, pain meds, Adderall, stimulants, and antibiotics for STIs and UTIs.

The most commonly prescribed antidepressants are probably Prozac and other SSRIs. For anxiety, it’s the benzodiazepines, like Valium, or Klonopin and Xanax. Usually more women than men. I notice the same faces and names coming in month after month after month, refilling a Xanax prescription. The benzo people are wealthier. They drive nice cars. You can look at the person and go, “Oh yeah, that guy is high-strung.” Or, “Hmm, klonopin … makes sense.”

You build a little story about their medical history. Especially if someone is older, they’ll get blood pressure, cholesterol, and diabetes meds, with an antidepressant and Ambien — I call that the “the aging pack.” They come in like clockwork to fill them.

The amount of meds Americans are on is crazy. So many of them are treating problems caused by their lifestyles. People are sedentary and don’t eat healthy. They pop a pill and never address the root causes. In this country, everyone wants to fix things with a pill. Then you look at who’s writing the scripts: doctors. They are in business and they have to keep their patients — their customers — happy. And if they come in and say, “I want this medication — I’ve seen it on TV and it’s supposed to be the best,” chances are the doctor will say yes even if they probably know the person doesn’t really need it. It’s easier for a doctor to prescribe medication than to say, “You need to eat better, see a nutritionist or a therapist, or go to a gym …”

Patients get angry. It’s usually because of increases in the cost of medication. Often their co-pay has gone up, and I have to take their anger, because I’m the face of how much they are paying for their medication. They’ll say, “It used to be $5 and now I’m paying full price! What the fuck?!

Fighting with the insurance companies is a whole other story. We call the same number as anyone else. We wait in the queue, too. And when we finally talk to the person on the phone, they’ll tell us they can’t help us and pass us off to someone else. Meanwhile, we’ve got four other customers in line and five prescriptions to get ready. It’s stressful. You’re just doing triage.

The thing that frustrates me about my job is all the big companies now have these metrics where they try to quantify the productivity of a pharmacist by tracking how many prescriptions we fill an hour. They count everything: how many rings before someone picks up the phone, how long it takes to verify a prescription. They track it all, and if they think your productivity is going down, they will pull you aside.

At the same time, they won’t provide any more help or address the root problems I mentioned earlier. It’s all about making money. It makes me feel demoralized and tired and like the company is not on my side. In school, you’re taught how to help people. You come into the real world, and you realize you’re a small wheel in a big machine that pumps out prescriptions.

Flu shots are a big moneymaker. Truthfully, if you are young and healthy, you don’t need it. The flu shot is an educated guess of what the strain is going to be. If you work in the hospital, sure, get one: You’re around sick people, the elderly, or pregnant women, get it. Store managers set goals for selling flu shots. Say, for one store, it could be 50 flu shots in a week, and they will incentivize you to meet that target. You won’t be penalized if you don’t, but you will fall from grace. Pharmacists might call smaller companies to see if we can go in and give their employees shots, which is an easier way to meet the target. That makes me uncomfortable. We’ll say to each other, “Oh, great, it’s flu-shot season — we’ve got to start pushing them again.”

It’s very common as a retail pharmacist to do 14-hour shifts without a break, without lunch, standing up for hours under fluorescent lights. I can’t leave because, by law, the pharmacist has to be on-site, so if I left we’d have to shut down the whole shop. The company is not going to let you do that. It’s not forced, but you “understand” you can’t leave.

Then again, retail pharmacy pays well. I’m on a low six-figure salary. At the end of a shift, you’re knocked out. Then you’ll look at your paycheck and remember why you do it.

The Pharmacist Who Tries Not to Judge You