The Legal Drug Dealer Podcast

Getting Pharmacy as a profession Closer to The Patient

January 7, 2020 ~ By Marilena

Retail Pharmacy But Only Big Chains...

Marilena Grittani, RPh

As a former Retail Pharmacist, one of the biggest chains these days, I have a specific view of it.

Also, I have included general information about how retail pharmacy works in general, and I will share it all with you!

Some of the most relevant points I made are:

  • A retail pharmacy is a store that has been registered with the National Board of pharmacy as well as their state Board of Pharmacy to have permission and licenses to distribute medication; to purchase and to dispense them
  • The pharmacist in charge, which is also called the pharmacy manager in other places, which is the person that is responsible in front of the Board of Pharmacy and in front of the DEA for every single pill that is in that pharmacy
  • The law forbids anybody that is not a licensed pharmacist in that state, to have the key of the pharmacy
  • The doctors think that is (a medication) the best for you, but he does not know what we know, that could harm you. We are the second check. We have to protect you. We don’t deny a drug. We don’t call the doctor with questions because we are annoying. We do it to protect you.

"The pharmacist proceeds to check if any of those drugs interact or not with other drugs that you might be taking. Like two drugs together can be against each other, can neutralize each other, or can make it more potent and then harm you. Certain drugs should not be mixed."

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"Whenever we (pharmacist) say it's gonna take x minutes, We have a reason for that... Maybe a bunch of people that dropped off prescriptions before you and they're ahead of you. And they have their place, and they're waiting, I cannot stop to work on yours. I need to be fair."

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Episode Transcripts

Marilena Grittani, RPh  

Hola! Marilena Grittani here. Welcome to another episode of the legal drug dealer podcast today. Today’s episode is number three. And we’re going to be talking about retail pharmacies, specifically chain pharmacies. So there are big companies that have pharmacies all over the country. And they are pretty much in every corner if you live in a big city. So because I have a lot to say about this, and I was once a retail pharmacist, I’m going to start right on. 


So a retail pharmacy is a store that has been registered with the National Board of pharmacy as well as their State Board of Pharmacy to have permission and licenses to distribute medication to purchase and to dispense them. It is a long process that a pharmacy has to go through before they’re allowed to distribute drugs. They need a pharmacist that is going to be the PIC or the pharmacist in charge, which is also called the pharmacy manager in other places, which is the person that is responsible in front of the Board of Pharmacy and in front of the DEA for every single pill that is in that pharmacy. The pharmacist that works that in that place is responsible that day. But the person that is responsible overall for everything that happens good and bad on that pharmacy is the PIC or the pharmacist in charge. We have different pharmacists working in the same pharmacy, and because most of these pharmacies are open extended hours, I remember working for CVS once upon a time in Las Vegas, Nevada, and my store was open 12 hours a day from 9am to 9pm. No breaks. Did you hear that? No brakes. I know. I did not like it. No brakes. 


Anyways, that’s not what this point is, but that’s how bad it was. And it still is, unfortunately. Anyways, what I was trying to say is that usually this type of pharmacies are registered under one farm PIC or pharmacist in charge, but also have other pharmacists that work the days that the pharmacist is not working because of course, you cannot work overtime because that is expensive for the company. So you are to work 40 hours or 30 Six hours, counting for a little bit of overtime the rest of the day, so you work so you pretty much work three days 12 hours and then the weekends you work shorter days or half days or whatever. However, they decided. But there’s more than one pharmacist that is working on that particular pharmacy, but only one is the pharmacist in charge. The day that the pharmacist in charge is not there. The pharmacist that is on duty is the person in charge. But that person is not 100% responsible for whatever happens in front of the DEA or the Board of Pharmacy. The pharmacist in charge is, have you noticed when you go to one of these pharmacies, whether it’s in the supermarket, a grocery store or a big chain pharmacy, that if it’s late if the pharmacist is not open. Yet, they have a gate or doors or window covers that do not allow anybody else to get in, have you noticed that you know why that is? Because the law forbids anybody that is not a pharmacist to have the key to the pharmacy. That means that the store manager who typically the store has a manager, whether it is a grocery store or if it’s a pharmacy, they have a store manager that is in charge of the front, but not the back. They don’t know the law. They are not certified to work there. They actually are not allowed to be there unless the pharmacist enables that. I am a very picky pharmacist, very picky. I didn’t let anybody my pharmacy because if you, for whatever reason, make a mistake, take something, dropped something, break something I am responsible for. So the least people that came over the didn’t know what to do in a pharmacy the better.


So just clarify That the pharmacist is in charge only of the pharmacy and the store manager is in charge of everything that is outside of the pharmacy. The pharmacist says the gate has keys that only the pharmacist can have. And they have codes that you need to punch in, and you have cameras everywhere. So it is very, very much regulated. 

Marilena Grittani, RPh 5:22  

So how does a retail pharmacy work? Well, it’s easy. Normally, you know, the past time now, it’s not that frequent. Still, you get a prescription written by the physician office or the prescriber, in this case of nurse practitioner, physician assistant and you get a prescription written, you bring that to the pharmacy, you drop it off, they find out if they have it, they get your insurance information. They get all your personal information like date of birth, full name, if you have any drug allergies and other general stuff, they put her in the system. They typed a prescription And with a prescriber, that is the doctor the drug, the specific strengths, how many pills you need, how frequently you take them, how many total doses you’re getting, how many refills you’re going to have, which is getting the same the next month or for the next time. And, and then that is in the system that goes to the insurance company that you might have. And then the insurance determines if they will pay for it or not. That happens all electronically. The insurance answer saying is cover is not cover or whatever they decide to do. And that is all done by a pharmacy technician. 


Once the claim sent to the insurance, they requested the insurance to cover that medication is approved if we’re lucky. Then a label gets printed. And then the pharmacy technician, another pharmacy technician, goes and gets the bottle counts the pills if that is the case, put them in a bottle, puts them label on and lives it on the side for a pharmacist to check. Then a pharmacist grabs that information, the labels that the technician printed their original prescription, whether it is physical, or if the doctor sent it via other vias. I will explain that in a little bit. And then the pharmacist compares that whatever the pharmacy technician typed is correct, that every single instruction that the doctor wrote there is included, and that the medication the drug and the strength and the number of tablets or capsules or volume of liquid that is requested by the physician are exactly the same. 


Then the pharmacist proceeds to check if any of those drugs that are included in this particular prescription interacts or not with other drugs that you might be taking. This means that two drugs together can be against each other, can neutralize each other, or on the contrary, can make it more potent and then harm you. Certain drugs should not be mixed. Certain drugs are not good for you because you are allergic, and they might be related somehow. Certain drugs shouldn’t be used in a certain diagnosis. For example, if you have a specific disease, certain drugs shouldn’t be used because it harms you. And if I give it to you, knowing that you have the disease, I am responsible as a pharmacist. So all those events need to happen after we build insurance and the prescription is covered. So this takes time. The computer system helps us, but we also have to manually physically visually review each one of this to make sure that the drug that we’re giving You is correct. 


I know you’re saying, but my doctor ordered. Did you listen to episode number two? When I said the doctors only go to school for one semester of pharmacology, which is how drugs work in your human body and, and one semester of medications. We go for over 20 semesters, 20 different classes that we take specifically about drugs. So yes, the doctors think that that’s the best for you, but he does not know what we know that could harm you. We are the second check. We have to protect you. We don’t do it. We don’t deny a drug. We don’t stop anything. We don’t call the doctor with questions because we are annoying. We do it to protect you. Did you hear that? I’m going to repeat it. We do all that to protect you from making sure that the drugs that you’re getting, which are potentially lethal. They could kill you! Are exactly what you need. And I’m not being dramatic when I say that they could kill you. I’m real with that, I am 100% real with that. I am personally very allergic to penicillin actually is what is called an S Alexis, which means that my throat is going to close and is going to get inflamed my tongue to the point that I won’t be able to breathe if I even smell penicillin. So if I take a pill of penicillin that I cannot take out because it dissolves in my stomach and there goes, I would die. I would die because my throat is going to close, and I won’t be able to breathe, my face is going to turn blue, and I will just die. I could do that to any patient. That is allergic to a drug. That’s why I take my time making sure that everything and anything that you’re getting is correct and is the way that it needs to be. And if I am your regular pharmacist and it is a drug that we have filled every month for the past five years, most likely, I will not take that long time checking this. Still, if I never been your pharmacist before, you’re going to bet that I’m going to do that because I’m protecting you, first of all, your life. And secondly, I’m protecting my license because I am responsible for every single thing that I dispense. And I do not want to be the reason why you get harmed, or your kids or your mom, or your husband or your daughter or your pet because we feel prescription for animals too 


So whenever we say it’s gonna take 15 minutes a half-hour, 45 minutes, two hours. We have a reason for that. Yes, that process doesn’t take that long. But guess what, we might have a bunch of people that drop off prescriptions way before you and they’re ahead of you. And they have their place, and they’re waiting, and they were told two hours ago is going to be ready now I cannot stop to work on yours. I need to be fair. 


Okay, so going back to other methods that we get prescriptions. We used to get them not that frequently anymore, but we still do via fax. The doctor faxes the doctor’s office or the prescriber’s office. Faxes a prescription to the pharmacy, and then we go check the facts, and we see if it’s there, and then we print it, and then we do exactly the same process. Like if you drop it off, but instead of you dropping it off, we get it into a fax machine. Another method to get him is A doctor, or a doctor representative calls a prescription in our voicemail via phone. And if we don’t answer the phone because we’re basically talking to somebody else or because we are with another doctor, they leave a message and then we pharmacist By law only pharmacists are allowed to take prescriptions over the phone, from a prescriber to dispense to a patient. There are no technicians who help there. There are no clerks help there, only pharmacists. So that is one of the duties that pharmacists are the only ones allowed to do. On top of the fact that we already have to review all your medications. The way that I explain: interactions if they if it works well if you’re allergic all that! 


Another way that we receive prescriptions is that the doctor sends them via computer to us, which is called now e-prescribed, which is that they put him in their company. And automatically they send the ask you which pharmacy do you go to, they find it and then they know that they need to send the prescriptions there. And then we received them they get into a queue. And then we have a technician that has to work on that queue. Which means that the technician is not only processing the prescriptions that were dropped off by a person that brought a written prescription is processing also the ones that came via fax but also is processing all the prescriptions that are coming to the queue, the from doctors offices that are sending them via computer system to us. So yes, technicians are very busy constantly, non-stop getting prescriptions for us, from your doctor to serve you before us the pharmacist, and they process them. The pharmacy techs and we’re going to talk about this in a future episode with one of my very good technicians about the process of how pharmacy technicians work with insurances. He’s such a long and painful process, I know you’re going to be interested in it, and you will understand why things take so long. But that is another episode. 


So then once the prescription is ready, once the pharmacist makes sure that all this interactions and diagnosis that you have and other drugs that you might have been clear that you don’t have any issues then, I don’t know what other pharmacists do, but I open every single vial every single bottle and I look inside. And I have a picture on the computer that shows me the shape, the color, and the writing that every pill that I dispense should look like. And I make sure it’s exactly the same. And not only that, I just look overall I shake it, and I make sure that every single pill that is in that container is exactly the right one that takes time to, but I’m making sure you get it correctly, because the technician might make a mistake or the bottle might have a wrong drug on it, things could happen, and I need to protect you. 


In the case that is a liquid, let’s say a syrup or a pain medication or a cough drug that is liquid. I open the original bottle and the bottle that the technician pour to give it to you, the portion of medication that you need and I smell it, and I look at it and make sure is exactly the same because I need to guarantee that the drug that you’re going to put in your mouth and your system is exactly what you need. That also takes time. 


Once all this is done, I sign up in the computer, I print another label, I bag it, and I leave it ready for the clerk to ring you up and then, you can pick up your medication and go home. That process takes time that processes are in place only for your safety 100% with your safety in mind. So when we take a little longer to take care of you understand that we’re doing it for your safety, understand that we’re doing it for you. We are not doing that just to annoy you or to make you spend more time there. We’re doing it because we are doing the process that will save you from any mistakes, any errors, or any possible human mistakes. Because we are humans too we pharmacists are human.


When I used to work in the pharmacy that I told you that I hated because I used to feel 600 prescriptions a day. I’m talking about 600 times doing the same process without a break. Doing the same thing. While talking on the phone with doctors, while talking on the phone with patients, while answering questions for Patience, while standing for 12 hours, while using my brains to understand and do exactly what I needed to do for you, that is tiresome. And there is one point that you need to take a break that you need to close your eyes for a minute or maybe, maybe take a little five minutes to break just to relax your brain because you are overloaded. That does not happen in this chain facilities. Well, not all of them. Let’s just put it that way. 


Because some states have laws that pharmacist cannot work more than eight hours because they have unions or other stuff but these others that don’t. And pharmacists work 12 hours and sometimes even 14 without a break. That, in my book, is not human. You’re not to do that for too long. I did it for only three months. I couldn’t do it anymore. It was just too much. And I was so tired and so Not 100% me, that was so bad that I was risking my patients’ lives. I could make a mistake at any moment. If you start working at 9am, and it’s 8pm, and you’re still working non-stop, no breaks, not even time to eat or to go to the bathroom. Doing the same thing, having people’s lives in your hands. That is tough. That is very stressful. That is very risky. Not only for us because we can lose our licenses before you because we can harm you not wanting to, but we could.


So whenever you bring a kid that is sick to the pharmacy, please take him outside. We’re doing the best to work for them, but the baby screaming or knocking down stuff in the pharmacy is distracting us from getting the baby the correct medication. So please be a little bit mindful of that we are working on getting your child what your child needs. So help us out. Just help us up. Just help us out. 


So the difference between a retail pharmacy that is a chain in comparison with other pharmacies is that they’re everywhere. They have huge stores, they have a lot of inventory. They have more stuff outside that other pharmacies like independent pharmacies, and they have a lot of people over the pharmacist. What I mean is that they have regional managers, they have district managers, they have state managers, sometimes the regional like the West Coast, East Coast, the south and what have you, and then all those people are, all the way to the owner of the company. Which means that every single of those employees needs to be paid. And that comes from the cost of your prescription. Somebody has to pay for that. And you the patient or the one that brings money to these places, right? So that is where the money that you pay for these big chains goes for all the people that are in between the pharmacy and the main owner or the president of the company. That’s the pockets that it goes to. 


So if that is what that is okay with you, if that is what you want to support if you want to support big companies, big corporations, for whatever reason you want to have that is where you go, and that’s what you want to have. Go right ahead. I have no issues with that. I worked there, and I had the patients that I love, I did the best that I could. I was extremely stressed out. I didn’t have time to dedicate to my patients as I wanted to because I was too busy, and I didn’t have any enough help, but it’s the way that it is in big chains. 


What I’m trying to say with this is that not every pharmacy like that.


That is not that the pharmacist is rude. The pharmacist is overwhelmed. Is not that the technician is mean is that the technician has been working for 10 hours, non stop without a break, and maybe not even eating yet. So whenever you go to a big chain that is that busy, that’s what is happening. That is exactly what the case is. So please understand what is going on and understand that it is not personal. 


They are overworked, and they get paid the same if they see 10 patients, or if they see 1000 patients. Did you hear that? They get paid the same. If they’d see 10 patients have filled 10 prescriptions or if they fill 600 prescriptions. A day. That is a lot! So if you if that is what you need because it’s convenient because it’s pharmacies are anywhere because you can travel and transfer your prescription to any other state and that is convenient for you. That is the kind of pharmacies that you need to use. If you don’t, if you’re not happy with a service, if you don’t think it’s fair to the pharmacist to be treated like that, if you don’t think that is fair to the technicians to be treated like that, if you think that not having a lunch break is cruel. And if you think that you don’t want to fill up the pockets of a bunch of corporate people that are behind these type of pharmacies, then these pharmacies are not for you,


Then you need alternatives. And that is precisely what I’m going to be talking about in our next episode. Episode Number four, which is about retail pharmacists, but independent pharmacists, the ones that are not big chains, the ones that are just local, the ones that are smaller, and the ones that are specific for certain communities. That is what is coming up in the next episode. 


So we’re done with this subject. I know it was a little bit heavy. I know it was a lot of information. And it wasn’t that much fun. But I’m sorry. This is the kind of episode that we have to go through, the first four, just to get the information that you need to get. After that, I promise I’m going to have interviews, and it’s going to be way more fun.


So thank you so much for listening. And please subscribe to the podcast. Give us a review. And if you have any questions, don’t forget to write an email to comments@thelegaldrugdealer.com, and I will personally, and I will personally answer them. You can also go to thelegaldrugdealer.com, which is our webpage where you can find the show notes and everything related to this episode there. And if you want to see the show notes is going to be on thelegaldrugdealer.com/4

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