Tuesday, May 04, 2010

The Insulin Nazi

This is a copy of a letter I plan to mail out once I calm down.  Apparently I have to choose between the friendly-but-incompetent pharmacy that keeps giving me bad insulin, or the effective-but-infurating one I dealt with today:



To Whom it May Concern -
I am writing to complain about unauthorized altering of a prescription by one of your pharmacists at CVS #XXXX.  I presented the pharmacist with a valid prescription written by my doctor for 3 vials of insulin per month, with three refills.  This is a dose I have been taking for years and filling without issue at a non-chain local pharmacy.  My insurance company has never had any problem with this amount.
Last month, when I brought the new prescription to CVS, the pharmacist at first only gave me a single bottle of insulin.  When I told her it was supposed to be three bottles, she said she needed to know how much insulin I took per day.  I told her that the amount varied greatly because I was on an insulin pump and had a variety of issues affecting my insulin sensitivity on a day to day basis (as do many people with diabetes).  
She said she needed to calculate what a thirty day supply of insulin would be.  I replied that a thirty day supply was what my doctor had written the prescription for - three bottles.  The pharmacist replied that she needed a number.  So I told her it could go as high as seventy units per day.
She said 70 units times thirty days would be 2100 units, and rounded down to two bottles (2000 units total).  I was in a hurry and needed to leave, so I agreed to the two bottles and was able to leave with my partial prescription.
There were a few problems with her calculation.  First, it assumes I can get every unit of insulin out of the bottle with no waste.  This is physically impossible. Second, it does not take into account that I use an insulin pump with 43 inches of tubing.  This tubing must be primed (filled with insulin) every two days when I change my infusion site. It takes a minimum of 21 units of insulin to prime the tubing, insulin that is discarded when the site is changed.  Third, it does not take into account that the very nature of diabetes is change.  A huge variety of factors can cause your blood sugar to rise, and very few of them are within a patient’s control.  Infusion sets get accidentally torn out, hormone levels change, other chronic conditions interfere with insulin sensitivity.  Three bottles was the amount determined by me and my physician to keep me healthy.
 What I actually should have said was on a typical site change I load the pump with 150-175 units of insulin, and change it every two days, but I was thinking “dose” not “priming plus dosage”.   This comes out to be about 2500 units of insulin - clearly more than two bottles.  
Also, I was not expecting to have to justify my doctors written directions.  Do patients with infections have to argue that 250mg of penicillin should be enough if the doctor had prescribed 300mg, or do I need to worry that this pharmacist will suggest that I only need to take Synthroid for six days a week?  
Since I still had a partial bottle at the time I filled the prescription, I was able to get through the month and figured I would explain as I picked up my refill that she had miscalculated the amount I would need.  That ran into a few snags.  First, my phone refill was not ready on the day I stopped for it.  They said it would be in by the next day so I agreed to come back then.  On the following day, a violent thunderstorm had knocked out the store’s power shortly before I arrived; the pharmacy’s computer was still running on back up power and I had cash to pay for the prescription so I thought I would be in the clear.
Once again, I was given a single bottle.  Apparently, while modifying my prescription to fit her idea of my doctors directions, the pharmacist wiped out all my refills; instead of nine bottles doled out stingily two at a time; only one bottle was left on my record.  After several minutes of arguing I was able to leave with my single bottle - no charge.  Of course it should be no charge, it was part of the incomplete original thirty day prescription.  I agreed to return again when the computers were up to try and straighten out the issue.
This mix up would not have occurred if my prescription was filled as written, and I would like your assurance that in the future your employees will not attempt to second-guess my physician.
I am not a junkie; I am not selling extra insulin on eBay or sharing it with my friends so they can experience the joys of a life-threatening insulin reaction.  I simply think that your pharmacist should not be determining my quality of life, simply because she suspects I might be trying to cheat my health insurance company - a company that has never once complained about the amount of insulin or test strips I use per month.
I am sending copies of this letter to the local CVS pharmacy, the CVS customer service, my doctor, and my health insurance company.    

(...And of course posting it on my blog to be read by diabetics everywhere)

21 comments:

sisiay said...

Wow, that's horrible. Are pharmacies allowed to change prescriptions without a doctor's consent? With oxycontin maybe, but insulin? I hope you get an apology from their management.

Anonymous said...

This same scenario has happened with me also. I called my Dr. while standing in front of the pharmacist,expained to him what had happened. My Dr. asked for the pharmacy # and made a call while I was standing there. Phone rings, I hear yes,yes sir, I am very sorry,I will take care of Mr.Murphy the way you have prescribed. She hangs up the phone,says I am very sorry and here are your three bottles of Humalog.

I do not know what my Dr. had said,but it sounded like she received a verbal thrashing.

Michelle said...

Yes, but they are just looking out for your well being, right? Maybe you should have explained that you have violent tendencies when your blood sugar runs too high and that you'll be thinking of her the next time your BG soars because you don't have enough insulin :-)

asskeeper said...

I have to giggle that you are dealing with CVS in this fight. The also employ Meter nazi's here in NJ. A long time ago when the freestyle first came out. They had coupons online buy x number of strips get the meter free. I ended up having the original script filled at a different CVS then the one I usually used. I got the meter and strips and was a very happy camper. Well at the end of the month I was running out of strips. The coupon was still good so I printed out another copy. I took it to the pharmacy to pick up meter and strips. Well the meter nazi felt it was his duty not to give me the meter. I ended up calling the company up and they said he was wrong and they called and told him so. I was peeved and told said meter nazi. I wrote a letter to his supervisor. The guy actually told me that coupons were for those who couldn't afford the meter. Well dude my insurance company wouldn't cover a meter. Actually I sent the meter I got to a friend in Canada. This is 15 years later and still REFUSE to use that CVS.

floreksa said...

I have no clue what's going on lately, but a LOT of us have noticed that our prescriptions suddenly say "use x units per day" instead of just listing a certain # of bottles. It makes absolutely no sense. "Sorry, you've taken your limit for today. I'm sorry its only 3pm. Enjoy your high. I hope you don't puke too much." *roll*

I'll have to ask my endo about it at my next appt.

Karen said...

That is totally unacceptable!! Good for you for letting everyone know about it!

phonelady said...

cvs , wal mart and a clinic i went to the pharmacist told me you cant possibly take that much insulin if you do , you need to see your dr and have them write for more and they need to know how many units i was taking too . Yes it is aggrivating and everyone looks at you like you are a freak . i asked them to call my dr and she said NO in a very loud tone THIS IS Your responsibility not mine !!! i could not believe someone would speak to me that way . dont expect anything to get done i wrote letters and emails and still nothing so dont expect it at all .

Tracy1918 said...

We had a HORRIBLE experience with CVS and will never go there again. They gave us the wrong needles for my son. Ones that were much too big. Of course, we didn't know since we were fresh home from the hospital. Once we discovered the mistake....confirmed by our doctor....we went back to CVS. They never would acknowledge the mistake and it was only by arguing non-stop that we finally got the proper needle. At CVS, they do not care at all.

Anonymous said...

You definately should mail the letter. I too am tired of my daughter's insulin needs being audited. We have a couple CDE's that feel compelled to do this. I get so sick of justifying why my child might need to have a couple extra units of insulin on hand you know, in case she wants seconds or something (we just switched brands and have NOTHING in supply closet). They do act like I'm selling this crap on Ebay!! Ridiculous when her life literally depends on us having a constant supply of this.

Anonymous said...

My son's prescription for insulin was written for amt. as needed, so when I told the pharmacist at CVS I needed a certain amount she told me that my son's
(age 17) insulin amounts were above the recommended dose and she would not give me what we needed. We then had to contact the Md for more specific dose. I told her that there was no real dose in the insulin because it was based on many varying factors and she told me I was wrong. I am a RN, CDE. This was after they gave me expired glucagon and tried to give me unrefrigerated insulin.

Anonymous said...

How unbelievable. That pharmacist should be fired. Who gave her premission to override dr's orders. She's not a dr. she's a pharmacists. I'd send it off to CVS (and I will no longer use cvs for anything) and I'd contact the local media.. who knows what she's doing with other peoples perscriptions, and she's probably charging your insurance the full amount!

chris bishop said...

It is funny the timing of this post for two reasons. !) I ran into a similar scenario at Walgreens when I transfered a prescription there and charged my my prescription copay for each bottle, and 2) I have a post 1/2 written about this.

It really seems like there is something in the air.

Scott K. Johnson said...

How frustrating!!!

I hate dealing with extra crap like this. Living with diabetes is hard enough!

Anonymous said...

Actually it is illegal for a pharmacist to change a prescription unless they notice that it may have a negative reaction with another drug one might be taking. I had the same problem this year with the amount of test strips I was using, but knowing the law I was able to put a stop to this behavior by the pharmacy I go to and they better not try this stunt again. You an always file a complaint with the State Pharmacy Review Board and the Attorney General's office if the pharmacy continues to pull this kind of stunt. I have and I will do it again..

Jacqueline said...

No pharmacist should alter a prescription. If there isn't enough in supply then he/she should advice the patient to return for the completion or write on the prescription how much was given. I believe that you should send the letter so that those in authority can see what is happening. This can also let the business lose customers as well.

therewasbefore said...

This is utterly ridiculous! You should not have to put up with that. I have heard of these problems, but using a local pharmacy...I haven't yet experienced them. It just seems wrong.

Anonymous said...

Thank You for bringing this to me as a diabetic and having to deal with pharmacies ....Im glad you shared your story....

Anonymous said...

yesterday I opened my last bottle of insulin,only to realize it was not what i had been using. i use novalin N. this was H. i use four vials a month. the four boxes are taped together and the script is stuck across all four. cvs had given me 3novalin N and 1 H. i called another pharm and they told mt that if i had taken my normal dose of 70 units that i probably would have died. THANKS A LOT CVS. Monday i am calling the home office.

Kerry said...

Keep complaining until you get what you need. Insurance and pharmacists can be difficult and it gets tiring trying to explain things that are just logical to us. Good luck and I hope you get good results.

Kristina Martin said...

I just ran into this situation at the CUB foods in my area, but with a slight twist. I have been begging and pleading with the pharmacy to give me the 3 bottles for my script (per my doctor) per 3 months. They kept saying the doctor changed the dosage (?!?). Still kept charging me the $90 bucks for two that I was paying for the 3 before. Now I called tonight and he said I only had one bottle left on my prescription because I had been taking 2 instead of 3 bottles at a time. But hey guess what, they didn't change the price, so I ended up paying $90 for one bottle of insulin. This has to be crossing lines somewhere. Any suggestions on how I can pursue this? I'm tired of feeling like I have been mugged every time I go to the pharmacy. Email me if you have any ideas.

Val said...

@Kristina - the best thing is to get your doctor to write a specific "dosage" on the script, rather than just a number of bottles. Something like "Use up to 90 units per day depending on carb counting and insulin sensitivity". I also had them phone my doctor to verify, and told them to enter that information on my account. I'm sure it's probably there in big bold letters "this customer is a complete b!tch, just give her the insulin and get her out the door..."