I had a pleasant xmas. The kids were happy with their presents and Santa was good to me. The gap between xmas and new year has always been a quiet time for me. I usually use the time to clear year-end paperwork and the like. This year was no different. Saturday morning, Monday and Tuesday was my contribution to the national GDP. On Monday I was happily enjoying my umpteenth mug of tea about lunch time when a patient came in with a High Tech prescription. He was not local or one of the regulars. I had dispensed a hospital emergency script for him a few months ago. “Would you have even one of these pens, I need it for the morning?” The box for the nominated pharmacy was blank. A quick chat with him revealed that he was getting it regularly at another pharmacy. I explained that he would have to get it from his nominated pharmacy. He told me that they were closed until the new year and that he could not contact them. He had been down to St James Hospital that morning and obtained a new script hoping to be able to get them from another pharmacy. I’m a bit of a sucker for a sob story and at least he had the initiative to travel the not insubstantial distance to St James to see what could be done. I only had one more delivery from Uniphar before closing up for the new year so I decided to give them a bell. Some of you are ahead of me here. It was a Direct To Pharmacy (DTP) line. So I rang the company. I was half expecting a “We’re closed until Jan 6th, leave a message and we’ll get back to you when somebody bothers to check the answer machine.” Instead I got the usual menu of choices. After a few buttons I got on the the High Tech orders department. “All our operators are busy.” I could wait or leave a message. Normally after the second round of these messages I leave a message but at this time of year I decided to hang on in case they were on holidays and a call back could be delayed. After ten minutes (a quiet afternoon in the pharmacy and a clock on the phone) I got to speak to a nice lady. Yes they could send one out with tomorrows round of deliveries. She couldn’t give me a time for the delivery until the sheets were done up tomorrow morning. However being new years eve and all I was closing early. She could give me a call in the morning when they set out. That would have to do for now. I could call the patient and let him know when I would have it.
No need for that. At 9:30 on Tuesday morning the delivery man was at the door of the pharmacy with his precious cargo. I contacted the patient and within an hour his sister had collected and was on her way. A happy outcome for that patient but I doubt that apart from feeling content with a good deed that I would be getting anything from this. There would be no patient care fee as he was already registered with another pharmacy. The best that I would get is material for this article.
I contacted the other pharmacy early in January and they confirmed that yes they were closed over the holiday period. I let them know that I had dispensed for this patient and they made a note for their records.
This incident brought home to me something which hadn’t affected me too much up to this. Being Dublin based I have not had too much difficulty in obtaining High Tech supplies from the various DTP companies. But throw in a bank holiday in a pharmacy in the hills of Donegal and you get some idea of the problems involved in getting supplies in a timely manner. With the move from wholesalers to DTP it has to be asked have the manufacturers put profits ahead of patient care? I do not begrudge the manufacturers their profit and I doubt that any patient will die from the delay but in the long run it will affect patient outcomes. It will also cost the HSE more as beds are blocked until supplies of their medicines can be arranged before discharge. I wonder if the Pharmacy Regulator, the HSE or the Department of Health have been asked officially for their views on this.
And what if this trend did not stop with High Tech medicines? It has already started with one high value medicine that I’m aware of. To obtain this nectar you must first ring the company concerned and then they will send you a pack directly and invoice you via their preferred wholesaler. In this case it is my second line supplier with no discount. So now I can add this to my list of FEMPI products that I am dispensing at a loss. Where will it end? With the advent of reference pricing it is not beyond the realms of possibility that at some point in time one of the manufacturers might decide that it is no longer profitable to supply to the wholesalers. This could possibly mean that we will all have to have accounts with a myriad of suppliers whether we like it or not. With minimum orders and less frequent deliveries this will be another nail in the coffin of small pharmacies.
The public don’t want to know about the difficulty in the supply of these medicines. They just want it now! But this doesn’t stop with the public. In the past few months I have had a number of run-ins with staff in a particular hospital about various ULMs. In each case a patient was discharged on Friday evening with a script for a ULM or a currently out of stock line. We contacted the hospital looking for clarification or an alternative to be met with “Why don’t you have it? We have it here.” On one occasion the pharmacist said to me exasperatedly said to me “I suppose that we will have to give her some!” That time I ordered in the ULM (Tuesday morning was the earliest delivery) only to have the product still sitting on my shelves four months later. Other hospitals are better. I regularly get calls about patients who are being discharged shortly with various hard to get meds. I endeavour to oblige but on at least one I have been stung badly with a patient whose discharge was delayed and then his meds changed. The other times the meds have been High Tech so at least there was no financial hardship for me. But don’t get me started on the hardship scheme! We are now into 2014 and plus ça change.