Everyone needs medicine sometimes. Maybe every day, maybe once in three years. If not, someone close to you surely does. But now you've heard about the potential for dangerous pharmacy errors.
I'm not going to sugarcoat it. The risk is real. But that doesn't mean you're doomed.
So what can you do to protect yourself and your family from medication errors?
1. Realize the pharmacists are on your side.
We absolutely never want to make an error. Hurting any of our patients is our gravest fear and most haunting nightmare. On an individual level, we truly are pharmacists because we want to help, it's just become more and more challenging for us in recent times, and we are human.
2. Don't hesitate to ask.
Do your tablets look different? Does something seem off? Most of the time if your tablets have changed in appearance, it will simply be due to a change in the supplier, and is safe to continue taking the medication. In an ideal world, your pharmacy will inform you each time this happens, or at the very least put a sticker on your Rx to let you know, but this doesn't always happen. If you have any doubt, ask. The pharmacist can double check what's in your bottle- likely even if you didn't get the medication from their pharmacy.
3. Know your medications.
Be familiar with each medication you take. Know it by name. Know what it's for. And again, if you don't know, ask. It's our job to give you this information. Remember how when you pick up a medication, the cashier asks if you have questions or would like to speak with the pharmacist? Don't brush that off, even if you have used the medication before. Carefully verify that what you are receiving is what you were expecting. Listen to the instructions from the pharmacist. Many medication errors can be prevented this way.
4. Stay up to date.
If you take regular medications (also called "maintenance" medicines), keep a list of them, and keep it updated. Make sure it includes OTCs, herbals, and other medicines that you take, including cannabis and related products. Have it available for every doctor, pharmacist, or other health care provider that you see. This can help us detect drug interactions we might not otherwise know about. Here are printable and fillable wallet cards from the Connecticut Depart of Public Health.
5. Get all your medicines in one place.
Again, this allows us to detect medicine problems and interactions that could otherwise be missed. Maybe your dermatologist prescribed something that interacts with something your PCP prescribed. Maybe your urgent care wasn't aware of an allergy or interaction that your pharmacy already has on file. The pharmacist will be able to check all of these against each other, but only if they know about them.
6. Be a patient patient.
If you need an expedited prescription or to "wait for it", let us know. This is intended for emergencies: discharge from the ER, treatments for acute infections or injuries, etc. If you don't need it, don't ask for it (here's why). Give the pharmacy a reasonable estimate for another time you can pick up the medicine, such as "I'll pick it up on my way home tomorrow, I get off at 6pm." We understand that expedited Rxs are needed sometimes, but if you do not truly need it, you are increasing the risk your pharmacy team will feel rushed, and you are taking resources away from other patients who are acutely ill or injured.
7. Plan ahead
Similar to point number 4, plan ahead. Try to request your refills a few days before you are out of medication. Not only does this give us more breathing room to fill your medication, it also gives us a chance to resolve issues you may never know about. For instance: the medication is in short supply or out of stock, there is an insurance rejection, or you didn't realize your prescription has expired and we need to get a new one from your doctor.
8. Pharmacy shop.
One factor that was not addressed in the NYT article is that many patients are forced by their insurance plan to use whatever pharmacy their plan prefers, or face non-coverage of their medications, effectively removing consumer choice from the equation. This is one of the ways that companies like CVS get away with their behavior - they know you can't leave and go to a different pharmacy. However, there are some things you can do about this. The first step is to pharmacy shop. Try to find a local or small chain pharmacy where you feel comfortable that patients are the pharmacist's priority. Two: Ask them to help you with price information. Depending on medications, it can sometimes be cheaper, or at least comparable, to fill without insurance. But remember number 5: try to keep all your medicines at one pharmacy. If that's not practical, make sure each pharmacy knows what medicines you get elsewhere.
9. Advocate for yourself.
If you have an employer-sponsored insurance plan, your HR department likely contracts in some form with a PBM or Pharmacy Benefit Manager. This is the company that decides the where, when, and what of your prescription insurance coverage. If your plan is requiring you to use a pharmacy that you don't feel safe at, make your complaints known to HR. Ask them to consider choosing a plan that gives you your choice of pharmacies for the next plan year. If they don't know how you feel, they can't take it into consideration. Make sure as many of your coworkers as possible voice their concerns as well, if they share them. If you have Medicare Part D coverage, make sure you choose a plan that includes your preferred pharmacy and doesn't mandate mail-order or increase your copays if you don't use it.
And finally,
10. Advocate for change.
The legal system surrounding pharmacy is very complex and very broken. A pivotal issue in eliminating the conditions we see in pharmacies today is the concept of PBM reform and stopping the elimination of competition in the market. Did you know that the 3 largest PBMs in the US control about 80% of prescription drug claims in the US? (source here) There is a reason that ~10,000 United States pharmacies have closed in the past 10 years. The US is the only country that utilizes PBMs to manage medications, and we are the only country with exorbitant expenditures on prescription drugs when compared to the rest of the world. Let your legislators know that you support PBM reform and/or workplace reform in America's pharmacies.
In conclusion, pharmacists and pharmacy technicians are here for you. We want to help. And though we are struggling, we will continue to fight for your safety by pushing for reforms at both the state and national level. These are just some tips to give you an edge when it comes to your own medication safety.
Love this article. It's the advice I give to my patients all the time. I'll shared it far and wide. Thanks for your care and honesty PA!