Aargh ~ monolithic veterinary practice and very poor communication

[urge to herd]

Gibbs saw an orthopedic vet about 2 years ago. Veterinary care was excellent. He was prescribed gabapentin for pain in his knees. I decided not to do surgery because of his age, the vet agreed that he could just be on pain medication.

A few months ago I ran out of re-fills for the gabapentin. Costco contacts the prescribing dr. for you when refills run out. I waited 3 days, called the pharmacy again and was told they hadn't heard from the vet. I called the vet and it was refilled. It happened again. THIS time, when I called the vet, I was told she's out of town and won't be back until August. 

Called my regular vet, whom I've been taking my critters to for about 30 years, and his receptionist said, 'You were just in here with Gibbs for a dental, right?' Me, 'yes.' Receptionist, ' I'll check with Dr. R in just a minute and call you right back.'  She did indeed call me right back, then called in the prescription.

I just got off the phone with the Monolithic Veterinary Practice, (a chain of them). I'd called to talk to the practice manager. She's not available until Sunday and will have to call me back. 

Let me be clear ~ my dogs and cats have all had excellent veterinary care at this place. Their administrative practices suck. Please correct me if I'm wrong ~ wouldn't you expect a call from the veterinarian's office if they'd had to deny a refill for whatever reason? I'd like to know if I'm off-base here, before I send out a sternly worded letter and leave a Yelp review.  AND, I'm grateful I have  a veterinarian who bought an old Rexall drug store and turned it into a small animal hospital.

Rant off.

Ruth & Gibbs

[Liz P]

No, you would not.  The pharmacy should have told you if the refill was rejected.

[urge to herd]

Hmm. So the pharmacy should notify me in advance of my showing up there that the refill request had been rejected? I just want to be very clear on whose responsibility it is to communicate this to me.

Thanks for your response, Liz.

Ruth & Gibbs

[SS Cressa]

I normally alway check the pill bottle to see how many refills are left and when I am down to about 1-2 week of medication on the last fill call the vet or pharmacy to get a new script sent over. 
I always follow up with the pharmacy to make sure they have the new script, are able to fill it, and the estimated cost since rx cost can fluctuate.

Vet offices get busy. Pharmacies get busy. It would be nice if they would let you know if there was an issue but I wouldn’t expect it. I guess I just assumed it was my own responsibility to make sure everything happens. 

[Liz P]

Yes, it was your responsibility to call the pharmacy prior to driving down there.

Unless the medication was discussed and prescribed as chronic (refills available), you should have called your vet to request the refill rather than just requesting it through the pharmacy.  

If the medication was chronic, during that appointment you should have also discussed recheck exams as required by the state (every 3 months, 6 months, 12 months).

Pharmacies automatically spit out refill requests from their computer systems constantly.  The pharmacies tell us to ignore them if the client did not first call to request the medication or our system shows we prescribed enough refills that the client should still have plenty of meds.

[GentleLake]

13 hours ago, urge to herd said:

...I'd like to know if I'm off-base here...

I don't think so, not at all. When there's something like a vet being out of town or even out of the office for the day and there are other vets to cover, they should.

Re: the pharmacy, most of them notify people when prescriptions are ready. If yours usually does and you hadn't heard from them before leaving to pick up the script, then I would have called to verify that they received the prescription from the vet and that it was ready for pickup. In this case I wouldn't say the prescription was rejected because it was never received. If it had been denied then by all means the pharmacy should have notified you so you could decide what to do. Not sure what to say about the pharmacy's responsibility to notify you of lack of response from the vet. How long should the pharmacy wait if they get no reply? And do they even track such things? Personally I would have called them to check before heading out just to confirm they'd received the prescription from the vet.

It might be worth asking the pharmacy what their procedure is for handling situations like this so you know in the future if it were ever to happen again. But in any case I believe the onus is on Monolithic.

10 hours ago, SS Cressa said:

...when I am down to about 1-2 week of medication on the last fill call the vet or pharmacy to get a new script sent over. 

This may vary from state to state but I'm in NY and I can't order a refill on meds 2 weeks in advance. I think 1 week is the cutoff IIRC.

[amc]

I wonder if it's because gabapentin has now been assigned a DEA schedule, same as less potent narcotics (Tylenol w/codeine, for example).  There may now be a requirement that the prescribing vet needs to re-evaluate the patient at least once a year in order to issue refills in California?  In any case, you should have been told whether the rx was authorized or not. 

I have an app on my phone direct to our pharmacy - I get a text when my prescriptions are ready.  Very handy indeed.

Good luck and keep us posted!  Extra skritches for Gibbs too!

Amy

[urge to herd]

amc thanks for the further info about the gabapentin. I get a text from Costco pharm whenever any thing is ready, it's very helpful.  Both my regular vet and the ortho vet told me that G would be taking this medication probably for the rest of his life. 

Further clarity on the situation as I reviewed what happened.  When I call in a prescription for myself. something that I take daily or weekly, if it's out of refills Costco pharmacy staff offers to contact the prescribing dr. If I need to see the dr before the medication is dispensed,  the prescribing dr's office calls and says we need to see you before we will re-prescrib. I assumed it was the same way with vet medications.

When this happened a few months ago,  with the same vet practice, Costco pharmacy staff told me, (exact quote), 'We can't get them to call us back'. I got a text msg 2 days later from Costco saying G's prescription was ready, so obviously Dr. Hayes had approved it.  I started following the whole process closely this time because I remembered what happened last time. And I assumed that because I'm a somewhat 'frequent flyer' at this Monolithic VP, that someone would either a) ok the refill or b) call to tell me I needed to bring G in for an update/check-up. Neither of those things happened. The Monolithic Veterinary Practice, (seriously, VCA bought or leased a building that had been built to be a multi-plex movie place but went out of business very quickly. It's a monolith, all right) 

At a minimum I believe it's poor business practice to not tell  owners what is happening and what they need to do. When I speak with the practice manager I'm going to ask why I wasn't called and told I'd need to bring G in for another eval before they would re-prescribe? There was no communication at all.

Thanks for all your input, you guys are the best!

Ruth & Gibbs

[urge to herd]

Pupdate! Went to Costco and picked up the gabapentin. This was a prescription that my regular vet had placed for me when I called yesterday afternoon. He also added refills to it, so we're fixed for a while. 

Thank you for all the feedback. I'm glad to have a more complete understanding of the process and will tuck this information away for the next time. Liz P,  thank you particularly for the info about 'chronic' conditions that need medication forever. I'll have a chat with my regular vet and the Monolithic Admin as well just to make sure we're all on the same page.

Such a great resource, you guys are! Have a good weekend.

Ruth & Gibbs