open letter to emergency room doctors in the USA who are prescribing medicines in the middle of the night:

do not send the prescription to the wrong pharmacy.

Yes I know there are about three or four people in a fucked-up game of telephone to get the prescription to whoever actually sends it to the pharmacy. And I know each of those people will independently try to decide what pharmacy it should go to, and if they haven’t been given clear instructions they’re gonna choose wrong a significant percentage of the time. Do not let them do this. Give them clear instructions, and make sure those instructions match what the patient asked for.

And. If what the patient asked for does not match “which pharmacy is actually open” or “which one you think the insurance will cover” or “which one you think will have the product in stock,” please have a fucking conversation to clarify this with the patient before you just pick something.

(like back when I worked for CVS, and got Kaiser Permanente insurance through CVS, and so my doctor visits were covered at any Kaiser office but my prescriptions had to be filled at a CVS pharmacy, because CVS was the only employer who had a deal with Kaiser that exempted them from having to go through Kaiser pharmacies, but absolutely no Kaiser doctor’s office employees ever knew this, so no matter how clearly I said “send it to CVS” I would get countermanded at every single step by an employee who was absolutely sure it could only be covered at a Kaiser pharmacy, and I’d have to go back at least three times every time a prescription was written to correct the person who fucked it up)

And if you send the prescription to a Walgreens you better be fucking certain the patient wants it sent to a fucking Walgreens. Because Walgreens has almost no locations that are open in the middle of the night, BUT, every single one of its locations is still set up to process prescriptions automatically in its fucking sleep. The very second you submit an electronic script to a Walgreens, the always-on Walgreens computer will grab it like a little goddamn insomniac piranha and put a sign on it that every insurance company can see that says “hey look! this prescription was just filled at a Walgreens!”

So, if the patient realizes that the closed Walgreens is actually a shit place to try and get an emergency med in the middle of the night, and asks the doctor to re-send it to a different pharmacy? that pharmacy will receive the prescription and try to fill it, and the insurance will go “lmao too soon! You JUST had this filled, bro!” And the doctor canceling it makes no difference. The Walgreens has to reverse it before the insurance will pay. Which requires there to be people at the Walgreens. Which there aren’t.

MAYBE you can convince the new pharmacy to hunt down some other Walgreens that’s actually open 24 hours, and call them and ask them to access the prescription through their worldwide Walgreens web and reverse it that way, even though they aren’t actually involved with this prescription whatsoever. But much much more likely the pharmacy tech at the new pharmacy will just have to sit and wait for 20 minutes listening to Walgreens hold music, until either Walgreens hangs up on them or the patient gives up, while all the other patients wait behind this one at the counter, and all the other calls ring to voicemail, because there’s no fucking way there’ll actually be MORE than one single technician on duty during night shift, and no way the one single pharmacist on duty will stoop to doing things like Counter and Phone, because that’s Technician Work and it’s soooo beneath them.

And so the patient has to either pay out of pocket, or beg the emergency room to send over a voucher from the Compassionate Care fund that doctors treat like it’s coming out of their own paycheck (because it kinda is), or wait until the motherfucking Walgreens opens.

Or, depending on which pharmacist and which tech is on duty, you might be able to convince them to send you a bill instead of making you pay at the register, but that’s left up to their discretion and none of them are given any consistent instructions on what they’re allowed to do, and the skeleton-crewed middle of the damn night is the time when you have the absolute fewest options when it comes to finding anyone who can help you with ANYTHING.

Because even hospitals that call themselves nonprofit (so they can qualify for grants) are obsessed with making the absolute maximum profit these days. And they will do basically anything to put obstacles in your path to getting anything without immediately paying them money. Yes, even if it’s for something you Really Need! And yes, a very high percentage of patients and nurses and doctors are surprised as hell when they find that out, because they’ve honestly assumed up til this point that there’s always a way to get you what you Really Need, no matter what. Because, like I say every time this sort of bullshit happens– one of the biggest damn obstacles to ever getting a real universal healthcare system in this country is that a scary number of people in this country are completely convinced we already have one.