In two of the three hospitals where I work patients are asked for their “preferred pharmacy” at the time of triage. That seems helpful and proactive, but for patients who are cost conscious it chops out some freedom to shop. The reason we ask the question is to facilitate e-prescribing. Unfortunately, every time I click “submit” to launch these prescriptions, I wonder if they’re actually landing where I’ve intended. Call me a dinosaur, but I still prefer writing the prescription and handing to my ER patients.

The Pre-R experience has taught me a lot about pharmacies too, and I can definitely say there is a wide range. Some pharmacies check their voicemails regularly. Others don’t. So I try to speak with pharmacists directly whenever possible. Also, pricing is far from consistent, as you can see from the attached pictures. (I love GoodRx.com)

During my last shift a one year old had what seemed like an early abscess in the making. It wasn’t ready for drainage, so I spoke with a pediatrician to get follow-up in a day. Cephalexin is a common, inexpensive, generic antibiotic for skin infections, but the pediatrician said there was a lot of local resistance to it. Instead she suggested I prescribe clindamycin.

I clicked the buttons to send the prescription to Grandma’s preferred pharmacy, but when she got there, she balked at the $70 price tag. She went home empty handed. Later that night she returned to the ER for a paper cephalexin Rx. Kids are usually pretty well covered in California so this possibility didn’t enter my mind, nor the pediatrician’s. However, had we known the price and grandma’s reaction, we would have picked a different path.

While I’d like to use GoodRx for every ER prescription, it’s just not feasible. Plus I’ve no clue what bills patients will actually see once their insurance coverage is factored in.

Moral of the story for readers: If you have Cadillac insurance where everything is covered, then ignore me. (You’ve probably already stopped reading.) On the other hand, if you watch every nickel and dime you spend in our crazy medical world, then request paper prescriptions so you have time to shop. Also, you’ll be amazed how much you may save with a $2 pill splitter.