I’m still having episodes of profound fatigue, even though my thyroid hormone levels are now near normal. My primary doc did a workup, and found that I had really low testosterone levels. That wasn’t news to me. I’d had it tested a few years ago and it was low then. Since my libido is more than adequate, I didn’t see any reason to intervene. It can be a cause of fatigue, though, and this fatigue is starting to seriously affect my productivity. So we decided to try supplementing with a bit of pharmaceutical testosterone.
Because it’s a controlled substance, I thought it best to try using a brick-and-mortar pharmacy instead of mail order. It also requires syringes and two different-size needles to administer (it’s in really thick sesame oil, and you need a fat 18- or 19-gauge needle to draw it up, but you don’t want to stick such a railroad spike in your skin, so a 22-gauge for injection is kinder). So it’s really four prescriptions that go together.
Doc sent the prescription right away (21-Jan-2025), and I waited a few days and then made the hour-plus round trip to the nearest pharmacy. “Oh, we couldn’t fill it.” Why not? “We faxed your doctor to let her know.” But what was wrong with it? “There was a problem with the prescription.” But they wouldn’t tell me what the problem was.
I asked the doc to see if the clinic got the fax or if she could call the pharmacy and correct whatever was supposedly wrong. That done, a few days later I again made the hour-plus trip. “Well, the testosterone prescription is now okay but we can’t get the needles.” Why not? “They’re just not available.” When do you think they’ll be available? “We don’t know. We’ve been trying to get them for a long time.” Could we try a different size? “You’ll have to go through your doctor.” They wouldn’t even tell me what she had ordered, nor what they have available. Really? You are in the business of filling prescriptions, aren’t you? They suggested I try the other pharmacy in town for the needles.
I then thought I would at least get the testosterone so I’d have part of the problem taken care of. “We don’t have it.” What? “We can order it, but we didn’t know if you’d want it. Give me your phone number, and we’ll text you when it comes in.”
The text never came.
In the mean time, I checked with the mail order pharmacy. Apparently, they have no problem with C-III controlled medications such as testosterone and, yes, they had it in stock. So I asked Doc to send the prescriptions there.
A few days later, I got a message from the mail-order pharmacy that “your prescription has been canceled.” Why? After multiple telephone conversations and text chats, the only thing I could get out of them is that it’s “probably” a supply issue but in any case there was nothing they could do and I would have to get the medication elsewhere.
We then tried sending the prescription to the only other brick-and-mortar pharmacy within 50 miles of here. I called before making the long drive (remember, there are no freeways here). They said the prescription was filled. When I went in, though, of the four prescriptions (testosterone, big needles, small needles, and syringes), they only had one ready. One other had been ready earlier in the day, but somebody had opened the pharmacist-sealed package, removed some of the needles, and placed the package back on the wrong shelf. Needless to say, sorting that out took a good long time, while people behind me in the ever-increasing line were starting to grumble. In the end, I left the store with testosterone (yay!) and 18-gauge railroad spikes, but no smaller needles and no syringes. Why? “Your doctor put ‘use as directed’ for the instructions for the smaller needles. We need more than that.” Do you? Did she put a quantity? “Um, yes.” So you have a valid prescription, with a valid sig (instructions) and a quantity to dispense, but you won’t dispense them? “Yes.” They were adamant, even after I pointed out that I’m a retired physician and I know that “use as directed” (ut dictum) is a valid instruction. To make matters worse, in this state it is legal for pharmacies to dispense syringes and needles without any prescription at all, though the law does not compel them to. The law does compel them to fill valid prescriptions, but I don’t think calling the police would have helped matters any. As to the syringes, they simply claimed to never have received the prescription.
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Long aside: When I was practicing, I did all the practice’s technology. I designed and programmed the phone system. I wrote the electronic medical record (EMR) software. I structured and maintained the email and fax systems. I had access to every voicemail, fax, and record created. The EMR would fax prescriptions directly, so we always knew exactly what was sent and when it was received by the pharmacy. Yet, almost every day, I would get a call from a patient who said “the pharmacy said you never sent the prescription.” I could always find a receipt for the prescriptions that I supposedly never sent. Sometimes, the pharmacy would have already submitted a prior authorization request from the insurance company. Once, on a controlled medication prescription, I asked the pharmacist to send a note to me so that I would have a record that they didn’t receive it. SHE WROTE THE NOTE ON THE BACK OF THE PRESCRIPTION SHE “NEVER RECEIVED” and faxed it to me, apparently unaware that her fax machine sent two-sided copies. In other words, the pharmacies lied and lied and lied and lied. I am 100% certain that the major chain pharmacies have an employee handbook that says “never admit that we haven’t got a prescription ready; always tell the customer that we never received it from the doctor.” Of course, at most practices the doctor isn’t in the loop and the front office takes care of the “missing” prescriptions so the docs never know that the pharmacists are blaming the doctors for the pharmacy’s delays. Someone once asked me what the most frustrating part of practicing medicine was, and I said “retail pharmacies.” That’s probably not true — insurance companies are probably worse. Probably. Maybe. Then there’s the fact that many pharmacies are now owned by insurance companies so perhaps there’s no point in ranking them anyway.
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So, at this point I have testosterone and big-spike needles, but no syringes so I still can’t dose myself. I checked with the mail-order pharmacy, and they still had prescriptions on file for the small needles and the syringes, so on 03-March I ordered them. Then next day, I was told that they had already shipped and I would receive them on 07-March (yesterday), a mere 46 days after I first tried to fill the prescription.
But did they arrive yesterday? No. No, they did not. Instead of receiving the syringes that I had been told had already shipped, I was instead told that they weren’t able to ship them due to “supply issues” but that I could expect them on 11-March. So here I am on the 47th day after I was supposed to start a medication. I’ve involved three pharmacies and eleven prescriptions (yes, there are parts of the tale I have skipped for brevity, believe it or not). I still don’t have my medication.
This is not only awful, it could potentially be life-threatening for some patients and medications. And consider this:
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The most common cause of problems getting medications filled are insurance issues, but these are cheap medications and I’m paying cash so that barrier — which would profoundly affect most patients and most medications — was completely eliminated.
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Most patients aren’t retired physicians and don’t know to question pharmacies that give them implausible stories about why their medications aren’t available.
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I have a really great primary care provider who is easy to reach and quick to respond to problems. She’s also apparently endlessly patient (or at least remains calm when talking to me) and willing to re-send the prescriptions over and over, perhaps with minor variations, to appease various pharmacies and their arbitrary policies. She actually offered to let me pick up a syringe at the clinic, but at that point I had been led to believe that the syringes had already been shipped to me (lie) so I declined.
Will I receive my medications on the 11th, a mere 52 days after I was supposed to start them? Stay tuned…
—2p
PS: At this point it occurs to me that I probably could have experienced immediate gratification by simply buying the testosterone and accouterments from those buff-but-shady-looking guys who are always hanging out around the gym.