Holiday Depression

Many individuals have an exacerbation of an existing depression, or, experience a severe depression for the first time during the holiday season.  

When starting anti-depressant therapy, it is important to realize that during the first week of therapy, you may feel a little anxious, agitated, tired, or irritable. The neurotransmitters in their brain are being adjusted, and this may cause all sorts of uncomfortable feelings. Usually, these are transient side effects and will shortly pass. 

Please click on the following link to read the entire article.


Copyright AudibleRx (TM), all rights reserved.

You Shorted Me on my Oxycodone Prescription

Not much raises the hair on the back of a pharmacists neck as when a patient calls in and states, emphatically, that they were shorted on their oxycodone prescription.  How the pharmacist handles the next two minutes will have a tremendous bearing on the outcome of the phone call.

Please click this link to read the entire article.


Copyright AudibleRx (TM), all rights reserved.

Prescription Nightmare

Following a few simple rules will greatly decrease the chance that you, a consumer, will consume a misfilled prescription.
  1. Always read the label to assure that the name on the prescription is the same as the individual who is taking the medication.
  2. If the prescription is new, assure that the tablet matches the medication description on the label.
  3. If the prescription is a refill, assure that the medication looks the same as it did last time. If it looks different, check the medication description on the label to assure that it matches the container's contents.
  4. If there is any doubt as to the contents of the prescription bottle, always call the pharmacist to verify the medication before taking the first dose. 
Please read the entire article:

Copyright AudibleRx (TM), all rights reserved.

New Year's Resolutions and Your Medications

This time of year many begin to think about resolutions for the coming months. Perhaps this year we can forgo the diet and exercise promises and focus on our Medication Management.

Please take a moment and read the article I just wrote for Pharmacy Times discussing three very important Medication Management issues.


Copyright AudibleRx (TM), all rights reserved.

Is your community pharmacy part of YOUR community?

Today I had a patient walk into the store and said she likes coming here because it makes her feel like she is on the set of the 80's T.V. show "Cheers".  She then continued by saying how great it is to walk into a store where "Everyone knows your name"!

I have recently been accepted as a contributor to Pharmacy Times online pharmacy magazine.  Today, I have my first article posted at the site.  Please take a moment and click on the link below and see what it means to be have your pharmacy be part of your community.

 Is your community pharmacy part of YOUR community?


Copyright AudibleRx (TM), all rights reserved.

The Unbearable Cost of Retirement

Unfortunately, many of the elderly population, for one reason or another, do not have family to look after them during their "twilight" years.  This may also be an interesting predicament for many grown children, being to busy to provide the needed care for their aging mother or father; while at the same time, encouraging their parents to find the most affordable care possible.  (Hidden meaning, we don't want you to spend our entire inheritance on your assisted living needs during your last years.)

One of my pharmacist/internet friends recently wrote an excellent review of the cost of assisted retirement care.  The numbers are mind numbing and, quite frankly, require two or three complete readings of the article to understand the depth of the situation.  Please take the time to understand what he is saying and pass it on to anyone you know who may retire some day!

You may follow and connect with Jonathan Shores through LinkedIn at


“The woods are lovely, dark and deep, But I have promises to keep, And miles to go before I sleep, And miles to go before I sleep.” Robert Frost, 
Stopping by Woods on a Snowy Evening

“You don't get to choose how you're going to die, or when. You can only decide how you're going to live.” Joan Baez

The annual Medicaid tab for long-term nursing care in the United States is nearly one hundred and twenty three billion dollars. Medicaid spends over one half of its total yearly federal budget providing for the unfunded healthcare costs of citizens receiving extended nursing care; primarily in lower cost, state funded, county nursing homes. Because the federal Medicare program does not pay for routine extended care, a figurative hole where the rain gets in; over two thirds of all seniors in need of costly extended healthcare at home or in a facility, will have no reliable way to pay for all of the care needed. Medicare’s baby sister,

Medicaid, eventually ends up holding that bag. What’s the buzz?
Seventy percent of all Americans will need some form of extended nursing care during their lifetime; forty percent of these patients will be under the age of sixty five. This form of care is not just for the elderly; many accidents, illnesses, and disabilities affect younger individuals. The average length of extended care required for this entire population is three years. To put this reality into perspective consider the following insurable lifetime events comparisons for this group of folks:

Filing a claim for an automobile accident: 3.7%
• Filing a claim for homeowners’ damages: 6.5%
• Requiring extended healthcare services: 70%

Because Americans are generally living longer, and because the baby-boomers represent such a bumper crop of individuals; the number of patients who will need extended healthcare services during the next twenty years will be very large indeed. The estimated annual tab for these services, which varies depending upon the setting in which they are provided, runs roughly as follows:

• Assisted Living Facility: $40,000.00 per year
• Home Healthcare: $60,000.00 per year
• Nursing Care Facility: $90,000.00 per year

Remembering that the average length of need for these services is three years; tripling these annual amounts would yield a good estimate of the total per-capita bill that might be expected.

How on earth do folks pay for an average three year stint at a nursing home that costs a whopping two hundred and seventy thousand dollars? Answer: they don’t. Because of lack of finances; three quarters of all extended healthcare services provided in this country each year are provided free-of-charge by untrained friends and family members in a family home setting. The other twenty five percent of patients pay the bill by exhausting personal assets, by utilizing funds from purchased extended healthcare insurance policies, or by some combination of both.

The typical scenario for an uninsured individual who is too ill to be cared for at home by loved ones, and who must be placed in a nursing care facility… is Dickensian. Upon admission to the facility the patient must sign a waiver transferring rights to all personal liquid assets to that facility. When all personal assets are digested down to an amount of about two thousand dollars, the individual becomes eligible for Medicaid in most states. This two thousand dollar threshold is called the spendown trigger. The newly eligible patient is then transferred to the nearest, lower cost, state funded, county nursing home; and Medicaid picks up all bills from that point onward.

Commercially available insurance policies that provide coverage for extended nursing care services are one sensible answer to the risk described above. They typically offer coverage in the form of: x numbers of dollars of benefit per day, for y numbers of months. Premiums are based on the extent, and benefit value of the coverage that is chosen. For example, if the average daily cost of care at a local nursing home was three hundred dollars per day; a policy might be purchased that provided a benefit of three hundred dollars per day for a total period of thirty six months. The pot of money benefit created by this coverage would roughly total three hundred and twenty four thousand dollars.

Although premiums might, on the face of things, seem steep for such forms of protection; that expense must be sensibly weighed against the seventy percent likelihood that these services will be needed, and the certainty of the consequences that the need will wreak upon personal assets. However, patients who would never think of living without automobile insurance and homeowners’ insurance; routinely dismiss the thought of insurance for extended healthcare.

An additional benefit to owning long-term care insurance, that exists in most states, is the state partnership agreement. Under this formal insurance agreement a participating state resets the Medicaid spendown trigger to an amount equal to the extent and benefit value of the insurance coverage that is purchased. In the policy example provided above, the spendown trigger amount would rise from two thousand dollars, up to three hundred and twenty four thousand dollars. In other words, Medicaid coverage would kick in when personal assets were digested down to an amount of three hundred and twenty four thousand dollars; offering a generous measure of protection for the legacy value of personal assets. States benefit from these arrangements by relieving some of the financial pressures placed on their Medicaid programs by unfunded extended care patients.

A map of states that offer partnership programs can be viewed by visiting:

The burden of paying for the cost of extended nursing care comes as an unpleasant surprise to most elderly Americans. Most Medicare recipients mistakenly assume that they are covered by Medicare for nursing home costs. The dilemma is made all the more threatening and prevalent by the fact that it is so generally unrecognized, so shrouded by ignorance of the facts. For this reason, the cost of extended nursing care is a leading cause of personal bankruptcy for persons over the age of sixty five, and places a crippling burden on state Medicaid programs. An emotional burden to provide care is often placed on family and friends.

Pharmacists could play an important role in generally educating their patients, their friends and their loved ones about the problem of paying for extended nursing care. As with most problems, awareness and planning are the keys to solutions. This form of documented pharmacist counseling could also potentially save state Medicaid programs millions of dollars of costs, adding to the deserved reputation that pharmacist-consultants already enjoy for sparing state and federal governments from needless spending of precious healthcare dollars.

Just as it is true that we don’t get to choose how, and when we die; it is often equally true that we don’t get to choose where, or how long we go about doing it. What is certain, however, is that we will die. We can, by the grace of our own good sense and actions, control how we prepare and budget for that eventuality. It is comfortingly fair to know that we can, at very least, command the reins as we travel the miles to go… before we sleep.

Copyright AudibleRx (TM), all rights reserved.

Chasing the White Light

How nice it is to actually have a day off, in the middle of the week, with absolutely nothing planned.  Free time!  My wife and I decided to catch a late afternoon matinee.  The not-to-be-mentioned movie we were planning to see was foretold by our daughter to have an extremely long line.  She even went so far as to say that if it were here going to the movies, she would stop by the theatre early in the day and buy tickets ahead of time, because you don't want to wait in line all afternoon only to be turned away at the gate when it is your turn to purchase the tickets.

Being the risk takers that we are, we chose to take a chance and just show up, knowing full well that if the movie was sold out we would have just as great a time walking around town.  Upon arrival at the Cineplex parking lot, 45 minutes before movie start time, we realized that our sleepy town perhaps wasn't as up on this particular movie as much as the rest of the country.  We purchased our tickets, retrieved a large bag of popcorn, and proceeded to be the FIRST to arrive for the 3:45 viewing of this movie.

After 45 minutes of chatting and joking with my wife of nearly 25 years (it still amuses me that after many years of dating and 25 years of marriage we can sit in a theatre and entertain each other for 45 minutes while waiting for a movie to start) the previews began to roll.  During one of these block buster previews there were some statue lions that came to life and were beginning to look as if they were about to attack.  The fast thinking night watchman turned on his flashlight and began making circles on the ground and immediately the ferocious looking lions became ultra playful attempting to catch the white light as it circled around under their feet.

Later, during the middle of the feature presentation, there was this dramatic scene where the electrical power to the lighting was temporarily cut off and many people promptly turned on their flashlights.  The characters are tense and nervous; however, they notice the token cat following one of the flashlight beams.  They then begin playing with the cat, circling the light from the wall to the floor, temporarily averting their attention from the crisis at hand, watching the cat chase the elusive white light.

The white light is elusive, distracting, and unobtainable. The suggestion is that it doesn't matter what the cat may be doing, it can't help it, it needs to stop everything else and chase the light.  I would like to think that eventually, if the light kept moving, the cat would cease and give up.  I would also like to think that if the light stopped and then started again, the cat would recognize that it was a useless effort and not chase the light again.  This I don't know; however, I am sure, with a little research, one could find the answer from an almighty search engine.

Perhaps the white light is the beauty in the advertising pages of a fitness magazine.  We are looking for the elusive and unobtainable figure we want to see when we look in the mirror.  We spend money on health clubs, diet plans, trainers, garments and perhaps even surgery.  If we are fortunate, at some point along the path we may realize that no matter how we see ourselves in the mirror, this is the body we are meant to live in.

Maybe the white light we chase is the perfect job.  The one we read about in the trade journal with the fantastic pay and the title we know we deserve.  Yes, we have chased different jobs in the past; however, this time it is different.  We are sure that if we are able to move into this new position, all will be right.  We are good at what we do, we get the job, and after 8-12 months we find we are again looking at the job search engine. 

Yes, our job involves our skills and our ability to perform in our field; however, it also involves our ability to communicate and relate to our employees, peers and supervisors.  Job satisfaction comes from committing to be part of the team, assisting others in their efforts and receiving recognition for our efforts.  No matter what job we take, in absolutely any location in the world, it will still be you standing in your shoes performing the work. 

White lights exist around us, all day every day.  What about the perfect relationship.  You know, the one that doesn't require any compromise or effort to make work.  The one that after three months is dumped because it has become difficult, and besides, there is a white light that just flashed in front of me that caught my eye.  Perhaps drugs or alcohol has worked their way into your life as a white light.  The elusive and unobtainable emotional feeling you thought you experienced once, and now, against all better judgment and reason, you seek to find that experience at all cost.

I have chased all of these white lights at one point or another in my life.  Fortunately, through strong relationships, therapy, and commitment, I became aware of the white lights and began to recognize their existence.  The lights still flash and circle; however, I am now able to recognize that they are just a white light and I don't need to chase them.

Don't get me wrong, I realize more white lights exist and I most likely follow them without even recognizing what I am doing.  One that comes to mind this morning is the impulse to check social media while I am writing my blog.  I am never 100% in control; however, today I am not chasing the white light of the unobtainable physique, the elusive job, a relationship that requires no work, or a non-existent drug induced emotion.


Copyright AudibleRx (TM), all rights reserved.

AudibleRx Company Description

"Consumer Medication Information, provided in audible format, with the intent of educating consumers to better understand their pharmaceutical care, increase adherence and decrease adverse events.  AudibleRxTM objectively bridges the medication-education-gap between the patient, their pharmacist and their doctor."

Provision of an easy to use web and app based program where consumers LISTEN to a pharmacist explain all of the important Consumer Medication Information associated with a specific medication.  This education will help an individual identify what they do and don’t know about the medication so they may take educated questions back to their own pharmacist or doctor.  The vision will be achieved through implementation of the Goal, Mission and Method.

Increase medication adherence, decrease medication related adverse events, and improve an individual's overall outcome of their pharmaceutical therapy.  This goal will be achieved through our mission.

Educate and motivate individuals to participate in their pharmaceutical care.  This mission will be achieved through the following method.

Provide Medication Specific Counseling SessionsTM, (Consumer Medication Information) in accordance with current practice standards, in audible format, through an easy to navigate website or tablet/phone app.

Problem Defined
Patients rarely receive the complete counseling and education they need to fully understand:
  1. Their medication regimen,
  2. The importance of adherence to their medications,
  3. The consequences of not taking their medications.

Without discussing all of the adherence statistics in this Company Description, it is agreed that prescription non-adherence is a leading cause of hospital admissions, re-admissions and emergency room visits.  The top five reasons consumers are non-adherent to their medication therapy include:
  • Don’t understand the need for medication.
  • Can’t afford medication.
  • Forget to take medication.
  • Personal beliefs against taking medication.
  • Don’t understand how to take medication.

Daily, patients pick up prescriptions from busy pharmacy counters or receive prescriptions in the mail.   Current barriers to effective medication counseling do not regularly allow for the pharmacist to sit with the patient and discuss their medications for 10-15 minutes at the counter. 

Pharmacists are under tremendous pressure to meet their performance metrics and will regularly cover the counseling points of three or four medications with a patient in fewer than two minutes.   Patients are then sent home from the pharmacy (or discharged from a hospital) with stacks of informational paperwork that is cumbersome to read. 

Furthermore, many patients are challenged with literacy or visual impairment and are unable to read the Consumer Medication Information leaflets they are sent home with.

Problem Solved
Of the top five reasons individuals are non-adherent to their medication therapy, three of them are related to education, sometimes called Health Literacy.  When a patient understands how their medication works, why they are taking it, and importantly, the consequence of not taking their medication, they will be much more likely to participate in their pharmaceutical care.

AudibleRxTM provides audible Consumer Medication Information (CMI) as an alternative to the paper handouts patients receive with each prescription at the pharmacy.  Each Medication Specific Counseling SessionTM lasts between 4-6 minutes and is available through a web or app based platform.  

Briefly, and in a simple to understand format, the session will describe how the medication works and what the consumer needs to know about taking that particular medication; while also highlighting all of the important required pharmacist counseling information associated with that specific prescription.  After listening to a CMI session, a patient or caregiver will have a clear idea of what they do and don't know about their medication and be in a better position to take educated questions back to their own health care providers.

Please understand, our goal at AudibleRxTM is not to replace the important face-to-face counseling sessions that a patient will have with their own Community Pharmacist; rather, to help educate patients and caregivers so they will be in a better position to engage their own health care practitioner in an educated discussion about their medication therapy.

Access to AudibleRxTM is free to the consumer; however, licensing agreements are necessary in order for Health Care Providers to promote AudibleRxTM as a patient education tool.  Health care providers are offered a FREE Six Month Trial in order to realize the value in audible CMI as applied to patient education. 

Specific Consumer Medication Information sessions are easy to locate on the web and app based program because they are categorized both alphabetically (by generic and trade name) and also by disease state.

AudibleRxTM is not affiliated with any drug manufacturer and offers no advertising.  Every effort is made to keep the recordings provide by AudibleRxTM completely objective and unbiased.  The AudibleRx website complies with the HONcode standard for trustworthy health information on the internet.

Counseling information is organized in a fashion that is in concert with the Omnibus Reconciliation Act of 1990, the American Society of Health-System Pharmacists guidelines on pharmacist-conducted patient education and counseling, and the FDA guidelines on Useful Written Consumer Medication Information. 
  • Scientifically accurate. 
  • Unbiased in content and tone. 
  • Sufficiently specific and comprehensive 
  • Presented in an understandable format that is readily comprehensible to consumers. 
  • Timely and up-to-date. 
  • Useful.

We currently have over 270 completely different medication sessions available. If we count all of the different dosage forms of specific medications, including both generic and trade name, that number is well over 1800. If we count different package sizes and different generic manufacturers, that number is well over 5000.

AudibleRxTM may be utilized as a consumer medication education tool in a variety of settings such as:
  • Community Pharmacy as an alternative to the paper CMI handouts.
  • Mail Order Pharmacy as an alternative to the paper CMI handouts.
  • Medication Therapy Management business.
  • Hospital Discharge medication education tailored to the learning needs of individual patients.
  • Medical Clinic or Medical Concierge service added value benefit.
  • Nursing Home or Skilled Nursing Facility patient medication education.
  • Employee Wellness Benefit.
  • Medication Counseling Education for pharmacy, nursing or medical students at your Institution.
  • Insurance Company provision of audible CMI to its clients.
  • Tele-Medicine as a value added benefit.
  • Any situation where consumers would benefit from non-biased medication education.

Whether it be someone who is challenged with literacy, visual impairment, or just one of the many individuals that learn better by listening, everyone deserve access to Consumer Medication Information.  Make a commitment to provide Accessible Medication Education to your customers, clients and patients; information tailored to meet the needs of those that learn better by listening.  Please visit, watch the short video, listen to a couple sessions, evaluate the Provider, Partner and Sources pages, and let us know how we may work together.

Steve Leuck, Pharm.D.

Copyright AudibleRx, all rights reserved.

"PART II" Out-Patient Pharmacist / In-Patient Rounds

Great thought must be put into the planning and implementation of any new service; for once it is begun, it must be regularly continued, monitored and evaluated if it is to succeed.

For those of you that haven't been following, five weeks ago we implemented a new program at the community hospital that I work at.  This program's implementation is described in detail in a previous post titled, "Out-Patient Pharmacist, In-Patient Rounds"; however, it involves a pharmacist from our out-patient clinic pharmacy briefly reviewing 50-70 charts every morning, looking specifically for potential medication discharge issues that would benefit from having a pharmacist help coordinate the process.  During rounds, the case managers, Rn's or MD's will refer at least one patient to the pharmacist who might benefit from a Bedside Medication Therapy Management visit.  This visit is then performed after rounds, before the pharmacist heads back to the out-patient pharmacy for the rest of their shift. 

I am not sure about everyone else; but I find this incredibly interesting stuff.  Us pharmacists have been working for the almighty line item productivity metric for EVER!  Here is an opportunity to break out of the fish bowl, have a positive impact on patient outcome and also help decrease readmission rates.  As the data unfolds, I will continue to take some time to put it into words.  As always, I appreciate feedback on similar programs others have implemented. 

Out-Patient Pharmacist, In-Patient Rounds
Five Week Evaluation

Out-patient pharmacist involvement in the Daily Rounds and Bedside MTM service at our community hospital began five weeks ago.  Subjectively, the service has been a success and is well received by both the rounds team and the patients who have been visited.  Objectively, the data collected from pharmacist involvement is significantly positive; however, the program has not been continuing long enough to gain any significant insight into whether it is making an impact on the 30 day readmission process.

This document will describe the successes and shortcomings of the program thus far. 

Data for first five weeks:
·         32 Bedside MTM consults were received during Rounds Huddle.
o   27 Bedside MTM consults were completed, charted and enrolled in follow up phone call program.
o   5 were not completed because patients were either discharged, sleeping, not in room, in an acute state, or in isolation.
·         40 Appropriate recommendations were made to help coordinate care regarding a medication that may be difficult to fill upon discharge. 
·         31 Verbal orders totaling 50 separate medications to be re-labeled so they may be taken home with the patient when they are discharged from the hospital. 
·         6 Clinical or Med Reconciliation issues were noted by pharmacist during chart review or during huddle and discussed.

Rounds Participation:
Importantly, the pharmacist has been well received on the rounds team.  Comments and suggestions regarding medication discharge planning are well received and definitely fill a gap in the rounding process. 

The efforts regarding coordination of "difficult to fill" discharge medications and the "re-labeling" of inhalers and eye drops makes a significant impact.  These are functions that do not need a pharmacist; however, they were not being done without a pharmacist.   
·         The 40 coordinated prescription interventions for "difficult to fill" medications has been limited to only 10 medications, with 3 medications taking more than 50% of the interventions.
·         The 50 re-labeled inhalers and eye drops was fully coordinated by the pharmacist; obtaining a verbal order from the physician during rounds, obtaining the medication from the unit med cart, taking it to the out-patient pharmacy and labeling it appropriately, then returning it to the appropriate med cart.
In my opinion, these two items alone justify pharmacist participation.  These two processes do not require the presence of a pharmacist in order to complete; however, as seen by the data, there is certainly an opportunity for pharmacist intervention.  Eventually, with some training, it is possible that these items might be performed without the presence of a pharmacist.

Bedside Medication Therapy Management:
Interestingly, the Bedside MTM visits are very well received by patients.  Our goal is to help educate patients about the management of their medications so they may be more prepared to manage their own medications when they return home.  As stated, during the first five weeks of the program, 27 Bedside MTM visits have been completed and all of them enrolled in 3 and 21 day follow up phone call service from the pharmacist.

It is too early for the objective data; however, subjectively, patients very much appreciate the opportunity to discuss medication management with a pharmacist at their bedside.  I believe this process will not only decrease the potential for readmission, it will also increase our patient satisfaction scores.

As a pharmacist, the difficulty we face is that we realistically only have time to visit one patient per day.  Rounds are complete at 11:30, at which time we need to return to the pharmacy office in order to print and review the med list for the patient we will see that day.  After our 20 minute Bedside MTM visit with a patient, we then need to document our visit in the patients electronic health record while also documenting our participation in rounds for the day.  Our time is complete at 12:30, at which time lunch begins, so we may be back at our out-patient post by 13:00.

Five weeks ago, this position didn't exist.  Today, there is more work than we are able to complete in our 3.5 hour shift.  The process of coordination of discharge prescriptions and re-labeling of bulk items has been a success.  The implementation of Bedside MTM visits is even more of a success.

Over the next few months I believe we will see that the greatest value comes from providing Bedside MTM visits to patients.  This is specifically a pharmacist driven process; coordinated and implemented by pharmacists.  Ideally, our daily flow will need to be evaluated so that we are able to see more than one patient/day.

Initially, we could potentially increase our participation time by 30 minutes so that we have until 13:00 (an even 4 hours) to complete our daily process.  Presumably, this would allow us time to see two patients each day which would significantly increase our presence.

Secondarily, in the future, we may look at training the case managers to recognize which meds will require special discharge coordination so they may follow up on these at least a day prior to discharge.  We may also be able to develop a process where charge nurses or respiratory therapists take  verbal order to re-label inhalers which may then be forwarded to the out-patient pharmacy for appropriate discharge labeling.  This may free up the pharmacist to see many more patients.

The pharmacist involvement in Daily Rounds and Bedside MTM program has been received well and is a functioning program thus far.  Over the next two - three months we will be training a couple more pharmacists who will be available to cover this shift.  Time will tell if the provision of these services eventually leads to a decrease in 30 day readmissions as an objectively driven, outcome oriented, pharmacist delivered program.

Copyright AudibleRx (TM), all rights reserved.

What Makes a Great Community Pharmacy

Recently, within the past 2 months, our community pharmacy created a relationship with the discharge navigator of a local hospital.  Our effort was directed at resolving a specific issue that had developed with patients being discharged after a specific orthopedic surgery.  Each one of these patients is discharged on six medications that are part of a specific protocol for this particular surgery.  The issue is, two of these medications quite frequently require a prior authorization with the patient’s prescription insurance company.

Regularly, these patients receive their surgery on Wednesday and then are scheduled for discharge by Friday afternoon.  Upon discharge, the orders would be sent to their pharmacy and the patients would be sent home.  Later that day, their family would go to the pharmacy to pick up their meds and one or two of them would not be ready because they are not covered by the insurance.  Unfortunately, both of these medications are only available as a brand name product, one costs $300+ and the other costs $500+ for a 30 day supply.

Physicians were frustrated because the hospital was discharging patients without their medications that are necessary for their particular protocol and the patients were frustrated because they could not get their medication.  After a few weeks of this scenario, the discharge navigator contacted us in the out-patient pharmacy.  After a few discussions, we set up a plan for the orders to be sent to our pharmacy, with the patients approval, at least 24 hours prior to discharge. 

In an ideal world, 24 hours should be enough time to obtain a prior authorization for these two medications through normal channels.  As we know, quite often, hospital discharges and medical staff availability do not always function in ideal world scenarios.  For the most part, this system has worked well.  We receive the orders in the out-patient community pharmacy, receive a face sheet with the patient demographic information, and begin the process of medication authorization with the prescription insurance company with the help of the physician’s office staff.

Three weeks ago we processed one of these particular discharge order sets.  As fate would have it, the ideal world scenario did not deploy as expected.  The patient’s wife came to our pharmacy Friday afternoon and all of the medications were ready; however, one of them had not yet been authorized by the insurance company.  The cost of this particular medication was a little over $525 for the 30 day supply.

Although the spouse was not too pleased, after a discussion of insurance companies, authorizations and medication protocols, she understood and went ahead and paid for the medication.  We agreed that if the authorization was approved, we would be happy to reprocess the claim and refund her the difference.  Over the next two weeks I talked with this particular spouse on the phone many times.  She had contacted the physician’s office multiple times and had followed up with both the hospital and her insurance company.  Her due diligence concluded with a letter of authorization from the insurance company stating that this medication was now covered.

She was very pleased as she came into the store with her insurance authorization letter; however, I attempted to process the prescription and it still was not covered.  I had a suspicion that the authorization had not been done retrospective, back to the day the prescription had been filled.  I wear a telephone headset at work so it is no big deal for me to get on hold with an insurance company while I continue to process prescriptions and such.  I offered to call the insurance company and see what I could figure out.

After 15 minutes on hold, I let the spouse know that I would be glad to continue the process and would give her a call when we figured it out.  I finally got through to someone, explained the situation and that we needed to change the date on the authorization so we could submit the claim and get a refund for THEIR CLIENT, and the young lady on the other line kindly explained to me that it was not her department, she could not authorize the change and she would gladly get someone on the phone for me who could help me.  This process went on for 70 minutes and 4 different transfers before the issue was resolved.

The catch is, by resolving this issue with excellent customer service and patient satisfaction; we decrease our reimbursement by 15% in order to accept assignment.  On the other side of the coin, the spouse brought us a wonderful box of chocolates and was more grateful for our efforts than words can describe!

So I ask again, “What makes a great community pharmacy”?

Is it the availability of the pharmacists, their willingness to work with you, the different services they offer, that they know your name every time you walk in the door, or one of many other factors we use when we are choosing which community pharmacy we frequent.

As a community pharmacist myself, I would like to think it is a combination of all of these items; however, I believe Customer Service is the number one factor. 


Copyright AudibleRx (TM), all rights reserved.

AudibleRx Bullet Points

  • AudibleRx provides audible Consumer Medication Information (CMI).
  • AudibleRx was developed to bridge the Medication-Education-Gap that exists between Patients/Caregivers and their Health Care Providers.
  • After listening to a CMI session, a patient or caregiver will have a clear idea of what they do and don't know about their medication and be in a better position to take educated questions back to their own health care providers.
  • The AudibleRx website complies with the HONcode standard for trustworthy health information on the internet.
  • AudibleRx is not affiliated with any drug manufacturer and offers no advertising.  Every effort is made to keep the recordings provide by AudibleRx completely objective and unbiased.
  • Access to AudibleRx is free to the consumer; however, licensing agreements are necessary in order for Health Care Providers to promote AudibleRx as a patient education tool.
  • AudibleRx is available as a Web platform, Android app, iPhone app and HTML5 web app.
  • AudibleRx does not replace the face-to-face counseling session with a pharmacist; rather, it provides an alternative to the written Consumer Medication Information for home education and follow up.
  • Consumer Medication Information sessions are categorized by therapeutic category and also alphabetically by generic and trade names on the web based platform.
  • Counseling information is organized in a fashion that is in concert with the Omnibus Reconciliation Act of 1990, the American Society of Health-System Pharmacists guidelines on pharmacist-conducted patient education and counseling, and the FDA guidelines on Useful Written Consumer Medication Information.  
    • Scientifically accurate.  
    • Unbiased in content and tone. 
    • Sufficiently specific and comprehensive 
    • Presented in an understandable format that is readily comprehensible to consumers. 
    • Timely and up-to-date.  
    • Useful.
  •  AudibleRx is currently licensed for use with one Independent Pharmacy and two MTM Organizations.  Here is a three month review from the two MTM groups.

"My client base is comprised mostly of socially and economically disadvantaged people aged 65 years of age and older. vision impairment and poor literacy are common. your shareable audio monographs on my android phone are a perfect answer.   An unexpected benefit: using these monographs disciplines me to be brief and concise during home visits. we consultant pharmacists always run the risk of 'wearing out a welcome' with boring levels of output. plus, the information provided is now nicely consistent... standardized from one consultant to the next."

"This has worked well with my current client base and with my future health and wellness utilization in the employer/employee benefits arena as it applies to the PP-ACA in preventative illness and health and wellness initiative along with medication adherence as a wellness benefit for employees in the workplace."

  • Whether it be someone who is challenged with literacy, visual impairment, or just one of the many individuals that learn better by listening, everyone deserve access to Consumer Medication Information.
  • Make a commitment to provide Accessible Medication Education to your customers, clients and patients; information tailored to meet the needs of those that learn better by listening.
  • Please visit, watch the short video, listen to a couple sessions, evaluate the Provider, Partner and Sources pages, and let us know how we may work together.

Steve Leuck, Pharm.D.,     Owner/President,     AudibleRx,,     

Copyright AudibleRx (TM), all rights reserved.

Medication Warning - Please Read

As a consumer, are you aware of the most critical warnings about your medication?  As a health care practitioner, do you always take the time to describe ALL of the Black Box Warnings associated with each and every medication you prescribe or dispense to your patients?

AudibleRx provides an "easy to understand" description of every Black Box Warning associated with each particular medication.  These descriptive warnings are near the beginning of each audible Consumer Medication Information session.

As a consumer, if you are unsure if your prescription medication has any Black Box Warnings associated with it, call your pharmacist today and ask them.  Alternatively, you may visit and navigate to your medication.  Click on the play button and LISTEN to all of the important counseling information about your particular medication, including the Black Box Warning information.

As a health care practitioner you may provide AudibleRx as a patient education tool to your patients simply by visiting the Provider Page at AudibleRx and signing a licensing agreement.  You may provide the service FREE for six months in order to realize its value.

After listening you will have a clear idea of what you do and don't know about your medication and be in a clear position to take educated questions back to your own health care provider. Remember, AudibleRx does not replace the important face-to-face consultation with your own pharmacist, rather, it is an alternative to the paper handouts you receive at the pharmacy counter.

What is a Black Box Warning?

This is a warning system used by the Food and Drug Administration to alert describers, pharmacists and patents that this particular medication has potentially dangerous side effects.

The Black Box Warning is the highest level of warning the FDA can give to a medication.  When a medication receives a Black Box Waring it means that studies have suggested that this particular medication has potential severe or even lethal side effects.

A Black Box Warning might be added to a product by the FDA after it has been used for a series of years and through routine use it was discovered that the particular medication had serious side effects that were previously unknown.  The FDA may also require a Back Box Warning on a new medication that has potentially significant benefits while also potentially serious side effects.

The term "black box" is referring to the thick black line that borders the warning information in the medication package literature.

If you receive a medication from your pharmacy that has a Black Box Warning you will also receive a Medication Guide that discusses the warning and what it means.  Ask your pharmacist to explain the warning information and any risk vs benefits associated with this medication  If the information is not explained clearly, please ask them to repeat the information to you so you may understand it.

After discussing this with your pharmacist, don't hesitate to call your doctor and discuss the risk vs benefit with them also

It is important that you understand why you are taking your medication so that you will be motivated to follow your regimen and achieve the best possible outcome from your pharmaceutical therapy.


Copyright AudibleRx (TM), all rights reserved.

"Part I" Out-Patient Pharmacist / In-Patient Rounds

In 1990 my wife and lived in an old country home on an acre of property in a small town just south of the Oregon border.  We had a well, abundant water, flat ground and at the time it seemed like a good idea to install a sprinkler system that covered the entire property so we may develop a lush and beautiful lawn.   For four weeks, after work and on weekends, I was out in the yard shoveling a strategic campaign of trenches, all 18 inches deep.  (Being a pharmacist and not a trencher I didn't realize that I could have rented a nice machine that would have done the entire job in one day.)

One afternoon, after about 3 weeks of shoveling, my Dad stopped by to check on the trenching progress.  I will never forget his words of wisdom, "Steven, if you continue to work on a project, eventually it will come to pass".  Over 24 years have passed since he spoke those words to me; however, whenever I am in the middle of a project and feel as if it is never going to reach the next level, I remember that if I just keep shoveling, it will eventually come to pass.

Just over two years ago I read an article written by the American Society of Health System Pharmacists that described how pharmacists can be an important component of a hospitals Accountable Care Organization.  Of course, the article described all of the ways pharmacists can play a significant role as part of the patients Care Team; however, what stood out for me was something completely different. 

One paragraph of this particular article went on to explain that the hospital administrators are not going to come looking for you (the pharmacist).  It is the responsibility of the pharmacist to explain, convince and define their role to the hospital administrative team.  This is new territory.  Pharmacists have worked in an objective world of medication orders, line items, order verification and clinical interventions for years; however, it has not been common place to describe and measure the subjective value of a pharmacist. 

How does the pharmacist move to the subjective world where it is common place to offer a bedside medication education consult prior to discharge.  What factors will a pharmacist use to explain and describe to their administrator that  there is value in educating patients about Health Literacy so a patient is able to describe their diagnosis, understand what medications they are taking to treat their diagnosis and importantly, what the consequences are if they don't treat their diagnosis.  Furthermore, the pharmacist will need to convince their administrator that there is value in educating patients about Medication Adherence and helping patients understand what their specific barriers to adherence are so they may be addressed. 

I work in an out-patient pharmacy for a community hospital and the pharmacist that I work with supported us in the process of pursuing this very initiative.  Together, we formulated idea after idea and presented them to our inpatient pharmacy administrator.  It didn't take long and we were invited to sit in as regular members of the bi-weekly readmission committee.  After many months of committee meetings, multiple drafts, training, education and staffing resolutions we are ready to implement a six week trial program.

Beginning tomorrow, one of the pharmacists from our out-patient pharmacy will be available as a discharge medication education resource inside the hospital for 3.5 hours every morning. 

As stated in our policy developed for this trial program:

Pharmacist involvement in the Hospital Readmission Campaign includes:

  • Attend rounds Monday-Friday as an outpatient-discharge-pharmacy resource.  Our primary focus will be looking for patients on new medications that may be difficult to fill when discharged.  We may help coordinate authorizations and discharge insurance formulary alternatives when appropriate.
  • Accept referrals for 20 minute Bedside Medication Therapy Management Consults with patients.  These consults focus specifically on eight education points that fall under the category of Health Literacy and Adherence.
  • Offer a discharge prescription service for patients which will include a 3 and 21 day follow up phone call from the pharmacist.
  • Document all pharmacist/patient activities in the patients EHR so the information may be tracked for value.
This is a big deal for us in the out-patient pharmacy world.  After many months of discussion, the hospital is willing to let us sit in on patient rounds as a discharge medication resource and visit specific patients at their bedside to help with Health Literacy and Adherence education.  Time will tell; however, I feel that if we put as much effort in to the next six weeks as we have into the last 18 months I am sure we will see value in our efforts.

Just keep shoveling!


Copyright AudibleRx (TM), all rights reserved.

Pharmacy Goes Sailing

I realize this isn't much in the lines of medication education; however, it is definitely a pharmacy topic.  Earlier this past Summer one of the pharmacists I work with opened his boat up to the pharmacists, technicians and their families for an evening on the bay.  It was foggy, not much wind; however, it was a fantastic evening!

Please, feel free to add some caption suggestions below in the comment field.  I will then add them to the pictures!

Copyright AudibleRx (TM), all rights reserved.

What You Need To Know About Asthma Inhalers

Our dedicated intern here at AudibleRx, Luka, has completed and posted for us a fantastic video describing the importance of understanding how to use your inhalers for asthma treatment.

For complete Consumer Medication Information regarding your asthma inhalers, please visit the INHALERS PAGE at AudibleRx and listen to the counseling session about your specific inhaler.


Over the past 18 months we have been fortunate to have an intern working with us here at AudibleRx.  Luka Tehovnik, a recent graduate of pharmacy school from the University in Ljubljana in Slovenia, has helped us with quite a few projects here at AudibleRx, including the development of the opening video, the Alphabetical page and the cool icons on the home page.

Susie and I greatly appreciate all the effort Luka has put into his work with us these past 18 months. We are looking forward to visiting with Luka for two days this October as he passes through the Bay Area on his United States tour, we congratulate him on his recent graduation from pharmacy school and wish him the best in his pharmacy career!

Steve and Susie Leuck

Copyright AudibleRx (TM), all rights reserved.

How does a Pharmacist GET PAID for Consulting Services?

Jonathan Shores oversees the operation of a Non-governmental Organization (NGO) charged with the mission of providing free annual Influenza Immunizations, free Pneumonia Immunizations, and free MTM pharmacy services to a growing target population of 22,000 seniors aged 65 years of age or older.  Emphasis is placed on providing in-the-home immunization services and immunization services at scheduled social clinics at each of several county locations.  Particular emphasis on serving the needs of physically home-bound, socially home-bound, and economically home-bound individuals is observed.  Jon is on the front lines, as a pharmacist, providing pharmacy services; all the while laying down the track on how to be paid for these services.  We owe Jon a debt of gratitude for his work in this field and are fortunate to have him as a guest blogger today on the AudibleRx Blog page.

Pharmacists work at the short end of some pretty restrictive provider agreements: networks with severe enrollment exclusions, mandatory mail-order, parsimonious prescription promises with poison pill payoffs, onerous minimum drug purchase requirements, just to name a few. The raison’d etre for boxing providers out is always the same: a monopoly that promises great gobs of cost savings for the American healthcare system. Whether these savings ever materialize or not, depends on who you ask, and how long you are willing to listen. The promise often carries more weight than the result. The latest adventure in restraint of practice involves Medication Therapy Management, MTM. It’s like deja’ vu all over again.

There is no problem finding pharmacy consultants able to provide counseling for eligible patients. A terrific certification program sponsored by APhA, and a splendid how-to manual called, “How to Conduct a Comprehensive Medication Review: A Guidebook for Pharmacists,” by Lauren B. Angelo and Jennifer Cerulli; have served to populate the playing field. The consulting process has been well defined: locate an eligible patient, gather data, identify and perform needed services, exhaustively document all work, perform the billing, then compile everything into a comprehensive, legal and durable health record.

The problem is how to get paid for the work that is done: bill insurance companies directly for the work, or hire a third party to do the billing. A popular method of getting paid is to buddy up with one of several companies that bill MTM services. The consultant gathers some data and performs some services, enters the work into some web- forms, and collects some fee for service. There are some perilous shortcomings involved with this approach.

Consider the following excerpt from page twenty-four of “How to Conduct a Comprehensive Medication Review: A Guidebook for Pharmacists”:
“Thorough and accurate documentation must be completed for all MTM encounters with patients. Documentation helps to justify payment for the service, and it may be needed if the pharmacy is faced with an insurance audit by the payer or CMS. Any documentation resulting from an MTM encounter with a patient becomes part of the patient’s medical record. Medical records are considered legal documents. If legal circumstances such as lawsuits or suspected insurance fraud arise, medical records, including the documented MTM, can be subpoenaed for use in court.”

The parties empowered to solicit this information from the pharmacy of record include: officers of the court, insurance auditors, law enforcement officials, and Hipaa-enabled patients. Each can reasonably expect to receive a comprehensive, legal and durable health record upon request, and in timely fashion.

Pharmacy consultants who use billing companies usually do the following: collect a limited amount of defined patient data, identify and perform services, enter the data into web-forms provided on a billing company website, and then collect a fee. The data held by the pharmacy consultant is often discarded after the fee is received. The billing company evaluates the data entered into the web-forms, creates a billing plan, bills the insurance, and then pays the pharmacist fee. The two parties seldom collaborate to combine the separate pools of information into one complete whole. The comprehensive, durable and legal health record that should be conserved by the pharmacy provider seldom results.

Billing companies negotiate exclusive provider agreements with many of the largest insurance providers. These small companies with limited resources have pledged to consult tens of millions of patients who are federally entitled to Medication Therapy Management services! Each billing company serves not as a convenient “gateway” to billing an insurer, but rather as an exclusive “gatekeeper.” A pharmacist who consults a patient who is insured by a contracted insurer must utilize the billing company contractor to get paid, even if the billing arrangement fails to meet minimally legal conventions for keeping health records.

These MTM billing arrangements restrain the practice of pharmacy consulting, foster poor record keeping practices, limit access to healthcare services, rob patients of health benefits and cost savings, and prevent the public from benefiting from the “best and the brightest” people our profession has to offer. Add them to a malignant list. Monopolistic arrangements are a common thread in the fabric of pharmacy practice, and dealing with them has become an integral part of the job. Expect to see such agreements occur again and again… and all over again.

“How to Conduct a Comprehensive Medication Review: A Guidebook for Pharmacists,” Lauren B. Angelo and Jennifer Cerulli, 2014 The American Pharmacists Association

Thanks to Jon for the post.

Copyright AudibleRx (TM), all rights reserved.

What Every Pharmacist Needs

You know how it is, you're in a hurry, using your fast walk down the hall way, where ever it is that you work.  You turn the corner and there's the person you've been needing to ask a question of.  Politely you  interrupt them and ask if they have just two minutes to spare for a quick question.  "Of course, what could I help you with?" they say.  In less than four seconds they have taken their focus off of all that they were doing and given you their 100% attention. 

Somehow, they have quickly made you feel as if your question is the most important item they have been requested to address all day.  They listen intently, allowing you to finish your sentences without rushing.  Interestingly, it feels as if they understand exactly how you feel about the concern you are expressing.  Even though it has only been two minutes, you were sure it must have been at least five or even ten minutes.  You leave the interaction with an assurance that you have been heard and are completely satisfied with the interaction and response.

We have all had interactions where we walk away less than satisfied with the response from the other individual.  For that matter, I am sure that many times individuals have walked away from us with similar dissatisfactions.  What is it that distinguishes an individual in a conversation?  What characteristic does someone have that quiets them and helps them listen when the other person is speaking?  Why does one person understand what the speaker is discussing and respond appropriately while the other is reminded of a story from their life and immediately routes the conversation in another direction?

Bartenders got it, barbers got it, therapists and counselors defiantly got it; and now, we expect pharmacists to have it!
Pharmacists , who have been tied behind pharmacy counters for years, complaining that they are underutilized in their clinical skills, are being pulled, kicking and screaming, out in front of the counter to talk with patients.  As a matter of fact, we don't just want you to talk with the patient about their medications, we want you to also educate them about their disease state, address their barriers to effective medication adherence, help them understand the consequences of not participating in their medication regimen, thoroughly explain their prescription insurance options to them, check in on them when they are in the hospital to assure their medications are reconciled appropriately, and then call them on a regular basis after they leave the hospital to assure they are maintaining adequate control of their ever expanding pharmaceutical world.

Don't get me wrong, I am all for it.  This is a truly exciting time in the pharmacy universe and I want to be part of the huge solution.  My concern is that not all pharmacist are ready for this process.  We are good at what we do.  We have been trained in all aspects of the science of medications.  Computer verification, dosing calculations, drug interactions and therapeutic duplications, heck, even the occasional telephone call to the physician's office for an order clarification.

Whether it be a patient picking up a refill with a quick question, an extended medication counseling session at the pharmacy counter, a visit to the patients hospital room prior to discharge to discuss their new medication regimen, or an full Medication Therapy Management session with a patient in the pharmacy or at their home; each visit with a patient is an opportunity to listen to their concerns, better understand their difficulties, and offer reasonable and empathetic suggestions.

As a colleague recently shared with me, "Medication counseling is an acquired skill which takes not only knowledge but communication skills which must be patient specific and flexible based on patient feedback."

When talking with patients, the communication required involves training and tact, needs to be patient specific and dynamic enough to change in the middle of a counseling session based upon a patient's changing situation and feedback.  In essence, a skilled pharmacist will be in a position to identify with and understand their patient's fears and concerns in order to assist them effectively and appropriately with their medication regimen.
Copyright AudibleRx (TM), all rights reserved.