Dear Kaiser,
I want to explain a problem with Kaiser Permanente’s system for managing pharmacy refills. I have been experiencing this problem for several years, but I am not submitting this complaint just to solve my own problem. Several professionals, both on the medical staff and on the pharmacy staff have told me that the problem is generic.
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The problem can be best understood by looking at one short entry on my own Medication List:
Pravastatin Sodium 80 Mg Tab Refills remaining: 2 Status: This prescription is not available to fill. Prescribed by: ___________________ MD Prescribed on: 11/10/2021 Instructions: Take 1 tablet by mouth daily to prevent heart attacks and strokes.
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Only one piece of relevant information is missing here – that the prescription is for 100 tablets – but that information is on the pill bottle, and of course in the pharmacy’s computer.
The rest is arithmetic: – On 10 November I was prescribed 100 pills. – I was told to take 1 pill per day. – 100 days from 10 November was 18 February. – I am authorized to get 2 refills. – I cannot have a refill. – As of today, 5 March, I have been without this medication for 15 days.
I know how to solve this problem because I have done it several times. I call the pharmacy and am told that the prescription is not available to fill. I explain the arithmetic. The pharmacist sees the problem, wonders why it has occurred, and directs me to contact my physician to authorize the refill – which, of course, he has already done. So I email my physician, and he re-authorizes the refill, and a day or so later my prescription is sent. No problem: just one more day of delay for me, a few minutes on the phone for the pharmacist, and an extra chore for Dr Won at the end of a busy day doing his real job. And, with luck, I won’t have a heart attack.
But because I was trained at West Point to eliminate obstacles, I make another call, trying to contact a supervisor in the pharmacy department to see whether this problem could be fixed before I have to do it all over again for the next medication that keeps my blood pressure under control – and this is the kind of problem that tends to make blood pressure an aggravating factor. Contacting a supervisor in any organization is, by design I suspect, never easy, but when after some delay I reach a pharmacy supervisor, she listens carefully and, because she has heard all this before, she has a series of answers ready: – That this is an IT problem, not a pharmacy problem. – That the IT people do not allow themselves to be contacted, by her or by me. – That therefore the problem cannot be solved. – And anyway, I have caused the problem because I ordered this prescription from the Kaiser pharmacy in Virginia!
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I confess that this last charge is true. Since I live part of every year in New Mexico, and since Kaiser does not operate in New Mexico, and since Kaiser cannot ship medications from California to New Mexico, when a medication runs out while I am in New Mexico, on Kaiser’s explicit instructions, I order a refill from the Kaiser pharmacy in Virginia (703 466-4900). There is no problem with this part of Kaiser’s operation. It works beautifully.
But not in California. That’s because of what I’ve come to think of as the Kaiser Reciprocal Interstate Prescription Paradox (KRIPP): A medication prescribed in California can be refilled in New Mexico by way of Virginia without a hitch, but a medication prescribed in California and refilled in Virginia cannot be refilled again in California. Worse, all other prescriptions, even those that have not been contaminated by passing through Virginia, can never again be refilled in California without the comic phone-and-email opera performed each time by me, a pharmacist, my physician, and another pharmacist.
Do you think you have an IT person who could fix this? (Please do not try to fix it by just getting my prescription filled. That is not what I’m writing you about.)
Dan Embree Berkeley, CA 94704
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