All You Need to Know About U.S. Healthcare: Pharmacy Basics
前言｜Introduction
當我剛移民至美國時，聽說美國的醫療費用相當昂貴，因此在生病時都不敢輕易就醫。隨著多年的生活，我逐漸了解到當地人通常不會因輕微病症而立即就診。在很多情況下，人們更傾向向藥劑師尋求專業建議，以選擇合適的成藥進行治療。只有在症狀嚴重的情況下，他們才會考慮尋求醫生的協助。這讓我深刻體會到各國就醫習慣的差異，並認識到對於成藥的基本知識有多麼重要。因此，這篇文章主要將介紹一些有關美國藥局的基礎知識。
When I first immigrated to the United States, I was aware of the significant expenses associated with healthcare in the country. Consequently, I hesitated to seek medical assistance whenever I fell ill. Over time, I came to realize that locals typically refrain from immediately seeking medical attention for minor discomfort, which is quite different from the healthcare practices in Taiwan. In many cases, individuals here prefer consulting pharmacists for professional advice to choose appropriate over-the-counter medications for treatment. Seeking assistance from a doctor is only considered in cases of severe symptoms. This experience has provided me with a deep understanding of the differences among countries in terms of seeking immediate care, and I've realized that having basic knowledge about over-the-counter medications is crucial here in the United States. Therefore, this article aims to introduce some fundamental aspects of pharmacies in the United States.
認識美國藥局的基礎人員架構｜
Understanding the Basic Personnel Structure of American Pharmacies
在台灣，由於缺乏藥劑師助理這個職位，初次來美國時我曾誤以為所有在藥局工作的員工都是藥劑師。我認為各國的藥局可能有各自獨特的運作方式，這使得某些職位在多數國家並不常見。因此，我打算花一些時間介紹美國藥局的基本人員結構。
In Taiwan, where the role of a pharmacy technician is non-existent in pharmacies, I once mistakenly believed that all employees working in pharmacies in the United States were pharmacists when I first immigrated here at age 14. I recognize that pharmacies in different countries may have their unique operational structures, resulting in certain job positions being uncommon from country to country. Therefore, I would like to take some time to introduce the basic personnel structure of pharmacies here in America.
#BasicPersonnel #Pharmacist #PharmacyTechnician
藥劑師｜Pharmacist : 負責確保病人的用藥安全和正確性。
Responsible for ensuring the safety and accuracy of patients' medications.
在美國，藥劑師自2000年後需完成相應的博士學位（PharmD），並通過國家的專業考試（Naplex）以及所在州的藥學法律考試才能取得執業資格。
在醫療領域中，這個職業常被稱為「最後防線」，因為所有藥物在使用前都必須經過藥師的審核。藥師通常會向醫療專業人員提供用藥知識，並建議適合的處方藥，同時負責監控患者的用藥情況。
最值得一提的是，在美國，藥劑師有責任提供免費的藥物諮詢，向患者詳細解釋藥物的使用方法和可能的副作用。因此，有些病人會攜帶藥品前往藥局的諮詢窗口（Counseling window），詢問有關藥物的相關問題。
In the United States, pharmacists are required to complete a Doctor of Pharmacy (PharmD) degree after the 2000s and obtain their professional license by passing the national board exam (Naplex) and the pharmacy law exam of the state they practice in.
In the medical field, this profession is often referred to as the 'last line of defense' as all medications must undergo pharmacist review before use. Pharmacists typically provide medication knowledge to healthcare professionals, recommend suitable prescription drugs, and monitor patients' medication use.
Notably, in the United States, pharmacists are obligated to provide free medication consultation, explaining in detail the usage and potential side effects of medications to patients. Thus, some patients may bring their medications to the counseling window at the pharmacy to inquire about related questions.
藥劑師實習生｜Pharmacy Intern：正在藥學院就讀的學生又或新進藥劑師(還在等國考通過)。
Students currently enrolled in pharmacy school or recent pharmacy school graduates awaiting the results of the national exam.
由於藥學生需要完成一定的藥局實習時數以滿足畢業資格，因此在藥局除了藥劑師外，有時也會有藥劑師實習生。在某些州，藥劑師實習生的權限可能比藥劑師助理更廣泛，例如能夠協助藥劑師提供諮詢服務、與醫生聯絡以更改處方簽等。此外，有時這個職位會提供給即將獲得藥劑師資格的新畢業生，讓他們在正式成為藥劑師之前能夠先在藥局工作並等待證照頒發。
As part of the pharmacy school graduation requirements, pharmacy students are required to complete a specific number of internship hours in a pharmacy. Consequently, pharmacies may have pharmacy interns in addition to pharmacists. In certain states, pharmacy interns may have more responsibilities compared to pharmacy technicians under the supervision of a pharmacist, including assisting pharmacists in providing consultation services or calling doctors to modify prescriptions as needed. Moreover, this position may be extended to recent graduates who are on the verge of obtaining pharmacist qualifications, enabling them to work in a pharmacy while awaiting the issuance of their pharmacist license.
藥劑師助理｜Pharmacy Technician : 協助藥劑師處理處方藥。
Assists pharmacists in processing prescription medications.
這項工作的範疇相當廣泛。藥劑師助理協助藥劑師配藥、製作藥罐標籤、處理保險問題，並提供基本的客服服務（例如，接/打電話、結帳等）。同時，藥劑師助理也會幫忙負責管理藥品庫存和一般藥局的日常運作。由於各州對藥局法律的規定不一，這項職位在某些州可能需要完成藥劑師助理培訓課程或持有相應的證書資格才能執業，有時也可能需要通過相關的專業考試（例如，Pharmacy Technician Certification Board 等）。
The responsibilities of the pharmacy technician are diverse, encompassing tasks such as assisting pharmacists in dispensing medications, creating prescription labels, handling insurance issues, and providing basic customer service (e.g., answering phone calls and performing cashier duties). Moreover, some pharmacy technicians assist in managing medication inventory and contribute to the daily operations of the pharmacy. Due to the differing regulations in state pharmacy laws, this position may necessitate the completion of a pharmacy technician training course or holding relevant certifications. For instance, passing professional exams like the Pharmacy Technician Certification Board exam may also be required.
認識美國兩大類藥局｜
Understanding the Two Major Types of Pharmacies in the United States
美國的藥局主要分為兩大類，即門診藥房（Outpatient Pharmacy）和住院藥房（Inpatient Pharmacy）。
Pharmacies in the United States are primarily divided into two major types: Outpatient Pharmacy and Inpatient Pharmacy.
Outpatient | Inpatient
門診藥房｜Outpatient Pharmacy : 提供藥物給不需要住院的患者使用。
Provides medications for patients who do not require hospitalization.
一般民眾通常接觸到的藥房主要是屬於門診藥房這類型。在美國，常見的連鎖藥局如Walgreens、CVS、Rite Aid都屬於此類。除了可以前往門診藥房領取醫生開立的處方藥外，藥局也會設立一個標記為諮詢（Counseling）的櫃台，供患者諮詢藥師有關用藥的問題。如果有一些輕微的症狀，民眾可以到諮詢櫃台向藥師詢問合適的成藥。若藥師判斷疾病狀況相對嚴重，他們會建議您盡早預約醫生看診。
Pharmacies commonly encountered by the general public fall into the category of outpatient pharmacies. In the United States, prominent chain pharmacies such as Walgreens, CVS, and Rite Aid fall under this type. In addition to dispensing prescription medications prescribed by doctors, these pharmacies also feature a designated counseling counter where patients can seek advice from pharmacists regarding medication-related queries. For minor symptoms, individuals can approach the counseling counter to inquire about suitable over-the-counter medications. If the pharmacist identifies a potentially serious medical condition, they may recommend promptly scheduling a doctor's appointment.
值得一提的是，有些連鎖藥局會提供免費的翻譯服務。即使沒有翻譯人員在現場，藥局通常會有翻譯專線以協助溝通。如果英文不流利，可以向藥師請求翻譯服務。
It's worth mentioning that some chain pharmacies offer free translation services. Even if there are no translators on-site, pharmacies typically have translation hotlines to assist communication. If English proficiency is a challenge, you can request translation services from the pharmacist.
除了上述提及的服務外，門診藥房也提供基本的疫苗注射服務，包括流感疫苗、新冠疫苗、RSV（呼吸道合胞病毒）疫苗、肺炎疫苗和帶狀疱疹疫苗等。由於各州的藥局法不同，但在大多數情況下，上述這些疫苗注射無需醫生處方箋，您可以直接前往藥局接種。因此，在藥局預約疫苗接種，可節省掉醫生的看診費用。
In addition to the mentioned services, outpatient pharmacies also provide basic vaccine injection services, including influenza vaccines, COVID-19 vaccines, RSV (respiratory syncytial virus) vaccines, pneumonia vaccines, and shingles vaccines. Due to varying state pharmacy laws, in most cases, these vaccine injections do not require a doctor's prescription, allowing you to directly visit the pharmacy for vaccination. Therefore, scheduling a vaccine appointment at the pharmacy can save you the cost of a doctor's visit.
而除了一般的門診藥局，這類別還可以另外分成兩類：
In addition to general outpatient pharmacies, there are two other types of outpatient pharmacies:
專科藥局｜Specialty Pharmacy：提供特殊藥物的藥局。
Provides speciality medication to patients in need.
專科藥局專門提供罕見疾病、慢性病或需要特殊管理的藥（例如，生育治療藥物）。由於專科藥物的研發成本較高，因此專科藥局提供的藥物單價通常相對昂貴。為確保患者能夠接受適當的治療，有時候保險公司會要求患者前往指定的專科藥局領取這些特殊藥物。
Specialty pharmacies specialize in providing medications for rare diseases, chronic conditions, or those requiring specialized management (e.g., fertility treatment drugs). Due to the elevated development costs of specialty drugs, the unit prices of medications from these pharmacies tend to be relatively high. These specialty drugs, designed for complex conditions like cancer, rheumatoid arthritis, and multiple sclerosis, are high-cost prescription medications. To ensure patients receive appropriate treatment, insurance companies may mandate that patients obtain these specialty medications from designated specialty pharmacies.
調劑藥局｜Compounding Pharmacy：專門調製特殊配方藥物的藥局。
Specializes in creating personalized formulations of medications.
這類型的藥局主要是調配特殊劑量或劑型的藥局。舉例來說，有時患者無法吞嚥口服藥片，而市面上只提供藥片的情況下，這種藥局可客製化特殊劑型，例如藥水或塞劑，以滿足患者的特殊需求。
These pharmacies specialize in blending unique doses or formulations of medications. For instance, in cases where patients face challenges swallowing oral tablets and only tablet forms are commercially available, compounding pharmacies can tailor custom formulations like liquid medications or suppositories to cater to the specific needs of patients.
住院藥房｜Inpatient Pharmacy：提供藥物給住院患者使用。
Provides medications for hospitalized patients.
正如其名，住院藥房主要為住院患者提供藥物。這類型的藥房通常位於僅限醫療人員進出的區域，因此對於一般大眾來說，這種類型的藥局可能相對陌生。在住院藥房內，可以進一步細分為三大類，分別為：
As the name suggests, inpatient pharmacies primarily supply medications to hospitalized patients. These types of pharmacies are typically located in areas restricted to healthcare personnel, making them relatively unfamiliar to the general public. Within the inpatient pharmacy, it can be further categorized into three main types:
無菌室｜Sterile Room：主要用於處理需要高度無菌條件的藥物，例如注射劑、手術用藥等。由於環境管理較嚴格，藥師及藥師助理須穿戴特殊無塵服裝去調配藥物。
Primarily used for handling medications that require highly sterile conditions, such as injectables and surgical drugs. Due to stringent environmental control, pharmacists and pharmacy technicians must wear special cleanroom attire for medication preparation.
非無菌室｜Non-sterile Room：主要用於處理口服藥、外用藥等。和一般的門診藥局基本無異。
Mainly used for handling oral and topical medications, similar to general outpatient pharmacies.
化療室｜Chemo Room：主要用於處理化療藥物。由於藥物通常具有高度安全風險， 此區設有特殊的通風系統、對於防護裝備的標準相對於無菌室又來的較高，因此會獨立在另一個區域。
Specifically designed for handling chemotherapy drugs. Due to the high safety risks associated with these medications, this area is equipped with a special ventilation system, and the standards for protective gear are higher compared to the sterile room, necessitating a separate area in the inpatient pharmacy.
因為這兩大藥局的主要劃分原則為它們所服務的患者性質，所以我個人把Outpatient Pharmacy稱呼為對外藥局 （藥局主要對醫院外的病人提供藥物），而Inpatient Pharmacy為對內藥局（藥局主要對醫院內的病人提供藥物）。
Because the primary criterion for categorizing these two major pharmacies is the nature of the patients they serve, I personally recall the Outpatient Pharmacy as an OUT pharmacy (primarily providing medications to patients OUTside the hospital) and the Inpatient Pharmacy as an IN pharmacy (mainly providing medications to patients withIN the hospital).
需注意的是這兩大藥局在藥物結算方式上存在顯著差異。門診藥房主要提供藥物給醫院外的病人，因此需參考先前章節介紹的藥物保險資訊，如Rx BIN、PCN 和 Group Number 。反之，住院藥房主要提供藥物給正在住院的病人使用，主要透過保險卡上的醫療保險資訊 Medical ID 向保險公司申請報價。這也解釋了為何在某些情況下，同一藥物在住院期間會被保險理賠，而出院後則可能不再被保險涵蓋。
Furthermore, it's essential to highlight the significant differences in the medication billing processes between these two pharmacies. Since outpatient pharmacies primarily serve patients outside the hospital, the medication billing would require the pharmacy billing code on the healthcare insurance card, such as Rx BIN, PCN, and Group Number discussed in the previous chapter. In contrast, inpatient pharmacies primarily serve patients who are currently hospitalized, and the billing would require the Medical ID on the insurance card for medical billing. This distinction elucidates why, in certain situations, the same medication may be covered by insurance during hospitalization but may not be covered after discharge.
認識美國藥物分類和基礎相關知識|
Understanding the Classification and Fundamental Knowledge of Medications in the United States
在美國藥物一般可分為兩大類：非處方藥（Over-the-Counter，OTC）和處方藥（Prescription）。
In the United States, medications are generally classified into two main categories: Over-the-Counter (OTC) and Prescription.
非處方藥 | OTC: 一般大眾認知的成藥。患者無需醫師處方，即可在藥局或超市等地點購買的藥物。
These are commonly known as non-prescription drugs. Patients can purchase these medications without a doctor's prescription at places like pharmacies or supermarkets.
這些藥品因為臨床應用時間較長、藥效穩定且不良反應較少，患者不須有太多的專業知識就可以憑藉著藥品說明書（Package insert）使用。
OTC drugs have a more extensive history in clinical practice, offering stable efficacy and fewer adverse reactions. This characteristic allows patients to use these medications with minimal professional knowledge, often referring to the drug's package insert for guidance.
處方藥 | Prescription：必須獲得醫生的處方才可以購得的藥物。
Prescription medications that must be obtained with a doctor's prescription.
處方藥物經過藥局人員分裝後，都會貼有帶有藥局信息的標籤，而根據藥局法，標籤上都會包含以下信息：
After pharmacy personnel dispense prescription medications, they affix labels containing essential pharmacy information, adhering to pharmacy regulations. The label encompasses the following details:
患者姓名｜Patient Name
藥物名稱、劑量、用法、用量、服用方式和處方開立日期｜
Drug Name, Dosage, Instructions, and Prescription Issuance Date藥物補充數量餘額| Number of Refills: 標明處方可以再補充的餘額量。可以知道處方藥可以補充的次數。
Indicates the remaining balance available for prescription refills. It informs patients about the refill limit.
服用注意事項| Side effects and Warning：包括有關可能的副作用、飲食限制等方面的警告和注意事項。
Includes warnings and precautions related to potential side effects, dietary restrictions, contraindications, and other pertinent information.
需注意的是”contraindications”這個標籤，這個警語是最高警示。也就是說只要有這個警語出現，一定藥完全遵從上面指示。例如，懷孕不可使用 (contraindicated in pregnancy)。
"Contraindications" is a label that demands the utmost caution. This warning indicates that under no circumstances should specific actions be taken while using this medication. For instance, if it is labeled "contraindicated in pregnancy," it means the medication must not be taken during pregnancy.
有效期限｜Expiration Date
這兩種藥物的包裝和罐子上都會寫有批號（Lot Number）和有效期限（Expiration Date），請看下圖為範例：
Both types of medications display lot numbers and expiration dates on their packaging and containers. Please see the example below:
需要注意的是，批號和有效期限並非全是墨水印刷，有時會以浮水印的形式印在藥物包裝上。
It's important to note that lot numbers and expiration dates are not always printed in ink; sometimes, they may be imprinted on the medication packaging as a watermark.
#LotNumber #ExpirationDate
批號| Lot Number : 識別藥物生產批次的編碼。
A code used to identify the production batch of the medication.
主要用於追溯藥物的生產批次，有助於追查、管理和回收有缺陷或可能有問題的產品。當患者或醫生報告不良反應時，製造商可以通過批號迅速識別相關藥物。
This coding system is primarily employed to trace the medication's production batch, aiding in the tracking, management, and recall of products that may have defects or potential issues. In cases where patients or doctors report adverse reactions, the lot number allows manufacturers to swiftly identify the specific medication involved.
有效期限| Expiration Date：過期日期。
The date of expiry跟食物一樣，藥物同樣有過期日期。而藥物的有效期限一般是指藥物可以保持其預期效力和安全性的期限。藥物在過期後可能失去藥效或產生安全風險。因此，藥物在過了有效期限後通常不建議使用。
Similar to food, medications also come with an expiration date. The expiration date of a medication typically indicates the period during which the medication can maintain its intended potency and safety. After reaching its expiration date, a medication may lose effectiveness or pose safety risks. Therefore, it is generally not recommended to use medications beyond their expiration date.
因為處方藥通常是經由藥師和藥師助理根據處方簽進行分裝，所以批號有時候不會直接印在分裝的藥罐上，而是透過藥局系統進行記錄。當需要回收某一批號時，藥局會主動通知患者相關事宜。
As prescription medications are typically dispensed into different bottles by pharmacists and pharmacy technicians based on the prescription, the lot number is sometimes not directly printed on the dispensed medication containers. Instead, this information is recorded in the pharmacy system. When a specific lot number needs to be recalled, the pharmacy will proactively inform patients of the relevant details.
了解品牌藥和學名藥的概念|
Understanding Brand Name and Generic Drugs
當你注視擺滿的成藥貨架時，可能會感到困惑，因為它們明明都是止痛藥，為何有這麼多不同的名稱。在美國，你經常會看到止痛藥品牌，例如安舒疼（Advil）和美林（Motrin），然而這兩者實際上都含有相同的化學活性成分，即布洛芬（ibuprofen）。安舒疼（Advil）和美林（Motrin）被歸類為品牌藥，而布洛芬則是學名藥。但實際上，它們都指的是同一種化學藥物。
As you peruse the shelves filled with over-the-counter medications, it's natural to feel overwhelmed by the variety of names. You might wonder why there are so many different names for pain relief medications when they all serve the same purpose. In the United States, you often encounter well-known pain reliever brands like Advil and Motrin. However, they both contain the same active ingredient – ibuprofen. Advil and Motrin are brand-name drugs, while ibuprofen is the generic name for both.
初入美國時，我其實對於這兩者的差別並不是特別熟悉。以為貴的就是比較好，也認為品牌藥才是正品，而學名藥則是仿品。進入了藥學院後，我才知道原來這並不是正確的看法。接下來我將解說這兩者的差異：
When I first arrived in the United States, I wasn't particularly familiar with the differences between these two. I used to believe that the more expensive a medication, the better it must be. I also thought that brand-name drugs were the genuine ones, while generic drugs were mere imitations. It wasn't until I entered pharmacy school that I learned this wasn't a correct perspective. Next, I will explain the differences between these two:
品牌藥 ｜Brand Name Drug: 由研發該藥物的原始製藥公司所命名的專有名稱，且只能由持有專利的公司使用。
The proprietary name given by the original pharmaceutical company that developed the drug and can only be used by the company holding the patent.
品牌藥通常較昂貴，因為它們需要支付研發、臨床試驗和行銷等方面的成本。很多時候，當新藥剛進入市場時，由於受到專利的保護，市面上只會有品牌藥。
Brand name drugs are usually more expensive because the original pharmaceutical company usually would make up the costs such as research and development, clinical trials, and marketing. Often, when a new drug enters the market, it is initially available only as a brand-name drug due to patent protection.
學名藥｜Generic Drug: 藥物專利保護期結束後由其他製藥廠所生產的藥物，和品牌藥擁有同樣的活性成分。
After the expiration of the drug patent, the medication can be produced by other pharmaceutical companies, and it contains the same active ingredients as the brand-name drug.
首先，"Generic Drug" 的中文常常被翻譯為「仿製藥」，但其實它並非仿品。"Generic Drug" 這一詞主要用於稱呼專利保護期結束後所製造的藥物，通常以藥物的通用名稱或者化學名來稱呼。由於專利過期後，藥物可由不同的製藥公司生產，所以可以用其化學名稱或通用名等非品牌名出售。
Firstly, the Chinese translation of "generic drug" is often rendered as "仿製藥," which may be directly translated as an imitated drug. However, it's crucial to clarify that a generic drug is not an imitation. The term "Generic Drug" is primarily used to refer to medications manufactured after the expiration of the patent, usually identified by the drug's generic name or chemical name. As patents expire, different pharmaceutical companies can produce these drugs, and they can be sold under their chemical or generic names without a brand.
價格通常比品牌藥便宜，因為它們不需要承擔其藥物的研發和行銷成本。由於成分和效果與品牌藥基本無異，所以學名藥基本上是很多人的首選藥，而保險公司也比較容易給付。
Generic drugs are typically more affordable because they don't bear the costs of research and marketing associated with brand-name drugs. Since their composition and effectiveness are essentially the same as brand-name drugs, generic drugs are often the preferred choice for many individuals, and insurance companies are more likely to cover them.
也因如此，在很多情況下，基本上會建議病人優先購買便宜且經濟實惠的學名藥。除非是沒有其他選擇，才會考慮購買品牌藥。在有些時候，擁有專利的藥廠為了促進病人使用品牌藥，會提供一些折扣卷供使用。但須注意的是，這些折扣卷很多時候都有使用次數上限 (且使用次數會跟身分證還有保險卡綁定)，當次數用盡後，病人仍需選擇其他藥物或者繼續支付昂貴的品牌藥。因此，選購品牌藥還是得考慮長期的治療規劃，而不能只參考短期的折扣優惠。
Hence, in many instances, it is generally advised for patients to prioritize the purchase of affordable and cost-effective generic drugs. Consideration of purchasing brand-name drugs arises only when no other options are available. In certain scenarios, pharmaceutical companies holding patents may offer discount coupons to incentivize patients to opt for brand-name drugs. However, it's crucial to be aware that these coupons often come with lifetime usage limitations (tied to identification and insurance cards). Once the limit is reached, patients will need to explore alternative medications or continue bearing the cost of expensive brand-name drugs. Consequently, when opting for brand-name drugs, it is essential to consider long-term treatment plans rather than solely relying on short-term discount offers.
結語｜Conclusion
這一章節主要介紹了一些基礎的藥物和藥局知識。由於單篇文章無法囊括所有相關知識，因此，我將在後續的文章中進一步擴充這方面的內容。如果您對任何部分有建議或需要改進的地方，請隨時在留言中提出，感謝您的支持。
This section provides an overview of fundamental information regarding medications and pharmacy practices. Given the vastness of this field, it's challenging to encompass all the knowledge in a single article. Therefore, I plan to delve deeper into this subject in subsequent articles. If you have any suggestions for improvement, please don't hesitate to leave your comments. Your support is greatly appreciated.
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