So some ignorant horrible spelling doctors decided to harass the *Angriest* Pharmacist over a rant I made about some idiot with 4 degrees who couldn't write coherently to save his life.

Now I may rag on the Angriest Pharmacist for stealing my idea and stuff, but I got his back when some uppity fuck decides to give him both barrels.

for all you uninforned assholes,first notice this is not in caps!!my parnter and best friends wife is a pharmacist at a major grocery store ad she will admit it is the easiest job and when i read last week i was actually published i got a dictionalry and learned how to spell vicoden and even lortab which is hydrocodone which in the 33 years i have been practicing i have never prescribed the frug and refuse to,when i do surgery they get ultram and or darvocett. then i can count on a pharmacist callinf and asking if i realized i gave 2 pain meds an always when i give anti biotics its for 7-10 days and then a 25 year old dr. want to be pharmacist will call and ask why 10 days the book says no more than a week. we also have a system for fraud which we rarely get taken and i do press charges, ill write 38 in 2008 and 39 in 2009 never with refills and pharmacys know if it is mine, we get a few “losts” scripts but we handle individually and if its stolen we need a police report to take to pharmacy and i still get calls. all replacements must have notorised letter to be replaced and controlled drugs are only replaced once. on major surgeries i might prescribe 18 oxycontin,6 times in 2007 all over 65 years old. i explain all medications as well as side effects and how the medications react with any other current meds.then the nurse brings in the rx and goes over questions,so by the time they see the pharmacist all needed is count the pills and run through insurance unless patient has questions and in our area its the tech the pharmacist doesnt have time.most pharmacists earn thier money and do have responsiblity its the young ones that i have to pay for 2 extra phone lines and they still want to tell me how to prescribe.we do recommend mail order to low income if it is long term usage on our internal medicine practice as long as they keep thier appointments or we give them samples but i keep no controlled. in 33 years i have had 4 malpractice cases, 3 dismissed and the 1982 casse was settled out of court in 1988 for a medicaid person who had no injuries just wanted to never work again,so my dea number is last of my concerns. so the assholes who say i have no degrees and speak 6 languages, does that mean i am smarter or above you i think not, i make mistakes like should have retired in 1996 when i was making 450k instead of 6 day work weeks 10-12 hour days for 125k, but i would do it for free. anyone want to put up something about my credentilals? I COULD BE A LYING DRUGGY WANTING ATTENTION. sorry i got carried away with the caps. glad i could raise your rating for your website, i thought it was a joke. maybe ill send a couple movie clips youve probably seen me before even though i am not a house hold name but bottom line the world needs to hear all sides before making a judgement. im not a dr. because i dont proof read and use large and small letters, i can live with it. t. elway,md facs scripts

Wait, this guy doesn't know how to spell Vicodin or Lortab however in his 33 years just prescribed Darvocet and Ultram? Uh, isn't Vicodin and Lortab a generation older than Ultram? This post is like a brain-dump with no sort of flow or break. It makes my brain burn.

If that wasn't enough:

Sorry, address must include host name. (#5.1.3) — Below this line is a copy of the message. Return-Path: Received: (qmail 9342 invoked from network); 31 Jan 2008 23:44:12 -0000 Received: from unknown (HELO DJ7K1K81) (cut@[76.252.49.133]) by 66.11.233.2 with SMTP; 31 Jan 2008 23:44:12 -0000 From: To: “‘prescription’” Subject: RE: Dr “4 Degrees” and the Caps-Lock key eludes him - The Angry Pharmacist Date: Thu, 31 Jan 2008 18:42:09 -0500 MIME-Version: 1.0 Content-Type: text/plain; charset=”us-ascii” Content-Transfer-Encoding: 7bit X-Mailer: Microsoft Office Outlook, Build 11.0.5510 Thread-Index: AchkC9H1X2XPRgMPTzWrPB+8Ad/cOgAVUFwA In-Reply-To: <4F258D9E03DE43A884B4FB1BDFF804F4@RHooverPC> X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.3198 Did you get the email today from dr.e and his numbers as well as dea to prove you and your readers that you can be wrong?? For something that was toungue in cheek it sure got you a lot of readers we all read it 1/25/08 and it was a good laugh enough that we have it hanging in our waiting room and after blocking our 3 of every 10 words out of the 95 patients a day at least 15 make a comment that it must be a real pharmacist that is disgruntled and hates his job.tried not to use caps or bad grammer or caps in an informal note,had no idea what your site was but have started reading it as we phycians get a good laugh after double shifts and watching the pharmacist at Albertson asleep, like I said my wife is a pharmacist and that doesn’t make her dumb or lazy she knows how well she has it plus benefits and retirement,she is way up the ladder as well as most pharmacists versus the audiologists we put up with dailey, one of our specialities is otology, that is ear infections,hearing and aids as well as stapedectomy surgerys invented by dr. shea in Memphis tn, say for not proof reading this also but I think you can read it if a couple words are turned around you are a phd,and thankfully not an md with that language that you use. God bless you and we pray for your soul and that you find happiness. C.r.shultz,md f.a.s _____ From: hoover [cut] Sent: Friday, February 01, 2008 8:20 AM To: hoover Subject: Dr “4 Degrees” and the Caps-Lock key eludes him - The Angry Pharmacist http://www.theangrypharmacist.com/archives/2007/12/dr_4_degrees_and_the_capslock.html

Well, first of all I'm glad people read my site. I have no idea how the TA'estP got the email bounce. If you want this dillhole's email address go to TA'estP site and look it up. I'm a big vagina and took out his email address.

All I have to say about this is:

i sure hope this doctor treats his patients more than he treats proper puncutation and grammar i know that i dont ever, use proper grammar but at least i know that the keys,on the keyboard are used to signify when sentences stop and start and i dont place,commas in places where they dont belong i have letters after my name like f.a.s and other crap that makes people think,that i am smart but really i dont know what i am doing because i like to type with only the letters because all of the other key,scare me like chicken.

DrugNazi was right, these websites just write themselves.

I saw this comment on Kevin MD's blog about a rant of mine. The url is: http://www.kevinmd.com/blog/2008/01/paying-cash-for-narcotic-prescription.html#comments

The attitudes shown on the referenced blog also show why there is no confidentiality once a RX is filled.

I had a doc who needed an antidepressant as a patient. The big clinic/hospital that he worked for also owned the insurance company, and he was in a political struggle within the administration. Given a history of personal destruction as a political tool, he didn't trust them to not use his medical care history against them.

Okay, right there screams that we aren't getting the entire story. I fill Rx's for Doctors all the time for stuff like this, and to be honest nobody gives it a second thought or look.

So he paid privately in cash for the treatment, and then went to a different pharmacy than his usual one, gave them no insurance information and paid cash for the prescription.

The pharmacy somehow uploaded the information to the insurance company anyway, where it was tapped by administration.

Something obviously isn't right there. I can't fill an Rx for an Insurance company 99% of the time WITH the card, what makes you think that we can just 'transmit' and have it magically go through? Gimme a break, now this story either screams exaggerated or made up. The chances that some pharmacy can just 'guess' the information from a private insurance patient who did not provide any card/info is on the same playing field as us getting U&C for Rx's.

His investigation uncovered all this after he was beat over the head and insulted with his "mental disability" as evidenced by taking prozac during a contentious meeting with his medical director.

Prozac for a 'mental disability'? Right. I wonder where the HIPAA police were during all of this? Oh, they were paid off by the 'administration' to keep their mouths shut.

Stopping drug addicts is all well and good, but the patient's right to privacy and need for it is not obviated by the "war on drugs"---and he shouldn't have to give that up to stop addicts from gleefully killing themsleves. I understand where the pharmacist is comming from. The state puts him in the position of policeman. But it shouldn't be like that. We shouldn't have to go to a policeman for our medical care.

You're right, we should just make Vicodin over the counter, and when a doped up addict comes crashing through your front door looking for more cash for his dope and murders/rapes your family you can rest assured that his privacy was protected. Give me a fucking break and come back from bizarro-land. Addicts dont just kill themselves, they hurt other people in the process of their dope. Those that don't end up on the state system that US working folk have to pay for over something that THEY did to themselves. I dont know about you, but I don't want to pay for a liver transplant for someone who has never worked an honest day in his life, and who's only accomplishment is how much vicodin he can pop before passing out.

Regarding these databases to catch pill poppers---anyone who doesn't think that is going to be used sometimes by snoops to personally or politically destroy enemies fell off the turnip truck yesterday. It's very existence creates a barrier to legitimate medical care for some.

Let me get some more tinfoil for your hat.

Anyone thinks that Rush Limbaugh wasn't a political target? Notice how they used search warrants rather than supoenas to get his records? Remember the viagra incident--cleary a deliberate ploy to use his (non-controled) med use to embarass him.

Any number of public and not so public characters have legitimate reason to fear filling something so benign as Prozac, viagra, or a properly used opiate RX in the information juggernaut that the pharmacy industry has created.

Uh, a supoena is a form of search warrant. If the police come with a search warrant and want Rx records, then by all means I need to provide them just as if they came with a subpoena. Just a search warrant is "Dont get up, i'll get those myself" vs "fax these over when you get a free moment". Rush was getting a huge amounts of oxycontin, a C-2 narcotic. A tad bit different than the person who gets his vicodin 2 weeks early.

That being said, here is some more tinfoil for your hat.

You state: Now I went to college for 7 years, got my PharmD, yadda yadda yadda. I know about drugs. I am trained in drugs. Ask me about a drug and I will tell you everything you need to know about it.

Okay--I'm asking about a drug: INSULIN. Tell me everything I need to know
about insulin . . . about older OTC natural animal insulins versus the rDNA
synthetic human insulin that is "just like the human body makes."

What do you want to know about it? How its more consistent than animal derived Insulin? Less prone to allergic reactions? Longer shelf life (if kept in fridge)? Less shit from animal-rights groups (god save the pork?). Or should I go into the long tyrade about how EVERYONE can use this product without being forced not to get treatment due to religious beliefs of not using pork products? When I said "I will tell you everything you need to know about it" with Insulin its going to be how to store it, proper aseptic technique to inject it, when to notify your doctor, confusion about sliding scales, mixing, etc etc etc. Basic stuff they tell you in school. However you are a "50+-year insulin user" (See lilly rant) so I think you're going to tell me that my 7 years of school + millions of bottles of insulin dispensed is completely wrong and I'm an idiot.

And while you are at it, I would like to know why pharmacists--whose years of education supremely qualify them to serve as an intermediary between patients and the FDA--have NOT stepped up to amerliorate the dysfunctional adverse events reporting. It has been shown that patients talk to their pharmacists 7 times more frequently than to their doctors. Ergo, you hear more tales, more quickly, about adverse events; and yet you obviously have opted to stay out of the mix, count your little pills, place them in bottles, and ask patients, "Do you have any questions?" Your education and position qualify you to do much more. Why don't you?

If I reported every damn 'side effect' and 'allergic reaction' that I get on a daily basis, I would fill up medwatch's books on "headache", "upset stomach", "dizziness", "gives me gas", etc etc etc. We filter out a /ton/ of bogus already-reported side effects from Medwatch. Now have I ever reported something to Medwatch? Yes. Woman had such a bad allergic reaction to the adhesive to Vivelle dots that it made a bleeding rash that spread. We arent "staying out the mix", we are just nodding our heads and telling Mrs. Jones who calls you 100 times a day that YES, it is common to get lightheadedness when changing blood pressure medications, and if she wasn't being such an uppity bitch about her copays she might of heard me warn her of that during the consultation. People hear what they want to hear, and the moment their copays change by anything more than $0.05 anything of value I tell them goes right out the window as they scream at me about their fucking copay.

I dont see where you are getting with this whole bitch to be honest. We ask the patient if they have any questions, yet don't submit every side effect to Medwatch? Do you call the police about a missing person when your child cannot be found for 10 seconds because they are in the restroom? You're probably one of those patients who has an "allergy" to codeine and tells us to record it as "upset stomach", then argues with us when we say that its a common side effect.

In other words, what YOU perceive as your STELLAR qualifications could--and perhaps will--be supplanted by a comprehensive PDR software program, automatic pill-counter/dispenser, and voice-activated computer that can spit out prescription inserts "on demand."

Yeah, and who's going to program said PDR software program that can turn medical speak into plain-person speak? How are you going to get around the Drug-Drug-Interactions/Dosing Mixups that aren't picked up in the software but are picked up via experience (Morphine ER/IR mixups or a good starting dose for the elderly). We aren't going to be replaced by machines because people like us, we talk to them.

Doctors have more of a chance of being replaced. They see patients for 10 seconds, take a quick look at them, and just leave giving them an Rx on the front counter. They could be replaced by an automated blood-pressure/DM/etc diagnostic machine, then patients can use a touch screen for their symptoms which spits out a diagnosis that then gets sent to the pharmacy where we pick out the proper drug and dose.

It sounds to me like you should be working at a mail-order pharmacy where patient contact is minimum. That should take care of your 'anger' issues. Then, of course, without those stupid, sick, suffering patients--and yes, sometimes thoughtless or clueless patients--you wouldn't have a job.

Do you realize that you are on the website "THE ANGRY PHARMACIST"? What part of "Angry" do you not understand? Have you ever read this site before? Do you realize that the whole reason /WHY/ I get angry is because I'm out there associating with everyone who walks into my store? This includes the village idiot, the whiny uppity rich bitch, and the 99.9% of the /normal/ people whom I don't get angry with (hence not bitch about here). Did you read how I /hate/ mail-order pharmacies because they give substandard patient care and make /me/ do all of their shit work (when I dont get paid for it)?

You will only find this here at "The Angry Pharmacist(tm)".  It is a smuggled document from the headquarters of a training facuilty (the drug company shall remain nameless) about how to train drug-reps.  This is the secret code! Lets take a look:

• Doctor, can I speak with you for a min about a new product?
• Translation: Our patent has ran out on our best selling drug, so I'm going to tell you how much the generic will suck and how our NEWER and BESTER product (which is the same shit just XR after the name) beats the living hoo-hah out of the stuff I was pimping to you as the latest and bestest just 2 weeks prior.
• Here are some studies for you to read.
• Translation: You wont read this shit, and we paid for them so what do you think they'll say you idiot.
• You know that our new product has 500% better bioavailability and the AUC is 15% higher big-word big-word.
  
• Translation: You have no idea what the fuck these numbers mean, and neither do I!  I just memorize them and spit them out to sound smart.
• I'm going to leave some coupons here so you can trial your patients.
• Translation: We're gonna fuck over pharmacies so they'll have to buy a $500 bottle of 100 to get a whole 7 tablets out for the fucking coupon.  The rest will just rot and outdate on them.
  
• All major insurance companies cover this.  Its Tier-4 on their formularies
  
• Translation: Which means its not covered without a prior auth.  I know you're too 'busy' to do PA's so we'll just fuck over your patients by feeding them samples until they run out, then force them to pay $200/month to continue therapy.  Wait, I think the coke dealer did that same thing to me when I was in college.
• Do you have any questions?
• Please don't be an ex-pharmacist.  Please dont be an ex-pharmacist! SHIT! I NEED A DISTRACTION! IT LOOKS LIKE HE'S GOING TO ASK ME SOMETHING!
• Oh, I dropped my pens.  Dont worry, i'll get them.
• Translation: Yes, they are real. I can make them bounce into each other.  Look into my mind control device doctor.. Loooooook.
  
• Here are some pens and notepads for you doctor.  I hope you have a wonderful day!
• Translation: Sucker!!!! HAHAHA!

I really do dislike drug reps.  However I dislike Medicare Part D salesmen even more!  More on that later!

As I have (and we all have) learned in school, a bottle of Humulin R or N is good for 1 month if kept at room temperature or if refrigerated good until the expiration date on the bottle.  Right?

Not according to the Lilly Reps.

They are telling doctors and other retarded janitor-types who can write Rx's that once a bottle of insulin has been opened, it is good for 28 days upon which it must be trashed.  That really great for the cash customer who is on about 10 units a day and gets to shell out the 40+ bucks a month for a new bottle (as they toss out a 3/4 full one).

This bullshit started about 4 years go.  The formula for Humulin R and N have not changed since god was a boy.  What the hell caused this?

Heres the kicker.  There are no studies to back this data up.  Thats straight from the Lilly mothership.  Turns out that Europe (thanks assholes) have this law that states that all injectables must have an expiration date of one month from the time of penetration (har har har).  HOWEVER if the product was made before 1990 this law does not apply.  Thats why Humalog and Lantus have the warning in the package insert to discard after 28 days.  Humulin R and N do not have this warning (also stated directly from the mothership).  The good ole USA just decided to adopt this standard without any studies to show that its even half way legit.  Yeah, lets just do what Europe does, it worked so well for thalomide didn't it?

Does this stop Lilly reps from spreading the gospel of 'discard R & N after 1 month' to every doctor and nurse out there?  Hell no.  Higher sales for Lilly!  Fancier pens!  Lower tops!  Higher heels!

Lilly, you are fucking retarded.  I hope all of you become cash paying diabetics who are forced to sleep in your own shit.

A really frustrating part about retail pharmacy is that everything seems to be "my problem".  Now I went to college for 7 years, got my PharmD, yadda yadda yadda.  I know about drugs.  I am trained in drugs.  Ask me about a drug and I will tell you everything you need to know about it.

However:

• I am not your fucking insurance agent.  I don't know how much your fucking deductible is because ITS NOT MY INSURANCE.  I can guess, but its only that, a guess.  Its YOUR job to know about your insurance, not MINE.  If YOU dont understand something, talk to your insurance company; not your pharmacist.
  
• I am not the keeper of your insurance card.  If you go to the store and want to buy something but don't have your credit card, do you ask the salesperson to call VISA and ask for your credit card number so they can finish the transaction?  NO.  Keep your fucking card on you, and when you get a new one don't make me fucking ask you 100 times for it before you say "Oh! Yeah! I got this new insurance card last month".
  
• I am not the welfare office.  If you bitch about your $3.10 copay and whine how the government hates the poor, let me charge you the fucking cash price of $150 and see how much you fucking whine.  All the welfare programs have done is create a bunch of fucking ungrateful bastards who think the F in Pharmacy stands for FREE.
• I'm not your mother.  If your medication got lost/stolen/etc its YOUR job to call the doctor to explain how you are not a fucking addict, not MINE.  If I call I'm going to say "Yeah, he/she lost his medicine.  He told me a story but to be honest I wasn't paying attention."  Keep your pills where you can find them, and if you lose them expect to pay cash for the replacements.  Insurance companies do not pay the copay on stupidity.
• I am not a drug company rep.  You can whine to me day in and day out how pricey the medication is in this country, then turn right around and ask me to sign something on a class action lawsuit over Avandia or Vioxx or something.  You know why medication costs so much in this country? Stupid bastards who sue over side effects inflicted from taking a controlled poison.  Lets sue Clorox because my kid drank bleach and died.
• And last but not least.  I am not your fucking personal bitch.  I am here to help you, and will do so with a smile on my face, but I am not your bitch.  I am your pharmacist, and if you treat me like your child or someone you think you can just boss around I am going to pee in your promethazine with codeine and shit on your Soma.  Treat me with respect and you will get the same in return.  Treat me like shit and you'll be waiting 4 hours for your Rx's at the Walgreens down the road.
  

Crusty RPh writes,

DEA, DEA, DEA, Bullshit. Everyone worries about the DEA. The DEA has bigger fish to fry then worrying about me dispensing a Vicodin prescription to some jackass who got it down the street at another pharmacy 5 days ago. If I beleive the lost story, it is my decision. Fuck the DEA. If I say no,it is my decision with absolutely no concern about the DEA. The DEA is trying to find prescription mills, not the occasional poor judgment of a legit pharmacy. They currently get transmissions from the pharmacies -- these transmissions include the Patient info, Dr. info, and drug info including the quantity prescribed. The DEA gets transmissions from the drug wholesalers which have the purchase information for each pharmacy for Schedule meds. In essence, all the information needed to audit each pharmacy, Dr and patient each month. With all this information, their answer to the problem is to limit the number of bottles of Vicodin I can order. Bullshit, if they have a problem with the amount of Vicodin I order, audit my store's usage, don't limit my supply. I am very strict with Schedule Rxs --I feel 99.9% totally legit, but I have high volume business and I don't need any fuckin government agency telling I can't order the meds necessary to fill these prescriptions.
I have requested reports from the DEA on patients, which show overusage and over prescribing. Why do I have to request this information--it should be forwarded to me as matter of record. That's why I call BULLSHIT on the DEA. A letter to the Dr, patient, and pharmacy should generated automatically when there is a history of "repeated" abuse.

I've emailed back and forth with him, and it turns out California is required to send all controlled Rx info to the feds weekly. There have been reports of wholesalers limiting how much Vicodin/Soma you can buy under orders from the DEA.

DEA, get your head out of your ass. You can tell if a pharmacy is a drug-mill just by looking at the data that you force them to send to you! Here, let me help you.

1. The wholesalers transmit to you how many vicodin they sell to a store in a month.
2. The pharmacies transmit to you how many vicodin they dispense in a month along with patient and doctor information.

Look at the two, if the pharmacy is 10,000 tablets off, they either have a huge stock in the store, or something is fishy. Pharmacies should get notices (along with the doctors) when say 100 vicodin are filled at 2 different pharmacies within an unreasonable period of time (say, 5 days). If the doctor auth'd the early refill (due to loss, stolen, etc) then the notice is just trashed and everyone moves on. This shit is all electronic now, so why cant they just generate reports to send to pharmacies about potential doctor shoppers? What the fuck is the DEA doing with all of that data that they require pharmacies to send to them? I'm sure it would be extremely easy to take all the data and give each pharmacy a weekly report on usage. At least then it would make the poor pharmacists who have to transmit this shit feel like they are actually doing something!

DEA is like the Highway Patrol. Useless unless you have your head up your ass and screw up once. Then they are all over you like flies on shit.

OneAngryTech (http://one_angry_tech.livejournal.com) wrote in:

Ok.. Pharmacist(s): Time for WHAT WOULD YOU DO?

Cash-Patient A comes into your pharmacy with 2 prescriptions, 1 for Vicodin and 1 for Xanax. The prescription for Vicodin is 100 tabs, TID and Xanax is doesn't matter. Patient inquires as to the price for the Xanax, but not the Vicodin.

Your enterprising tech (me) for some unearthly reason decides to do a central search (which checks all the pharmacies in your chain) and finds that Patient A just filled the same prescription for Vicodin 7 days ago (30 day supply) at the neighboring town store.

What do you do?

This brings up a good point. Whenever someone who usually uses insurance comes to you with a narcotic and demands to pay cash, something isnt right. I always do a courtesy run-through to see what the magical insurance company pops up with. 9 times out of 10 they received some narcotics from another doctor and another pharmacy just like in this instance.

Then I outright ask them if they picked up the Rx from [storename] a week ago. Usually thats enough for them to give me the deer-in-the-headlight look as if to think "holy shit, how does he know?" If they say "no" then I call the other store to see if they are lying (which they are). If its from another doctor I outright ask "Did you tell Dr. A that you are getting pills from Dr. B?" When they say "Yes" I call. You wouldn't believe how many people I get kicked out of practices that way. They especially get pissed when they tell me "I specifically asked them if they were getting vicodin from another doctor and they outright said no!" Whoops.

Sometimes they demand the Rx back (to try another store). Before I give it back I write on it in pen "Filled [date] [quanity] [store]" on the front of it. Is that an asshole move? Yup. Do I care? Nope. Whats the doctor going to do, bitch at me that I defaced his Rx that he gave to someone who is fraudently doctor shopping? Yeah, lets call the police on that drug dealer that put borax in my cocaine while we are at it. I mean seriously, if there is so much deception going on that they need to outright lie to me, what legitimate purpose do they have trying to get it filled?

If they are up front with me and dont lie/give me any lip, I give it back without question and say that I wont fill it until its due. What they do from there is their own dealing.

Lets see how this story pans out:

When Patient A comes to pick up both RX's, the Pharmacist in Charge lets patient know we didn't fill the Vicodin prescription since it was just filled 7 days ago. We have said prescription in the bag.

Patient then remembers that "well.. er someone stole my Vicodin so I went to Dr. Pain Clinic and he wrote me another one.. der der der"

Pharmacist let's patient know that we will need some kind of proof as to this happening (maybe say a Police Report.. it IS theft after all) and patient angrily walks away and shows us birds.

We then decide it would be a good idea to give neighboring store a call and let them know what happened. They thank us.

Good move. Usually when you say the word "Police" they bail. Works especially well when they use the line "Well I didnt pick up my vicodin Rx, you gave it to someone else". Just saying "Well I'll call the police and pull the surveillance tape" turns their bitch into "Oh, I forgot my cousin picked it up for me, no need to call the police". Its like magic!

They then proceed to fill that prescription the very same night.

I am only a tech, so of course I don't know shit, but would I be within rights to say WHAT THE FUCK IS WRONG HERE AND WHY THE FUCK WOULD THEY FILL IT??!!??

The only response: "Well, it is the pharmacist license.."

Pharmacist, Pharmacist in charge, your store license, and a whole bunch of DEA paperwork. Yeah, fun shit. I hope they jacked the cash price up to cover the cost of all of the crap that could of went down.

Working for an independent gives you sort of a bond with other independent pharmacists. From shitty reimbursements to dealing with patients; we don't have the luxury of a 'corporate office' and people in suits with fancy lawyers to cover our asses.

So I recieved this letter from a pharmacist in California. Since he claims he has bitched to everyone he can get his hands on via phone, I think its time to give some good ole public harassing.

TAP,

My name is [Name Removed] from [Store Name Removed] in [City Removed]. California. Long time listener, first time caller. First off love your website. I was wondering if you could light a fire under a problem that I've been having.

In case you are not from California, our Medicaid system (Called MediCal) has a 6 Rx limit per patient per month. Any Rx over 6 needs to have a Treatment Authorization Request filled and sent in (Think of it as a retarded prior auth that they approve for like 6 months to a year). Since it is being done electronically now vs fax, the usual turnaround time was a day or two for maintenance medications and a bit longer for stuff that was non formulary.

Over the past few months, I have been getting TAR's back for stuff like Lisinopril, HCTZ, glyburide with only 3 authorizations. Now why they would only give 3 fills for something the patient is on chronically is beyond me. To make matters worse, the turnaround times for maintenance meds is now approaching close to 14 days in some instances. Imagine if I did not dispense insulin or digoxin to a patient until I got that TAR back so I could get paid.

So I call the TAR office, and they say the delay is because they are "Really Busy" (yeah, who isnt?). Them giving us only 3 fill units on a lisinopril Rx is like if I dispensed 10 tablets at a time then used the "Really Busy" bullshit when they bitched as to why its taking so long.

I think they are giving away a low amount of refills for approved maintenance medications to save their own jobs. Unfortunately their shortsightedness is giving them such a backlog that approvals are not being sent out in a timely manner and people are not getting their medications.

I hope you publish this letter to your site to light a fire under the MediCal TAR office and to see if any other pharmacist from CA is having the same problem. I can be reached at [email TAP for address].

Thanks
[Name Removed] RPh

Thats pretty shitty if the MediCal TAR office is screwing over TAR's that THEY THEMSELVES REQUIRE in order to save their jobs. I always thought that PA approvers are just pharmacists/techs who could not cut it in the "real world" so they have to get some desk job hiding from the public behind an ID number so they cant be called out for being a fucking retard. If there is anyone from the MediCal office reading this, why don't you get your own shit in order before you force your problems down the throats of the pharmacists who actually work for a living. I have his email address if you wish to get a hold of him and explain your case. 3 fills for a maintenance med, thats fucking absurd. "We're busy" is also fucking absurd. Wah wah wah, cry me a fucking river and let me powder your balls while we're at it. Hate to break it to you, but we ALL are busy, and judging from this letter you are just adding more shit onto this poor independent.

I'm just glad that there are still some people out there like myself who will fill an Rx even though they will not get paid this very moment just so they don't end up in the hospital (actually, I think all pharmacists will do this, huge $ items excluded of course, we're kind but we need to eat too).

Dear BravoRx,

Please get your collective heads out of your asses and research what is and is-not information that is protected by HIPAA.  Today I had to spend 20 min on the phone yelling at one of your representative because they would not give me the birth date they had on file (which was wrong) because they said it was a HIPAA violation.   Because your company sucks and you are lazy, I will spell it out for you.

If I fill Rx' for a patient, I fall under "patient care" therefore no medical information can be withheld from me in the name of HIPAA.  Go look it up.

Here, I'll do it for you:
http://www.hhs.gov/hipaafaq/administrative/259.html

Can a pharmacist use protected health information to fill a prescription that was telephoned in by a patient's physician without the patient's written consent if the patient is a new patient to the pharmacy?

Yes. The pharmacist is using the protected health information for treatment purposes, and the HIPAA Privacy Rule does not require covered entities to obtain an individual’s consent prior to using or disclosing protected health information about him or her for treatment, payment, or health care operations.

See that? FOR TREATMENT PURPOSES.  However this clause does not apply because a birthdate is not MEDICAL INFORMATION!!!  Its a fucking birthdate! Get your head out of your ass!  Its not a SS# but something that is pubically available!

So thank you BravoRx Rep, for wasting my time with your shitty substandard service and lousy reimbursement rates.

May the pox of Argus be upon thee,

TheAngryPharmacist

This is a comment by a "Med Student" to that 4-degree doctor comment. I love getting emails from students.

--- Part 1 ---

I completely understand what this Dr. is talking about. I always have problems with insurance at the end of year, start of new one. I have chronic pain and also am on a maintenance drug, I take daily for my heart. I went to refill both as I normally do on day 28-29 since the last refill and of course I get the dreaded "It's too early" from the insurance..but no problem right?

That right there tells me that something is up. Most insurance companies will give a 5 to 7 day window before it kicks back the "refill too soon" error.

Because they tell me to pay cash, and send them the receipt, so I tell this to my pharmacist. Well now, even though I have been going there for over a year, same meds, same amount, same Doctor..she parrots the insurance company (who doesn't realize there is a HUGE difference between the meaning of THEIR "too early/soon" and a Pharmacies "too early/too soon") and I ask her, how is it too soon? It's been 28 days since I last picked up my meds? She wouldn't answer me. She instead says that she would fill it next week (which btw is at day 33, which means, I'm without my meds for 3 days, which is HUGE, if I miss even one night without my heart med, I start getting some major palpitations..) but it seems she's made up her mind. She decided to make her OWN medical decision without knowing my complete medical history, as my own personal doctor of over 7 years knows.

To be honest, you are giving me only the information that you wish to give me and I'm sure there is a key bit of information that would make sense that you aren't giving me. There could of been an ER script in there for a week supply thats throwing everything off, another pharmacy involved, etc. Something however really doesn't jive with what you are saying. I'm not saying that you are at fault, but with all of the insurance companies I have never heard of one that will kick back a 'refill too soon' error when its 2 days remaining on a 30 day supply. Even if you had no coverage, it would say 'patient not covered' not 'refill too soon'.

So, tell me, why is there NO recourse for me for Pharmacists like this when I assure you, I'm no crack addict. I'm a normal person who unfortunately got JRA at 13 with horrible joint damage and chronic pain that I have been living with all my life. Instead of collecting disability like most would, I instead went through school (honors) and now am in my 3rd year of Med school getting my MD/PHD while also working with Congressional members and House members on a daily basis.

Dont take this the wrong way, but if I had a dollar for everyone assured me that they didn't have a problem as I am looking at their state narcotic report and seeing 4 doctors, 3 ER's and every Walgreens in town I think I could retire. When everyone and their brother lie to you day in and day out, you tend to not believe everything at face value unless compelling information states otherwise. I hope you would actually read the study on a new drug rather than take at face value what some drug rep tells you, right?

You may think this is bad medicine, but wait until you get out and get a visit from the DEA because you are shoveling vicodin out of the door to everyone who gives you a half-assed sob-story. Its amusing to see new Dr's backpedal from their 'we must treat everyones pain' after I tell them that their patient is going to 3 different pharmacies and 2 other doctors for their narcotics. Its like a real-world shock that there are people who lie and deny to get what they want.

I deal with tons of legitimate pain patients every day, and you know what? I never deny them their pain pills if they are a day or so early. However, this being 'The Angry Pharmacist' it doesn't make for a good read to tell how much I help people. People want to read what pisses pharmacists off, and I know that I have been extremely clear stating this in the past.

There is WAY too much stigma attached to ANY type of pain killer. If it's for legitimate pain, one shouldn't be denied healthcare.

Yeah yeah, save me the 'chicken for every pot' story. There is no stigma unless you make it a stigma, and in your example above something red-flagged that pharmacist. Vicodin + "Refill Too Soon" = something is going on. Now if your insurance company would not have given that error message back, do you think this would be even an issue? I dont think so. I would also like to hear your definition of 'legitimate pain', because last time I checked people don't go into the doctors office saying "Hey, I need a vicodin Rx to make my car payment or to deal with my bitchy ass wife".

I do want to point out that: A. This has never been a "problem" for the Pharmacist before, until insurance denied my claim for a week or so until coverage kicked in B. The amount, doctor, strength has NOT changed and it IS a legit script, so you cannot argue that she may have denied it on basis of some sort of "suspicion" that it may be fraudulent, etc..

Blame the insurance company, not the pharmacist. They are the ones who threw back a "refill too soon" message. As I said before, if the insurance company wouldn't of thrown that back, would we even be having this debate now? So, lets break this down a bit more.

Something happens and DEA gets on your case for something. DEA officer comes in and asks to see the hard copies. DEA also has subpoenad your insurance company. DEA asks pharmacist "When you filled this Rx, it came back from the insurance company as 'refill too soon'. Why did you fill it?" Whats the pharmacist supposed to answer? "Because shes in legit pain and says that she isnt a pillhead?" Yeah, that'll fly like a turd on a birthday cake.

THOSE are the types of Pharmacists that are trying to practice Medicine without a degree. There should be some sort of consequences. *I* was ticked off at the fact that she "offered" to call my doctor to see if it was ok to "refill early"..MY argument here was, it was NOT early. 28-29 after getting the original fill is NOT early, ESPECIALLY NOT when your on maintenance medication in which you must take it every day. My doctor is a nice guy, but he REALLY is busy, he spends 12 hours at a busy ER and the rest of the time at the practice, he does NOT have time to get on the phone (which can be backed up by his wife!) to be questioned about nonsense!

I think you should nail your insurance company for practicing medicine without a degree. If the insurance company is kicking back an early fill error, then something else is going on. I would call your insurance company to see who possibly stole your identity or your insurance card and is running up some vicodin scripts with it.

--- Part 2 ---

I'm sorry, I forgot to add a little more background.

I had been at Walmart Pharmacy last year and the same thing happened then. At the end of year, my insurance changes because that's what the company forces us to do, they LOVE making life miserable. Well, Aetna has 2 numbers, the business number for customer service and the PHARMACY number the pharmacies are supposed to call. Well, when I needed my refill, the computer denied the claim and the tech called the BUSINESS line, which BTW they are completely useless. All they said was basically it was "too soon"

Wait, so this has happened with 2 pharmacies? Something now is really fishy especially if its coming back 'refill too soon' both times.

Well, at THIS point, I had been EXTREMELY busy, I was the campaign manager for a House member and forgot to call in my refill, so I called at day 30! (I almost NEVER do this..or at least try not to..with my luck, something comes up and I forget to pick it up..so I always give myself 2 days wiggle room)

Filling your Rx on day 30 when you have a 30 day supply should go through with no errors. Unless you are getting it filled somewhere else, the Rx was mistakingly put in with a days supply higher than 30 (doubtful with Aetna, it would of gotten rejected), or someone else is using your card.

Well now, I get there and the pharmacist and I literally get into it, she starts screaming that it's TOO Soon! I KNOW this is wrong, so I sit there and call the CORRECT number for the Pharmacy portion of the insurance and I actually am able to get the DIRECTOR of Aetna on the phone, she tries to speak with the Pharmacist, but the pharmacist will have NONE of it. the director feels bad for me and apologizes and says, I'm sorry, but she just wont listen to me. (The director tried to explain it's all about the coverage and end of year etc..that it's NOT too early for the refill)

You got the Director of Aetna? I'm sorry, but I'm having a hard time believing you. The pharmacist has to go by what is on his/her screen, and if Aetna is claiming its too soon then tell them to fix their shit to give back accurate error messages.

So, my DOCTOR calls the pharmacist (keep in mind, Im standing there at the pharmacy for 2 HOURS watching all this) and he tells her, you HAVE to fill this refill! The pharmacist REFUSES, quoting the comment of the clueless wonder at the insurance company the very 1st time, "Insurance is saying it's too soon" which at THAT time, everyone in line almost faint FOR me because the director actually called and the pharmacist would NOT listen to her. So, my doc calls me on MY cell phone and boy, is he pissed! He's like, I dont know why she wont listen to me, I'll go ahead and call a new script at a different Pharmacy because this is ridiculous.

THATS when I go to this new pharmacy, I explain what happened and even though I feel as if I dont HAVE to or need to, I actually go through all my medical conditions, etc. MY thinking is, this is a smaller Pharmacy, I want a more personalized interaction. I want to feel like a person and NOT a refill number, ya know? My Physician even went as far as to stop in and introduce himself! Seriously, we have gone above and beyond here.

Its always good to explain yourself even though you don't HAVE or need to. You know, we're just stupid pill dispensers and don't need to know ANYTHING about you. Give me a fucking break, you must really be a med student with an attitude like that.

Pharmacists tend to get a bit pissed when you withhold information especially when the words "another pharmacy" and "refill too soon" are in the same boat as your narcotic Rx.

So, That is just another reason why I'm sooo ticked that I'm having this problem. Is it so difficult for her to look at the dates? I'm thinking (in both cases) it's a matter of their pride, they were wrong and don't want to admit it. But *I* am paying the price for that while they have absolutely NO consequences for their actions.

Blame Aetna, didnt they give back the refill too soon message that started this whole thing?

After reading quite a few posts of yours, I know you have this thing about thinking everyone is a "pillhead", but I'm guessing even you would be able to put aside pride or ego and not actually DENY a patient legit care...afterall.. isn't that why you became a pharmacist? One has to wonder about these pharmacists, is it an ego trip that put them in this field or is it helping people.

No, I dont think everyone is a crackhead or an addict. I however dont take people's word for anything now days unless I have good and solid evidence that they are being legit with me. Its not pride or ego, its doing our fucking job to control narcotics and to manage the medications that multiple doctors prescribe because its impossible to call each other to see what the others is giving. Amazing how stories change when I get a refill too soon error, ask the patient if they received some at another store about 4 times, call the insurance company to find out what store filled it, then ask the patient point blank if they got it as that store. Then I asked why they fucking lied to me when I have to crowbar out of them that they did get some at another store. Get this done to you (which is a complete waste of my time) about every other day, then you'll realize that its not "pride" or "ego".

Lets face it, Aetna probably gave that pharmacist some bum information. If it would have been me, I would of called Aetna and had them give me the pharmacy that last filled it. If you had no idea about this other pharmacy then I'd ask for a copy of the sign-out log and inform the police about narcotic/insurance fraud. You would not believe the amount of shit dropped in pants when I threaten to call the police. Amazingly they manage to remember that they got 30 from an ER doc YESTERDAY. Must of slipped their mind.

However from what you have wrote, you don't really sound like the easiest person to get along with or work with to get this sorted out. You probably just started screaming at the pharmacist which really doesn't help anything. Screaming isn't going to get your pills filled when there is documentation (from the insurance company) that it was too early to be filled (something had to trigger that message).

Of course I will also entertain the fact that you gave me everything and the pharmacist is just being a dick. It happens just like there are asshole doctors in the world who think their shit is worth as much as Zyvox and their farts smell like Warrick Albuterol MDI's.

So good luck in Med school. When you get out you can rant to me about that mean ole asshole pharmacist who wont fill the Rx's you write for yourself.

Did it go smoothly? No.  Was it a complete clusterfuck? Yes.  Am I suprised? No.

Today was a diaster.  I had some insurance companies publish the completely wrong information on the cards, bunch of stuff that isnt formulary, "card? what new card?", and a shitpot full of people whom a deductible = rocket science.  Lets not even get into how fun it was to try to get through to any helpdesk.  The only shining moment is that Argus did not go down, and to be honest most of the big processors were not down for any length of time.  They had 3 years to figure this shit out, good job boys.

Yes, please bitch at me a bunch because you have a $0.05 increase in your copay for your $100 medication.  Plus, just to show how much fate hates TAP, it made one of my printers blow up today, and our pharmacy software glitch like mad.  Wonderful.

I barely have the ambition after a good night of drinking Jack Daniels to even write more.  I'm just so happy that today is over.