I’m of course, talking about the MediCal 10% reimbursement cut.  For those not in the Stupidty State, MediCal is our implementation of Medicaid.

Let me back up to explain some stuff before I go on this rant so those not in pharmacy will understand.

You know when I bitch about getting paid $1.50 over my cost of the medication fee?  Thats called our dispensing fee.  Thats the amount that I make over the cost of the medication that covers my labor, the vials, the power, the tech who fills it, the clerk who has to take your annoying phone call, etc.  I’m hesitant to call it a ‘profit’, because in most cases its not.  It allows us to stay in business.

Now, back to the rant.

Usual reimbursement from MediCal is our drug cost (give or take a few percent to account for wholesaler markups, etc) plus a dispensing fee of a single digit number (less than 10 bucks for those drunk at home).  If I dispense, say, Fukitol, with a ballpark (yet entirely reasonable) price of $200, I can expect to make about $210 bucks.  Those slow out there may be saying “HOLY SHIT, YOU GOT $210 BUCKS FOR THAT PRESCRIPTION! PHARMACY IS A GOLD MINE!”  For those who think this, go work for the State of California, because you are a fucking retard.  Yes, we did get reimbursed by the state a whopping $210 dollars, but unless I can wave a magic wand and make drugs out of thin air, my wholesaler wants $200 out of that $210 so he can pay HIS bills.  So I get $10, which really is fucking good.

So California; despite having Silicon Valley, Google, dot.millionaire companies, San Francisco and LA (that combined pay more taxes in one second than we will all make in a lifetime) is broke.  Go fucking figure.  They decide to whack the MediCal reimbursement for drugs by 10% to stem the bleeding of throwing the baby out with the bath water.  This first was voted into effect on June 1st.  Us pharmacy and medicine peeps said “HOLY SHIT, YOU CANT DO THIS” and did what Americans typically do, tie it up in the courts (read on and you’ll see why).  Well, recently they lost the injunction, so the cuts happened.

Now you may be thinking “gee TAP, 10% cut in your fee isn’t so bad, thats only like a buck”.  Therein lies the problem.  MediCal didn’t cut our dispensing fee, they cut THE WHOLE FUCKING REIMBURSEMENT.

Quick and Dirty:

Drug costs 200 bucks.  We get paid 210 bucks.  Take 10% off of that 210 bucks and you’re left with 190 bucks.  The drug still fucking costs the pharmacy 200 bucks.  We make a whopping -10 dollars.  Thats right, the pharmacy LOSES 10 dollars (in this case) with EACH FUCKING HIGH DOLLAR TRADE NAME FILL.  Throw in some chemo drugs like Xeloda that costs the pharmacy THOUSANDS or HIV drugs at 600 bucks each, and you have yourself a closed pharmacy.

But no, it gets better.  You see, MediCal is in bed with the drug manufacturers.  The drug manufacturers give “kickbacks…er..REBATES” to the state to use THEIR  product.  Why else do you think Nasonex is the ONLY nasal steroid instead of generic Flonase.  Why do you think generic Morphine ER isn’t covered, but BRAND ONLY Kadian is?  The state is getting a rebate for having these on their formulary.

So not only do we lose money on each brand-name prescription, but we are forced to use brand name for certain drug classes.

See how absolutely fucked this is?  So whats a pharmacy to do?

Easy, send the patient somewhere else for brand name drugs.  California Business and Profession code prevents the selling of products for less than what it costs you.  Its part of the anti-predatory pricing laws.

Does this suck for the MediCal patients who need HIV/Actos/Nexium/Kadian/etc? Yup, it sure does.  Our hearts are out to those patients who can’t get their drugs filled, but what other choice do we have?  The chains can absorb the cost for a time until they pull the plug, and the independents cant absorb any of that.

Oh no, it doesn’t stop there.  You know how I said that the cuts were put into law June 1st but got held up in court?  Well they made the cuts retroactive.  Pharmacies are going to get a BILL from MediCal for the 10% difference for EVERY FUCKING PRESCRIPTION they filled since June 1st.

If you are an independent store owner, give money to the Pharmacy Defense Fund (if you haven’t already).  If you’re a district manager for the chains, get your head out of your ass and tell your people to STOP FILLING BRAND NAME DRUGS or you might be out of a job.

I’ll leave you with that.  Don’t send me the bill to cleanup the mess of your head exploding.

Several factors led Morton’s executives to make the decision to sell most of its retail pharmacy business. “It’s the declining reimbursement environment, mandatory mail-order plans, the closed networks that are starting to become popular across the country, $4 generics programs, and predatory audits,” Morton said.

Both health insurance companies and government programs are slashing reimbursements, according to Morton, a practice that is “not providing enough margins for us to serve patients.” In addition, the purpose of audits conducted by pharmacy benefit managers (PBMs) has changed from detection of fraudulent claims to making extra money for the PBMs, according to Morton. “They are looking for administrative mistakes so they can look to recoup claims. It is a revenue-generating technique,” Morton said.

For those not in the industry, Walgreens has a Pharmacy Benefit Manager called Walgreens Health Initiative.  This is similar to how CVS/Caremark work, and the infamous Merck/Medco.  Now for those of you who work retail, this whole article makes perfect sense.

1. Have your PBM give ridiculous low reimbursement rates to kill the independents.
2. Be first in line to “take your failing pharmacy off of your hands for you”
3. If they refuse, audit the shit out of them for every little fucking thing until you bankrupt them
4. See step 2
5. Profit!

Funny, how it’s technically illegal for a bunch of independents to meet to discuss if they are going to take a PBM contract due to antitrust laws, but the major chains and their PBM backers can pull this kind of bullshit.  Of course the major chains can bribe (yes, I said bribe…er.. LOBBY) the corrupt government to look the other way.

Having gone through a dozen+ audits, the article is 100% right.  The auditors aren’t looking for blatant fraud and abuse, they are looking to generate profits.  When you fill an Rx, if you mark a faxed back OK as ‘written’ in your software (instead of a ‘faxed’), that’s grounds for them to take the entire cost of the Rx out of your next check.  I bet, with a bit of digging, you’ll find that these auditors actually get an incentive-pay based upon how many ‘errors’ they find on the pharmacy end.  I will also bet that Caremark doesn’t audit CVS stores, WHI doesn’t audit Walgreens, and Merck doesn’t audit the Medco mail-order chains.  Even if they did audit them, do you really think they would take the money out of their next check? Isn’t that taking money away from themselves?

Sometimes the audits pick up things that are just mistakes, like when you have a Robatussin-DM in your computer as 1 bottle of 273mL and your floater bills 273 bottles by mistake thinking that it’s in the computer as per-cc instead of per-bottle.  Those I can see, but taking back the ENTIRE reimbursement over a 28 day supply vs 30 day supply for eye drops is petty and bullshit.  We have the Rx, its legit, yet you are back-charging us for the entire amount due to a clerical error (and a stupid one at that).  The Rx wasn’t filled fraudulently, and it was filled in good faith with no intent to fraud.  However try to argue this point with the auditors and you’ll just get a blank stare and 100 more ‘errors’ that will make your next reimbursement turn into a bill.

So the million dollar question is: Where is APhA in this mess?

The owners of 3 independant pharmacies go out for dinner.  During the dinner they talk about how (for a very accurate yet hypothetical example) low MedImpacts MAC’s are compared to other insurance companies.  During the discussions they rabble on about how they cannot do business at COST + $0.75 and jointly decide to fax their contract termination letters into MedImpact.  That, right there, violates the Anti-Trust laws.

Now think of this:

CVS/Caremark (a pharmacy/PBM merger) decides that MedImpact doesnt cut the mustard.  They threaten to terminate their contract which will effect a couple hundred stores.  MedImpact tries to play the hero and refuses to negotiate, and now 300+ stores are off of MedImpacts provider list.

Three independent pharmacies get dinged for Anti-Trust behavior, while CVS/Walgreens/Rite-Aid(?) can nix hundreds of their stores without violating anything.  Tell me if that was the intent or spirit of that law.

Since we’re talking about the exploitation of the Anti-Trust laws that were made to protect citizens from such behavior; lets take CVS/Caremark.  Now a while ago we (meaning every independent in town) underwent a Caremark audit.  Now considering those auditors are paid by the infraction, and they will cancel out any prescription that was written for tablets but filled will caps (even if the medication did not come in cap dosage form) among other totally bullshit non-fraudulent-act (like the MD instead of the NP checked off), do you really think CVS gets held to the same exact standards by Caremark as us non-CVS stores?  Have you ever thought about how shady and corrupt a PBM looks taking money away from the direct competitors of their affiliated pharmacy (probably in a futile hope of putting them so far under they will sell out to *their* affiliated Pharmacy chain)?   CVS Pharmacists: Do the Caremark auditors come into your store and audit your records?  Since you’re affiliated, aren’t they just taking away from themselves? Or do you guys write off the store losses by filling ‘fraudulent prescriptions’ thereby making your store less profitable and thereby pay less taxes?  Marvel at my TinFoil hat and how its shiny!

I wonder if Medco audits its mail order pharmacy, god knows they love to audit us independants.  I wonder if all of the big PBM/Retail anti-trusters have some sort of unspoken fraternity-boy truce going around leaving the independants/grocery-outlets/walmarts on the audit chopping block.

Naaaaah, that would be in violation of the anti-trust laws that prevented 3 small pharmacies from speaking out against a dont-give-a-shit-about-you PBM.

On with the rant!

As you all well have known, we are in 2010 and we are one week past the dreaded first of the year mayhem.  If you are a pharmacist, and have not died from alcohol induced liver failure you obviously have first hand experience about HealthNet (Or their processor, CVS/Caremark) screwing up SO bad that I can’t even believe that they are still in business.

For those not “in the know”, lets set a few things straight so people don’t get confused.

• You have Medicare + Medicaid
  • You have no deductible (of usually $250 – $300 depending on plan)
  • You have little to no premiums
  • No doughnut holes (ie: the coverage gap)

Pretty much if you are on the state tit because you cannot take care of yourself, you get all the benefits of a Medicare part D plan without the annoying doughnut hole, deductibles, and screaming high copay tiers.  Nice isn’t it?  The rest of us however have the initial deductible, blah blah blah.

Now, lets rewind to HealthNet’s Medicare part D plan oh, a week ago.  At least in California, NONE of the “Dual Eligibles” (the people with Medicare AND a state welfare insurance) were flagged in HealthNet’s computer system as being on a state welfare program.  Which means that almost all of the people who should of had NO deductible suddenly got one (with a $200 copay for their Advair)!  Compound this with the usual first of the year plan changing clusterfuck and you have yourself a 2 hour hold time with HealthNets pharmacy help desk!

Oh, lets not forget that HealthNet also didnt flag generic Vicodin and Septra DS as being covered items.  So for one insurance company, we have a shitpot full of welfare-recipients pissed off at us because “we” want to charge them more than $1.10 or $3.20 AND their vicodin is no longer covered.  So whats a pharmacist to do?

Easy.  Let the fucking patient get off of their asses and take care of it themselves.  Why should we have to suffer the fallout because some computer idiot over at CVS/Caremark (which I wonder if CVS pharmacies had this problem) totally fucked up the data import from California MediCal.  Yeah, I’m a heartless asshole but I’m tired of being the human fucking shield for these PBM’s who make more per prescription than I do.  What happened with HealthNet was completely unacceptable and embarrassing.  Of course HealthNet/CVS/Caremark will continue to collect their fat ass subsidization checks from California as they tinkle in our faces with their whopping $3 above cost reimbursement.  Here me now HealthNet, unless I see some MAJOR lawsuits from you to CVS/Caremark over this bullshit, I will do everything in my power to switch my Dual Eligible patients to any plan that is not administered by you.

Oh, and just icing on the cake, I got the fax yesterday evening from HealthNet that everything was fixed.  Thats 8 days of chaos due to  a company that makes more in 1 week than I’ll see in 10 years.

Post your hateful HealthNet comments (or funny first of the year stories) and lets see if I get a response from them (and hopefully not a C&D letter).

As all of you are quite aware, there is a push in this country to give every man-woman-child government sponsored health-care.  Here I will tell you why this is a horrible idea and is doomed to fail.

Here in the wonderful USA, we already have 2 forms of socialized medicine:

• MediCare – Given to citizens over the age of 65, or to those under 65 who qualify (renal disease, disability, etc)
• MediAid – Welfare

Both of these are wholly sponsored and paid-for by Uncle Sam.  Sure Medicare Part D plans have a small premium, but usually those are taken out of your MediCare check (and are no where near the cost of private insurance).

What this socialized medicine bullshit wants to do, is to give “universal health-care” to people who do not fit within those two categories.  Now mind you, that anyone can go to any county hospital (paid for by the taxpaying citizens of that county) and receive medical care without having the ability to pay.  Most private hospital ER rooms will also give you stabilizing treatment without you showing proof of ability to pay.  That seems pretty damn awesome if you ask me, however people want more.

The big idea that some Americans throw around is that access to health-care is a right.  Let me clarify this for everyone who thinks that way:

HEALTH-CARE IS NOT A RIGHT!

Access to a Doctor is as much as right as having access to a Plumber, a Roofer, an Electrician or anyone else in a specialized trade.  Until the government FORCES AND PAYS people to go to medical school, it is not a right. You see us Doctors, Nurses, Pharmacists? We chose to go into this profession, we weren’t forced into doing it.  Do you see an amendment in the Constitution showing the right to see a medical professional? No. Do you know how to re-shingle your roof, install a shower, fix a rotting foundation, lay brick, or do a bunch of other jobs that you have NO PROBLEM hiring someone to do; but the moment you can’t get in to see the doctor RIGHT NOW (because his/her practice revolves around YOU) the “I HAVE A RIGHT” card gets thrown down as you throw a 2 year old tantrum?   Quit fucking whining about your “right” to see a doctor and be thankful there’s more than 1 doctor in 300 square miles like in some 3rd world countries.  Be thankful we even have people who choose to be doctors, pharmacists and nurses after dealing with shit-ass people like you.

Now that we cleared up that “confusion” that some entitlement douches like to throw around, we can move on why socialized medicine will not work here:

IF ITS FREE, USE UNTIL CANNOT USE ANYMORE!

Irresponsible humans have a nasty of habit of seeing “free” and totally abusing the shit out of it thinking it is indeed free when its not.  Its free to them, but costly to someone else.  Let me give you a situation:  You have a sore throat.  You should probably go and see the doctor but you might want to wait another day.  Judging that you can see the doctor “RIGHT NOW”, are you more willing to go if its going to cost you a $100 copay, or $0 copay?  Now imagine EVERYONE doing this to the same doctors office.  Now get really mad when your appointment is 3 years away, and the doctor sees you for 30 seconds.  Now bitch about something that you get for free off of the backs of the working class.

As evidenced by the MediCare system (why do old people need so many fucking lab tests.. OH ITS FREE!) and the welfare system (I need my Nexium, Diovan, but I only really take my VICODIN), if something is perceived as free it will be used, abused, and taken for granted.   Just look at e-mail and the internet for example.  People believe that email is free, so as a result I get thousands of spam messages a day to my inbox.  People believe that its free for me to run this site, so they have scripts setup to check it every 30 seconds for new content (if you’re slow, you wouldn’t realize that I try to post something every SUNDAY).  Humans abuse what is free.

I’m sure the Canadian and the UK readers will share how most of them have PRIVATE insurance because the socialized stuff has a 4 year waiting list for appointments for the socialized docs.  Hate to say it, but copays filter out the “I must see doctor!” from the “Eh, im bored, lets go get drugs”.  If you don’t believe me, go sit in the ER and see what piddly shit comes in to waste our dollars.

THIS COUNTRY IS BROKE

Yeah, we’re broke.  We bailed out every corporation that should of failed (will Obama bail out my pharmacy and the other independents when the insurance companies force us under? No) and have a few trillion dollars of unaccounted free money (our money) floating around.  Now how exactly are we going to pay for this?  I’m paying into a MediCare system that will be long dried up before I ever get to get a lab or appointment covered by it.  Medicare part D has to have the ‘coverage gap’ to keep it from going broke (faster), and now we want to give subsidized health care to everyone?  Reading above how people abuse what is free doesn’t really make much sense that this is going to financially fly.  The government couldn’t throw a 5 year old’s birthday party without tons of red tape and spending 100x what is would normally cost and there is talk about making them have a hand in our health-care?  I think this whole ‘universal healthcare’ is just a government ploy to give new jobs to the idiots who work on the federal dime so they can keep their meaningless pointless jobs.

So I don’t really know what the future holds if we have socialized medicine in this country.  It might look good on paper, but I think its going to flop.  At least I’ll get my opinions in before the government forbids me from giving them (or maybe the’ll just take over this website like they are taking over everything else in this country).

UPDATE: Look, less than 24 hours and already I’m trying to explain what I wrote.  So this post was to clarify on how I think that healthcare is not a right (which it’s not, disagree if you will)  and two huge issues that any government subsudized plan is going to have (which could apply to ANYTHING that ANYONE pays to service that someone else uses)  It wasn’t “YAR YAR NO SOCIALIZED MEDICINE” like the words some of you are putting in my mouth.  Since /any/ plan that is made by our broke government is going to be 1000% funded on the backs of taxpaying citizens (since obviously doctors aren’t going to take a huge pay cut, pharmacies aren’t going to take a huge pay cut, where is the cash going to magically come from?) these are the concerns I have (and rightfully so).  Like one reader said, we can’t take the usual government approach and throw this together, dust off our hands, and pat each other on the back.  You would think that most of you who dealt with the Medicare Part-D bullshit would understand that.  This is huge, and its with our money, so we should demand that it be perfect, well thought out, or we’re just throwing money away.  And to the federal workers to got offended by my joke about the ‘government conspiracy’, get back to work, quit wasting time reading my website, and dont be so easily offended by the unfaulting sweeping brush that I make jokes under.

Pharmacists see this all the time, but its a little known fact that work-comp has become the “richs mans Medicaid”.  It has spiraled so out of control, and gotten so outrageous that now I view it as just another form of welfare.

How its supposed to work:

You get injured on the job via some fault other than you being an idiot.  Equipment fails, your employer had something go wrong, some freak accident happens.  Work comp then pays  for your doctors visit and medications.  If you cannot perform that job any longer, you find another job doing something that doesn’t require a bad back or missing fingers, etc.  You continue to work, your (former) employer’s work comp insurance premiums go up, and life goes on.

How pharmacists see it work (ie: how it really works):

You were at work and get injured because you’re a fucking lazy idiot (with your head firmly planted up ass) and go to the ER for a smashed pinky finger.  They give you an Rx for 40 vicodin and some ibuprofen and keep you off work for 3 weeks.  You (and your work comp lawyer) then sue your former employer giving you full paid time off.  You relax and go on vacation and do other fun stuff with your wife and kids while receiving a fat work-comp check (and free medications).  You OBVIOUSLY cannot work any longer because of the MENTAL ANGUISH of having a mangled up pinky finger.  It is SO HORRIBLE that you then obtain full disability and never have to work again.

Yeah, its really like that.  I’ve seen people get a few medications (like ibuprofen and like 20 vicodin every other month) and continue to work.  All the work comp pays for is just a few doctors visits a year, and 2 measly prescriptions that are filled once every 45 to 50 days (and they are 20 day supplies at that).  I’ve also seen people who have basically nothing happen to them, go off work fully, get medicare prematurely because they are “disabled”, then have me try to get vacation overrides for their cruise to the Bahamas.

It all comes down to how well you can play up your “injury” and how good of a scumbag work-comp lawyer you can hire.  Work comp is raped to the point where the premiums are outrageous for employers, and more and more people (read: police officers; that’s right, I’m calling your ass out) are comping out just before retirement so they can collect their fat retirement check along with their work-comp check.  Their reason? MENTAL ANGUISH.  Yeah, try to work as a pharmacist for 30 years and see what kind of mental anguish you get from dealing with the same ghetto public without a bulletproof vest, a gun, backup, and a radio to call for help.  Another reason why hanging your head in the public trough of state-worker is the way to go.

If dealing with the scamming-free loading work-comp abusers wasn’t enough (as they brag to you about their next vacation, knowing that you’re working hard and they are just freeloading from a system that cant say ‘no’); processing a work-comp prescription is a nightmare all in itself.  Some companies make you call a 800 number EVERY TIME YOU FILL AN RX so the processor can get approval from the comp adjuster (the person who decides if your drugs are needed for your comp condition, a position that is filled by an idiot with zero medical knowledge what so ever).  Now I admit that it was better then the old days where the pharmacist had to track the adjuster down, but you also got paid a whole lot more for those paper billings vs electronic billings.

Personally, if I was king of the work-comp world, unless your injury left you permanently handicapped or mentally disabled (ie: a vegetable), all of you leeching fucks would be at a desk job, a greeter at Walmart, or any of the 100 million jobs out there that does NOT INVOLVE THE PART OF YOU THAT WAS INJURED.  Just because you are a lazy fuck who got hurt because you had your head up your ass, it doesn’t mean that us HARD WORKING PEOPLE (including those who are on comp yet find another job) HAVE TO PAY FOR YOUR FREELOADING LAZY ASS.

Maybe your injury wasn’t your fault, but sure as shit it wasn’t mine, so why should my premiums go up because of your fuckup?  Sounds more and more like the welfare system to me.

As of the first of February, MediCal (that’s California Medicaid for those out of state) decided to take a big steamy dump on the faces of pharmacies/pharmacists.  No, these are not the 10% cuts that I wrote about before, but something equally as stupid.

Before 2/1/09, if you had the patient’s Social Security Number, you could query either by POS device (a little credit-card looking machine that dialed into Medical) or their phone Automatic Eligibility Verification System (AEVS).  The little tape/magical voice on the phone would tell you the patients MediCal ID number (because we cannot use the Social for billing anymore).  Took about 1 min to do, and saved a bunch of time/trouble when the idiot forgot his/her card (or lost it (surprise)).

Now everyone who deals with Medicaid patients realizes that these people can’t even manage a $5, let alone be responsible enough to carry their MediCal card with them.  I mean shit, their Vicodin and Soma get lost every other week!  The POS/AEVS system made it easy.  They tell you their SS#, you get their MediCal number, no card required!

Well, they shitcanned that service.  That’s right, if you do not have the patients MediCal number you cannot get it via their Social Security number.  Let me tell you why I’m writing about this.

See that patient coming in the pharmacy at 6:30pm on a Friday night with that Rx for Levaquin?  He can’t get that because he doesn’t have his card on him (and he’s not in your system).  Doesn’t matter if you call MediCal and talk to a person, they refuse to give out MediCal ID number over the phone INCLUDING TO THE PATIENT THEMSELF!!!  This means the patient must GO TO THE SOCIAL SERVICES OFFICE and get a paper printout with their ID number on it.  Since MediCal is a government operation, lets put money on their hours of operation including weekends and all major (ie: every damn made up) holiday off.  Their social workers (for having ‘worker’ in their title, I have yet to see one actually ‘work’ or is worth the air they breathe)  can also provide them their number.  Yes, entrust someone with a few semesters of useless squishy classes with access to their ID numbers, not their pharmacist.

Now here we are at the rubber meeting the road.  You have a teenager or child with expensive antibiotics/medication that MediCal usually covers but they have no card (and obviously are not in your computer) Are you going to trust a MediCal patient with $200 of antibiotics to come in Monday morning with his card so you can bill for them?  Fuck no!  They have no incentive to help you out even though you helped them out.  Face it, its a fact.  Laziness beats ‘whats right’.  Fuck this ‘give some now and hold the rest’, you wont see them again!  Most of these people need to prepay for their Soma that is due TOMORROW because they don’t have the self control to keep that money in their pocket UNTIL TOMORROW!!  For the majority of them, if they had any ounce of responsibility in them, would they be in the situation they are in now?  I know I’m infamous for making blatant blanket statements on here, but how many hundreds of dollars must be lost on “whats right” before you put your foot down?  Why don’t you just dispense #100 vicodin/soma every other day because the patient is “in pain”.

You want to complain about this? Good luck, the MediCal office hires the most stupid, ignorant, minimum wage retarded dropouts on the planet.  You know all the “stupid people” in the Health Care profession I rant about?  Yeah, all of them are GENIUSES compared to MediCal phone operators.  It took 4 (FOUR!!) people to try to get the idea across how much of a BAD IDEA eliminating this service is for not only the patients but the pharmacies that service them.  They just didn’t get it.  One of which told me “I don’t see why you pharmacists make a big deal about this, just ask them for their card”.  *sigh* I almost died.  In fact, as I type this my soul died.

Requests for a complain phone number/email gave me a “There is none”.    I guess MediCal patients have no rights to voice a complaint about the care they are getting (but to be honest, why would a MediCal patient complain?  Their formulary is beat only by the magical CASH insurance).

So I told them “I am going to turn away every new patient who does not have their card because you have forced me to make the choice to either take a loss on their Rx’s, or to not give them medicine.”  They just said “uh huh” a lot.  I must of used too many words too fast for their small brains to comprehend.

Now the ironic part of it is that I always bitch about how we need to make the Welfare folk more responsible, and them not having their cards (and thereby not having their medication and dying) would in fact pound some responsibility into their brains.  However what kills my soul (more) are the kids who really need antibiotics and due to mommy and daddy being ‘winners of life’ (by losing their ID card) get doubly fucked over by this change.  You are forcing their medications to ride on a card given to someone who can’t be entrusted to always have the card, however I guess that’s the same argument with a child isn’t it?

I’m hoping this is just a huge oversight that will be taken care of.  However if you, your staff, or your patients have been effected by this, please comment and maybe MediCal will get the idea (hah! right).

Before I start bitching about old people and Medicare part D, I would like to bring to light the best comment I think I have ever received.

All you people who think TAP is so funny and so smart. You know who you
are. The ones who come here daily and encourage him and his behavior.
Will you still be proud of yourself when this human time bomb goes to
work one day and shoots up a group of innocent people? There is no one
more psycho and disgruntled than TAP. You people couldn’t care less
about him. If you did you would try to help him with his displaced
anger, instead of being the enablers that you are. I hope when you read
about him in the newspaper one day, you take your share of the guilt.

Wait, are you saying that there is nobody on this earth more psycho and disgruntled than me?  Oh how my heart flutters with bile and hatred!  Take that Angriest Pharmacist and DrugMonkey!  Have you gotten a comment saying that you’re a time bomb? Have you gotten anything that predicts you murdering a bunch of innocent people?  No!  Me – 1 and You – 0!  But realistically, “try to help him with his displaced anger”? Give me a break.  This isn’t a self-help group therapy site!  Lets all sit around the ScriptPro and sing songs of peace.  Obviously Marcia W, poster of the comment above, needs a big helping of the clue-bat to realize what kind of site this is.  Of course she agrees with Ken, so shes probably with Ken asking if he can get his narcs early if she pays for them with a two-party check.

Anyway, since this isn’t the Ken and Marcia show, and all of you “enablers” out there (50+ comments and counting!) are about to get fucked over on the first of this year, lets get back to the task at hand.

I have an idea.  Lets take a insurance plan and make it as complicated as possible.  Lets add shit like deductibles, a coverage gap (aka: doughnut hole), catastrophic coverage, multi-tiered copay systems, the works.  Now lets force the one class of people who have the least amount of understanding: The Old.  Now lets pawn the explanation of everything to our local pharmacist who we will pay $2.00 above cost for this service.  Lets send out ID cards with the wrong information on them as well send deceptive ads and salesmen around to complicate and confuse things even more.

That boys and girls, is Medicare Part D, and its the utter-clusterfuck of pharmacy.  They have made the absolute complex insurance plan possible and forced the old and stupid to use it.  Lets face it, the 65+ crowd aren’t the sharpest crayons in the box and are the most willing to bitch and moan.

On the first of the new year, retail pharmacy as a collective will either stick the proverbial shotgun in their mouths and pull the trigger, or will drink themselves into oblivion.  On the first is when all of the deductibles reset (and yes, you WILL have to explain what a deductible is to the same patient for the nth time in a row), plans merge, shuffle around, Argus and Wellpoint go down, etc.  Its going to be a mess.

However seniors, being old and confusable, forget about a few years ago when there was no Medicare Part D and they had to PAY OUT OF POCKET FOR EVERYTHING minus that measly discount the Medicare card gave them.  How quickly they bitch about $3.10 COMPLETELY FORGETTING they were paying $65 just a few years ago.  “I’m old and I deserve something.”  Yeah, well I’m not old, you’re using up the Medicare money that I put in but will never see, and I hope your little electric scooter shorts out in the parking lot so I can laugh at you.  You would think they would learn the routine now that Medicare part D has been out for 4? 5? years.  Yeah, you would think.

I’ve said it before and I’ll say it again, that Medicare Part D is a mean and cruel joke on the old and stupid and revenge on pharmacists.

I’m dreading the first

People always sing to me the ‘I’m on a fixed income” blues when they are paying their Medicare Part-D $3.10 copays for their $200 Nexium Rx.  Oh, how soon these idiots forget what life was like before Medicare Part-D took effect.  Did they somehow forget paying full price out of pocket for their medications?  Why is now $3.10 so much of a financial drain on their “fixed income” when just 4 years ago they were paying 10x that amount with a smile on their face.  I really do get a huge hard-on when I bring up how much they were paying before Part-D and how they are only paying $3.10 (which makes them feel like huge ungrateful douches).

Medicare Part D has spoiled seniors, plain and simple.  They are so hung up on their “fixed income” that they have completely lost sight that the people who are footing the bill for their expensive medications are the same people who will never ever see a dime of the money that they contributed to the system.  They also fail to see how Medicare is pretty much socialized medicine for people over 65, and we can see how well THATS going.  Medicare recipients complaining how we should have socialized medicine in this country just makes my irony meter fly off of the chart.

What do you expect from old people other than cow eyes, the same question asked every week, and bitching about $3.10 copays.

Imagine if you will, when all of the PBM’s have driven all of the little guys out of business.  No more mom and pop stores as far as the eye can see.  Sure, this might make the PBM’s happy because their executives got a 4.5 hochillion dollar bonus this year off of the backs of the little guys they put under, but now they have to deal with the two big angry gorillas of the pharmacy world:  CVS and Walgreens.

Now, when MedImpact/Argus/etc sends their contracts to these retail giants with their AWP-25%+0.07 rates, do you think that the two big boys on the block are going to sign that?  Hell no.

You see, now they sorta have to, because independents are still around to take care of the patients if the big “evil” chains refuse to sign that contract.  Its illegal under anti-trust acts for true independents to collectively refuse to sign a contract.  So you’ll find at least one pharmacy in town who’s stupid..er..CARING enough about “Patient Care” to sign that horribly low reimbursement rate.  However when we’re all gone? It’ll just be the big boys, and they have a LOT of stores and don’t like to use much lube when it comes to the bottom line.

MedImpact will waltz up to CVS and offer something horribly stupid (because thats how PBM’s roll).  CVS will look at the contract, send it around to each store for the pharmacist to wipe his/her ass on it, then return it to MedImpact.  If they terminate CVS’s contract, then MedImpact’s patients just lost about 1/3 of the stores they can get their Rx’s filled.  Walgreens will do the same thing, and eventually you’ll have a PBM that has no pharmacy to call home.  See, the PBM’s will have eliminated all of the competition of the chains vs independents.  They don’t realize it yet, but its slowly happening.

So whats a PBM to do?  Easy, stop fucking over pharmacies.  Take a REASONABLE fee for processing the prescription (ie: don’t make more per Rx then the person who is filling the prescription like you are doing now), PRINT THE RIGHT INFORMATION ON THE FUCKING ID CARDS (so we don’t have to call), and stop being fucking slimy crooked piece of shit banes of the pharmacy world.

Which brings me to my second issue:  At what point do we throw down the gauntlet and put ‘patient care’ aside for our own livelihood and well being?  At what point to we refuse to sign the new contract that these pieces of shits send our way and collectively stand as a profession against the abusive-husband that we call PBM’s?  When do we grow the balls to tell Mrs Smith “I’m sorry, but we no longer take your insurance because doing so will cause us to go under.  Go and complain to your insurance company about their processor”.

You know how I rant on here about how annoying and stupid patients can be?  Now imagine them not yelling at me, but having them collectively yell at the PEOPLE THEY PAY to manage their pharmacy benefits.  Of course trying to get pharmacists to do anything collectively is like herding cats; and we probably need a committee, a fancy name that has a cool acronym like DILDO, yearly meetings with pharmacy school students, a publication, lots of pictures of people who have NEVER WORKED A FUCKING HONEST DAY IN THEIR LIVES with fancy letters after their names, award ceremonies for “Something” of the year (which means absolutely nothing), scholarships, more publications, requests for membership dues, etc.

Thats right, I’m ragging on CPhA, APhA, ASCP, and the other alphabet soup organizations who want me to join their organization in exchange for magazines full of pictures of students who don’t have a fucking clue and old-guys trying to re-live their glory college days.  WHY AREN’T ANY OF THESE “organizations” DOING SOMETHING ABOUT THE PBMS!!!  Oh, because they have no idea about PBM’s because THEY DON’T WORK RETAIL.  Before you can “Advance the Profession of Pharmacy(tm)(r)(wtf)” why don’t you try to fix the insurance clusterfuck that we have going on now.  I know that its hard work shaking hands and getting your picture taken at the latest convention at the Marriott, but seriously, DO SOMETHING or we’re going to have to take your “patient care” that you so dearly hold true and preach to everyone about (btw, whens the last time you even SAW a patient? How about actually worked in a pharmacy?) and throw it aside so we can pay make payroll.  Roll up your sleeves, put your fancy labcoat (with your name embroidered on it and has never seen a pink amoxicillin stain) aside, and GO AFTER THE PBMS!

The organizations should be going to the PBM’s and say “The cost of doing business is $x.  At your reimbursement price, pharmacies CANNOT survive.  We are going to recommend to ALL OF OUR MEMBERS to not sign up with your plan.”  Anti-Trust? Sorta, but this is to all the members, most of which who are chain pharmacists and non-owners.  Bah, its a pipe dream.  Maybe they are doing this, but seriously to the guy in the trenches whom it effects, I see zero.

Realistically, I’m betting on the chains to do the dirty work based solely on their monopoly on the industry vs the people that I pay dues to represent how I see the profession.