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Copays are the bane of our existence.

There isn't a day that goes by that I don't get into an argument or discussion with some retard about their copays.  Be it too high (even though they paid the SAME amount last month) to the infamous rocket-science-level deductible, its like we spend 99% of our time explaining something that should be common knowledge.

Why do people think that WE have anything to do with their copays? As if I pull a number out of my ass and slap it on the label for them to pay.  Are people really that fucking stupid? Oh, wait, dumb question.

What really pisses in my cornflakes is when someone is getting a $300 prescription, say #60 Aciphex, and has a $10 copay.  Then has the balls to sit there and openly complain to me that they should NOT have to pay that $10 and how much their insurance sucks.  Heres a typical conversation:

Them: WHAT! I have to pay $10! This can't be right!
Me: Well, according to my system here you paid that last month.
Them: THATS OUTRAGEOUS!  HOW MUCH IS THE CASH PRICE?
Me: Uhm, close to $350 dollars
Them: $10 is way too high for this Rx! I want it lower
Me: Uh, I dont set your copays, you'll have to call your insurance.
Them: IM GOING TO WALGREENS

Now this is what I wish would happen:

Them: WHAT! I have to pay $10! This can't be right!
Me: Listen here you fucking ungrateful moronic fuck.  You are getting $300 worth of medications for fucking $10.  /MY/ copays aren't that low, and you have the fucking balls to sit here in front of me and my staff and whine over paying $10.  You are a fucking moron, and I am embarrassed to be in your presence.  Take your fucking prescription and go somewhere where they give a fuck, because I have better things to do than to sit here and listen to the diarrhea babble flow out of your mouth.  You are an ungrateful fuck and I hope you die in a car fire.  Eat shit you whore.

However business and that crazy ethics crap dictate that I can't really fly off the handle at them while they are in the store (but I do tend to do it when nobody is in the store).  It really does however piss me off when people whine about copays that cost less than a good meal at McDonalds.  If your copay is $150 bucks, sure, bitch away.  $10 not so much.

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).

This post should of been titled "Putting the 'oh shit someone told on us' in WellCare"

See what happens when you cross The Angry Pharmacist (tm)? You get raided by the FBI, your stock tanks like a post-thanksgiving turd, your exec's abandon ship and put their business on CraigsList, and Pharmacists everywhere are digging your grave. Remember that.

On a more serious note, if you have lived in a barn the past week, Wellcare (the one we all know and love) got raided by the FBI/Government/Granny/etc. Their stock promptly went from $130 to ~$27. Dont believe me? Click here.

Why did Wellcare get raided? Well, people aren't saying much. I read somewhere on that yahoo link (that I cant seem to find the article now, interesting) that they were misrepresenting their earnings, especially when dealing with officials in charge of reimbursement (meaning OUR reimbursements probably). Something about contracts with an off-shore business or something to lower their overall profits. For some reason actually making a profit of 49% higher than reported rings a bell somewhere in my head.

What does this all mean? That the "Fair" reimbursement we have been getting of way too low like cost+$1.50 is bullshit. Wellcare obviously was rolling in the dough, so why couldn't they up our reimbursements? Oh, because they were funneling their money around so their company looked less profitable thereby giving them an excuse to fuck over the pharmacies and our shitty reimbursements. "We cannot afford to reimburse you more" they spew as they light their cigars with fresh $100's.

Since Wellcare's crap-ass reimbursements were just in jive with the other big-hitters of the Medicare Part D crew, I wonder how many exec's of the other big Medicare Part D providers (Caremark, etc) are currently forging their books expected to be investigated next? Are the Exec's cleaning the turd stains out of the boxers bought with their $400,000/yr salary? Are we magically going to see new contracts appear in our fax machines with higher reimbursements? God I hope so.

Stockholders are suing. I would sue too if I had my retirement invested i Satan at $130/share to barf down to low 20's. I wonder how long until the pharmacies class-action WellCare's ass over reimbursement rates generated from an incorrect profit statement (not just a little 2% incorrect, but probably ~40% incorrect, whoops). We can only hope. You can be sure that I'll have more commentary as the info comes rolling in.

Happy 1st everyone. I hope your day wasn't as shitty as mine.

Turns out that Walgreens Health Initative (http://www.walgreenshealth.com not Walgreens the Retail Outlet. Same Bat-Time, different Bat-Channel) decided to do a "system upgrade" on a Monday that resulted in downtime all of Monday and Tuesday.

Gee. You would think that with their bazillions of dollars they are making (since they pay us retail folk jack-and-shit) they wouldn't be down for a whole 2 days. Furthermore, you would expect that they would do a "systems upgrade" at like 2am on saturday morning when all sane pharmacies are closed.

But no, I had to deal with a huge stack of claims that needed to be billed today because WHI screwed the pooch and decided to take themselves out of pharmacy gene pool for a whole 2 days.

Sorry this isn't very angry'ish. However I will leave you with a bit of fun information. Take your usual Gin and Tonic. Now instead of drinking it right away, put a slice of cucumber in it. Now sip and taste the wonderfulness. Some chap from Australia dropped me that note, its magical.

I just wanted to comment/elaborate/etc on a post made by the recent post by theDrugMonkey about the "Heather" of insurance companies.

For all of those too lazy or stupid to click the link above and read DrugMonkey's post, "Heather" (as he called it, so they shall all be dubbed "Heather") is the person on the other end of the phone with the insurance company who doesn't realize that shes riding an emotional atomic bomb down upon the healthcare system. She usually has a nice voice, and has been working for Satan a whole 2 days. She has no idea about the perils of health care nor that her employer managed to get about 4.5 billion ID cards issued with the wrong group number.

I, like the DM, feel horrible for these people. They are the human shields of an industry who cannot help but piss on their own shoes while shitting on all of the people who make up their paycheck. They sound happy on the phone, but you know after a few months of being screamed at by doctors and pharmacist (over something they did not setup, have no control over, and really have no say in to make it better) they stare down at the empty bottle of burbon and wonder why in the fuck do they put up with this abuse. They then look at their kids and realize they are taking one for the team so their kid could have a good life. They refuse to go on welfare or fake a work comp or disability like everyone does.

So it pains me to be upset when I hear Heather's voice on the other end. I know its not her fault that her employer is retarded, or that the wrong ID number got printed on the card. I know that if she ran the world everything would probably work smoothly. Shes there to pay her rent and buy herself food. She is probably going to college or basically cant get a job anywhere else. Here we are screaming at them for something that they have absolutely no control over just to vent our frustration. Are we any better than those asshole doctors who scream at us because expensive-drug-x is $900?

So next time you're all fired up about WellCare not having the right ID number, and you hear Healthers voice on the other end, think of this post and realize that its not Heathers fault. She's there to do a job much like you are and probably goes home and rags on pharmacists like I ran on Drug Reps.

(Yeah, I realize this post isn't full of hate, bad words, sexual talk or anything like that. It just sorta struck a nerve that I'm sure lives deep down within all pharmacists. I'll try better next time. Fuck insurance companies and drug reps..There.. All better.. :-) )

There are some things that go on in a pharmacy that are set in stone like the sun rising in the morning. Pharmacy school should publish this list for their students. Seriously, its all true. Lets examine a few:

Drug reps/Headhunters/Pharm Companies/etc will always call you/stop by at the absolute worst time. Much like the tuesday after a three day weekend, or on the first of the month. During the slow times of the month you wont hear a peep from them.

Your most important tech will make a doctors appointment on the tuesday after a three day weekend and be gone for half of the day. You wonder why he/she couldn't make that appointment for some day when you aren't contemplating suicide.

The patient who you thought you filled that Rx correctly for ended up having another last name and the same birth-date as someone else in your system. Of course they don't tell you this until after they have received the Rx and loudly proclaim that you filled it for the wrong person with a store full of people. I mean aren't we supposed to know that her full name is Maria Consuelo Rodriguez Maravilla Hernandez Guadalupe AIAIAIAIA ARRIBA?

That bottle of expensive-drug-x is exactly one tablet short to fill that Rx, and the patient wants you to order a whole new bottle of #100 so you can fill the balance of 1 tablet. Oh, and the patient is the only person you have on this medication.

Someone will always come into the store with a fistful of Rx's at exactly 1 min until closing, and want them all right now. This is after most of your staff have already left leaving you alone to do all the work.

Your bazillion dollar counting machine will blow up only when half of your staff calls in sick, and you really really need it.

Insurance cards + correct ID number = HAHAHAH RIGHT!

Argus and Wellpoint will be down, but not at the same time. We cant have you do absolutely nothing all day, so we're just going to fuck up half of your day.

Your computer system/network/DSL goes out when your computer guy is on vacation.

"This is not the ID card you are looking for" *hand wavy jedi trick*

When you call out a patients name to tell them their Rx is ready, the wrong person will come up and claim it. Then get pissed off because to them "John" sounds like "Steven".

30 min into a phone call to the pharmacy help desk of the insurance company to get an ID number, the patient will magically pull a current ID card out of his/her ass then wonder why you are upset at them.

The "Nurse" calling in the Rx wont be able to read doctors handwriting, then spend 10 min taking a poll in the front office as to what that sig looks like. Heaven forbid she couldn't read over the Rx before she got you on the phone.

When looking at a doctors scribble, you will always pick the wrong doctor in your system. We are expected to be able to read sloppy signatures much like we are able to tell our own shit-smear on a piece of toilet paper.

The one doctor who does not know about the iPledge program or NPI numbers is the one you deal with on a daily basis, and the only one that you can't really tell to go eat a dick.

The pharmacy calling you for copies doesn't have a pharmacist, and the two-bit clerk who called you doesn't know their fax number or have any Rx numbers.

A patient brings in lunch for your staff, but you cant eat it because you are up to your eyeballs in work. It smells really nice though.

There is only 1 scoop of coffee grounds left in the container, so you just drink brown water all day.

Last but not least:

That bottle of gin that you were so looking forward to after days like yesterday will be sitting on your bar empty when you need it the most.

This is a directed bitch at WellCare. Yes, WellCare. I hope they read this, and I hope they give me an 'offical reply' to their stupid ass policies as you'll see below. If you have a bitch about WellCare, then comment below. If I'm going to get a subpoena or court order to take this entry down (which I'm not, because its the truth), we mine as well go down swinging.

Its 5:30, right before closing. One of our terminal cancer patients (11159.2) came in with an Rx for some Duragesic Patches. He is out of oral meds, so doctor figured now would be a good time to put in him on the patch. He has WellCare. So we try to bill the Fentanyl Patches. Not covered. Hm, what about trade name? Nope. No fentanyl patches are covered. So we call the wonderful WellCare customer service number only to be told that there is NO provision for early, lost, or emergency override fills. We pleaded and told the douche that the patient has terminal cancer, and if there was any way to fill the Rx.

Short answer: No.
Long answer: No.

Who the fuck does NOT cover fentanyl patches? Its not like fucking that new quinine thats out. Fentanyl patches are used for one thing: Chronic or cancer pain. I bet they require a prior auth for all HIV medications too (because those arent important)! Anyway, back to the story:

They would fax to the doctors office a prior auth form which needed to be completed and sent back. This is on a Friday, at 5:30pm. Yeah, snowballs chance in hell of that being done. Even if he doctor did it that very moment it probably wouldn't be processed until Monday.

Thats right, this terminal cancer, no pain medication, all because WellCare is ran by a bunch of fucking heartless idiots. The patient ended up shelling out a few hundred bucks for his patches so he wouldnt be hospitalized over the weekend.

I hope someone from WellCare reads this, and realizes how fucked up they are, what a shitty program they run, and how bad this makes them look. Figures they are processed by WHI AKA Wallgreens. "Pharmacy America Trusts" my ass. So to any of the big CEO's or important people at WellCare: I, The Angry Pharmacist think you guys are fucking assholes and I hope someday when you get cancer from those $100 cigars and top shelf booze that YOU get to spend the weekend in pain because your insurance company dicked you over like you dicked over my patient.

Fuck Off and die.

Love,

The Angry Pharmacist

Who thought this NPI (National Provider Identifier) would be a good idea? What bored non-working bureaucrat with too much time on their hands (and has never held a 'real' job) decided to bring hell down upon us hard working pharmacists? Oh wait:

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard unique identifier for health care providers. The National Plan and Provider Enumeration System (NPPES) collects identifying information on health care providers and assigns each a unique National Provider Identifier (NPI).

Thanks Hillary, you fucking twat. DrugNazi set me straight (for once). Hillary is still a twat for reasons not gotten into here (this is a pharmacy blog, not a place to voice my political opinions).

For those of you not in pharmacy, currently Providers are identified by insurance companies as so:

Pharmacies: NABP/NCPDP number. Its 7 digits long.
Doctors: DEA Number. Its 2 letters and 7 digits long. Or a Tax ID Number.

Easy isnt it. Short, sweet, and has been effective for the last 100 years.

Now everyone has to apply for a NPI number. Thats right, a NEW number that we all know ALL insurance companies will have installed flawlessly in their software so there will be NO slowdowns in processing. Right, until you get that doctor who has not gotten his yet, and refuses to give it to you. So for this to work, EVERYONE needs to get an NPI number, swap it amongst each other like Garbage Pail Kids cards and assume that the insurance companies have their shit together and everyone added.

So lets take a solution, and run madly around finding a problem. Sounds like HIPAA

As you all probably know, good old albuterol (with CFC's) are no longer being made. No longer can we get an Albuterol MDI by Warrick for 9.95. Now we get "environmental friendly" pieces of shit for $20/each.

I recieved a phone call from a friend of mine who works in the People Republic of California. He told me that the state Mediaid (Medi-Cal) program decided (with their infinite wisdom) to take every albuterol MDI off of formulary. Thats right, he said no Ventolin HFA, no Proventil HVA, no ProAir HFA, nada.

You know whats covered? Xopenex HFA. 29.99 a pop too. What makes it even better? The company cant supply them fast enough to meet up with the demand of California! I laugh at him! Ha Ha! Oh, get this, they wont accept prior auths for albuterol either! Ha Ha^2! Guess patients are screwed there! Ha Ha^3! Who needs 'clinical data' or 'efficacy' or 'studies' when you put on your formulary the product that will give you the biggest kickback, er.. rebate. California (like Camelot) is a looney place!

So the FDA is saying that you cannot switch a patient from a CFC MDI to an HFA MDI without a new Rx. They are not equivalent and require a doctors OK to switch. They also say that all of the different HFA MDI's arent interchangeable. I laugh at that too! You know how much bitching we would get if we faxed every doctor saying "Is it okay if we switch this CFC MDI to HFA MDI?" They'll say "Are you retarded?". I mean think about it; what doctor is going to say "NO! I DEMAND A CFC MDI! I KNOW THEY AREN'T BEING MADE! COMPOUND IT PUNY PHARMACIST!" Pretty retarded if you ask me.

But what do I know, I only have to hear the complaints.

Currently the only way that us pharmacists get paid in a retail setting is by filling a prescription. The store makes zero dollars directly on phone calls, walk-in advice, or anything other than filling a prescription. Now I realize that being nice and giving advice = more patient support = more Rx's for that patient filled at your store vs other stores = more money in your pocket. However, taking that phone call to help Ms. Jones find out what white pill is her lasix = 5 less Rx's you can fill/day = less money made vs if Ms. Jones had not called.

So we already are giving away a valuable service for free rather than just machine-gunning Rx's out and making the store some money. Here is where the insurance companies take a good natured thing that we do for society, and bend us over for it. Medicare Part D is forcing many of the smaller independents out of business. AWP-95% + 0.01 (here is your 1 cent dispensing fee, just hand the pills out in ziplock baggies with the drug/patient name written in sharpie on the outside).

So, stuck in a clusterfuck between the Insurance companies and being the most benefit to society, we have painted ourselves in quite a corner. Our choices?

Screw patient care, hammer out the Rx's as fast as you can, and stay in business. Possibly fuck up and kill someone in the process by a medication error.
vs

Maintain patient care, be the most trusted profession, and flip burgers on the side because your store went out of business.
vs

Charge for services, have patients go to corpo-chain X where they get treated like shit, but dont have to pay the pharmacist for sorting out their pills because they dumped them all into a candy dish and forgot which ones is which.

Pretty screwed arent we? But alas, here is the kicker:
Insurance companies are the cause of this. They are the driving factor in why we need to hammer out at least X Rx's a day to break even (but cutting reimbursement rates). However by making us do this, they are increasing the chance of medication errors which will land their patients in the hospital costing them /more/ money in the long-run. So they force us to fill more Rx's per day with less staff, yet they gladly pay out the ass when we fuck up and someone lands in the hospital! Ingenious!

So how do we fix this? Obviously the insurance companies are reporting record high profits year after year, so the answer isn't to increase our reimbursements. Medicare part D has that patient care thingy (where they pay us like $65 bucks for an hour of consultation or something like that). But if you get a net profit of $10/Rx (HAHAHA! Quit laughing you guys!!) you can do at least 20 Rx's an hour and make more than that. Plus you have a set amount of time to bill for the Medicare part D consulting before it sunsets and you cant get anything. Not to mention its probably paper-billed and not online billing.

Answer? We're screwed. Plain and simple. Short of selling the narcs out of the back door (or not taking any insurances and just charge patients your usual&customary) we will never truly be paid for our time and knowledge.