Recently in Medicare Part D Category

First off, Merry Xmas to everyone.

The 1st is looming closer and closer.  For those in you not in pharmacy, the best way I can describe the feeling is as such.

You just ate at this Mexican food restaurant.  The food was good, but you have this feeling in the back of your mind that you will be spending the evening peeing out of your butt.  However you aren't 100% sure that you're gonna expode out of your backside, you're just 98% sure.

Thats how we feel right now.  I'm about 98% sure this is going to be total clusterfuck, but there is a small hint in the back of my head that it might be okay.

Now something that complicates this whole clusterfuck even more: The dreaded NPI number.

How many doctors have you gotten an NPI number from?  How many insurance companies are going to 'suddenly' require an NPI number on 1/1/08 without any prior warning or notice?  How many doctors have you asked "Hey, whats your NPI number?" only to get a "Whats an NPI number?" answer?

For Xmas, all I want is a 5th of good scotch, a few cigars, a box of fentanyl patches and a well-heated hot tub.

Does anyone but me have this feeling of impending doom about the first of the year?  For those not in the know, a whole bunch of Medicare Part D plans are changing/merging/switching/etc as of the first of the year.  I know that HealthNet (I think its HeathNet) is switching processors, and there are about 4 or 5 new plans to replace the 4 or 5 that are going away.  People are getting switched around, new cards issued which means new ID/Group numbers (if they have the card AND its printed correctly).

It's going to be hell all over again.  New cards, down systems (*ahem*Argus*ahem*), confusion, copay changes, formulary changes, hour long help-line hold times, everything hitting us all at once.  The Medicaid/Medicare people are getting auto-switched into new plans, there are confusing letters flying all over the place along with salesmen who will promise golden turds to any senior who will sign on the dotted line.  Add onto that a system that is horribly complex and confusing thats targeted at the population segment that is confused by the most simplest things.  Breaking out the booze yet? :)

I hope after the first I quote this post and say "You know, I was wrong, I was really wrong".  Somehow I don't think that will happen.

However, aside from all the lost reimbursements, forwarded medication, confusion and swearing, we will again show the rest of the world that us retail pharmacists are the most stubborn, determined, hard working and just outright relentless healthcare professionals out there.  We are the glue that holds the industry together.  Its times like these that retail pharmacists and their staff show their true colors to all of their patients.

I can't speak for all the retail folk out there, but I know there is a good majority that sat there after Jan 1st of 2006 and 2007, looked deep down into that tall glass of booze, and felt a sense of pride in their profession that wasn't there before (or it might of just been gas, or psychosis setting in).

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

I'm not dead! I swear! I just have been busy with work and not drinking myself into a coma.

The Donut Hole.

Those three magic words that all Medicare Part D patients hope they never hear. The gap in coverage where you must pay out of your own pocket for your medications.

I hold Doctors partially to blame for the shit we have to go through when patients hit their donut hole. Before you give me hate-mail-o-rama, lets elaborate:

You have a patient who is on Medicare Part D. Suddenly, all of these new and spiffy trade-name medications are only $3.10! So what does the doctor do? He starts writing for that ARB when a generic ACE-I is okay. He starts writing for Lipitor when the patient has been on generic Zocor for months. He starts getting blowjobs and lapdances from the drug reps in return for prescribing Levaquin when generic Cipro would be okay. "Hell! Its only $3.10! Why not! The patient only pays $1 for generics, whats another $2.10 for a drug that works 'better'!!!".

In reality, the doctor is screwing over the patient, big time. In fact, he's screwing over the patient more than anyone else could. You see, all of those big expensive trade name medications are going on a tab. A tab that pushes the patient further and further towards the donut hole. So their $2400 allotment of 'coverage' is now burnt up in 3 months because Mr "Its only $3.10" Doctor switched them all over to trade name medications. How many doctors realize this? About 10. How many doctors care? Zero.. "Its the pharmacists responsibility to take care of this, even though I'll deny any generic request he submits!"

So who's sitting there with their puds in their hands. Isnt the doctor, he gets his kick..er..incentives from the drug companies regardless. Its the patient and the pharmacist. The patient because he now has to pay out of pocket for $2,000 or so dollars until he hits "catastrophic coverage"; and the pharmacist because WE have to explain all of this shit to the patient and hear their whining.

Sure we can switch them all back to generics, but its a catch-22. If you switch them all to generics they'll be in the donut hole longer (because their total cost of drugs per month decreased due to generic switch). If you keep on the expensive trade name medications, they'll be out of the donut hole quicker, but will pay more per month. Wonderful isn't it?

In the defense of doctors, they really have no clue how much stuff costs now days. If you're a doctor, and reading this, the cost of the drug is directly proportional to how many annoying drug reps come and visit you. Why would a drug that cost pennies be pushed so hard by men in suits and women in short tops? Think about it.

Who here wants to drop Humana? Seriously. 2 friggin buck profit from each Rx. Where does Humana get off paying us this?

See, this is the inherit problem with the system(tm). Our best customers, the cash paying ones, have to subsidize the losses we take from taking retarded insurance plans like Humana. So who does this punish? Not Humana, they are reporting high profits this year (gee, wonder why). Not the patients, they pay their $3 copays while bitching the entire time. Its us and the private pay patients.

When are we going to put our foot down and say "I cant operate making $2/rx!" and stop taking Humana? Humana needs a good kick in the teeth to realize that if nobody takes their shitty plan, they are boned. Seriously. I hope Humana reps actually read this to realize that they are costing pharmacists their businesses. They need to get with the program. Their exec's dont work for minimum wage, so neither should we.

Now I know you all may be saying "ho-hum, we're used to it, same shit different day" but is it really? There are a bazillion Medicare part D plans out there, and the MediCare/MedicAid patients can change monthly! No excuse for them to switch to a similar plan that isn't going to bend you over without lube! We aren't dealing with the private insurance patients (obtained through their work) that are pretty much unchangeable. I realize that the non-Medicaid patients are pretty much screwed until November, well, cant win them all.

Send a comment if your pharmacy terminated their Humana contract. We've sent ours a bunch of times to their contract department, but so far no confirmation. Lets give Humana the bitch-slap they deserve for being the flithy whore of the Plan-D's.

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.

If you're a pharmacist, and reading this, you're probably drunk (or hung over). I just had about 5 shots and a bottle of wine with a dentist friend of mine, so this might not make too much sense (im pretty hammered). But you'll understand why (if you're not a pharmacist) if you read this entry.

Needless to say, today was chaos, hell, and a bit of clusterfuck all rolled into one. Words cannot describe it. All I can say is that if you were working in pharmacy 1 year ago (when Medicare part D shit hit the fan) it was like Deja Vu.

Prescription Solutions was down for a good majority of the day. In fact, it was down the entire day. I must of gotten less than 50 prescriptions transmitted through them, and god only knows how big my switching bill is going to be from all the failed transactions and retransmissions that I did today. I got error messages from 'Server Busy' to 'Non Contracted Pharmacy' to 'Please process with 2007 card if in 2007, 2006 card if claim is in 2006' to getting paid.

To make matters worse, some Medicare Part D programs decided it would be a good idea to issue 2007 cards that have a different ID number than the current 2006 cards. Way to go! Lets really drive the pharmacists crazy!

This combined with the 1+ hour wait time on hold makes for a really really drunk pharmacist.

Seriously, the PBM seriously need to get their shit together. I mean lets take Prescriptions Solutions (RxSoln) for an example. As of 1/1/07 they took over processing for the AARP Medicare Part D program. Common sense would tell you; "Hey! As of the first we're going to have a fuckload more traffic! Lets put more servers in place, and hire more staff, etc to take the increased load!". Did they do this? FUCK NO! So as a result they were down all fucking day. They must of learned from Argus how to be a shitty PBM. So in my drunken haze, I have written them a letter:

Dear Prescription Solutions,

This is The Angry Pharmacist. Most of my patients use you for their Rx Processing. Unfortunately today (since your systems were offline) they could not get their medications. As your CEO's are sleeping soundly in their beds, most of your customers are in the ER without medication because of your lack of server scaling and planning for the increased load of the AARP customers you took over (like hell i'm giving them any medication, you've fucked us over last year on the first, what makes us think you're not going to fuck us over this year on the first). I hope you sleep well knowing that you have just fucked over a good majority of patients, and pissed off a ton of pharmacists who took the brunt of your ignorance and lack of planning. The same pharmacists who are going to suggest that their patients move off of plans administered by you and your shitfuck cronies. But of course you are making record high profits, so obviously you dont need our business to afford your sailboat, RV and your house in Maui. I pray that your own family does not use your processing company for their prescriptions.

Love,
The Angry Pharmacist

PS: Fix your fucking shit.

Oh, and if you havent already; Drop Humana. Seriously, they pay cost + 1.50 for all of their prescriptions. If you work for a corpo-chain, talk to your district manager about it. If we keep on accepting shitty plans, the other PBM's are just going to walk all over us.

Im too drunk to type any more. I hope you all have a good first week of the new year; and remember, when slitting your wrists its 'down the road not across the street' (and if you do it under hot water, you wont feel it) :)

I <3 scotch. Mad props to my homies in Ohio. You read this blog, you know who you are.

Sorry I havent been posting much. This medicare part D bullshit has finally stopped hitting the fan, so now I have a breather.

Things are pretty bad in the retail biz now. The reimbursement rates are a staggering low. I mean, i tip my fucking pizza boy more than I get paid for filling your mothers prescription. Patient care took a backseat to paying the bills and putting food on the table.

President Bush burned his bridge with me. Yeah, I voted for him (Kerry was a douche), but saying that we need to protect our seniors from those greedy pharmacists was the final straw. His administration trusted our senior's care to a bunch of dipshit private companies who cant pour piss out of a bucket. We picked up the ball after they dropped it and worked our asses off to cover their fuckups. Now he's got the balls to say that we're greedy? Thanks a fucking lot! We'll see how long you have to wait for your next prescription!

At least the insurance companies that totally fucked up are giving us a little respect and kind words. Now if they'll just take the dagger out of our backs and look us in the face as they are fucking us over we'll be happy.

Not good, really really not good.

After a nice relaxing dinner, a few drinks and a puff of some fine pipe tobacco, i'm ready to bitch more about Medicare Part D(iaster).

Things are getting a bit better. Not by much, but a bit.

However Argus/Prescription Solutions have totally screwed the pooch yet again. Their servers are STILL unable to handle the load and are going up and down like a $2 Thai Hooker.

Prescription Solutions powered by Pacificare still hasnt added our pharmacy to their program, so we're encouraging everyone to switch over to someone else (and we're also leaving a message to their contract dept everytime we do it too, just to encorage them to return our call, which they havent). If they want to play that game, then we can play it too. We moved over 40-50 people just today off of their plan to ones that have their shit together.

Im reading on all the other blogs on how people are blaming Bush and the Republicans for this whole clusterfuck. However, what do they have to do with private insurance companies completely dropping the ball? Last I checked the government didnt run Argus, PacifiCare, Health Net nor any other Privately/Publically owned company. The government didnt issue wrong ID cards to people, or completely understaff their call centers. They arent responsible for the long hold times or help desk reps that cant tell their asshole from their nostrils. What they /are/ responsible for is trusting (and paying) idiots to run the show for them.

I think the whole Medicare part D system is one of those 'Looks good on paper, but totally blows in real life' bits. Although I have seen people who have been paying cash for kilo-buck drugs such as Aricept whom are now just shelling out a $35 copay thanks to Part D. If I were saving $150+ a month, i'd put up with the bullshit, however thats not the case.

So be aware what you read on these other "blogs" from people bitching who arent there in the trenches. Anyone can be an armchair quarterback and put the blame on the nations scapegoat; but take it from a person who spends 9 hours a day on hold with privately owned companies, its not totally the governments fault. Its all Argus' fault.. :)

This entry isnt very angry, and I apologize. Its been a little over a week and i'm tired of dealing with the whole situation. Im not to the point of giving up yet, but im getting there really really quickly.

If you're a pharmacist and want to help out with a collabrative info warehouse, go to http://www.partdrphinfo.com and contribute any information you have. Everyone seems to need to pool their knowledge to help get through this.

Welcome to the start of Week 2 of hell, er.. Medicare Part Diaster!

Today we have a very very special award. It goes out to Prescription Solutions powered by PacifiCare.

Today is the start of week 2, and my place of employment is STILL not enrolled in their Medicare part D program. Last week they were backlogged, this week they really dont know whats going on and why we're not signed up. I left voicemails to their contract department telling them that they better act on this to stem the outflow of patients that soon will be switching to a medicare part D carrier that has their shit together.

Do they care? nah. Just another random voice after a 20 min hold time giving another BS excuse.

Its besides the point that we faxed over our contract not once, but twice, about 2 weeks apart, plus mailed the hard-copy to them. All this was the first part of December.

Typical insurance run-around. They arent suffering any; the patients are because they dont wish to change pharmacies (bless their hearts) yet their insurance company completely dropped the ball.. ROCK - ME - HARD PLACE

Argus is still on the crap-list for having slow/unresponsive servers. Get with the program dudes, its been a week. BUY MORE FUCKING MACHINES TO TAKE THE LOAD. QUIT SPENDING YOUR MONEY ON HOOKERS AND BLOW AND BUY MORE GODDAMN SERVERS SO YOU CAN SERVICE THE PEOPLE WHO PAY YOUR DAMN PAYCHECK! (i feel better now). If thats not the case, then tell us WHY your service sucks, and why companies that use you for Rx processing (like Health Net) shouldnt sue your ass into oblivion for making them look horrible. Ive worked in the computer industry, I know how things can get, and I know that keeping everyone informed. Plus I love how their main webpage (http://www.argushealth.com) has a huge area about KickBack..er.. Rebates! Way to go! Why dont you use that and BUY MORE SERVERS!

Shouts out to Mike in IN, stick with it man, we'll get through this! Once in a while you get that pearl in the rough that makes your job worth while. I know I get mine on a daily basis.. If this site would be about all the good parts about pharmacy it wouldnt be called 'theangrypharmacist' now would it.. :-)

Friend of mine from school made this website to help you all with the ins and outs of Rx processing through MediCare part D. It has stuff like what person code to put, ANSI BIN numbers, PCN numbers, etc. Its a wiki, so anyone can create an account and add information and stuff (there is a hand holding page to help out). He's put a ton of time in so let him know how you like it. Heres the address

http://www.partdrphinfo.com

Tell your friends and co-workers.