Recently in Pharmacists Category

The first of the month is always super stressful for pharmacists.  Not only are we usually busy, but it seems like everyone saves their shit/drama to explode on us.  If you think that I'm a callous asshole (and obviously are not a pharmacist because if you were you'd understand) then read on and maybe it'll give you a bit of insight as to why not only myself but all pharmacists either drink or are on antipsychotics.

First thing in the morning, I have to do the backlog of call-ins from the answering mac-

Phone rings.. Pharmacist on line 1.  Mrs Jones needs all of her regular medications refilled.  She wont give any of the numbers to any of the clerks, will not give you the numbers, says "you know what I normally get" and she wants them delivered.  She mumbles like she has marbles in her mouth as the answering machine is blaring in the background because you forgot to pause it when you grabbed the phone.

-hine.  There are about 15 Rx's on the machine, and after playing each about 4 times you think you can understand what they want.  You write down everything and start to fill them as people start to mosy around the store.  Vicodin, Soma, Vicodin, Soma, Valium, Vicodin, Soma you fill and fill and-

Pharmacist line 3.. Dr Dumbfuck's high school dropout receptionist is trying to sound out amitryptline but it sounds like amultryptillyinyling.  She cant make out the strength so she has to-

Pharmacist out front for a question.  Some woman is bawling in front of you asking for her somas early because her grandbaby died and she has to leave for texas RIGHT NOW.  You tell her that you'll be right with her as she gets pissy and yells and says that she has to leave RIGHT NOW.  You pull up her profile to see a nice array of Vicodin/Valium/Soma with a huge note that says "NO EARLY REFILLS PER MD".  You tell her that you really can't refill it early as she throws a fit that would make 2 year old proud right in a store full of people making you look like a complete asshole because HER COUSIN DIED AND YOU WONT FILL HER NARCOTICS EARLY.  You're the only one who caught that her story changed half way through.

-ask the doctor for clarification.  You wait on hold trying to hold back the urge to scream at this ignorant non-english speaking twat but the Doctor is one of your heavy writers so you just bite your toung-

Pharmacist on line 4.  Dr Smith is on the line.  You tell your clerk to hang on line 3 while you talk to Dr Smith on Line-4.  He wants Wellbutrin XR 75 and manages to hang up before you can tell him that strength doesn't exist. 

The phone gets thrown at you from your tech who is waiting on line 3 from you with Dr Dumbfuck giving you both barrels because you didnt understand his fucking daughter who must of just gotten off of the boat from India.  You make some backhanded smart-ass remark about being sorry for caring for patient safety and the horrendous idea of filling the correct medication and hang up on him.

-fill. (still with me? Good!)  You wonder if any of your patients are on any blood pressure medications or just narcotics.  You put the calendar you have right by your workstation in front of your monitor so you can count the days to see if people are due for their refills.  Notes such as "Wants to see if she can get early" or "Requesting early fill going out of town" litter your stacks of refill call-in requests that your clerks relentlessly place up for you to process.  Obviously you know the answers to these early fill questions already, but you pull up the numbers just so you dont put your foot in your mouth later on.

The more you process, the more the stack grows.  Your techs are a flurry of counting awesomeness as the printer churns out the labels like they are going out of style.  Wellpoint goes down, and your entire pill churning operation decides to start to nosedive as you make a stack of Rx's to bill later when Wellpoint comes back up.

You take a few deep breaths to try to keep the wave of panic from destroying your day as your tech scratches your back in a half-ass comforting way-

Pharmacist Line 2.... Its Mrs Jones..  Mrs Jones got her delivery, and WHY IN THE HELL DID YOU SEND HER LISINOPRIL.  HER DOCTOR TOOK HER OFF OF THIS LAST WEEK AND LIKE HELL SHE IS PAYING THE $1 COPAY FOR THIS.  YOU TAKE THIS BACK RIGHT NOW AND SHE CANT BELIEVE YOU SENT THIS OUT *click*.   Life just got a little bit worse, you didn't even get to yell at her to call in the Rx's numbers next time and this shit wouldn't of happened.

Pharmacist requested out front rings throughout the pharmacy.  A mother does not know what 1.0mL means on the TriVitFlor (for those who are NOT pharmacist/techs, TVF has a dropper that has 1 mark on it.  1.0mL).  You are walking back to your station as your tech screams at you to check off the counter-full of Rx's filled so they can be put-

Pharmacist Line 3!  Its Mrs Jones again, she wants to know why her copays went up from last month.  You balance the phone on your ear as you try to check off the Rx's on the counter so your techs can continue to work.  Mrs Jones is screaming at you like you are some sort of monkey at the zoo flinging poo at her.  You run to the computer to find her copays have not changed in 2 years.  You pray for either your death or hers.

You try to work on things throughout the day to have customers scream at you from across the counter as if it is their personal pharmacy.  They get pissy because they are going "on vacation" and need their shit RIGHT NOW.  You feel less and less like a professional and more and more like a fucking vicodin dealing slave.

You'll feel anger towards your fellow man, that how someone that stupid can continue to pop out kids as if they have no idea how they are being generated.  You'll feel disgusted at the healthcare system and allowing people who contribute nothing continue to further their own genetic legacy.  You bust your ass and are treated like shit so these people can live a "good life" without having to work one honest day, and they have no problem cracking the whip over your head for not counting out their valium faster.

The day goes on, you almost have a breakdown.  You dont feel like eating lunch because you are so stressed out.  Your techs try to give you some comfort and your clerks try to handle the brunt of the insanity of the public coming in but eventually the walls crumble.  After your day is done, you sit there alone in the empty pharmacy wondering why in the hell you went into this profession, where we went wrong, and how you can do this again.  You stand up, knees aching and back tingling and make your way to your car.  You sit at home and prepare yourself to do the same thing in the morning.

Ask any pharmacist out there who works retail, and they will agree that its EXACTLY like this.  Pharmacy is a interruption based profession.  You have no time to actually concentrate and work on something from start to finish in an environment that fosters good thinking.  You have people screaming at you, demanding things, bitching and blaming you for stuff that you have no control over (like copays and not-covered drugs).  You went to school to learn really complex shit to use in an environment where the only 5 min's of peace is spent sitting on the toilet.

However, take heart that there are others like you.  Others that are in the same boat and feel the same way about work.  I, for one, take some comfort in that.

Take a step back for a second and look at retail life.

We went to school to learn about drugs, the human body, a little bit about diagnosing stuff, interactions, CYP450, Kreb's Cycle, Chemistry, Biology, Kinetics, blah blah blah.  Most of us spend 3 to 4 years in classes, then went out on rotations for 9 to 18 months working for free, etc.

However what do we do for 9 hours a day?  Do we actively use this knowledge to further better our patient's lives?  Do we use all of the crap that they force-fed us in pharmacy school to do the things that they promised us we'd do?  Do we get to spend an hour talking with little old white ladies while wearing our pristine white coat (gotten at the UOP White Coat Ceremony, die UOP) while we laugh and talk and go over her disease states and medications with smiles on our faces like the chains portray pharmacists in their ads?

No.

We are the babysitters, the nannys, the ass-wipers and the caregivers of the general public.  When there is a problem, we have to deal with it (even if it had nothing to do with us).  Patient loses their medication or takes it wrong? We have to deal with it.  Patient flushes her Percodan down the toilet its OUR job to put the call in.  We are the common sense of the public and the bearer/invoker of their personal responsibility.  Doing this makes us a doormat, not doing it makes us no better than fucking McDonalds or Burger King.  Fuck, some stores are already no better than fast food chains with drive-through windows.

We went to school to end up using our deep pharmacological knowledge so we can apply it via AARP covers Zocor and not Lipitor or that nicotine patches are a DAW-1.  Lyrica is only covered if Neurontin is failed and nobody covers fucking Adipex-P or Xenical.  We wait on hold to speak with some dillhole in India who speaks like a robot because the ID card has the wrong information or PCN printed on it.  See that AWP -%30 + 1.50? Take it and like it; you don't have a fucking choice anymore.

We try to decipher handwriting that looks like shit-covered toilet paper as office staff who cant speak a fucking clear word of English try to sound words like atenolol while using phrases like "Well this *looks* like....".  We are a slave to the machine known as a "Fax" and the 2 doctors in town who still think that its a HIPAA violation to use one.  Our jobs revolve around the public whining at us because they waited until they were out (typical idiots) to have us send the fax over to the doctor for the refill request.  Did I mention that its also Friday night and the doctor turns his fax machine OFF when he's not there?  Doctors think that we are nothing but fucking pill counters and treat us like some ignorant plebe who knows nothing about medications (or anything for that matter).

We are the vicodin police to a completely inept and retarded DEA (Fuck you DEA, more on you later) who collects data from us yet does absolutely nothing with it.  We live in fear of inspections from the only professional licensing agency that is AGAINST us.  You fuck up, the state board wants your head.  They aren't there to protect you, they are there to protect the public FROM you.  Tell me how that works and why I send them money every 2 years for a green piece of paper with my name on it.

We go through this day in and day out so we can live a good life.  We put in our 30 years to hopefully have some sort of retirement (since Medicare will be long broke when I retire), and after those long days, 2 heart attacks, refills upon refills of the Buspar and Wellbutrin you take to keep your sanity, and the dumpsters full of alcohol bottles to make the pain go away, you can look back at your career and really ask yourself was it really worth it.

You'll think.. You'll think some more.. You'll drink.. You'll drink some more...  Days will run into weeks will run into paydays will run into months into years.

You'll remember this post, and say to yourself "yeah, it was worth it".  For all the shit that we deal with, for all the frustrations, the hold times, the yelling, the swearing, the hugs your techs give you when you're about to have a breakdown, the throwing of pens and dumping of Alpharma's (now Activis) insanely sticky Prometh with Codeine on the counter (as you scream "SHIT!" and hope your patients didnt hear you) you'll have those handful of patients who's life you really did make a difference.  You'll have the metaphorical little white ladies in the chain commercials who you *did* help out and *did* make life just a bit better.  You will be someones hero and a person that people look to for nothing more than a smile, hello and acknowledgment that they exist.  You'll walk through the parking-lot wearing that beat-up white coat that you got in school 20+ years ago like a badge of fucking honor and respect as your patients know you by name and will drive across town to come into *your* pharmacy to say nothing more that what you suggested to them OTC worked like a charm.

From this post you must get the idea that retail pharmacy sucks, that I hate it, that I wish that lightning would strike me down and put me out of my misery.  Certain days there is nothing more in life I would wish for, however everyone is like that with their job. When its a really shitty day and nothing is going right, yeah, I hate it.  However those days are few and far between.  Thats why its called work, not fun ("How was fun today dear? Oh, tiring").

I wrote this because retail pharmacy is changing and I really don't feel like pharmacy students are getting the proper picture that retail paints.  This isn't designed to scare people away, but to let them know exactly what they are getting themselves into.  After spending tens of thousands of dollars and all that time in school, wouldn't it be a waste if you learned you couldn't take getting yelled at for an early soma refill your very first day as a pharmacist?  That on the first day working alone you realized that retail life was in fact nothing like what your school had prepared you for?

I really wish that Drug Topics or somewhere else would publish some of what I write, but I think that I use too many bad words are too "real" for most magazines out there.  I wish they would grow up and realize that people swear, and that medicine/life isn't one big hugfest.

You know that feeling you get when you work really hard at something,
and in the end it turns out exactly how you wanted it to turn out? Well
look at this gem I got in my inbox last night/this morning:

Dear [TAP's Name Removed],

After reviewing the case presented by your lawyer over the trademark
infringement of "The Angry Pharmacist" by one of Robert [TAestP's last
name removed] of [address removed] of "The Angriest Pharmacist" we have
declared that you are the rightful trademark holder of "The Angry
Pharmacist(tm)" herein known as "TAP". By ICANN policy, we have routed
all traffic going to "www.theangryestpharmacist.com" and
"www.theangrierpharmacist.com" to your held trademark at
"www.theangrypharmacist.com". We hope that this policy decision is
acceptable to you and your company, and request that you contact us if
you have any questions or comments.

Sincerely,

Pat McGearn
ICANN Page-Removal Task Force

Hear that? Thats the sound of victory. The sound of someone who tried
to come and step on my fucking coattails to skim off of something that I
worked hard to build and HE decided to mooch off of.

Oh, but it doesn't stop there, oh no. Just look at this email I shot
off to all of the major chains a few weeks ago after I subpoenas his
webhosting company for his personal information:

To Whom It May Concern,

I would like to request that you search your personnel records for one
Robert [Last name Removed] residing at [Address Removed]. His is making
known about patient records and store policies at the website
http://www.theangriestpharmacist.com. I have attached the subpoenaed
records from his hosting provider proving his identity. I would hate
for a HIPAA lawsuit to soil your reputation over an angry blogger who is
unhappy with his job. Consider this an anonymous tip.

Thanks.
The Angry Pharmacist.

He shoots, HE SCORES! I hope the fucker gets what he deserves. Now its
time to break out the bubbly and celebrate who the real
honest-to-god-true angry pharmacist is. ME!

Now before all of you Chain guys and gals send me anthrax and bombs in the mail, let me say a few things.

• That rant was targeted.  Some of you know who it is, most of you dont.  Those who know are probably saying "oh damn" but the rest of you just took offense and are storming my house as we speak.  As you all will point out to me, chain life is not the devil, but some people are making it sound like it is.  Stop your bitching, if it were fun it would be called FUN and not WORK.  I'll leave it at that.
• 3 independents have closed this year just around where I work.  If the Medicaid/Medicare cuts go through the rest of them (including myself) might be joining them.  Think about that for a second then wonder if whining about your store manager is really as bad as you say it is.
  
• That post was fueled by a number of factors that put chains on my shit-list over the past few days, some of which include:
• Making a long-term CASH customer of mine wait at 11:30pm for an ER written Z-Pak for 2 hours while she said the pharmacist just sat there and talked on his cell phone while wandering around the drug isles.  She didn't want to disturb me at home to open the store even though she has my cell number.  This was at a store that initials start with an upside-down M.  Don't give me this backlog shit, its a z-pak ran as cash.  Run the label, slap it on there, let her get home and get better.  I doubt shes going to spend much time shopping in the front-end shit.
• Me waiting on hold for 20 min for copies yesterday when the store does about 1/2 the volume as we do and has twice the staff + a scriptpro.
• Having said pharmacy decide to not just fax me the transfer sheets, but the entire screen printout which tied up my fax machine for a half hour.
• Its fun to stir the shit pot once in a while. Wait, its not fun I guess when its directed at some (if not all) of the readers, but fun when its directed at doctors, nurses, crackheads, welfare patients, etc.  Funny how that double-standard works.
  

Now, to all the people who emailed me calling me an asshole, and they are never going to read my site again, wah wah wah:  Go ahead, leave.  Heaven forbid I rag on doctors, PA's, welfare people, and the world in general for you to agree and be on my side with only to have you take your red-wagon and leave once I rant about something that maybe hits close to home for you.  See this website? Notice the word ANGRY in it?  I make no money off of this, it costs me an arm and a leg to keep up, and to be honest I'm not going to censor what I write on here because it might *gasp* offend you.  This site isn't called "The angry (but-only-when-its-not-directed-at-you) pharmacist".

So I'm going to make a rule now that I'm not going to make fun of any more groups of pharmacists because feelings got hurt.  Thanks a lot.

Theres some talk about how bad pharmacists that work for chains have it.  Be it under staffing to bad working conditions to a store manager that only dealings with a pharmacy is buying extra small condoms.

There is one aspect and benefit that Chain Pukes have that us Independents don't, and I think that its something huge that they take for granted and really shut their mouths when its brought up.

Job Security

Thats right, Job Security.  You see, with an independent, we don't have a multi-billion dollar company backing us up.  We don't have a corporate office that we can just defer shit to.  We don't have a guarantee that our paychecks will cash every two weeks.  When huge Medicare/Medicaid cuts happen and the reimbursement goes down to shit, we don't have the luxury of over productive stores to help float us during the bad times.  Our bank accounts are not tied to a place where people in suits crunch numbers and fancy lawyers give us advice.  We're out there on our fucking own doing it the old fashioned way, the "old school" way.  The way our grandfathers did it.  Our "corporate office" is the owner of the store trying to get the fucking payroll done in the back room while handling calls from doctors office so we don't die up there in front.

You know what we get when the shit turns sour? Walking papers and a chance to search for a new job.  Thanks for fucking playing.

Furthermore (to make you all look like a larger big whiny sandy vagina), we are just as overworked as you, and we still have to deal with the same shit that you do.  Same patients who want and demand everything, same insurance companies that fuck us over (only WE have to do our OWN recon sheets and we don't have the "power" to negotiate), and we shafted by the same expensive drugs (which is coming out of the OWNERS pocket, not a corporation pocket).  We watch reimbursements and what we order so we don't put the business under.  We can't hire more help not because "corporate office says that we need to hit x/day" but because we cant fucking afford another pharmacist.  Do we get to hide behind "corporate policy" or "well the corporate office says we HAVE to do this"? No.  Our "corporate office " is usually the guy working next to you who has owned the store for 30 years and has his whole livelihood invested in not only his staff and store, but in his patients as well.

However you go to bed every night after bitching to everyone about how overworked you are knowing that your store is going to be open in the morning, while we sometimes have to wonder if our wholesaler bills will get paid, payroll will be made, and if Humana/WHP/Argus/etc will be on time with their payments.  We have to deal with the stress of not only running the pharmacy, but running a business as well; down to payroll, taxes, workman's comp, everything.  Even buying the fucking bags that we put the drugs in with our names on them.

New graduates don't want to deal with the shit of running a business.  They want to work in their nice chain store jobs with their stock options, vacation times, sign-on bonuses and the satisfaction of knowing that the business aspect will be taken care of someone whom they will never meet, and their paycheck will magically get direct deposited on the 1st and 15th.  On top of that they have the balls to sit there and bitch about how working for the chains is so fucking hard.  Hear that? Thats me playing the smallest violin for you.

So quit bitching.  I'm tired of it.

The *Angriest* (sigh) Pharmacist wrote a Kick Ass Post that I think all of the students should read.  Comment to his if you need/want something added to help the students out.

So I believe I am the last one on this gravy-train of pharmacist bashing that the USA-Today is onto.  If you didn't read the article (I barely skimmed it to be honest, its the media, and we all know they know everything there is to know about pharmacy and medication) it talks about Walgreens pushing their pharmacists to the limits, an error was made, blah blah blah.  I realize that the article focuses on overworking pharmacists in the chains, but I know that the shit thats splattering against the fan is going to trickle down to the independent level, so this bitch is sorta about mistakes in general.

If you read the article, it plays on the emotion of the poor kid who got the wrong medication, and the poor baby who got 5x the amount of amoxicillin and would 'writhe in pain' (give me a fucking break, a 16 day old baby isn't even developed enough to know it even exists, let alone what pain is). Wah wah wah.  The kid probably was colic or had some gas and was fussy.

I'll tell you first and foremost.  If you are a student, and have never worked in a pharmacy before, go work in one before you decide to continue any further with your career.  Retail pharmacy is high stress, no if-and-or-but about it.  If you do not take stress well, go dig ditches somewhere and stay out of pharmacy.  If you crack under pressure, or do not take interruptions very well, go sell shoes and do not go into pharmacy.  I don't want my profession being drug through the mud due to you cracking and fucking up/going on a murderous rampage any more than it already does. :)

I'll be up-front, if a pharmacist ever has said that he has never made a mistake, he's a fucking liar.  Mistakes happen.  I have made them, you all have made them.  Be it the wrong strength (grab the wrong bottle), or the wrong drug but in the same class (dispense Zestril instead of Lotensin, brain fart), or you can't read the fucking doctors handwriting (Hydralazine/Hydroxyzine, Lamisil/Lamictal, others that im too retarded to think of right now). 

Most of the times these are caught by your checking system, or the patient tells you that the pills look different.  Sometimes the patient mixes the bottles up at home, puts the wrong medication into another bottle, and blames you for it.

Now some math: If you make one mistake a day (which is huge), and you fill 300 rx's, thats an error rate of %0.3.  Now if you make one mistake a week, and you fill 300 rx/day x 5 days = %0.06.  Now consider the fact that most phone-in Rx's are by people who have zero medical knowledge and can barely speak English, or a doctor from India/China who can't speak nor write English to save his/her life.  Throw in ePrescribing with adding technology to a technological illiterate profession with tiny mouse pointers and drop-down drug lists and you have yourself a class-A clusterfuck. I would say that pharmacists everywhere are doing a pretty damn good job keeping the error rate down.

This is all beside the point, the USA Today article blows autistic donkey ass.  Talk about a piece of shit written article.  Why don't they do a fucking article about the Walgreen pharmacist who saved a life by warning the doctor that Mrs Jones was getting Amioderone from her cardiologist and her GP put her on Warfarin.  Or that idiot dermatologist who thinks that Doxycycline + Accutane is a good idea (go look up that interaction and tell me if thats not in left field).  Or the 100 billion drugs that causes QT-prolongation with Erythromycin. What about that 5 day old baby who's life was saved because the fucking pharmacist saw the mother getting the pedicare liquid and told her to just put a vaporizer in the room instead of doping up the kid.  Oh right, that doesn't get ratings so they don't fucking publish it.

A pharmacist was overworked, fucked up, and now has his mistake published all over.  How do you think that makes him/her feel? Oh, it doesn't matter, because a CHILD was endangered and thats more important.  Give me a fucking break.  Let the USA Today do an article about the hundreds of pregnant women who drink booze and smoke and how that TRAGEDY could of been prevented.  This shit is just like anything that has to do with guns, they only publish when some kid gets his head blown off for being an idiot and ignore the 99.5% of cases that they are used for self defensive purposes.

Fuck you USA Today.  I'm tired of your and the media's sensational bullshit that you produce and spit out to increase your own ratings at the expense of the professions/lives of others.  Mistakes happen, and the first one that I made was going to your fucking website.

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.

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).

The entire tirade about retail pharmacy is here

My last comment...the one I'm sure will draw fire, is regarding the
Birth Control Pill argument.... I am on your side that moral and
religious believes should play no role in pharmacy dispensing...
Refusal to dispense based upon those things goes against everything the
healthcare industry stands for (do no harm, yada, yada)... But I must
have read 15 comments you've posted over the past number of months that
all relate some story of a 'vicodin addict or loser' trying to get an
early refill or pull one over on you... Let me ask you.... What
percentage of vicodin (or pick your drug...I won't go the route of
mentioning your personal favorite) prescriptions do you fill? Of 10
that you get, how many are legit in your view and you agree to
dispense? Does someone's appearance play a role in determining that
script's validity in your eyes? Some of your comments on the person's
smell, clothing, hygiene all seem to imply that you do.... Is that a
'moral judgement you're making'? One person's street drug is another
person's morning coffee and cigarrette. The only difference is that one
is illicit and therefore hard to get, and the other is has entire store
chains devoted to it....(Starbucks...?)

First off, comparing a moral objection to dispense birth control vs refusing to dispense vicodin thats a week too early isn't even an argument.  Its even stupid to even start to compare them.  How can you even start to equate "You know, God says that abortion is wrong so I refuse to fill your pills.. MURDERER" to "Uh, you just got 120 vicodin from another doctor 4 days ago, I'm not filling this until you are due"?  One is a 100% your own personal opinion and the other is doing what the DEA mandated our job to be (not to mention a huge safety/health/do-no-harm issue).  To answer your question, of those 10 Rx's I have a pretty good assumption that at least 7 or 8 are being diverted (does everyone need Vicodin, Valium, AND Soma?).  However can I do anything about it? No. Why? I have no proof that there is, and there is that chance that they aren't being diverted and actually used. So if they are on time, I dispense it without question.

So would you call someone who "loses/gets stolen" their vicodin Rx at least 3 times a month, always calls in 10 days early, doctor shops and is on every ER's "do not dispense" list an addict?  Is that a call of morals like refusing to dispense Plan-B or a good statement of fact that you need to keep an eye on this person.  Its not even a moral call but a 'get-you-head-out-of-your-ass' call.

The personal appearance argument is vague at best.  I look at every Rx with a huge grain of salt especially if they are a new patient or an out of town patient/doctor.  I'm just as quick to call out doctor shoppers if they are a long-term patient or someone i've never seen before.  You know why? Its my job. 

Never in my career have I ever said "you know what, you look strung out and I think you are on way too much of this.  I am going to refuse it for no good reason other than my own".  It doesn't work that way.  I have however refused to refill based upon "Uh, if you take this how you are taking it, you are going to blow out your liver from 10 grams of tylenol a day, let me call the doctor".  Thats a safety issue, not a "moral judgement".

Judging by the rest of your comment, I doubt that you work retail.

An interesting tidbit of real-life info for those pharmacy students out there... One of the sucky part of my job is having to monitor diversion in a large setting... We use many tools to do this in order to track patterns.

Ah, I was right.