Copays.

Probably the most confusing and frustrating concept in the pharmacy world.

The idea is simple.  You pay the pharmacy money to help pay for your drug, hence the word Co-Pay.  Like Cooperative Pay, you and your insurance company are joining forces to pay the pharmacy for the goods given to you.  If it were that simple then I wouldn’t have a website.

When I hear that I’m needed out front because a patient has a question about a copay, my GERD goes through the roof.  Not because the concept is hard, but I know that I’m going to get yelled at and blamed for something that is 100% not my responsibility, not my fault, and to be honest a whole truckload of not my fucking problem.  I’m a pharmacist, I make sure drugs don’t kill you, I don’t give a fuck about an issue between you and your insurance company.  Your insurance company says I need to collect $x, so the bill is $x.

The most frustrating (and that requires the most restraint on my part) is when people bitch that their copays got bumped up from $5 to like $15 for shit like Aciphex, Nexium, or some other drug that costs over $100.  I really have a hard time not taking their prescription back, running it out as cash, and saying “here ya go, pay that now you ungrateful stupid fuck”.  These people are stupid, and really dont get the concept that they are getting $150+ worth of medication for $15.  “I pay premiums I want my insurance to pay for all of it!” says the idiot who is getting about $500 worth of medication totaling $50 worth of copays with $200/month premiums.  You are getting MORE OUT than you are PUTTING IN and BITCHING ABOUT IT!!!! No wonder why this system is all broken.

Idiots on socialized plans (Medicare/Medicaid) are even worse, because their copays are like $3.10 which is MORE of a slap in the face when they bitch/cant pony the cash for their $200 worth of shit they probably don’t need.

Enbrel, $3.10 copay, cue the massive whining and bitching on how someone is on a “fixed income” and cant pay.  Enbrel is thousands of dollars for $3.10.  Three fucking ten.  You cant even buy a fucking value meal at McDonalds for $3.10!!! This fucking twat is whining at me for having to pay!!  I’m sorry honey, but that $3.10 is my whole profit from this Rx, so I’m not letting you pay me on the first.  Personal finance 101, make sure you have $3.10 for your Enbrel – Thank you.

I mean really, if you went to go and buy a TV at Best Buy that costs $400, and you threw a fit because you had to pay out of your own pocket $25 for this $400 TV, would you be upset if people called you stupid?  Would you be upset if the salesman said “Listen you fucking idiot, the rest of the world has to pay a whole fuckload more than you, and you’re whining about a measly $25 for a $400 product?!?”

Then there is this bullshit rumor that we set the copays.  If pharmacists could set insurance copays, then maybe the bitching and whining would have some merit.  However the HUGE FUCKING NON-SECRET is that PHARMACISTS DO NOT SET YOUR COPAYS (unless you are paying cash).  They are transmitted to us via computer and are set by the insurance company that YOU PAY (or we pay) TO PROVIDE YOU Rx COVERAGE.  Does the Taco Bell drive up teller set the price of your burrito?  NO! They punch a burrito into the computer and it spits out how much you need to pay.  Pharmacy is the exact same fucking thing, but people still don’t get it.

People want something or someone to bitch at because of their copays.  Yeah, that’s fine, but bitch at some Indian drone at Blue Cross, not me.

Here is my outline as to what could be the perfect socalized will-fail-less government subsidized medicine plan.  Since obviously this is going to be passed riding on the coattails of the H1N1 fear and panic machine, I could at least throw in my $0.02 as to how this is to be laid out.

Now before you read this, remember years past when WalMart came into town?  How they used their huge might to pretty much crush any competition in the area with “low low prices” all while shitting on their employees and being an all-around shitty store with poor service.  Now considering this government plan has the financial backing of every taxpaying man and woman in the nation (regardless if they want to or not); think of Walmart as your cushy retirement insurance plan goes bankrupt and you’re forced to enroll into a government ran plan.

The Angry Pharmacist Socialized Health Plan Solution

By: The Angry Pharmacist

http://www.theangrypharmacist.com

Here are some nice and easy (and unrealistic) points that this new government funded (with freshly printed money/stolen from the working class) health plan should have:

• No trade name drugs are covered.  No exceptions.  Prilosec/Protonix doesn’t work for you? Tough shit.  Cough with ARB? Too bad.  None of the trade name medications would be covered.  The government needs to eat its own dogfood (or practice what it preaches) and only does business with companies that drive down the cost of medication (ie: generic companies).  That expensive chemo drug not covered? Then let the government use taxpayer dollars to buy out Amgen so they can give it out for free (why not, everyone else got bailed out).
• The plan is voluntary.  If you wish to be a part of Obamacare, then you get the premiums deducted out of your gross-pay.  If you wish to have private health care, then you won’t be dinged a dime for Obamacare.  I’m not paying for all of your PacifiCare and Blue Cross plans (and your insurance premium dollars dont pay for my private insurance) so why should I have to pay for someones Obamacare?  The chances of this happening are as likely as you buying the nice bridge I have for sale.
• You get 4 doctors visits a year with no/low copay (say, $10).  Every doctors visit after that has a $25-50 copay.  Yeah, it sucks for the people with chronic conditions like diabetes and stuff, but its better than nothing.  Don’t get the unlimited text messaging plan and you can afford your doctors visits.  Don’t order a large pizza and you can afford another doctors visit.  Wait, actually becoming an active part in my health? What is this witchcraft you speak of!
• You get 1 $0 copay ER room a year.  Every ER visit after that is $100 minimum.  I’d like to see this figure raised to $250 or higher since ER is for……. EMERGENCIES!  You know why the ER rooms are so packed? People view them as “Free”.
• Since all Rx’s will be billed to the government, if you are on a maintenance medication and you are non-compliant, guess what, your premiums just went up unless YOU (not your doctor, not your pharmacy) can submit documentation showing that you were taken off of that drug, or switched to another one due to intolerance.  Whats the point of the government dumping all this cash into your doctors visits and medications if YOU are TOO LAZY to do anything about YOUR CONDITION.  Not taking your medication is just pissing away money.  No matter how many times I bitch, your doctor bitches if you don’t want to take your medicine then you can get dinged in the pocketbook.  True this can be thwarted by people just picking up their regular drugs and not taking them, but it might make a few people think twice before asking for medication they have no intention of taking.  Cue the “Waah, we don’t want the government poking its nose into our lives” as they happily promote Obamacare.  Wait, are you confused?
• If your doctor kept up to the standard of care, then unless his peers can show an act of negligence, you cannot sue him/her for 1.4 zillion dollars in a huge malpractice suit.  Lets face it, without your doctors care, you would have died a long time ago.  We don’t need your doctor running up the bill with 400 lab tests every damn office visit out of fear of getting sued if he/she happened to miss something weird.

Now on the surface, this plan looks pretty damn shitty.  However we have a fundamental problem in this country where we want privatized health-care at socialized prices (ie: Free).  Not going to happen, actually it can’t happen!  Look at MediCare and how broke it’s becoming!  No seniors bitch about Medicare (doughnut hole), because they are so (doughnut hole) happy about the coverage (doughnut hole) that it provides (doughnut hole).  Did I mention that the government had to implement the doughnut hole to keep the Medicare system from going completely broke?  Did I also mention that we just slapped Rx drug benefits on top of an already stressed system like an idiot taking a 4th mortgage out on his house to buy a boat then wondering why he can’t make the payments.  Should I just ignore the point that before Medicare part D came out, seniors on MediCare were paying cash-money for ALL of their medications and were doing just fine on all generics?  It wasn’t until the government decided to “feel sorry for them” and slap on a part-D plan that they became greedy and wanted trade name shit (all for no copays).

If health plans were cars, this would be the basement model with no A/C, manual transmission, manual windows/door locks, and it pretty much just gets you where you need to go.  This would be the ideal solution.  It gives people the basic care they need, and to be honest if they wished for a plan with more bells and whistles then some most-costly private plans could do them well.

Oh, but wait, we all want our cake and eat it too.  Mark my words, this plan will give people an inch when they want a mile, and short of the entire collapse of the healthcare system, the public will just want MORE for LESS.

I’d like my bailout in 20′s please.

Sometimes I wonder why we even listen to what patients have to say.

How many times a day are you lied to by a patient.  A patient who on the phone will tell you they “lost” their medication, but when they magically show up at the store they say they are going to Mexico for 2 months. A patient who cried how his pain pills were stolen 2 days ago, yet is in the paper today for selling his prescriptions to an undercover officer.

Heres a colorful metaphor.  You have two sparkling clean containers (the doctor and the pharmacist).  One is filled with clean pure drinking water (the message) and must be moved to the other container.  How we join them? A piece of uncleaned retired sewage pipe (the patient).  Sure, water is going to get from one container to the other, but its going to pick up a whole lot of shit along the way.  However heres the kicker, some doctors listen to what these patients have to say as the absolute truth.

Example:  Doctor calls up the pharmacy pissed as hell because the patient said that the “bad pharmacist wouldn’t fill my pain pills”.  Doctor gives the pharmacist both barrels before being fed some humble pie by learning that his beloved patient got a month supply a week ago from another doctor.

Patients are horrible translators, historians, and message carriers.  How many times has a patient told you a message they recieved from the doctor (like to stop a medication), only to have it be horribly wrong?  How many times have you had patients spout medical jargon they learned from their doctor about their condition only to have it be sorta right in a ignore-the-big-picture sort of way?  Yet doctors and pharmacists use the patient to carry messages to each other.

“Contact myself or your doctor if your lisinopril gives you a bothersome cough” turns into “My pharmacist told me to stop my lisinopril because I coughed” and “Maybe you should ask your doctor about a pain management referral” turns into  “My pharmacist said that you should send me to a pain management doctor because you don’t know what you are doing”.  The shit that patients twist and fabricate with a single grain of truth just boggles my mind, and just makes bad blood between the doctors and the pharmacists.

What kills my soul (which a lot of things do, this being one of them), is when patients have a tiny-yet-dangerous bit of medical knowledge gained through the internet or one nursing class 15 years ago.  Then the bullshit they spout actually sounds like it really did come from the doctor or pharmacist even though its completely wrong.

So how to handle this?  Easy, treat the child like he’s a fucking 5 year old, and pin a note to his/her shirt to give to the doctor/pharmacist.

In this world, there are two types of social workers:

• The ones you never see or hear about.  The one that the patient calls and they get the shit done fast.  The only time you actually speak with them is a 5 second phone call with an ID/Group/etc number and a “did it work?”.  Pharmacists love these kind of social workers.
• The social workers that are not like the above group which I will elaborate below.

Every profession has its fair share of idiots.  There are idiot pharmacists, idiot doctors, idiot bus drivers and idiot ditch diggers.  The only exception to this rule is patients, which they are all idiots.

However social workers seem to collect and concentrate the “duh”.  The social workers that make their presence known to pharmacists turn out to be the most incompetent, inept, and whiny people on the planet.  They are like like Steve Urkel (“Diiiiiiid I do that?”) of the health care world, out to do good, but end up pissing people off/making it worse in the end.  A whining contest between a crackhead and a social worker? I’ll let you guess who wins. Here is a conversation I had recently with a wonderful social worker:

SocialWorker: “Hi! I’m Billy and I’m a social worker”

TheAngryPharmacist: “Hi billy”

SW: “I got a call from John Smith who said that his Zyvox was not covered and he would have to pay for it”

TAP: “Yeah, his insurance doesn’t cover Zyvox withou-”

SW: “BUT HE IS ILL AND HE NEEDS THAT MEDICATION!”

TAP: *sigh*

SW: “HOW CAN WE GET HIM THE MEDICATION!”

TAP: “Uh, its well over a thousand dollars”

SW: “THAT IS HORRIBLE! HE NEEDS IT!”

I’m going to save you the whining that followed, because to be honest my brain had switched off at that point.  It just involved complaining about the price of Zyvox, how evil MediCal was (oh really?) and that the doctor should just be able to write for something and have it covered.  The whole concept of having a medical resident just write for Zyvox without trying anything else (or doing a C/S workup) completely eluded him.  Oh, and somehow it was /my/ fault that I wouldn’t give him the medicine for free.  Yeah, COMPLETE knowledge of how the system works.

Here is another gem:

SW: “Hi! Im Jane, the social worker for Billy Mays”

TAP: “Hi Jane”

SW: “Billy’s MediCal isn’t working, and he’s out of medication, what can we do for him”

TAP: “Well, he’s should only be out of Prevacid, he can go a day or two without it”

SW: “Well, can you fill the Rx, then call MediCal and find out when his coverage will be turned back on and bill it then?”

TAP: “Uh, no.”

SW: “Why not! HE NEEDS THE MEDICATION! HE IS IN PAIN!”

TAP: *sigh*

These two were in the span of about a week of each other. They were different social workers but I assume must either share the same lead-coated coffee cup or used the same lead-painted crib growing up.

Whenever a Medicare/Medical patient comes in and say “I spoke with my social worker about my MediCare Part D coverage” I want to bang my face against the counter.  99% of these cases end up in the patient not having coverage for a month (while one gets shut off, and the other starts the first of the following month) and suddenly it becomes my problem.  For someone who supposedly knows how the ‘system’ works, they sure manage to screw things up.

Like I said earlier, there are social workers out there who are completely ninjas and are awesome at what they do, however they never TALK TO ME!  Share your funny social worker story!

As I was reading a drunken rant by The Angriest Pharmacist about unions, I started to think as to why haven’t pharmacists formed a huge union to fight the evil employers about working conditions, etc.  I know that the topic has been brought up before, but yet a union doesn’t exist.  I came to a few conclusions as to our profession:

• Pharmacists who bitch about their load, how many Rx’s they have to do, their hours, just working conditions in general (ie: not the patients like I bitch about) play the “I am/my position is in demand, so I should get work conditions of X”  Thats fine and good, but if you’re in so much demand, go and work for someone who doesn’t put you through such a shitty work environment.  I mean that’s pretty simple isn’t it?  Eventually when NOBODY wants to work for Evil Corporation X, maybe they will give you more techs/shorter hours/pee breaks/lunch, etc.  Oh, Evil Corporation gives benefits/pay of Y above everyone else, never mind.
• Pharmacists (like their Doctor counterparts) are alpha creatures.  We are the keepers of the castle of pharmacy, and we all have an opinion.  A union of Chiefs does no good if there are no Indians.
• Pharmacy is different depending on what chain/independent/hospital you work for.  Maybe your working conditions are fine (like mine).  A union won’t work if only the chain pharmacists join because some peeps who work for Target and the grocery stores are happy with their working conditions.  Is this union going to be the “High Volume Chain Pharmacist Union?”  Doesn’t work that way.  To be effective everyone needs in.
• A pharmacy union would need mandatory enrollment for all pharmacists.  Like long-shoreman, electricians, etc we would need everyone to be signed up and pay dues into this union.  We all know how much we love to be forced into things, let alone forced into things where we need to pay money.

Now lets take things into perspective.  Say all the pharmacists in the nation joined this uber powerful union.  We’ll call it the American Pharmacists Union (APhU).  Now a bunch of CVS pharmacists go to the union for help because CVS is evil and they treat their employees bad (or whatever they whine about this month).  The union leader, to show CVS that the APhU means business, calls for a strike.  Do you really think that pharmacists would listen to that?  Realistically, do you really think you’d follow the orders from some union leader (who probably has not worked a day of retail in his life, but is a damn good bullshitter) as to when you can and cannot go to work?  What if you work for a CVS that doesn’t treat its pharmacists like shit, are you going to take one (and make your patients take one) for the team for a bunch of “woe is me, 100 with only me and my tech!” whiners in a town you’ve never heard of before? Well, you’d have to.

Now APhA and the associations should be stepping up to fight bad working conditions, but then they’d have to give up the revenue for that full page add from CVS on Page 58 in the August Pharmacy Today (and a small Walmart ad on page 60).  Hell, if I didn’t know anything about pharmacy and was looking at Pharmacy Today, I would think pharmacy involves sitting smiling in front of a computer screen, and getting handed awards while shaking hands and smiling all day.  This is between the page after page of drug-company ads for another “Me Too” formulation of an already shit product or Savella, a drug made to treat a made-up condition.  Where are the crackheads yelling at you? Where are the pictures of some strung out druggie pointing her finger at you while shouting at the tops of her lungs? The happy old white people in the magazines dont exist in real life. Where are the cow-eyes and looks of “duh” or that dirty plastic produce baggy full of scummy bottles?

So we have associations for every aspect of pharmacy, why are they not taking care of the work condition problem?

I’ve ranted about how DAW-1s in the past, however a good chunk of “doctors” out there cant seem to understand exactly what it means when that “Do Not Substitute” box is checked.  I use the word “doctors” in quotes because I am also referring to people who write prescriptions such as NP, PA’s and the extremely clueless Dentists and Certified Nurse Midwifes.

In California (and pretty much every state), pharmacist have the authority (which are few and far between, trust me) to switch from a brand name drug (Prilosec) to an FDA rated generic alternative (Omeprazole).  We can do this all by ourselves!  7 years of college and a doctorate degree and doctors have trusted us with the power to switch the Brand to the Generic of a SINGLE DRUG without their all-knowing permission.  I’m sure that when this law was snuck under the doctors nose they shit all over themselves!  In fact, most pharmacists love it when doctors write the old brand name because I’d rather see “Adderall” than “Mixed Amphetaminescribblescribbledontknowwhatcomesnext”.

Now here is where the confusion comes in.  That little box that says “Do Not Substitute”, that is to prevent us from switching from the BRAND name to the FDA approve generic FOR THAT DRUG.  Idiots seem to think that we have the authority to switch from a Brand name to ANY GENERIC, we don’t.  Unless you work for a hospital, have some P&T committee overseeing you, or have some collaborative practice agreement; pharmacists CANNOT switch to a completely different drug (even in the same class) without the doctors approval.  We can just switch from the BRAND to the GENERIC of the SAME CHEMICAL.  See how simple? Obviously not.

What blows my mind is when Dentists (*sigh*) check that box and write for Amoxicillin and Ibuprofen.  So I read that the Dentist (*double sigh*)  does not want me to auto-substitute a generic for… the… generic that he/she… uh.. just wrote for…. yeah.  Certified Nurse Midwifes (uh, yeah, they can write for Rx’s and we cant, how’s that kick in the nuts towards our profession) LOVE to forbid me from substituting Docusate.. uh.. for docusate… hmm..  These people have prescriptive authorities?  They don’t even understand what that damn little box means!  “Oh, I don’t want this pharmacist substituting a generic alternative for this GENERIC THAT I’M GOING TO WRITE FOR!”  I’m sure that DDS’s and CNM’s have their reasons for needing prescriptive authority, they could at least do their profession some justice by not sloppily abusing that privilege.

The other end of the spectrum is when MD/NP/PA’s write for Lipitor and check the little idiot “Do Not Substitute (DNS)” box.  Uh, is there a generic out for Lipitor?  Why are you preventing me from switching to a generic that hasn’t even come out yet?  Do you even know what that little box does?  Obviously not.  Single-source drugs (meaning drugs that come from one source, hence the name) doesn’t require you to check the little “DNS” box because there isn’t anything to substitute them for (hence, single source)!

Then you call the doctor up and call him on it because obviously the insurance company is NOT going to pay for a brand name that costs 100x more than the generic just because he checked a little box.  What response did you get?  “Oh, the generic is fine.”  I really feel like answering “WASTE MORE OF MY TIME BY CHECKING THAT MOTHERFUCKING BOX YOU ASSHOLE!!”  Doctors can be so damn frustrating at times.  All that college and they can’t understand a simple concept like the DNS box on their Rx pads.

Don’t get me started on OB/GYN’s and checking that fucking box on prenatal vitamins or iron tablets.

If the state allowed us to switch a non-covered brand to a class-equivalent brand/generic (meaning switch the whole drug to another in the same class) then I can see them checking the box for everything.  However we can’t switch drugs, so checking that box just because you have no idea what it means just makes yourself look like an idiot.

This has been a Public Service Announcement by The Angry Pharmacist.

I’ve ranted about this. JP has ranted about this in Drug Topics. However some big-chain pharmacists *ahemWalMartahem* don’t seem to get the idea across.

You see, I really hate to bug pharmacists for copies/transfers.  Usually I’ll call their confusing little voicemail system, hit the proper combination of buttons to get to the “Voice Mailbox for New Prescriptions” (that is reserved for doctors), and kindly give all my information, what I need, my fax number, etc.  I figure that the pharmacist will check the mailbox for any new prescriptions, get my request, and fax over my copy.  Works great for Walgreens, Rite-Aid, CVS, etc.  The pharmacists like it too since I’m not bothering them and they are already in the ‘write down stuff’ mode when they check the voicemail.

Note to all of you out there:  I tried to do this with WalMart.  I waited 3 hours with no response.  I called WalMart and was left on hold for over 10 mins.   My tech called on another line and said “My pharmacist has been on hold for over 10 min, why are you answering my call?”.  I didn’t even get the common fucking courtesy of “The pharmacist is tied up, can he/she give you a call back”, “What numbers do you need and your fax number and I’ll give them to the pharmacist”, or even a “We’re really sorry, it’ll just a little bit longer”  I was just left on hold for 10 long non-intterupted mins with nothing but dead air to listen to.  I fucking hate being on hold because not only do I hate working while cradling a fucking phone on my shoulder, but its $1/min wasted for the store and just tells me what kind of outfit I can expect when someone does pick up the phone.

The response when I finally got through to someone (15 min hold time total by the timer on my phone): “You shouldn’t leave copy requests there, you should just call us.” *blink blink*  For once, I was at a total loss for words…  Yeah, after I was left on hold for 15 mins he said that…  Please tell me that I’m not the only one who thinks that what this pharmacist just said the completely wrong thing to me.  I’m sure glad I wasn’t a doctor leaving a new prescription on that voicemail system since it would be 5 hours before it would be filled!

Is this really how we treat our own?  Seriously, what the fuck.

Listen, we’re all busy.  We all have shitty patients we have to deal with, shitty doctors offices, and shitty staff.  We are overworked and stressed.  However that’s no excuse to shit all over someone who is in the SAME boat you are in and sooner-or-later you’ll need a copy from them.  If you didn’t get the whole idea about professional courtesy from my previous rant and JP’s rant, then obviously you need to go work in a mail-order joint and get the fuck out of retail.  I don’t give a fuck what your ‘corporate’ office says, or what your district manager or store manager says.  You know those people who boss you around in ‘management’ positions?  They couldn’t cut it in the trenches, thats why they have to boss you around.  If your manager actually works retail, they won’t bitch at you for letting that whiny crackhead bitching up a storm wait a whole 2 more mins longer while you give some professional courtesy to someone else who has that exact same crackhead bitching at them on the other end of the phone.

Unlike how I act on here, I choose to take the high road.  I don’t “lose” copy requests from pharmacies that are slow/unresponsive to copy requests.  I don’t get even with them.  I don’t fax over reams of pure black pages in the middle of the night to burn out all of the toner in their fax machines nor filling up their voicemail with me singing drunkenly in their voicemail at 2am on weeknights.

In the long run, its not worth trying to get even by petty things, real retail pharmacists are better than that. What really counts is when you’re at that fancy CE dinners (with the free booze), and after 4 gin’s you meet that WalMart pharmacist from the store that is giving you grief.  As you look him/her straight in the eye, you introduce yourself and say “Your store is the shittiest store in town for sending out copies.  I send copies to you within 10 mins, and you send them hours later if that.  That’s really bullshit, I hate calling your store, but your lack of service brings a ton of business to mine so I’m forced to.”  Then you see the reaction.  You see the stammering, the excuses, and with all that Gin in your system you can get that good concerned/blank look.  Blowing up on the phone at the person won’t do a bit of good, but in person, face-to-face is when you can really nail someone.  And after all of the excuses and apologies that fly in your direction, you just shake your head and walk away disgusted leaving them feeling like shit.  One of these days I’m going to stop by the DrugMonkey’s store and use this on him, then we’re going drinking afterwards.  I know he’ll want me to subsidize his bar-tab.  Some things never change (I kid, I kid!)

I’m prepared for the onslaught of Walmart pharmacists now who read this site commenting with “You’re right” or “You are so wrong I’m never reading this site again”.  You know, thats life, sometimes the truth hurts and it takes someone to publically blast the lack of professional courtesy that some chains have (plus you all get off on how awesome and blunt I am).  If you give this letter to your boss/DM and they say “eh, whatever” vs “I’ll look into this”, doesn’t that say right there what kind of company you work for and how they view pharmacists?

Walmart – $4 prices, $4 service.

Unlike some angry websites out there, I will never make you send money to a politician campaign fund for articles (who will just be bribed by your employer to sit there and do nothing like most politicians.  More Kool-Aid anyone?)  No briber..er..contributions needed here, we only serve raw recycled rants with some filler thrown in for roughage and some ads thrown in for good measure.  Not that I’m against anyone sending me money or you throw-..er..donating your money to someone…. Of course I work for an independent so what the shit do I know about anything?

Anyway, I’m sure you get the point.

Does anyone else find it a bit sad that our profession has sunk to a level where the chains have to bribe patients to get their Rx’s filled?  Oh, its disguised as “gift cards”, but its really bribery.  Lets call a duck and duck here.

Rite-Aid is now offering $25/rx (max of 4) for prescription transfers.  Wait, Rite-Aid?  They are still in business?  Drugmonkey said it best: New Rite Aid slogan: “We are the Chrysler of health care”

Obviously Rite-Aid/Walgreens/CVS/Whore-Chain-Y has some real winners running the show to think of these bribe cards.  Now let me ask you this, is the patient who transfers his Rx’s over for a $25 gift card (max 4) a patient that you really want?  Is this patient going to be loyal to your store and come to you no matter what?  No! This patient is going to call in his 10 medications, wait until you have them already filled and ready to go, then want them ALL transferred to Walgreens because they are offering free blowjobs with every Rx transfer!  These are the patients who view pharmacy as McDonalds (which most chains I believe have the same outlook.  Drive thru anyone?) and don’t give a rats ass about you, your store, your job, or what you say.  They are only fueled by what they are getting for free (and last I checked, it was illegal to give gift-cards to MediCal patients since the state is paying for their Rx’s).  This is the patient that will fuck you over the moment you let your guard down.  This applies to any store that does the gift cards/$4 generics/free antibiotics/etc bullshit.  You will end up spending more labor costs on these pain-in-the-asses than you will get back with their shitty insurances/$4 plans.

How about this novel idea:  Why doesn’t Rite-Aid/Walgreens/CVS lower the cash price of its generics to a REASONABLE level (ie: a price that’s based upon actual cost, not AWP) so they wont need to bribe idiots with gift cards.  Why don’t they offer SERVICE (Rx’s in say, 10 min vs 3 hours) rather than a CASH BRIBE to lure people in through their doors.  You know why In-and-Out burger is so damn popular? Because you get a smiling (and always cute) face, good food for not much money, and your order is ALWAYS RIGHT.

However the execs at Rite-Aid (way to drive that plane into the ground boys!) are a whole lot smarter (and higher paid) than me, so that means they obviously know what they are doing (*crash!*)  You can have all of the gift-card freeloaders.  I care about my patients, and my patients care about me.  If thats worth less than $25/rx (max 4) then so be it.  Better off without them.  The’ll come crawling back once the freebie well has dried up, they always do (and like an idiot I always take them back).

Has anyone but myself noticed how pharmacy has turned into a profession of nothing but fighting?

• Fighting patients: Early refills, lost medications, the lies, the bullshit, “Do you have any other insurance cards?”, “What do the pills look like again?”, “There is no way you should be out of those yet!”, “Who told you to double up, and why didn’t you let me know!”, ARGH!!!  It seems like no matter who walks into the store its going to turn into a stressful conversation.  The happy patient who brought their refills in on-time with a smile on their face and a compliment are long gone.  Patients are the number one stressor in any pharmacy.  From bitching about copays (that they think we set) to the pills looking different, they are both the boon and the bane of pharmacy.
• Fighting doctors/staff: Cheap front-end staff, people who cant call in medications correctly, sloppy handwriting, ignorant doctors and their drug-rep propaganda, the list goes on and on.  Most doctors are pretty good about listening to what we suggest (because they know they really have no choice) but it takes a fight with one to ruin your day.  “Yes, doctor, EVERYWHERE is short on generic Toprol XL” to “Are you sure you want Soma 250 or that new Prevacid???” at least doctors are mostly on our side.  Fighting with the office staff is more of a problem, especially the ones who think they know as much as the doctor (“No, I want this!” when the doctor says “I dont care”) when in fact they know nothing.
• Fighting insurance companies: If there was a top-10 list of places to blow-up before you die, I’m sure that every pharmacist would have insurance companies as numbero-uno.  Shitty contracts, reimbursing below cost, unavailable products, rejects, wrong shit on insurance cards, mystery person codes (like person 88), prior auths, “Plan Limitation Exceeded”, quantity limits, sig limits, day supply limits, limits on the limits on the limits, this list never ends!!  It costs a pharmacist $1/min to stay on the phone, it cost the insurance company $3/hr (if that) for that Indian call-center person to answer your call.  Who do you think is getting the deep dicking on that deal?  Fighting with automated systems which require you to say your NPI number 4 times to be transfered to a live person who requires your NPI another 2 times.
• Fighting other pharmacies: Waiting on hold for a transfer for 10 fucking hours or calling every place around town to see if Cracky McCrackhead is doctor shopping.  Pharmacist doesn’t speak english/is too busy to talk to one of his own/is off for lunch/the list goes on.  Yes, it does take 4 hours and 2 phone calls to get that copy faxed over.
• Fighting technology: The fax machine jammed, the printer needs a new fuser, the pharmacy software crashes randomly as you feel like you’re talking with an insurance company when you call your corp help desk.  Some days when the shit rains it pours.  You hit your coffee and dump it into your keyboard or some tech sneezes all over your monitor you wish you could just crawl in a hole and die.

At the end of the day, when you sit down for the first time in 9 hours, you realize that it all is just going to repeat the next day.

Going along with my previous (and popular) socialized medicine post, I have a solution from the pharmacy aspect that I thought of while reading some responses to it.

You see, we shouldn’t have the folks like Walgreens, Rite-Aid (if they are still around), CVS, and the hundreds of independents profiting off of the pain and suffering of our aging and sick population.  We all know that Walgreens charges like cost + $30 on most of their generics, that’s just pure profit and its wrong!  The $4 menu is just suckering you in so they can pass the “savings” off on the bigger ticket items.

The federal government should open its own pharmacy, a huge one, and go 100% mail order for everyone.  They can negotiate directly with the drug manufacturers to drive the cost down, and people will just have one flat copay regardless of drug (the rest will be subsidized by the government).  All citizens will use this pharmacy because it’ll be cheaper than anyone else.  Most insurance plans require mail order anyways, so what would be the big difference doing consultations over the phone (since we do them now anyways).  Sorta like how the VA or Kaiser does it, only on a much larger scale.

Since its the government, it can make its own rules with regard to how many pharmacists/techs it can have.  50 techs to 1 pharmacist?  Sure!  Huge warehouses of nothing by filling machines and techs certified to check off prescriptions? You got it!  You want Cozaar? Too bad you’re getting Diovan and LOVING IT.  Got a complaint? Call this 800 number.  Meds get lost in the mail? Call this 800 number again!

Just think, $5 for Zyvox since the government can tell the manufacturers to either lower their cost or take a hike.  I’m sure they would get a deal also since they run the postal service.

Except… most of you (including myself) would be without jobs because the price would drive down so low that you couldn’t stay in business.  Much like what WalMart did to the local mom-and-pop shops.  At least the cost of drugs (brand name) keeps the chains vs independents in line with each other.  Obviously pharmacists are all about ‘helping the patient’ so our jobs really mean little in the whole grand scheme of things.  Techs on the other hand are set!  You only need a bare staff of pharmacists to just sort through the massive amount of medical data the government would be collecting from filling your prescriptions.

Drug reps would be a thing of the past because doctors wouldn’t have any choice in what they prescribe, it’ll just be what the government approves of.  Hell, maybe they can pay-per-view drug-rep battles to see who’s PPI gets on formulary!

Just a thought you know, because some of you feel that having the government play the healthcare game is a good idea (which I don’t expect you all to agree with me ALL the time, just most of the time when it involves crackheads and Soma).  In fact, the government stepping in is a great idea until they bottom out most of the private insurances (because what private company can compete with the government?  A private company backed by a few billion in shareholder cash that people choose to invest in vs the federal government which is backed by every working citizens taxes that they are forced encouraged to pay.  Lets see who’s going to win!); which turn cause a bunch of layoffs (cue whining), and give them a 4.8 trillion dollar bailout like every other failing corporation gets. But hey! Those laid off people will have AWESOME health benefits regardless if they are contributing taxes or not!

Just a thought I had.  Continue your discussions.