The right and wrong reasons to give your pharmacist both barrels

I admit, my shit is far from smelling like I rose.  I fuck up as much as any pharmacist out there (yes, we do fuck up, more than you think and a lot more than we want).

However, you must choose your battles with your pharmacist carefully.

Its sorta okay for you to give me both barrels when you call in “all my regular monthly meds” and I miss that albuterol MDI that you filled 9 months ago because (silly me) I didnt realize it was part of your “regular monthly meds”.  I mean in my world, meaning common-fucking-sense-land, the world ‘regular monthly’ means the shit you take every month; like your vicodin, soma, and the other unimportant non-narcotic shit that you take to keep your sorry ass alive.  Usually I’ll send my apologies (and raise the price on your narcs for next month) and kindly ask that next time you tell me if you need anything that you dont pick up every month.  Oh, and I’ll be sure to remind you of this conversation next month when I fill your albuterol and you scream at me that you don’t need it, and ask why did I fill it.

Fuck I hate not having the power to read minds… Or blow people up with a thought.  I’d be the shittiest X-Men around.

However dont you ever, fucking EVER give me both barrels because your lazy sorry ass didnt realize that you had 0 refills remaining and I haven’t heard back from the doctor (and of course you’re out).  Thats your fucking fault, not mine.  If you want me to hold your hand like your mother, then I reserve the right to slap the living shit out of you for being fucking stupid like your mother should have.

Don’t ever make me drop everything Im doing because you need your hospital discharge meds filled RIGHT NOW that were written a fucking week ago.  You waited a week to get them filled? You obviously can wait for me to get to them after I finish the Rx’s of the people patiently waiting who do have their shit together.

Don’t ever put me in the middle of your fucked up family issues because your ‘caregiver daughter’ (who has picked up your narcs for the last year) decided to sell them to get that new tattoo and you want me to get the drugs from her.  Don’t even get me started with your daughters crackhead boyfriend who ‘stole’ your oxy 30’s.

Don’t ever give me both barrels and throw down the race/poverty/etc card as an excuse on why I wont fill your narcotics early.  Oh, and by early, I dont mean like a day or two, I mean like 2 weeks early.  Race/poverty/etc isn’t a excuse card for being stupid and not taking responsibility for your actions.

Going on vacation? See 0 refills on your bottle? Obviously you planned enough ahead to get plane tickets for your 3 month trip to a far away land yet were mentally incapable of at least giving me a week’s notice to try to get auths for your medications that (you know) you need to survive.  Must be nice to go on vacation for 3 months.

Fuck, I need a drink after writing this.

Back with a vengeance.. Well, not really.

So, here we are again.

Where as the mighty angry one been all these years?  I’ll be honest.  Life.  Thats right, fucking life.  Happens to the best of us boys and girls.  Get married, have kids, and suddenly you’re on statins, getting a colonoscopy, watching your pharmacy infamy die a horrible rotting death, and watching ‘my 600 lb life’ hating that fucking doctor’s gold stethoscope.

Well, that and I just didnt give a fuck anymore about the daily crackhead grind and idiot patients.  I had reached pharmacy-zen where every problem was no big deal.  I expected the early refill bitching and the stupid lost script song and dance.  I expected idiots to not understand they had a deductible first of the year (like the previous 5+ years that they magically ‘forgot’ about).  It’s hard to rant about shit when you expect it coming in the door for 10+ hours a day.

Plus the server the site was on was held together by duct-tape and bailing wire.  I was afraid to post for fear of the entire deck of cards falling down.   No really, it was a strong Go-Lytely fart away from exploding.

Not to mention (I absolutely hate this fucking part) that I had to watch what I post and couldn’t be as raw as I had in the past.  Yeah, censoring yourself sucks.  However since our president is 1000x worse than I am, fuck it trebek!

In other words I’m as full of excuses as your typical crackhead…. Only i’m not hounding you on the phone…. or staring at your face… or wishing you dead… or wanting a gallon of prometh with codeine for my ‘bronchitis’…  Ya’ll got the yellow norcos? I’ll pay cash!

HOWEVER!  That being said, after hearing the calls of help from you all, I dumped money into a server, got my shit together, got a new shitty site layout that will not be 100 years out of date, and decided to MAKE PHARMACY GREAT AGAIN (Okay, so maybe I wont make it ‘great’, I’ll just make it suck a whole lot less)!  Like motherfucking Batman coming out of retirement (actually I think im more of a Deadpool’ish sorta crazy).

Motherfucking #tapreturns (for the record, I fucking HATE hashtags.  Like really hate them.  Twitter ruined the internet.

Enough about my excuses! Here are some tidbits that are in the pipe for ranting:

  • eScripts and how much they make my life hell (complete with image examples of some whacky ones if I can figure out how to strip all the metadata out so people dont get in trouble with the HIPAA police)
  • Docs who take altered C2 Rx’s and say “Oh just fill it anyway”.  Yeah, what the fuck.
  • All the bullshit the DEA makes us do now for stupid Opoids + Soma + Benzos.  As if I did enough babysitting.
  • Just general fucking bitching about DIR fees and other insurance bullshit.

Norpocalypse

It had the makings of a perfect fairy tale story:

There stood princess Norcoella, her yellow gown flowing in the slight breeze of the crackhead party.  Surrounded by her fellow patrons; crackheads, pushers, dealers, she was on top of the world.  Everyone bowed down to her yellow goodness.  The lied, cheated, faked to get the privilege of holding her hand just for a moment.  The twins, Tylenol #3 and #4 sat there, thumbing the big 3 and 4 on their chests in disgust and depression.  They were once the kings of the party, now pushed aside to this yellow bitch that everyone wanted.

Then on 12:01am on 10/6/2014.  Her party came to a close.  DEA agents stormed the royal  yellow palace, seizing Norcoella and throwing her into the big-boy party.  Demerol, Percocet, Morphine, Fenantyl, Dilaudid, Oxycontin.  She stood there shocked as they all mocked her for the lack of her analgesic potential.  Then, the undisputed king of the C2 party, King Oxycodone the IR himself made her bow before him.  Her crackhead reign suddenly came to a close, and soon, she’ll be forgotten.

On 10/6/2014, the DEA made all hydrocodone-containing products C2.  No more refills, no more phone-ins, no more faxes.  Hard copy (or EPCS e-scripts) only please.  A day known as C-Day, Norpocalypse.  A day where millions of crackheads screamed out in withdraws, and were suddenly silenced.

I have mixed feelings about having Norco go C2.  As I lurk on the various pharmacist forums, other than the billion of “Will I have a job/Whats being a pharmacist like” newb questions that get posted every fucking day, I feel the pain of some of my fellow brethren.

Some stores require all C2’s to be locked in a safe (rather than be inter-dispersed in your inventory).  Others require an RPh to count all C2’s.  Tons of new paperwork, filing, computer changes are dictated by this DEA decision.  Ambiguous laws and interpretations of said laws about existing refills of Norco run rampant.  Nobody really knows what to do for fear of the DEA’s wrath.  Its a mess, a huge fucking mess.

On the other hand, some doctors offices are closing up.  Last week everyone who comes in gets #120 Norco-10, today the office refuses to dispense any Norco.  If you’re an MD and feel that Norco is necessary for your patient to live a normal life, what difference does it make if its a C3 or a C2? Oh, probably because you can’t justify the bucket-load of Norco you shovel at them to get them out of your office.

This will cure one problem though, no more arguing about refills for Norco.  Doctors will be forced to move to ePrescribing C2s via EPCS to prevent their offices from being swarmed by people scrambling to get a hard-copy.  Nothing good can come of this.

I do however see a huge problem with Norco going C2.  That means the street value of Norco will increase since it’ll be harder to scam your MD with some ‘lower back pain’ bullshit story to get a handful of them.  Doctors don’t want to be under the gun from the DEA for writing C2’s.  You can guess what happens then.

10/06/2014 – C3 Norco, we shall never forget.  Save an empty stock bottle folks to reflect on a time where Norco paved your angst like a yellow brick road.

Purpocylpse

I cant believe I’m writing this.  The news is so shocking that my brain cant wrap around exactly how this could be.  I mean, part of me wants to do cartwheels, and another part of me just wants to sit and sob.  Its like I came home to find my wife making out with another hot chick and asked me to join while throwing me a huge dildo.   Shit I’m getting blue balls just typing that.

Hold on to your hats because……………

ACTAVIS IS NO LONGER MAKING PROMETHAZINE WITH CODEINE!

IM NOT FUCKING KIDDING YOU! THE INFAMOUS PURPLE DRANK IS FUCKING DEAD!

Dont believe me? Check your ordering system.  Amerisource has no listing.  McKesson has MANUFACTURER DISCONTINUED.  One of my sources reported that someone called Actavis and they stated that they have just decided to stop making promethazine with codeine.tumblr_mklix14Yc81rrotfzo1_500

No longer will we be getting “do ya carry da actavis?” calls.  No more bitching from the crackheads that the QT or Hi-Tech brand “Dont work” or “I be allergic to dat shit”.  No longer can people say “I can only take Actavis” because you know what, they can take a bunch of fucking nothing now.

Prometh with Codeine will no longer taste like ghettofab syrupy purple, it will taste like how all cough syrups should taste, like goat anus.  They aren’t meant to fucking mix with Sprite and enjoyed after a long night of fucking your bitches and collecting taxpayer-funded benefits; they are meant to be choked down because you’ll do anything to get rid of that fucking cough.  Wait, did I imply that ‘da Actavis’ WASN’T used for legit medical reasons?  Well unless theres an ICD9 code for “My life sucks and want to get high”; then yes, I did imply that.  If you want to get fucked up on cough syrup, deal with the aftertaste of pennies and last nights digested dinner in your mouth you fucking crackheads.

This is fucking great.  Hats off to Actavis for actually realizing that their name was synonymous for “Abuse and Diversion” like Kleenex is to facial-tissues. If Watson stops making the DAN Somas, I think I just might die.

Now if we can only get QT to take the yellow out of the Norco 10.

Paying the PBM’s to service them.

So I had this nice 2014 post queued up that involved:

  • Me shutting down the site and hanging it up.
  • Me meeting this awesome hospital pharmy named Michelle who has (of all else) a totally awesome cooking website that (used to) throw down f-bombs worse than yours truly AND wrote a kick-ass cook-book (plus she was all “OMFG FAMOUS PHARMACIST” when she met me).  Every fucking pharmacist is published but me.  At least hers involves food porn and fucking tons of delicious bacon.  Uh.. Fucking as in the adjective, not the verb of her having sex with bacon.  Sorry NomNom, didn’t mean to imply that you have sex with bacon.  Fucking bacon is delicious though.. ARG FUCKING AS AN ADJECTIVE GOD DAMMIT.  You get the picture.  Her website is http://www.nomnompaleo.com and go buy her book, its awesome.  Her little cartoon of herself has no nose, which sorta bugs me, but I will certify, under penalty of perjury, that in real life she DOES have a nose.
  • Me getting pissed off at this derpy douchebag patient and reviving the smoldering blaze of TAP that lives in my soul.  No, really.  I almost brained this fucker with the cash register I was so fucking pissed off at his utter waste of a life, and a resulting waste of my time.  Then his mother got all involved.  He is 40 by the way, that should speak enough right there.
  • How in the past few years, I have taken into consideration not offending anyone (ie: Crackheads) with my ranting, and by doing so I am doing you all a grave injustice.
  • How gasoline cans in California fucking suck with the safety valve (instead of a direct spout) and as a result you spill more gas on the ground (and all over yourself) then you get in the tank, thereby making the “save the world” mentality that California wants to impose on people a fucking waste of effort, not to mention a huge safety hazard.  Plus you smell like fucking gasoline for a few days and must resist the urge to light yourself on fire to end it all.
  • Other shit that Im too lazy to type because Im fucking livid about the topic below.

However, this topic came up and is far more important (and involves far more swear words).

We all know that drugs are like stocks, the price goes up and down (mostly up).  However recently, a ton of shit has just skyrocketed in price.  Take various creams.  They used to cost 10 bucks a few months ago, and now they are just shy of 100.  Digoxin ranges from 900-1000 dollars for a bottle of 1000 where a few months ago it was 50 bucks for 1000.  Morphine ER has jumped from pennies to fucking hundreds and Endocet is almost 100 bucks a bottle.  Nobody knows why the price is going through the roof, and nobody has any answers other than the generic drug manufacturers must enjoy raping the American public so they can sell their shit in Mexico for reasonable prices.

Now usually this isn’t a problem, because as the price of the drugs go up, the PBMs (The companies that YOUR insurance companies hire to do the processing/computer shit and pay US, the pharmacies) adjust their prices and pay us more.  Its done on a contract basis like Cost + shit + a crap fee.  Its not the greatest, but it keeps the doors open and paychecks from bouncing.

HOWEVER, due to some fuckery or just plain greed, as the price of medications go up, they PBM’s are paying based upon the OLD price.  That means that little ms crackhead who gets Morphine ER that now costs me $200 the store is getting a fat check for $40, the price of the drug from 5 months ago.  In other words; under cost.  Thats right, I’m expected to dispense medications and take a $160 dollar loss.  Then the fucking twat has the balls to bitch about her $3 copay and take up 20 mins of my time as she bitches about what she can take (for FREE) because her turds resemble a fucking piece of plaster-of-paris.

So whats a pharmacy to do?  Take care of the patient so they don’t die and take a $100+ loss? Or tell her to take her shit elsewhere? The choice is easy, give her back the Rx, tell her it pays under cost, and you dont know where she can go to get it filled.  Per your contract with her insurance company she can’t pay cash (HAHAH PAY CASH!! AS IF!!).  Only rich fuckers and chumps pay for their medications now days.  Its not called Freemacy for nothing.

There are two huge points to be made about this:

  • Unless I can pay my fucking house payment and put food on the table using “Good Deeds” as a currency, Im not going to take a loss filling a prescription.  That little lady, when push comes to shove, doesn’t really give two dicks about you, your kids, your store, or the good deeds you do for her.  She wants her fucking dope, plain and simple, and she doesn’t want to pay for it.  By you taking that loss, you have just shown her that your time/profession/skills are worth nothing to her.  In fact, you’re just a fucking whore to her and her insurance who takes a fucking and then gives $100 for the privilege of getting your asshole reamed out.  Its reverse prostitution, and we as a profession are better than that.  Well, I used to think better than that, until the chains started handing out gift cards to PITA patients instead of backing up their abused staff and showing these fucks the door.  Grow a fucking pair chains!
  • By refusing to fill the Rx based on losing money, you are putting the ball in her court.  The insurance companies dont give a fuck about the pharmacies, but they give a fuck when she gets on the phone and cries that nobody will fill her medication.  SHE pays their paychecks, not us.  A problem with HER insurance reimbursing is not OUR problem, its HERS.  Does the grocery store give a fuck that your credit card was stolen by hackers who got into the Target systems and thereby wont work? No, because its YOUR credit card through YOUR bank so its YOUR responsibility to take care of that shit.  If enough patients complain and whine then maybe they will do something about it.  Yeah, and I can pull gold out of my asshole.

Now this all sounds fine and good, however the chain stores (and the pharmacists who staff them) really don’t give a shit if they lose money on an Rx.  They hand out gift cards to whiny fucks who complain that their prescriptions weren’t fill in 2 seconds or less.  The chains are so afraid of losing business they will gladly take that loss with a smile on their face.  The chain stores are killing the profession of pharmacy.  By having the chains put up with this bullshit, they are just showing the PBM’s that we are nothing but fucking whores who’s time and education are worth absolutely nothing (because we will fill the Rx even if we lose money on it AND reward patients for abusive behavior).

I’ll just make another point, that the PBMs, the insurance companies that hire them, and the pharmacists who work for these companies are nothing but fucking idiots.  They are so blind to the big picture, that they have NO CLUE that independent pharmacies are the counterweight to a huge big deep dicking thats on the horizon.  Let me elaborate:

You cut your reimbursement so much that it drives all the other pharmacies out of business.  Sure you make a zillion dollars and your CEO can afford that beach-house.  Sure you traitors to the profession get that fat bonus for saving “all this money” and the CEO strokes your cock a bit for being a “good little insurance-company pharmacist” for saving their plan a ton of cash with your bullshit cost-analysis and P&T handjobs.  However now all there is left are Walgreens, CVS, and Rite-Aid.  Three huge companies that will gladly pay that million dollar anti-trust lawsuit fine for the sole ability to COMPLETELY FUCK OVER YOUR INSURANCE PLAN AND RUIN YOUR PBM.  How?  Easy.  The men in suits from Walgreens come to your insurance company and want to talk about their contract:

“So, since there are no independents left, we want to renegotiate our contract.  We want cost + 25% + $15 for EVERYTHING.  Oh? You don’t like that? Well then I guess you’re going to lose a few hundred stores in your network.  Oh, and see CVS and Rite-Aid? They want the same deal that we want.  Man, its going to suck for you when the members who use your plan cant go ANYWHERE ELSE to fill their prescriptions because your shit reimbursement rates put the independents all out of business.  Why don’t you think about that for a few hours while we go to lunch with the CVS and Rite-Aid execs and discuss if your plan fits within our business model.  Oh, and we don’t care if you sue us for anti-trust, because we’ll make up that fine in a month from this revised contract.  Im sure that your members will understand.  Chao!”

You have painted yourself in a corner with only a few HUGE chains left.  Huge chains with a TON of stores that your members are forced to go to because there are nobody left.  Your penny pinching now cost you your anal-hymen.  It fucking kills me how people shop at Walmart because they have done the exact same thing to the manufacturers of household items because there are no little mom and pop shops around anymore to offer any competition.  They can name their own price, and that price is a few steps up from FREE.

So when you fill that Rx and see the fat negative reimbursement and your pharmacy system blows up with warnings that you’re losing your ass; think of me.  Think of where you are going to work when the toilet of pharmacy finally flushes and we’re all out of a job.  I’ll see you fuckers in the unemployment line with a huge smile on my face and a huge bowl of “I FUCKING TOLD YOU SO” for you to eat.