Paying for our time, making money, and screwdom

Currently the only way that us pharmacists get paid in a retail setting is by filling a prescription. The store makes zero dollars directly on phone calls, walk-in advice, or anything other than filling a prescription. Now I realize that being nice and giving advice = more patient support = more Rx’s for that patient filled at your store vs other stores = more money in your pocket. However, taking that phone call to help Ms. Jones find out what white pill is her lasix = 5 less Rx’s you can fill/day = less money made vs if Ms. Jones had not called.
So we already are giving away a valuable service for free rather than just machine-gunning Rx’s out and making the store some money. Here is where the insurance companies take a good natured thing that we do for society, and bend us over for it. Medicare Part D is forcing many of the smaller independents out of business. AWP-95% + 0.01 (here is your 1 cent dispensing fee, just hand the pills out in ziplock baggies with the drug/patient name written in sharpie on the outside).
So, stuck in a clusterfuck between the Insurance companies and being the most benefit to society, we have painted ourselves in quite a corner. Our choices?

• Screw patient care, hammer out the Rx’s as fast as you can, and stay in business. Possibly fuck up and kill someone in the process by a medication error.
  vs
  • Maintain patient care, be the most trusted profession, and flip burgers on the side because your store went out of business.
    vs
    • Charge for services, have patients go to corpo-chain X where they get treated like shit, but dont have to pay the pharmacist for sorting out their pills because they dumped them all into a candy dish and forgot which ones is which.
      Pretty screwed arent we? But alas, here is the kicker:
      Insurance companies are the cause of this. They are the driving factor in why we need to hammer out at least X Rx’s a day to break even (but cutting reimbursement rates). However by making us do this, they are increasing the chance of medication errors which will land their patients in the hospital costing them /more/ money in the long-run. So they force us to fill more Rx’s per day with less staff, yet they gladly pay out the ass when we fuck up and someone lands in the hospital! Ingenious!
      So how do we fix this? Obviously the insurance companies are reporting record high profits year after year, so the answer isn’t to increase our reimbursements. Medicare part D has that patient care thingy (where they pay us like $65 bucks for an hour of consultation or something like that). But if you get a net profit of $10/Rx (HAHAHA! Quit laughing you guys!!) you can do at least 20 Rx’s an hour and make more than that. Plus you have a set amount of time to bill for the Medicare part D consulting before it sunsets and you cant get anything. Not to mention its probably paper-billed and not online billing.
      Answer? We’re screwed. Plain and simple. Short of selling the narcs out of the back door (or not taking any insurances and just charge patients your usual&customary) we will never truly be paid for our time and knowledge.

Comments #

Comment by Melissa on 2007-01-29 11:18:27 -0800 #

Hi angrypharmacist…I’m not sure what the solution is to trying to get paid more for your filling Rx’s in the US is, but here in Canada, our standard dispensing fee is $10.70 per Rx (goes up to $15.70 and $20.70 if the cost of the actual drug we’re using is $75-150 and $150+ respectively). We are usually looking at 125-150 Rx’s per 10-12 hour day which seems busy enough for us and leaves lots of time for counselling/med reviews/ consultations etc. which is also nice. It’s too bad the insurance companies/medicaid/medicare programs have done that to you and the profession, but like I said I’m sorry, but I don’t have the answer for you.
Keep up the good work on the blog 🙂

Comment by LJG/Pennsylvania Independent on 2007-01-29 12:14:05 -0800 #

I have bipolar disorder and have been in many pharmacies since being diagnosed with it. (Diagnosed with ADHD in 1997, Bipolar Disorder in 2000.) I have ventured into many pharmacies, both local owned and national chains and had both good and bad experiences from both.
However, my best experience came from a local pharmacy, who was able to go the extra mile and was able to get me on a patient assistance program when one of my meds was too expensive even with the co-pay(was like $55).
I am no longer on meds because of insurance reasons and the pharmacist that helped me retired from the business.
My insurance will not cover any type of mental health treatment, except for hospitalizations, but I would have to pay for any medication while inpatient.

Comment by Bill on 2007-01-29 21:04:08 -0800 #

I suspect the DrugNazi may well disagree with me on this, but it seems like the more the govt gets involved in health care, the suckier it gets for everyone. I didn’t realize you all got hit up for advice so much though. I go nuts b/c I write software for a living, but people are always asking me to install RAM and stuff like that, which I gladly do for friends but isn’t really my cup of tea. I can do it the same way I can change a car’s oil. In general though, asking other professionals for free advice is cosidered bad form, particularly if you make a habit of it. It’s a shame you guys get nailed like this.
The really icky part is that even when they pay you, they do it for only 65.00/hr? I bet their PMP charges a little more than that to sit around and explain stuff to them and PMP’s aren’t nearly as qualified as you all.
Whenevre you get really fed up, give me a call and we can start working on a PharmBot with Speech integration to do most of this crap while you can do other things, like read Maxim and drink Scotch.
I wrote a bot for my cell phone that detects who’s calling and is pretty good at answering stuff for them via text messages. Most people haven’t figured out it’s not me. Maybe we could write a bot that , when asked a question, forwards the call over to the DrugNazi (of course we’d only do this for a day or two for humor’s sake, then we could permanently forward the calls to that douche bag you wrote about who thinks the morning after pill is the most dangerous drug on the market;-)

Comment by Jesse on 2007-01-29 21:11:55 -0800 #

We aren’t the most trusted prof. anymore. Nurses are. We’re #2.

Comment by CeeKay on 2007-01-30 10:57:12 -0800 #

What is the solution?

Comment by Mark on 2007-01-30 14:50:06 -0800 #

Just got done filling a RX for Simvastatin thru HIP…copay comes back 3.45 cents profit made=45 cents. Lets face it the facts were just a bunch of cattle being led by a bunch of wolves into a slaughter house. Its time to say FUCK YOU to the antitrust law(set by the wolves) and fight for our lives.
Angry Pharmacy Owner

Comment by Drug Czar on 2007-01-31 04:27:29 -0800 #

I agree with you on this… one thing to remember though. Its not $65 per hour, its $65 per patient. Consults usually take less than 15min each. I’m seeing $75 per patient on initial consult. Do 5 per hour and we’re up to $375 per hour. I wonder where this is all going to shake out.

Comment by canoehead on 2007-01-31 08:36:00 -0800 #

I can understand that pharmacists feel obligated to make sure people understand their medications and how to use them. On the other hand if someone DID dump all their pills in a bowl and expect you to sort them out they should have to pay for that assistance. If you need to give teaching on meds you didn’t dispense- you should be able to charge the customer. If you fix a glucoscan machine- charge too. You can’t take 30 minutes off your workday to do something without productivity value, and something that you weren’t responsible for in the first place. In all those cases if the customer needs to take responsibility for their own education and/or go back to the original dispenser of the product for help.

Comment by VanduchiPharmD on 2007-01-31 20:32:02 -0800 #

Got you beat, Diovan HCT 160/12.5 (or something like that) 90 day supply thru AARP, lost 36 cents on it…I’m so glad they pay me for my time