Yes! Hate Mail!

Wrong on many counts.

1. Family docs are well aware of the costs of the meds. We know which ones
   are covered by the government for seniors, which ones require a limited use
   code for coverage and which ones don’t have a generic equivalent. The
   pharmacists don’t do that for us. If we don’t get it right we get a fax
   from the pharmacy refusing the script.

Are you sure? Why do I see at least three times a day a doctor prescribing Levaquin to a known private pay patient. You know, the types that get pissed off because now they have to wait to get it changed because a 10 day run costs over 100 bucks. Yet when I ask “did you tell the doctor you didnt have Rx insurance” the response is “I sure did, he said it costs ‘about 30 dollars or so’”.
How about the rare times doctors themselves actually call in Rx’s, and say “oh shit” when I say “are you sure you want to prescribe that? Mrs Jones has no Rx coverage, and thats over 200 dollars”.
I call bullshit on your statement. You may know the cost of the medications, but ‘family doctors’ have little to know clue as to how much Crestor or Levaquin or Lipitor costs. Unless I somehow work in town full of retarded doctors (which I seriously doubt).

2. Docs get nothing from drug reps for prescribing their products. They’re
   not allowed to leave anything more than free samples, so no one is getting
   lap dances out here.

Riiiiiiiiiiiiight. You must live in a state that has those ‘free good’ laws out there. We have a clinic next door, and they look like santa waltzing in with bags and bags of free shit. They have paperweights, coupons, notepads, pens, etc, etc, etc. They come with their dinners and golf trips and vacations and on and on and on.

3. Some newer drugs have evidence behind them (meaning large-scale RCT’s)
   proving that they work better. And some patients have had side effects or
   poor response to the older ones. So not every doc prescribing the new med
   over the old one is doing so with no therapeutic intent.

Did you read the studies? Or just listening to the reps who push them. The devil is in the details, and I bet if you actually sat down and read that clinical study (rather than just listening to a talking head), you’d actually realize that the glamor and hype whats news is just a rehash of something old and generic and cheap. Remember the first rule of Journal reading: See who paid for the study.

Rant away, angry one. But maybe you’ll want to step out behind the counter
every now and then and get back in touch with reality.

Dont have enough time too. Im too busy listening to your patients complain about their cost of their medications, answering questions about their health because ‘the doctor was too busy to answer this for me’, and giving explanations/excuses on why your office hasn’t faxed back my refill request/med change in 2 days.
Oh, you’re a Canadian ER Doctor (from what it looks like on your blog, i spent 2 min’s looking at it, so I might of missed something huge). Lets see how this changes things:

• Different laws in Canada with regard to drug reps
  • Different pricing scheme (regulated by the government, not free market) so of course you know the prices of everything.
    • You’re an ER doctor. I hope you have a private practice somewhere.
      I’m at a loss to understand why you are bitching about an American Pharmacist ranting about an American Senior Drug Program and American Doctors.

Comments #

Comment by Rebecca on 2007-03-16 10:11:34 -0700 #

here, here!!!
someone who practices medicine in the socialized universal healthcare system of canada should probably not taunt the angry american pharmacist. our systems are completely different. the two canadian pharmacies i visited in toronto were very pleasant. the pharmacist was smiling.
also, the streets were clean. there were pedestrians. no visible road rage.
utopia? or mars? you tell me.

Comment by Shelby on 2007-03-16 14:14:52 -0700 #

Just wondering how much traffic your site gets each day?
Would you ever want another contributing writer? (Please don’t post my name!)
Anyways, regarding this post, you are right on the money. People need to start reading what you are saying instead of disagreeing with you. You write the truth, and all of its ugliness.

Comment by Drcouz on 2007-03-16 16:03:43 -0700 #

Hmm. Nope, it wasn’t hate mail. I like your blog. And I wasn’t bitching– I was countering your experiences with mine, which have obviously been completely different.
You were complaining about doctors in general, perpetuating stereotypes. So I just thought I would correct some of your misconceptions.
But point taken, things are obviously very different in Canada. I don’t meet with drug reps, it’s against the law for docs to accept gifts from drug reps, and the prices of drugs are different here.
Glad I gave you something to rant about. The hostility is impressive. Either you hate your job, or you need some serious counseling.
And yes– although I’m training to be an emerg doc, I do family medicine as well. I have just come off 6 straight months of ‘private practice’.

Comment by scarletvirago on 2007-03-16 18:20:38 -0700 #

to the good dr: Honey, we wouldn’t be in pharmacy if we didn’t need some serious counseling. American pharmacy employee = must be out of their mind. Come spend a day in one of our private little hell-holes, then talk about perpetuating stereotypes!

Comment by Ashley on 2007-03-16 19:57:17 -0700 #

I really think that a lot of physicians DO understand the costs and somehow magically think it will be taken care of.
Our hospital has a “charity” fund in our budget so that we don’t send any patient away without meds if he won’t be able to get them.. yet our hospitalist last week asks us to fill 30 days of Zyvox for a patient who has an HMO. His reasoning? “It won’t be covered.” Well, no crap, that’s why you do a prior auth. Instead, he wanted us to drop $3k for a guy that had insurance instead of using that money on one of the guys with asthma who frequents the ER cuz he can’t afford to keep his inhaler refilled. The doctors are just lazy.
And my retail experience.. why in the world would a doctor write a script for AugmentinXR for a patient with no insurance? No idea.. but I’ve seen it more than once.
As a hospital employee, we do have tons and tons of pharmaceutical rep goodies, pens and notepads galore. In fact, our hospitalst came down last week after a rep gave him this fancy new book about antithrombolytic therapies and wanted to know why we aren’t using drug A instead of drug B. Probably because drug A is contraindicated in half our patients, but he wouldn’t accept this without a cost analysis.. thank you, drug rep, for wasting my afternoon.
Drcouz: It’s called “The Angry Pharmacist,” what did you expect?

Comment by Mike on 2007-03-17 21:18:35 -0700 #

I don’t think the Canadian doc has it right either. I’m a pharmacy intern in Canada (graduating in a few months) and I can agree that the systems aren’t quite that different. Docs may not get free gifts, but I don’t often see them turn down a free dinner.
They hardly know anything about the drugs, and although our medicare is socialized, drugs largely aren’t.
And we spend a large part of our day correcting Rx’s from doctors who simply don’t seem to understand the system.
Rant on, angry pharmacist.

Comment by A Bohemian Road Nurse on 2007-03-18 11:49:06 -0700 #

Actually, Angry Pharmacist, I like your blog a lot. That’s because until I read it, I had never heard the pharmacist’s side of things. It has been educational for me and will help me in my work—because home health RN’s frequently get very involved with their Medicare patients’ med regimes–both on the pharmacy end and the doctor end. It is we home health nurses who communicate the patient’s tolerance of the meds to their docs, it’s us who talk to the pharmacies to help the patients get their refills, we also review our patients’ med lists to see if any are incompatible, and we frequently set up their weekly med boxes if they are forgetful and can’t manage that task. Also, I know what you mean about the relationships between drug reps and doctors—and I admit that I have mixed feelings about it. For example, when I used to live with a doctor, I went on many a Scottsdale, Arizona trip with him courtesy of some drug rep or another. But lately, the trips are a thing of the past, but the docs still get lots of free drug samples—which I am very happy about because they generously give them to patients (like me) who have no health insurance and can’t afford them easily. Anyway, I like your blog. It’s informational—and you’re funny as hell.

Comment by Kerri on 2007-03-19 22:15:28 -0700 #

Why is a Canadian MD posting about things he has no clue about? Jeez. Work for a year or two here in the good ‘ol US of A. You’ll have your own “angrymd” blog. I’m with ya, angrypharmacist. I cringe every time I hear the words, “But my doctor said it would only cost …..” You can almost hear my eyes roll. Do I tell the patients, “Well your surgery should only cost about $50???” No. Either know your stuff or keep your mouth shut

Comment by Disgruntled Intern on 2007-03-20 20:56:55 -0700 #

To the Canadian doc:
A majority of US family practice doc’s have NO clue when it comes to US drug pricing or insurance coverage. My personal favorite is the quinolone lottery. Most drug plans in the US will only cover Avelox or Levaquin (or Tequin when it was still marketed). That will be $130 for 10 pills please. For children it’s either Omnicef or Ceftin. And if both are covered, one is $20 and the other is $60 so the pt. still bitches at us because you never prescribe the right one.
I had one last week where the MD ePrescribed diclofenac potassium which was $75/mo and the elderly lady it was prescribed for couldn’t afford it. I called back (amazingly actually being able to speak to the doc herself which is a general rarity) and had to describe salt forms of drugs (This is an apple… this is an orange… while they are both fruit… yadda, yadda). And then I got hit with it, “But they’re both generic….” Long story short, I finally had it changed to diclofenac sodium which was only $30/mo. She placed the blame on the fact that the computer told her to use the former rather than the latter…. I give up… seriously.

Comment by Anthony on 2007-03-21 04:51:35 -0700 #

Pertaining to hate mail #3, how many of those “large RCT trials” actually compare the new, expensive med to the old one? Many ARB trials just compare themselves to other ARB’s

Comment by vicodinfairy on 2007-03-22 09:06:28 -0700 #

ER docs in my neck of the woods are more clueless about cost than the family prac docs. I guess it’s because they don’t have to do Prior Auth and such. I had one tell a lady that 10 days of Biaxin XL would run her $20 or so. The GENERIC is almost $100! He might as well have written Levaquin. On the other hand, he also wrote her Tussionex (to the tune of about $120) and she…miracle of miracles…actually BOUGHT the antibiotic and REFUSED the narc!!
There may be hope for humanity yet…

Comment by KK on 2007-03-28 16:34:02 -0700 #

AP,
Just like to give a shoutout and heap on a bit more praise about your blog. I find your writing and insight extremely engaging and quite hilarious, and this is coming from someone who has really no attachment to the medical community at large (a junior in college).
Despite all of your rantings, I’ve always been interested in pharmacy. Is there any way that you could post a bit about pharmacy school and the related things associated with it? I’ve looked over many of the generic Pharm sites and all, but would really appreciate the perspective of someone who’s really ‘in the know’. Would you recommend this job to someone else? What other fields in medicine might be good (I’m currently wavering between pharmacy and medicine, believe it or not) for someone to enter, through the experiences you’ve racked up in the medical world?
Anyway, if you have the time, I (and I’m sure many others) would definitely appreciate it. If not, no worries. Keep blogging!

Comment by Paul on 2007-03-28 20:12:15 -0700 #

Okay, Drcouz – how’s about a viewpoint from a Canadian pharmacist? I can go over some of the points the angry pharmacist went over, with a slant from this side of the border…
First of all, most family physicians DON’T know the prices of most drugs – nor the coverage codes needed for exception status for most drug plans. They do however, know that they can call on us to get prices (which a lot of them do) and they usually take our calls when we attempt to get the codes needed for coverage. We don’t fax the physician to “refuse the script” as you put it.
On the next point, don’t even TRY to tell me you don’t get anything from drug reps. We know better – we’ve seen it…
As for the third point, you’re partially correct – but have all of the physicians taken a critical appraisal course to determine whether the RCT was properly conducted? I don’t think so… I’ve seen “studies” that on first glance seem pretty convincing but on closer examination don’t have any solid evidence to back up their claims. Just because a drug is new and expensive doesn’t necessarily mean it’s better.
You may know prices, and not take anything from drug reps, and read all the studies, but if that’s the case you’re an exception. I’ve been a pharmacist for 26 years and most doctors I know don’t fit that mold.
And before anyone says anything, yes I love my job – and I guess that’s probably why I bristle when someone takes jabs at my profession… To be honest, I kinda feel that most days, the angry pharmacist doesn’t hate his job either. This is just a way to let off steam. Believe me, I can relate…

Comment by Kim on 2007-04-02 18:47:18 -0700 #

I just had to say I love your site. I’ve have some great laughs, but actually learned a thing or two. My husband is your IT counterpart, lol. I tell him he’s the angry IT guy all the time.

Comment by filet on 2007-04-02 23:13:25 -0700 #

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Comment by Kristen on 2007-04-20 22:25:14 -0700 #

Canadian docs.. know NOTHING about the cost of meds.. how could they? There’s no magic book out there that gives them the cost! We get people all the time walking into our pharmacy saying “the doctor said it would only be $30” and I say “how on earth would your doctor know that” – to start with.. there is a Fee difference of about $8 between Wal-Mart and downtown Toronto Shoppers Drug Marts.. so is that $30 from which pharmacy.. despite the fact that the pricing is controlled here moreso than in the states.. they still have no clue, but continue to advise their patients of the”cost of the medication”. Dear Dr.’s – PAY FOR IT YOURSELVES THEN

Comment by Rxinside on 2007-05-17 20:16:13 -0700 #

I’ve just graduated in pharmacy from UDM, Montreal. As long as I’m concern, 1) Rx coverage is universal in Quebec ie if you’re employer doesn’t provide you with a Rx insurance, you’re on the province insurance. Not being covered by whether a private insurance of the province’s plan is regarded as fiscal fraud. #1) implies #2) Doctors don’t give a damn about the prices; “hey motherf#$&er, you’re covered”. But watch out when the medication is not covered!

Comment by Cyndi on 2007-05-28 03:53:45 -0700 #

OMG after reading all your posts, I think I am in love with the AUSTRALIAN Health Care System where all drugs covered on the pharmaceutical benefits scheme are either $30.70 for a normal patient or $4.70 on concession! Even at that price, I stay behind the Rx counter and let the shop assistants deal with the till because patients still complain about the price if it goes up 10c from the year before!
and i loveeeeeeeeee your blog angrypharmacist. Its too funny!

Comment by pharmacyintern2010 on 2007-09-29 22:28:29 -0700 #

I’ve seen plenty of docs prescribe meds that could be replaced with much cheaper generics though knowing some of the patients, I wouldn’t be surprised if it was to get the patient out of their office becuase they’ll constantly demand brand and say they’ll pay the $60 or so in copays a month when if they went generic it would be about $15 a month.
On the topic of drug reps in the pharmacy, I’ve seen plenty of drug rep junk, there is even a large drawer we keep filled with pens and sticky notes, I usually stock on pens for college from there as it usually doesn’t make too much of a dent. I loved one day we had a rep coming to push prilosec OTC and one of the pharmacy manager, though the rep didn’t know because the manager had just transfered from a different store, just took the box of stuff from the man and told him he would give it to the manager. We ended up taking what we wanted when we were closing the pharmacy. I got a couple of pens and so did the other intern and the pharmacist just put the free samples in the bin to give to customers and the rest of the promo material, including this huge cardboard display and posted just went into the trash. Though now most mega-chains ban reps from the store in my area and you aren’t suppose to have rep swag on you but when the customers keep walking off with pens to sign the RX pick up log, the swag can be a cheap way to replace the pens, and its always interesting to see how many different pens you can collect.

Comment by Canpharm on 2009-01-08 13:03:22 -0800 #

As a Canadian pharmacist I can correctly comment on the Canadian Emerg Doc’s incorrect and irresponsible comments.
“1. Family docs are well aware of the costs of the meds. We know which ones
are covered by the government for seniors, which ones require a limited use
code for coverage and which ones don’t have a generic equivalent. The
pharmacists don’t do that for us. If we don’t get it right we get a fax
from the pharmacy refusing the script”
Absolutely incorrect, although I wish they did know, it would save everyone a lot of time and effort. I know they don’t know because I don’t know, that is until I send the Rx off for direct adjudication. You don’t know, the patient doesn’t know, the rep doesn’t know and I don’t know either. Let me explain:
a)some drugs are covered and some aren’t.
b)every patient’s drug plan is different. eg some cover a percentage of the total amount. The plan may cover 100%, 90%, 70%, 50% etc. Some cover a percentage of the drug cost and a portion of the pharmacy fee. ie the plan may cover 70% of the drug and only $5.00 on the pharmacy fee or zero dollars on the pharmacy fee, etc. (note: there is no markup on drugs sold in Canada. Drugs are sold at cost with a dispensing fee added so the pharmacy can pay the elecric bill.)
c) price of drugs change all the time. Brand drugs usually increase by a couple of dollars every 6 months it seems.
d) sometimes plans have a deductible that must be satisfied every year. ie patient would have to pay full price for meds until they reach say $500 for example.
e) doc’s do not have a price list of drugs in their office. They could look up price of provincial formularies but none will do it. I would bet 99% don’t know the website exists.
f) some doc’s will ask a patient if they have coverage. If the patient says yes, they still have no idea how it works. Trust me. To be fair pharmacist don’t know either. How could we? How could anyone? The only way to find out what the patient will pay is to run it through the pharmacy dispensing computer. BTW, doc’s don’t have any adjudication capabilities in their offices.
g) doc’s only know what a drug rep feeds them. The rep will tell the doc the drug is affordable and that it’s covered by every drug plan. Drug reps have no idea, they want to push their product and collect their sales bonus.
“2. Docs get nothing from drug reps for prescribing their products. They’re not allowed to leave anything more than free samples, so no one is getting lap dances out here”
Total lie, you may not have been a part of it or seen it yet emgergy doc but let me tell you doc’s definitely get kick backs. How do I know this? Because of have friends and family who are docs and as a pharmacist I see it first hand with the docs in my building. Yes, by law, reps aren’t supposed to give doc’s anything however it happens. Reps, on a weekly basis will deliver lunch for all doc’s and their staff members, I’ve seen drug reps treat soft minded docs to NHL hockey games, rounds of golf, dinner and drinks, etc. I’ve seen drug companies give Canadian hospitals up to a million dollars in funding to insure the hospital keeps on buying their drug for renal therapy. So yes, Canadian emerg doc, lap dances are happening and these are influencing Canadian docs to prescribe expensive brand drugs that are no better than generic alternatives for half the price. It’s a scam.
“3. Some newer drugs have evidence behind them (meaning large-scale RCT’s) proving that they work better. And some patients have had side effects or poor response to the older ones. So not every doc prescribing the new med over the old one is doing so with no therapeutic intent.”
Ever notice how every drug trial a brand rep shows you is sponsored by their own company? Little conflict of interest don’t you think? They skew their facts and charts to pitch their sale to you. If you want reliable evidence based medicine take the time to search pubmed or medline. If you truely value patient care you should review these unbiased sources instead of believing every thing a biased sales rep chooses to feed you. Here’s another idea, ask a competing drug company what they think of their competitor’s product?

Comment by jlawac on 2009-12-08 05:22:17 -0800 #

Honestly, it sounds like all jobs associated with health are pretty well dodge. I have been reading both this blog and medschoolhell, they really put things in perspective.