Pharmacist Hate mail!

Ah, I love it when I get hate mail from other pharmacists. After reading this over, I mostly agree with him/her (surprisingly). Though I dont think CVS wants this persons name attached to what he/she wrote.

1. You don’t have the staff to handle the load from mail order pharmacies
   if they disappeared tomorrow.

You meaning me personally? No, you have me there god dammit. If every mail order place closed and they all came to /my/ store, then I guess I’d be up shit creek without a paddle. So would you. Thats sorta like saying “If someone drove a car through your front room, you’d be upset”. Pretty much a big “Duh” there.

2. I get one of my meds via mail-order, because I got tired of paying 3
   copays when I could do 1 instead. I’m not an idiot for doing this.

Then don’t bitch when your patients jump ship and do it to you. Of course I see that you take gifts from drug-reps, so that says something. At least you had the common sense to throw out the DAW-1 forms when the Coreg vultures came circling pushing Coreg ER. I did the same thing too, but I didn’t get any loot from them. Actually I told them they were a bunch of liars for pushing Coreg just months before, but suddenly going against all they told me once the generic came out for $5 per 100. Amazing how all those studies just aren’t worth dick if the drug company that paid for them isn’t making a $100+ profit from each Rx that I fill. Thank you Mylan for making generic Coreg so inexpensive.
Working in a pharmacy Im surprised you even have to pay copays for your medication. Even I dont have to pay the $25 copay on my medication. 🙂

3. You bitch and moan about “kickbacks”. Sounds to me like you’re a whiney
   independent pharmacist pissed off because you don’t have the economies of
   scale that a mail order house does. (And neither do the big chains,
   incidentally.) Since you’re throwing out some pretty serious accusations,
   you should offer some sort of proof. But since you’re full of shit on this
   particular point, you can’t. Go ahead, though, I’ll wait to see what you
   come up with.

• Why do insurance companies mandate their patients go to a mail order pharmacy? Say, like Express Scripts. The ones that don’t mandate it by flat out rejecting the claim penalize the patient by a higher copay. Doesn’t that sound wrong? If they gave a choice as to which retail outlets is one thing, but to mandate they go to their mail order pharmacy exclusively sounds like a huge conflict of interest. I mean that would be like saying that WHI (Walgreens Health Initative) can only get their Rx’s filled at Walgreens. Or that Blue Cross patients could only go to one doctor (and no other doctors could see these patients). Explain to me how Express Scripts can actually get away by forcing their patients to use their outfit even though they wish to go to me or you to get actual “service”.
  • Why can’t retail outfits buy “Mail Order Only” diabetic test strips (say by AccuChek) at a discounted price? What’s so special about these ‘Mail Order Only’ strips and why are they cheaper for Mail Order than regular retail stores? Why brand them differently? If bulk is the answer, then whats the point of re branding them vs just selling them at a lower price to the mail order outlets like all the other medications? Why is it illegal for Retail outlets to even carry Mail Order branded strips?

    • You can call it rebates/kickbacks/bribes whatever, the fact of the matter is that Mail Order Pharmacies get special treatment that retail outlets don’t. You would think that Walgreens/RiteAid/CVS (ahem) would get some sort of pricing break since they obviously dispense more Rx’s/day combined than the mail order outlets.
      Read the comments of the people who get screwed due to “mandatory mail order”.

      Yeah yeah insurance companies are the devil, I won’t argue with you there.
      You’re not stupid, you knew that before getting into this business.

      By the email you sent me you assume that I am. Insurance companies didn’t use to be like this, you and I both know this. Its spiraled out of control.

      4. I called Walgreens last week for a transfer, and I got some kid with a
         fucking stuttering problem. “W-w-w-waaaa m-m-m-may I [something]?”
         “Uh, what?”
         Repeats himself.
         “Uh, what?”
         Repeats himself.
         “I have no idea what you’re saying to me. I need to speak to the
         pharmacist.”
         “W-w-w-algreens m-m-may I h-help you?!”
         “Oh. That’s what you said. I need to speak to the pharmacist.” (Thinking
         “WTF” at this point because I had the pharmacy for 5 seconds before they
         put me on hold for ten minutes then this kid picks up the phone, and I’m
         thinking I got transferred to a psych hospital or something.)
         How in the fuck is this good customer service?

      Uh, did I say this is good customer service? Or is this just an aside from the whole bitch on how much i’m wrong. Whenever I get copies from Walgreens I just call the ‘Doctor Line’ and leave a message with what I want.

      “Ok, I am just a tech, but I am also a pre-pharm student, so when I read
      this I see my future going down the drain.”
      TAP is a drama queen. It’s what makes his writing compelling. It’s like
      dessert, a little is good, a lot is just sickening. You need more than just
      TAP if you want to get an accurate picture of the profession today. Enjoy
      it, but don’t read any more into it than one man’s thoughts. Always
      remember that someone has been prophesying doom and gloom for every
      profession on the goddamn planet since time began. Pharmacy included. You
      might want to diversify your reading a little bit, and read someone like
      Jim Plagakis instead of just TAP.
      If you hate retail pharmacy, it’s probably because you have/had a shitty
      mentor.
      And don’t ever say you’re “just” anything. Let your words speak for
      themselves.
      The impression I get is that TAP is also an independent pharmacy elitist.
      (After all, everyone else is “shitting on the little guy,” why not the big
      chains, too?) Most of the chain stores in my area are run far more
      effectively than the few independents around here, which leads me to
      believe it’s a local problem for him.
      You can still do a great job working for a big company, and you still deal
      with the same ground-level shit as anyone else behind the counter,
      independent or otherwise.

      Shitting on the little guy? When did I say the chains were shitting on the little guy (or even imply the idea)? I was making a joke that the Walgreens distro warehouses hires retarded folk and how that relates to me getting copies from their store. The retarded folk dont even work in the retail stores but the warehouses! The post you were responding to was regard to Mail-Order (which do shit on the retail folk) and really had nothing to do with the chains! Hell, I’d rather transfer the Rx to a chain that I know will actually /see/ the patient than some Mail Order place who will lose their medication.
      However from reading how you handled the Walgreen example above, I think you’re just a bitter unhappy pharmacist like the rest of us. Welcome to the club. All I hear from patients all day is how Walgreens take 2 hours to fill their Rx while the pharmacists just sit there and drink coffee as they offload the script-pro. Patient care has taken a back-seat to a quota that corporate imposes on the chains. I have worked in a chain, I’ve worked in a hospital, and I choose to call home in a small family owned store that does about 300 rx’s a day without any fancy phone answering machines or bazillion dollar counting machines. If someone stays on hold for more than 2 min’s I start to drop everything and answer it. My livelihood isn’t shielded by corporate offices and mega-funds, but the honest-to-god service that I dish out on a daily basis. If I give you totally shitty service, the store gets no patients and I don’t get paid. I don’t have a mega-corp guaranteeing that my paycheck will clear every 2 weeks. I think that says something vs the pharmacist who never talks to patients, just sits in the back and answers the phone, and has a bunch of barely trained clerk-typists pounding away on 1000 keyboards as the script-pro machine churns out drugs by the hundreds. That being said, I have seen the kind of service that I dish out in every chain on the planet. So don’t get your panties all up your crack thinking i’m ragging on your precious CVS.
      Some of the best pharmacists that I have ever met (and who have a huge following) used to own their own stores, and now work for some of the mega-chains because they don’t want to deal with the shit that running a business takes. One of the things you’ll learn in pharmacy is that the pharmacist makes or breaks the store. I’m sorry if I act like an elitist (and actually /care/ about people). I don’t shovel out Rx’s by the truckload, and actually will go out and explain medications to people that they got filled at a chain store (even CVS).
      On the comment about reading this site and seeing the downward spiral of pharmacy:
      Why would anyone with half a brain read a blog saying “The Angry Pharmacist” and expect anything other than the bitching and rants from the profession? Lets take the 0.02% of pharmacy that really pisses us all off, and judge the whole profession by it! If you work retail, and you hate retail, then something is wrong with either the place you work or you just happened to draw a really shitty staff. Even I don’t hate retail. By reading only this site you are looking at only a small portion of one side of the coin, and I’ve said it time and time again that you need to take what i say here (or what the DrugNazi says, or what the angriest pharmacist says thats what we say but changed a bit) with a grain of salt and not the gospel. You just gotta laugh, relate, and move on.
      I am not “prophesying doom and gloom”. I’m telling it how it is. Plain and simple. Colleges have banned my site from their school networks because of this. Of course pharmacy school students just love me, other pharmacists love me, and (some) doctors love me. It gives us all a common place to bitch, laugh, and relate to frustrations of a very stressful profession.

Comments #

Comment by Biggest Fan on 2007-09-18 02:21:40 -0700 #

I love how “pre-anything” students are always so idealistic. It’s sweet. I remember when I was an idealistic pre-med. I remember when 90% of the physicians I spoke to tried to talk me out of going to medical school – but since I was “pre-something”, I already knew every single thing about the profession. Ahh…to be young and naive again!

Comment by Dean C - Blo, NY on 2007-09-18 06:59:29 -0700 #

I agree with what you say about mail order and chains. As you may know Eckerd was bought out by Rite-Aid. I am effected by this buy out, and all I hear on a daily basis is how Rite-Aid is a terrible place, and how they screw up meds. People have even said they will not come to our pharmacy anymore because of this. These complaints are subtle compared to what I hear about mail order. Even some of our local insurance companies force people to mail order, and this is because that company owns a couple of pharmacies in the area and they consider those to be mail order if used. The point I am trying to make is that the chains and mail, order set there own reputation. I once tried to get a job at Walgreens, but after seeing there operation, I decided against it. I don’t want to work for any place that treats the techs like slaves and the patients like shit. $100,000 a year doesn’t mean that the person making $10,000 has to do all the work. So if people want to go into pharmacy just to take it easy later, I’d seriously think about that before choosing that career.

Comment by RJS on 2007-09-18 12:43:43 -0700 #

You’ve read everything I wrote as adversarial, which I expected, but hoped you wouldn’t.
I agreed with you about Walgreens, and offered up an example to support your point of view. (I still can’t believe they’d let someone with a stuttering problem answer the phone.)
“Then don’t bitch when your patients jump ship and do it to you.”
I don’t. Because they usually come back.
“At least you had the common sense to throw out the DAW-1 forms when the Coreg vultures came circling pushing Coreg ER. I did the same thing too, but I didn’t get any loot from them. Actually I told them they were a bunch of liars for pushing Coreg just months before, but suddenly going against all they told me once the generic came out for $5 per 100. Amazing how all those studies just aren’t worth dick if the drug company that paid for them isn’t making a $100+ profit from each Rx that I fill. Thank you Mylan for making generic Coreg so inexpensive.”
Agreed. Sanofi-Aventis did the same shit with Ambien. Also amusing is that ambien.com now redirects to ambiencr.com. Lame.
“Working in a pharmacy Im surprised you even have to pay copays for your medication. Even I dont have to pay the $25 copay on my medication. :)”
You work for an independent. 😉 If I worked for an independent, I probably wouldn’t have to, either.
“Doesn’t that sound wrong?”
Yes of course, but this is business.
“If they gave a choice as to which retail outlets is one thing, but to mandate they go to their mail order pharmacy exclusively sounds like a huge conflict of interest. I mean that would be like saying that WHI (Walgreens Health Initative) can only get their Rx’s filled at Walgreens. […] Explain to me how Express Scripts can actually get away by forcing their patients to use their outfit even though they wish to go to me or you to get actual “service”.”
That’s illegal, unlike the first part of that paragraph, which is not. We do tons of Express Scripts business. As far as I’m concerned, they’re far better than the likes of UnitedHealth and Humana. They’ll even let most patients get two months worth of meds at retail (though they’ll pay two copayments), whereas most PBMs will not.
This is true in my area, anyway, where most of the ES business is through BC/BS of MA, which is probably the best, most cost-effective insurer around. (I have to buy insurance privately, so I did a lot of research, and they were by far the best.)
I don’t know about your mail order strips issue, because I don’t work for an independent. This is one of the reasons I’m glad I don’t — I don’t have to worry about problems like that. Maybe that makes me a shitty person, but frankly, I have enough of my own problems, and not worrying about who my supplier is, and what they’re charging me is nice. That bullshit as you so eloquently put it, that indepedents DO have to worry about.
You call it a kickback, which is usually illegal. I call it preferred pricing, which is quite common. If all we’re arguing is semantics, then we have no argument at all. I would say that’s a pretty big semantical difference, however.
—
“By the email you sent me you assume that I am.”
I never assume anything. You write extremely well. That alone says you aren’t stupid. And yes I agree that it’s gotten ridiculously tight these days. A good example would be the preferred fluoroquinolone shit that happens every fucking day. Even though Levaquin and Avelox are pretty much the same f’n price. (Or at least they were the last time I bothered to look at the AWP for the two.)
Shitting on the little guy is a dig at you, obviously. Didn’t you complain about someone shitting on the little guy over diabetic supplies a while back? Or am I thinking of someone else. That’s possible. I read lots of pharmacy blogs.
“The retarded folk dont even work in the retail stores but the warehouses! The post you were responding to was regard to Mail-Order (which do shit on the retail folk)”
Yes, they do. On the other hand, as transfers are a royal pain in the ass, it’s nice to tell people that we can’t transfer their prescription because Mail Order houses won’t give it up. This is just one straw that usually causes people to come back to us in the long run. Yes, I do mail order. The savings for me is not insignificant.
“However from reading how you handled the Walgreen example above, I think you’re just a bitter unhappy pharmacist like the rest of us.”
Hah! I love my job. I just don’t like waiting on hold, and talking to stupid people. (Unless they’re patients, which is part and parcel of being a pharmacist so I don’t see a need to complain unless it’s something over the top.)
“Some of the best pharmacists that I have ever met (and who have a huge following) used to own their own stores, and now work for some of the mega-chains because they don’t want to deal with the shit that running a business takes. One of the things you’ll learn in pharmacy is that the pharmacist makes or breaks the store.”
Agreed, 100%. The best pharmacists I know used to own their stores, too. This translates into how well they run their stores as part of a chain. That bit was directed more at folks who really are retail elitists as though working for an independent is the be-all, and end-all of retail glory and everything else is the pits. Which is simply not true. And if I could hyperlink things in the comments, I’d link you specifically to the attitude that I’m referring to there.
“Colleges have banned my site from their school networks because of this.”
I can say with authority that the school I attended has its head firmly embedded in its rectum, so this doesn’t surprise me one bit. Though it’s fucking stupid.
—
Glad to see I pushed your buttons in a meaningful way, though I happen to be a member of TAP’s fan club on facebook… I laugh and agree with most of the stuff you have to say.
But I don’t think I’m alone when I wish that you would write more clinical stuff, too. Your po vanco post, for example. While I knew the stuff already, it was extremely well-written, and enjoyable to read. I have no doubt you might have other things to say that I certainly *don’t* know.

Comment by ILPharmStudent on 2007-09-18 17:28:26 -0700 #

Amen, AngryPharmacist. Amen. PS- I wish my name could be abbreviated to something as sweet as “TAP.” Ha.

Comment by rph3664 on 2007-09-18 20:34:45 -0700 #

About having a stutterer answer the phone: That sort of thing doesn’t bother me as much as pharmacists who don’t speak English (this seems to be nearly universal in Florida – what’s with all the Asian women who are only marginally competent in the language?) or the deaf phone nurse at one clinic in the town where I used to work. I kid you not, this woman had to be stone-deaf and needless to say, she didn’t last very long. This happened around the time the movie “Being John Malkovich” was in the theaters, and if you have seen that movie, you will know what I am talking about.
Harkening back to the Walgreens warehouse that hires disabled people, I had a male classmate who I am certain is autistic and once worked with another pharmacist who was almost certainly on the spectrum herself. She was completely normal socially except for one little thing: she did not look at people. Not didn’t make eye contact, DID NOT LOOK AT PEOPLE. How this woman managed to find a husband and have 2 kids, one diagnosed with Asperger Syndrome (big surprise), defied logic, to me, anyway. As for my classmate, he’s one of the nicest people you could ever meet and is an excellent pharmacist to boot. And I heard from many older colleagues about a pharmacist who lost an arm in an accident as a child. He had all kinds of adaptive devices all over his store.
As for Ambien (CR) and Coreg (CR), the hospital where I work has gone in circles about these me-too drugs as well. It’s as annoying as the constantly changing Rondec formulas were when I was in retail.

Comment by sabella on 2007-09-19 07:59:49 -0700 #

Wow – school sites are banning you? That is so sad. I actually tell a large number of my students about you, mainly so that they won’t get blindsided when they get out into the workforce.

Comment by John Roman on 2007-09-19 08:07:29 -0700 #

I know for a fact that mail order houses change prescriptions ( generic substitution ) at will. For example Lipitor 20mg becomes Simvistatin 20mg with out the doctors knowledge or consent. While I’m all for generics this is an example of just how big their balls and how they feel immune to regulation. While I have no proof of there kick backs, I’m convinced they are there and in the form of multi millions.

Comment by Hope on 2007-09-19 09:01:06 -0700 #

Oh, Angry. It is SUCH fun to read your rants. Most of us know that you are writing about the ONE idiot of the hundreds of customers you see daily (or the insurance company that ruined two hours of your life, or the drug rep), and we enjoy it very much. It DOES help to know it’s not only happening to me (some days I feel like a freak magnet), that I am not the only one out there who wonders daily ‘wtf?’ You speak so eloquently for us.
If you are banned from pharm school access, this says you are doing the right thing. My old school probably has, too, because they are only in business to make money, and losing students means losing money.
Keep on keepin’ on, sir. We need you.

Comment by Martin S. on 2007-09-19 11:26:08 -0700 #

the pre-pharmacy soon to be prostitute at the mail order money machine needs the jaws of life to get his head out of his ass. Mail order pharmacies and kickbacks? have the idiot read Medcos morningstar report-the 2004 report gave a rebate of 400 million bucks from Merck alone that year accounting for 15% of Medcos total rebate income.
do they teach math in pre-pharm now? run the numbers and remember to move your decimal place. hint:the answer is in the billions

Comment by Sara on 2007-09-20 06:14:58 -0700 #

yes,, I agree that a pharamacist can make or break a store.
Hell, I work for CVS (hello lawsuit!) and we had a RPH there for years, and surprisingly, since he “retired” business has been booming!
There has been the few favorites that have been upset he left, but actually, most people just smile and actually don’t bitch when they wait to get scripts filled.
I certainly won’t go to school to be a RPH, just for the fact that I will be damned if I don’t get to go pee/poo or even eat for 14 hours! F*** That!
I would rather be a doctor (don’t shoot me)

Comment by Meg on 2007-09-26 10:56:57 -0700 #

I have to say, I must work at the best Walgreens in the world. My pharmacists do not sit on their asses all day (with the exception of the VERY PREGNANT manager who will go into labor if she stands too long), they help with insurance, they answer the phones, etc. Two of the pharmacists are experts on abso-fucking-lutely everything and we could not be luckier to have them. Yes, corporate are ass-holes, and Loss Prevention lurks around a lot, and they do treat techs like shit in some ways, but we are lucky to have at least a few people worth working with. I know everyone bashes Walgreens, but it is really not that bad. Sorry, the store I work at is not too bad. That being said, please, continue to bash them. It makes me happy to know there are worse situations than our store!

Comment by Marc B. on 2007-09-29 17:51:56 -0700 #

I’ve worked for CVS and walgreens in the past as a tech and now an intern and I have to say some stores have pharmacists that I’ve worked with that are great and love helping people, others seem to like standing around talking to their uncle who just came in about going on vacation while the scripts back up and the phones are ringing off the hook.
I also have to say that I’ve gotten pissed off at alot of “pre-pharmacy” students when working back in my hometown on break from pharmacy school. They claim to know more than me (I’m in my 4th year of a 6 year PharmD. program) when they couldn’t pass a stripped down chemistry class at the local community college and actually haven’t even had anything related to pharmacy in their classes. And the one thing I was ready to spit fire over was when this pre-pharmacy bimbo tech told me that an intern wasn’t allowed to compound a suspension but she was because she was “trained” in the community college 1 credit hour class, and I had no knowledge or experience in what I was doing. Sure, I’m pretty sure only pharmacists and interns can compound in Massachusettes by state law, and I know that true in New York. She also got pissed when I told her that I was trained in compounding. My college starts your 3rd year of the program and you compound almost every semester during years 3-5. You got to know how to compound properly if you want to pass the part III “wet lab” exam of the NY state licensing exam. This twit wouldn’t know a how to make anything as I could tell when she tried to get 1/2 tablets of an antibiotic to dissolve in a suspension because she decided to grind way to many tablets by just hitting them with a pestle a couple of times. There in lies why only those trained in compounding, ie. interns and pharmacists, should be compounding something, or at least have the tech supervised to makesure their doing it right.