When you are loaded, who cares what your pharmacist thinks

Before I go into a tirade about the population with a chronic Vicodin deficiency, I’ll do some preemptive damage control here.

If you are taking narcotics to treat chronic pain so you can live a normal life, that’s fine.  OBVIOUSLY this doesn’t apply to you.  Read, and share in the anger towards the people who are ruining it for you.  Justifying your position with a 10 page comment is just wasting your time (we don’t really care to be honest).

If you are taking narcotics to get loaded because your life sucks balls and you want to get high, that’s fine too.  But know that you’re a fucking addict and I hope your die a slow painful death for ruining it for the legit people.  Don’t try to justify your position because you’re a fucking addict and we have tuned out the bullshit lies that come out of your mouth.  Yes, I said the Addict word, get used to it.  This site is not “politically correct” or “professional”, its Angry and realistic.

Pharmacists don’t think this way about all people, just the ones who make themselves stand out from the crowd.  We call these PIA customers, both for Pay In Advance (ever see a legit check from someone who gets nothing but Vicodin/Valium/Soma? I haven’t!) and Pain In the Ass (read on!).

Its a known fact that the moment that a prescription is written for Vicodin and Soma, your IQ drops about 150 points and a black cloud of bad luck ruins your day.  Suddenly your checks somehow bounce and you have cash for cigs and a cell phone, but not your copays.  You suddenly are prone to leaving your pain pills on the bus, on vacation, in your hotel, in your (now impounded) car, stolen, dropped in the sink, excuse, excuse, excuse.  You cannot do simple math, and your stories become so obviously made-up that they should come with a shovel.  You call up obviously loaded out of your fucking skull to try and spoon feed us such the nastiest line of fake bullshit in an attempt to get your narcs early.  Your entire family seems to suddenly die (which requires you to take twice the amount to “cope”).  Half the time I’m not sure if I should just laugh at the bullshit or be embarrassed that you would think I would actually believe that.

I really wish we could speak our minds, and to be honest its getting to a point where we’re going to have to.  Leaving your purse on vacation with your narcs in them should be a lesson to keep better track of your shit.  If those pain pills were SO important to you, how would you even think of leaving them places (except if this is a crock of shit story, which it usually is).  The words “too fucking bad” comes into my head, but I really don’t have the balls to tell a patient this.  Usually these patients have small children! Small children! Ban Vicodin and Soma! Think of the children!

However, when you call, and you are so fucking loaded that your slurred speech sounds like another language as you give us this story (that makes no sense) to get your pain pills early; know that I’m going to write on the call-tag to the doctor “Patient requesting early refill.  Will have patient call office to explain story”.  Almost guaranteed denial right there.  Pharmacy – 1, Lying Addict – 0.  Lie better next time, don’t act drunk and/or loaded on the phone.

Who really gets fucked out of this deal are the legit pain management people.  The people who are on-time, are nice on the phone, who are never early, and who are taking these drugs for the intended purpose.  After getting fucked over by 40 addicts, a pharmacist cant help but be initially jaded towards the 1 new legit pain management patient.  You may think that we are assholes, but if you shovel shit all day, everything starts to smell like shit after a while.  Yeah, it sucks, however pharmacists (if they want to keep their license) are pretty much forced by the addicts to always have their guard up.  Addicts fucking lie to get what they want, that’s why are they are addicts and not legit pain management patients.  If every red car on the road is being driven by a drunk driver, and you see about 10 accidents every day involving a red car, don’t you think you’ll be leery of every red car on the road?  Don’t bitch to us saying we’re “unfair” or “mean”, bitch at the addicts who are ruining it for you.

Plus, some doctors are wimps when it comes to putting their foot down and saying no to early refills.  If a doctor tells me “do not fill until <date>”, I have no problem telling some idiot that I can fill it on this day.  The crackhead may whine, and bitch, and even cry or call me names, but I don’t really care (it just gives me more to write here!).  If the addict calls me more than 2 times regarding this date, I fucking boot them and tell them to go somewhere else.  However doctors who are pussy pushovers make it hard for me to do this.  Hard to be an asshole when our MD partner is a pansy pushover who caves in to every sob story out there (and believe me, I’ve had stuff auth’d early when the story was so bullshit I almost laughed at them).

But what really twiddles my neither-regions is when a patient goes “out of town”, and you call them at home 3 days into their “trip” and they answer.  Holy fucking backpedaling.  “Hey, since you didn’t go on your trip, can you bring those narcs you got filled early back to the pharmacy, they are due in a week and it looks like you didn’t go out of town” gives you the response of “uhh, I cant”.  Yeah, CANT BECAUSE YOU TOOK THEM ALL ALREADY.

The public makes my soul hurt.


Pharmacists who don’t speak the engrish

Its pretty bad when I have a post-it (Upsher-Smith Klor-Con no less) with all the website fodder I think of during the day.

I’ve ranted and bitched on here about nurses, “nurses”, and other health care people about their lack of verbal English skills, but I think its time for me to shit in my own profession gene pool a bit.  Now I’m the last one to bitch about someone’s written grammar, however in this case we are talking about verbal skills.

To be an effective pharmacist, you need to speak clear English.  Plain and fucking simple.

I get really pissed off when a pharmacist calls for a copy only for me to hear nothing but vowel noises on the other line.  Sure, you may have more therapeutic and clinical data in your genitalia than I do in my entire body.  Sure, you may be able to recite LexiComp and Facts verbatim to me.  You may be the fucking master of warfarin dosing or can just recite off a Vancomycin dose like Rainman.

However if you cannot speak clear English, you have no business in retail pharmacy.  Sorry, that’s the truth here.  Go work in a hospital or in mail order or somewhere where the public isn’t going to be talking to you.

Yeah, this sounds like a total dick-move on my part, but think about it.  To be a good pharmacist, you need to be able to speak to your patients and other health care professional in a clear a concise manner.  Patients (as stupid as they may be) should not have to guess or decipher what you are saying.  Other health care professionals can barely speak English, so why add to the confusion with your own lack of English skills?  We are the forefront of free advice, why confuse the matter (and the patients) even more than they already are?

This isn’t a dig towards one specific nationality or background, its just the cold hard truth being delivered in the most un-politically correct way possible.  Speak English.  We expect it from everyone else, so why shouldn’t we expect it from you.

Fixed Income Medicare Blues

I know I haven’t been posting lately compared to my DrugMonkey and Angriest counterparts.  Don’t feel like getting into politics here and I dont like to rehash stuff (too much).  Had to reprime the angry-reserves. 🙂

People always sing to me the ‘I’m on a fixed income” blues when they are paying their Medicare Part-D $3.10 copays for their $200 Nexium Rx.  Oh, how soon these idiots forget what life was like before Medicare Part-D took effect.  Did they somehow forget paying full price out of pocket for their medications?  Why is now $3.10 so much of a financial drain on their “fixed income” when just 4 years ago they were paying 10x that amount with a smile on their face.  I really do get a huge hard-on when I bring up how much they were paying before Part-D and how they are only paying $3.10 (which makes them feel like huge ungrateful douches).

Medicare Part D has spoiled seniors, plain and simple.  They are so hung up on their “fixed income” that they have completely lost sight that the people who are footing the bill for their expensive medications are the same people who will never ever see a dime of the money that they contributed to the system.  They also fail to see how Medicare is pretty much socialized medicine for people over 65, and we can see how well THATS going.  Medicare recipients complaining how we should have socialized medicine in this country just makes my irony meter fly off of the chart.

What do you expect from old people other than cow eyes, the same question asked every week, and bitching about $3.10 copays.

Debunking the myth of what brings home the dollars

Pharmacy school students live in a delusional world of pharmacyland.  I have taken it upon myself to give them the harsh reality check of retail-life so they don’t end up wasting 50k (or more) in schooling to end up becoming a plumber.

Pharmacy professors wield the term “patient care” to their students like its what brings home the bacon every pay-period.  Hate to break it to you kiddies, but they are full of shit.

You know what makes the store money? Filling prescriptions.  Like it or leave it, filling an Rx fills your paycheck.  This precious ‘patient care’ where you go out front and waste your time consult Mrs Smith on how to take her atenolol for the 4th time this month ends up costing the store money in the long run because you are not filling prescriptions.  Spending hours with patients may make you feel warm and fuzzy, but getting off your ass and filling Rx’s is what keeps your paychecks from bouncing.  Remember, Pharmacists cost the store they are working for $1 to $1.50/min.  Spend an hour with a patient who’s Rx’s net you $15 profit just sunk the store into the hole (by just your time alone).  Not to say you should have a timer, but remember that pharmacy is also a business, and you and your staff have to eat/pay bills as well.  Time management, again not taught in pharmacy school.

This ties into my ‘health care is a privilege not a right’ rant that’s coming soon.

So thats the reality of the situation, and nobody can say that I’m way off base here.  However the kicker here is that patient care will bring patients to your store and increase the amount of Rx’s you fill (thereby giving you more money).  That being said, the most important thing that your store has to do to make money is fill Rx’s.  Patient care does not directly give you money, but indirectly gives you money.  Got it?

“But TAP, MTM this and MTM that and MTM MTM MTM!”  MTM is a pipe dream, and the sooner you realize that the better off you will be.  How can Medicare afford MTM when they can barely keep their heads above water by processing that prescription (doughnut hole anyone? Why are we making a $4 profit?).  How much hourly wage will you have to pay a dedicated staff person (because having an RPh do that is just wasting money) to keep up on the MTM billing and making sure they pay?  For what, a net profit of about $30?  Plus most patients who need MTM are too stupid to take their medications as prescribed anyways, so why are we wasting Medicare money and our time!

“But TAP, that’s why we have techs and typists!”  Yeah, I’m not sure about you, but I personally want to override that Drug-Drug interaction and make sure the reimbursement on that Rx isn’t doing me in the ass.  If you want to value a CPhT education vs a BS/PharmD when it comes to interactions, then I suggest we make the CPhT consult patients, take new ones on the phone, and just shitcan us all together.  Ever see a tech blow through the reimbursement screen to realize that Medical is now paying $11 (the generic reimbursement price) for trade name Zoloft without as much as a warning?  The thought of having a Tech do everything while I sit there and drink coffee while checking drugs as they come out of a ScriptPro makes my asshole pucker.  But hey, its your license, not mine.

Now I know that most of you wont agree with me on this topic and you’ll rant about the “future of retail pharmacy”.  Why don’t we worry about the NOW of retail pharmacy before we look years ahead (like why PBM’s are making more than we are).  Lets teach the students the TRUTH about retail pharmacy and teach them skills so they can work/operate/design a well ran efficient pharmacy that allows them to consult but still allows them to safely fill Rx’s.  MTM is just verbal masturbation to appease all of the associations who pat each other on the back and think they did something.  Lets quit fooling ourselves and deal with the problems of now rather than making the solutions for tomorrows problems.