Walgreens: The Pharmacy that Screws America

Gee, where do I start bitching about Walgreens. Oh, I know!
AARP Medicare part D was down for most of the day. Guess who processes them? Walgreens!
Come on guys, get your shit together. I have to pay about 10 cents per transmission and I really hate having to transmit about 10 times per Rx because your servers have shit the bed. You’re probably taking a cue from Argus arent you?
To add fuel to the fire, I saw this on the int0rweb:
http://www.grassrootsrx.org/node/165
Now for those of you out there who want the cliff-note version, here ya go:
Basically Walgreens sent out a pity letter a few months ago to most of the independant pharmacies in the country. I got one, my friends got one, everyone got one. The letter basically stated that if you wanted out because of shitty Medicare part D reimbursements, Walgreens will happily buy your business, blah blah blah.
Guess who’s on the top of shitty and late reimbursements? WHI (Walgreens Health Initative) who processes for AARP. Hmm, the plot thickens. So let me paint the picture here:
WHI gives low/late reimbursements while a sister company (Walgreens) sends these “we’ll help ya out if you sell out to us” letters. Sort of like if the oil company offers to buy your car for $20 bucks because fuel that they produce is $10 a gallon.
Now comes the million dollar question: For Rx’s filled by a walgreens store that are processed by WHI, are the reimbursements higher than your local independant pharmacy? I believe to avoid a “conflict of interest” lawsuit, there has to be some division between the retail Walgreens and WHI. Agreed?
These are some tough questions, and I hope an official Walgreens or WHI rep can get to grassrootsrx.org to give them some info to make them look like less-douches.

You can DAW-1 my foot up your ass

Every town has at least one asshole Doctor. You all know the type. They think they are Gods gift to medicine. They shit out golden eggs, their farts smell like baking bread and everything they write for is covered with zero copay. Their brain is some infinate vast tome of medical knowledge and splendo;r and magical pixie dust wiffs from their pens as they scribe perfectly legible words to form the complex mixture of science and compassion in every Rx they birth.
*vomit*
Now i’m all for living in your own delusional world of hookers and blow, but when it starts to involve me and my patients I tend to get a little frustrated. These guys are douchebags and really shouldnt be practicing. They spend more time patting themselves on the back than keeping up on the latest drugs. If they would spend as much time working as they do banging the hot drug-rep from Lilly, life would be good. Walk in with a nice pair of tits, high heels, and some samples and he’ll do whatever you say; call him up to change a drug thats not covered he’ll give you both barrels.
What gets me is when they check the DAW-1 box. God that pisses me off. It pisses me off more when some dumbfuck PA or NP does it (because you know they really dont know what the fuck they are doing). It gets better when you call their office and they say “well i’m the doctor, and I want this drug *click*”. Your ass, meet my foot.
They dont seem to understand that who has the most power in this whole patient – doctor – pharmacist triangle bullshit isnt any of it. Its whoever is footing the bill. I guarantee you that the insurance company has no problems putting that doctor in his fucking place and being bubba his prisionmate.
We had this Rx brought in today for some whacky zany new eyedrop. Like Zymar or some bullshit like that. Its like 60 bucks for a 2.5cc bottle. It wasnt covered under medicare part D, so we called the doctor asking if we could change to something that would be covered (like generic cipro eyedrops). He very rudly said that he wanted this product and this product only and the patient would have to pay for it. We politely informed him that the patient was not financially able to pay for this medication and said that by not changing it, she would go without the eyedrops . He didnt care and refused to change it.
Way to go dickhead. I promptly looked up where he went to medical school so I could tell people to NOT go there. Obvously he failed common-sense 101. It would be a completely different story if he would of given us some sort of explination like studies showed it worked better pre-surgery, or he had a culture, or something other than “waaaah I dont want to you pharmacist meanie! I’m taking my toys and going home!”
But what do I know, i’m just a stupid pharmacist.

FDA shot themselves in the foot.

All this Sudafed hooplah really has my panties in a bunch.
There is some stupid ass law that as of like 9/06 we need to log all sudafed sales in a book, blah blah blah, etc.
One question. Who the fuck cares? Just put the raw bottles of sudafed behind the counter (like all sane pharmacies do) and just be aware that its being abused. You dont need more laws to do this, its like HIPAA, its fucking common sense!
But no, the FDA needs to do something about the “problem” about meth production. I think its time to write them an angry letter:
Dear FDA,
I’m concerned about your position about sudafed and its diversion to make methamphetamines. Unfortunally you shit in your own bed on this one. You see, pulling Phenylpropolamine (PPA) from the market was a bad idea. If you would of read the study for yourself rather than cave in to the retarded media (whom last I checked were NOT doctors or pharmacists) you would of learned that yes, PPA did cause brain hemmorages in women aged 16-39 (or something like that). Now dont you think thats a bit odd that it only occured in women between those two ages? Lets assume that you monkies can read english. Second lets assume that your actually have free thought and can make basic decisions. But since obvously you cant i’ll summarize it for you.
The women who were dying of brain hemmorages were taking well over the labeled dose in an attemtpt to lose weight. Makes sense doesnt it?
In fact, here are some papers that you might want to read that shows that incidence of stroke in PPA vs Sudafed is pretty much equal in recommended doses:
Drug Safety
Mostly this part
Stroke related to over-the-counter sympathomimetics was associated with acute hypertension and/or vasospasm or angiitis mechanisms, most related to the use of PPA; however, stroke also occurred with the use of other sympathomimetics, particularly pseudoephedrine. Although stroke complications occurred when doses were used that were higher than recommended doses, apparently there is also a stroke risk when these agents are taken properly.
Pubmed is full of articles like this. You guys know what pubmed is right? www.pubmed.gov? Scientific paper search engine? God I hope so.
Will you pull Tylenol off the shelves next for liver failure at higher-than-normal doses? How about ASA and all the NSAIDS for ulcers? Why not encase everyone in a little plastic bubble and put corks on their forks so they dont poke out their own eyes.
FDA, you are not my babysitter and you need to stop caving into media pressures. You created this meth nightmare by pulling PPA off of the shelves and forcing sudafed to take up the slack. You shit in your bed and you’re expecting the pharmacists to clean it up.
So this letter isnt all ranting and bitching, i’ll offer some suggestions:

  • Limit sales to only pharmacies. Not gas stations, whore houses or truck stops. Pharmacies are all over the place now and many are open 24 hours.
  • Take a gander at the US/Mexico boarder. I think you’ll be in for a surprise when big-rigs full of sudafed roll into this country without even a second look from immigration.
    Other than that you’re doing a great job! Now approve more generics before i stab you in the face with a spork.
    Love,
    The Angry Pharmacist.
    Aah, that felt better. 🙂

  • Take a shower!!

    This bitter hateful rant isnt really specific to pharmacists or pharmacies. Its to everyone who has to deal with the public in person.
    What aversion do people have against showers? I’m being serious!
    I get people all the time walking straight up to the counter and emit this rank death from their person that honestly makes me feel nauseous. Usually they have some stupid ass question that involves some ‘strange bumps’ on their body. Unfortunally conversations like these involve them showing me their nasty ass armpit, or chest, or some other god-forsaken place that hasnt seen the light of day (or a bar of soap) since ive been born. 9 times out of 10 those bumps are natures way of saying “Sweet Jesus take a fucking shower you slob!”.
    People might think that stanky asses only come in the summer time. Oh no, the dead of winter is much much worse. See, some people think that if they dont sweat, they dont need a shower. Hell, whats the use of wiping my ass when I shit when i’m just going to take another one a day later! So you get these people waltzing in without a care in the world reaking of a mixture of BO, piss, and stank and wonder why nobody wants to help them. If i smeared shit all over my body and walked around town with a grin on my face (“hey! how ya doin? *smile*”) do you think people would want to help me?
    However the summertime is fun-time because people just walk around in their sweat stained wifebeater all week and think things are just hunky-dory. Its a lose-lose situation for pharmacies and their staff.
    Now we’re at a catch-22, because there is no polite way to say “Take a fucking shower you slob” without sounding like a total dickhead. So we’ve tried the usual thing when people walk in who are notorous for rolling around in their own urine hoping we’ll “drop the hint”:

  • Turning on all the fans in the front when they come in
  • Spraying Lysol into said fans while they are being helped
  • Spraying lysol in the air in front of them while they are being helped (if this doesnt say something, I dont know what does).
  • Slamming said Lysol bottle in front of them while they are being helped
  • “Have you tried using a strong soap and water on those strange bumps?”
  • Handing out tokens for the car-wash down the road.
    Of course, they are oblivious. Doesnt matter that people are coughing and dry-heaving all around them; they just go about their merry way shopping and carrying on a grand old time. I bet they think everyone has horrible allergies with all the mouth-breathing going on.
    Whats sad is that its always the overweight people that have the no-shower problems. I dont know if they have a problem making their way to the car-wash to be hosed off, or if their short little arms cant reach past their man-titties (i wonder how they piss or wipe their ass. Wait, i answered my own question) to wash. I’m not trying to rag on the morbidly obese, because you know its not their fault that they can only stuff McChickens and Quarter Pounders in their mouth for breakfast, snack, lunch, snack, snack, snack, dinner, snack, snack, GIMME MORE MORE!!!
    So next time someone who hasnt bathed since jesus was a boy walks into your pharmacy. Do the poor man/woman a favor and just take them out back and hose them off. Make sure you scrub under their tusks and ears and in the creases of their fat. Who knows, you might find some coins or maybe a TV guide from the 70’s!

  • Buh? Angry Tech? No way!

    So I get this angry comment from some rabid tech:
    So you don’t think techs deal with as much crap as pharmacists? Have you ever worked as a tech? Not only do we have to deal with customers but also pharmacists. Who has to retype entire scripts when they get sent back because the s was missing from teaspoons? Who has to apologize to the customers when they complain because they were sitting in the waiting room forever because the pharmacist forgot to page? Who has to deal with their bosses constantly over their shoulders dictating every task for 8+ long hours a day? Who has to deal with the brand new pharmacists who don’t even know what phenazopyridine is or how to figure out the package size for a box of albuterol nebs? Who always has to deal with the drive-thru?? Who has to run back and forth between filling and the register while the pharmacist pulls up the dreaded chair to verification? Most pharmacists–not all–but most would rather just stay at verification and let technicians work their butts off. All this for 1/5th of pharmacists pay. Finally, about all the complaints you have about insurance/medicare problems, I don’t know about your pharmacy but at mine the techs deal with all the insurance problems.
    And I thought I was bitter.
    Lets get a few things straight first:

  • I love my techs. In fact there is no way that I could get as much work done as I can if it wasnt for them.
  • I dont work in the “McDonalds of Pharmacies” with drive-thru and a tech turnover rate like Ron Jeremy turns over the porn bitches.
  • I dont let my tech’s do the insurance handling because I want to be the one to blame if shit goes wrong.
  • This isnt going to be a “I hate tech” rant, but honestly the cold hard truth.
    Dear Angry Tech,
    Who’s licence is on the line when you fuck up? A licence that took 7+ years of college and a ball-buster test to obtain. Your existance depends on a pharmacist, like it or leave it. Yes, I have worked as a tech; Yes, I realize that you do the shit that pharamacists dont want to do, but thats your job. Now gimme 100 soma before you taste the back end of a vicodin bottle. 🙂
    Love Always,
    The Angry Pharmacist
    <3

  • Happy May!

    Happy May Everyone!
    Its still early as I write this (you all probably arent open yet) but I want to wish you all a very happy May 1st (that falls on a monday, ugh).
    May 1st wishes:

  • Your patients didnt decide to all change to another MediCare Part D plan today
  • Argus will remain up (yeah, i hear your laughter)
  • All of your patients medications will continue to be on the formulary and not require a prior-auth
  • New insurance cards were issued with the correct ID/Group # on them
  • The PBM’s didnt cut our reimbursement rate
    Oh, and hug your Pharm Tech. Even though they dont deal with as much of the crap as we have to deal with, they are still there to cover for you when you’re sobbing in the back room (“he’s got new contact lenses, he’s fine”) or throwing vials at the wall. I wouldnt be here if it wasnt for my Techs, i would be in jail for strangling an idiot.. 🙂

  • Mail Order Douchebags, Part 2

    Why cant patients be upfront with us? Here we are with virtual control over their lives, and they are too stupid to be upfront with information that would save us both time and money.
    Case in point: I had a long time patient come in the other day to get meds refilled. They recently switched insurances so things were sorta whacky. In the process of filling their medications, I got a DUR reject from the insurance company that this was a “duplicate billing”.
    For all you non-pharmacy people out there; the insurance companies (when we transmit the billing info) sends us back warnings once in a while that we have to override. Usually its because its an early refill, a late refill, the crackhead got it 4 days ago at another pharmacy, etc. They are somewhat useful, but intentionally made vague just to fuck with our heads.
    So I’m checking the other terminals thinking that maybe the Rx came in via fax and it was already billed from us. Spent 10 min interrogating everyone if they filled an Rx for this person. Then I interrogated the patient asking if they filled it at another pharmacy, etc. Of course the patient said those magical words “You’re the only pharmacy I go to”. Right, and I shit gold.
    So I call the insurance company on the vague chance that it somehow got transmitted but our computer system didnt receive the response and record it. On hold for 15 min. At this point the patient starts whining about the medication and I fight the urge to throw my shoe. Get someone at the insurance company, who looks it up and tells me it was filled at a mail order pharmacy.
    I hang up the phone and ask the patient: “Are you sure you didnt get these filled somewhere else?”
    “Oh, we go to mail order.”
    I mentally pictured my size 12 shoe fly across the counter and smack that dumb fucking ass right between the eyes. I had visions of me pooping in the sunroof of his/her car. I wanted to rend her/him limb from limb and play jump rope with his/her intestines. I wanted to cram lightbulbs up his/her ass and give a good kick. I wanted to give papercuts on his/her eyeballs.
    “But they give us 3 months for one copay!”
    I felt like saying “And thats fucking worth the 30 min you wasted of mine?” but instead said “im sorry, but you’ll have to pay cash on these Rx’s if you want them filled. *add a 30 buck waste-of-my-time fee*”. If there is a Heaven, I just earned a place in it by not saying what I was thinking. Of course I just lost it by making all of this public. Whoops.
    When he/she left the store, I screamed to my boss “Do people like to waste our fucking time? Is it fun to them?” He just said “Yup” and kept on eating his lunch.
    Now I can understand why people go mail order. 3 months of Rx’s for 1 copay does appeal to those who are lacking in braincells and are cheap. But who has to bail their asses out when the mail is lost or late? Me. Thats right, you are now expecting the guy you shafted to bail your ass out when you need it.

  • You went mail order to save a few bucks and are out. Who do you turn to? Your retail pharmacist!
  • You got medication from Canada or Mexico and it was siezed by the feds. Who do you turn to? Your retail pharmacist!
  • You got out of the ER at 3am and need an Rx filled right now. Who do you turn to? Your retail pharmacist!
  • You have a question about a medication, but dont want to wait on hold. Who do you turn to? Your (non walgreens/rite-aid) retail pharmacist (sorry fellas 😉 !
  • Your daughter got drunk and didnt take it in the butt during a fraternity orgy (Actually she told you “the condom broke” riiiiiiight). Who do you turn to? Your retail pharmacist!
  • Your bitch ass was too cheap and too stupid to use common sense to support the people who could bai you out. Who did you just fuck over and piss off? Your retail fucking pharmacist!
    No wonder why pharmacists drink.