Mail Order Scum

Now everyone knows that nobody is safe from The Angry Pharmacist(tm). I always wonder why I never get featured in Drug Topics or any other pharmacy magazine that pharmacists read while taking a dump. I guess I’m too hard core (or use bad words way too often) to be in any cool magazines. πŸ™
Oh, yeah, mail order pharmacies.
Lets just say that I hate Mail Order Pharmacies. Plain and simple. If you work for a Mail Order pharmacy, seek a career as a prostitute or maybe a Drug Rep or something. My hatred is from a multitude of colorful points that every retail grunt knows:

  • Mail order places get kickbacks from the insurance companies. Yes, I said kickbacks (not rebates, but fucking bribes/kickbacks). Why cant retail pharmacies dispense a 3 month supply for 1 copay (without losing money, a la Walgreens Medicare part D). Why do mail order joints get special deals on “Mail Order Only” test strips and supplies? Why do mail order (and hospital) pharmacies get special price breaks on generics? Oh, kickbacks. Did I mention that some insurance companies will only allow 3 fills at a retail pharmacy before mandating the patient use their mail order pharmacy? How can you say thats not kickbacks. Seriously, get your head out of your ass and wake up and realize that Mail Order pharmacies and the insurance company’s asshole they screw every night are making not only us retail folk look like money-grabbing bastards (“how dare you charge me $5.00 copay/drug a month! I get $5 for 3 months from my local mail order pharmacy!”) but………….
  • They waste our time! How many of you retail folks have had a Mail Order patient come in with a sad-panda face and an empty mail order bottle saying “Uh, my mail order medication got ‘lost in the mail(tm)’. Can I have a few atenolol so I dont die?” The Angry Pharmacist(tm) in me wants to say “Fuck you! You said that I was ripping you off for charging you a copay every month (because their insurance company wont let us fill a 90d supply, only their mail orders get to do that) and now you come begging and groveling to me for medication because it got lost in the mail? HAHAHAHA DIE!” but the actual pharmacist in me doesn’t want to see more of the MediCare money (that i’ll never see) wasted on a pointless ER visit (see DrugNazi, I care). So I charge him a whopping dollar for like a week of atenolol and send him on his merry way to go fuck me behind my back with his Mail Order Pharmacy mistress.
  • Patient comes in (who you know goes mail order) with a brand new testing machine. They plop it on the counter and wish to know how to use it. They said “The mail order pharmacy said to just take it in to any retail pharmacy and they’ll show me how to use it”. Uh, go fuck yourself? Do I work for the mail order pharmacy? Is my employer going to be happy that his over $1/min pharmacist is out helping a patient (who will never trade with us) with his machine that another pharmacy made a fat profit on? Let me consult you on the medications that Walgreens filled for you while I’m at it. We all know those chain pukes are too busy to actually do anything than shovel Rx’s out the door and drink coffee, so let me do their jobs for them (for free!).
    While I’m ragging on “The Pharmacy America Trusts(tm)(r)(blah)”, did anyone read the article on how a Walgreens DC has over 40% of its employees have a “physical or cognitive disability”? Now I realize this is a distribution center and not an actual store, but have you ever tried to get a copy from a Walgreens? Have you ever tried to speak with one of their clerks? Yeah, I’ll just stop right there. As a sidenote guess how many of my Walgreen buddies got a fax when that article came out. πŸ™‚ I’m so loved. Back to hating on Mail Order.

  • Doctors offices are even getting bribes from Mail Order joints. We have had more than one patient suddenly (and unknown to him/her) that all of his Rx’s were mysterously filled by a mail order pharmacy (we tried to fill them, and the insurance company gave the reject). A few phone calls later we found out that this Mail Order pharmacy that “partners with the doctor” magically got a full copy of all the meds this patient was on, and filled them without the patient even knowing what was going on. The pretense was that the medication was going to be “Waiting for the patient in the doctors office” so they “Didnt need a trip to the pharmacy”. Did I mention that said mail-order joint filled a 3 month supply when the insurance company put a 30 day restriction on retail? Amazing how fast the claims got reversed when the word “kickback” and “bribe” got thrown around between us and said Doctor/Mail Order Pharmacy.
    So what can us retail folk do about this? Complain to the insurance companies? No, they are in on it. Complain to the Doctor? They don’t care, not their problem. Complain to the State Board of Pharmacy? HA! The Mail Order place is in another state, good luck!
    Guess we bend over and take it. The problem is that unless we are total incompassionate dicks (not only a failure to our profession) and make folks go to the ER when their mail order shipment gets “lost”, they will never learn. Unfortunately I’ll be the first to admit that even I am not that much of an asshole. I have to ™ my shit or else the angriest pharmacist will steal it(tm). Heh.

  • 14 and pregnant – Warning! Offensive!

    This entry is going to piss off some people. You’ve been warned, this is ‘the angry pharmacist(tm)’ and we know that we cant be angry without painting people/society/your mom with an extremely large overbearing brush. I also had a few beers after a long and frustrating day at work, be warned, be very warned. The hatred is flowing like the DrugNazi’s scotch.
    You get an Rx for some prenatal vitamins. You pull up the patient by name and 14 year old comes up. You realize “shit, I must have the wrong person”. Then you realize that the 14 year old in front of you is indeed pregnant. The parents stand proudly by as happy as can be. As said before by the DrugNazi, “You turn the dials behind your eyes from stun to kill, but they just wont work” (or something to that extent).
    Some of you out there would feel sorry for this poor girl. Some of you would feel happy for this girl. I, for one, think that I’m filling an Rx for the stupidest human on the planet. Why feel sorry for her? Pregnancy isn’t some virus that swoops down like the flu and afflicts people without discrimination. It requires a conscious act between two individuals. Whats even more frustrating is that its not hard to get birth control these days! So the only reason why these kids are getting knocked up is due to laziness!
    If someone comes into my store and wants condoms, and says “yanno, do you have any free ones, I really cant afford them” I’d throw them a box right there on the spot. In fact, we have a stock of free condoms that anyone can take that are furnished to us via the county! You just have to ask! Girls (because they aren’t women, they are in fact girls, deal with it) can go to any clinic and get some free birth control. What provider is going to turn down a 14 year old who wants birth control because she is sexually active? One that obviously doesn’t have any foresight of whats going to happen. Even in the age of HIPAA/parental consent police/cover your ass/etc it doesn’t require an Rx or anything for girls to get condoms!
    People use the excuse that they are too shy or afraid to ask for these things, they don’t have the transportation to get these, they don’t have an education, they “don’t know better” (whatever the fuck that means), etc. Put that on the very top of the list titled “Not my fucking problem”. These kids should NOT be having sex if they aren’t prepared for the consequences. End of story, write that on my fucking tombstone.
    Some girls at 14 might decide that they want a baby. You know, to be a ‘grown up’. They may think they can ‘handle it’ or some bullshit like that. Way to rationalize a big fucking lie. No girl knows what they want at 14. In fact, having a kid at 14 pretty much screws over your chances of doing anything productive with your life. Actually, if you do something productive with your life after having a kid at 14, it means that you weren’t being a good parent and putting your child first!
    Lets not leave the guys out of this. They may use the “i’ll be there for you baby” lines, but when the shit hits the fan (or the girl gets incredibly fat during/after pregnancy) we know who’s on the next bus to the nice piece of ass that comes their way. I’d trust a vicodin addict to watch the store while I get some lunch over a 14 year old boy who says he’s going to be a ‘good father’ to his 14 year old baby-momma.
    It boggles my mind how a 14 year old can get pregnant. I cant even put myself in their position as to how they would think having sex without being prepared for the consequences would be somewhat of a good idea. Sex is a very well known cause-and-effect thing. Its not like they “didn’t know she was going to get pregnant”. Sorta like using a chainsaw not knowing that it can actually hurt you. Brain + Penis = bu-buy.
    Plus the parents, being so proud that their little baby is having a baby of their own. They need to be hit with a 2×4. Maybe they are just delusional, or seeing the silver lining of a very black looming cloud that tore their daughters future limb from limb. I could see if the child was 18, or 19, or 20. Hell, as long as the child is old enough to drive her ass to the pharmacy for her free Tylenol and pediacare. 14? Come on. Look how your daughter is dressed, no wonder why she got knocked up! Seriously, 14 year old girls are not people, they are property. They are property that YOU are responsible for. You may think that your little girl having a baby at 14 is cute and fun, but the huge glaring fact is that your daughter just screwed the pooch in the life department.
    So people are going to ask me “Well, say my daughter was stupid and got pregnant. What do you think we should do?”. Obviously murdering your daughter (and the penis she rode in on) is out of the question (heh). This isn’t a place for me to get on a soapbox and spray you all with my political and moral opinions (even though I just sorta did, oops). All I can say to this question is “Do what you have to do to insure that this child (if she decides to have it) gets the best damn upbringing that you can manage and have it turn into a success story, not another unproductive member of society”. Thats not really out of the question is it? That should be what every mother and father years for when they have children. Key word here is “Should”.
    Now I realize that there are plenty of success stories from people who had their first child at 14, and I’m sure I’m going to be up to my neck with hate-mail calling me an insensitive asshole. People will question why I am a pharmacist since I’m so full of hatred and bitterness. To those people I want to leave this parting line:
    She is 14, she did know what she was doing, and don’t say that it was not her fault because no matter how you slice it, it is. She has every right and power to not have this happen, but she didn’t due to laziness or stupidity. Personal responsibility. Learn to deal with it and keep it in your fucking pants. Just because you like to flush your future down the toilet over an orgasm doesn’t mean you need to leech funds allocated to help people who didn’t have a choice what cards they were dealt in life.
    Heaven forbid me to be the personal responsibility police pissing in your cornflakes and telling it like it is.

    Oh yay, another uppity Medicaid person.

    Usually I get a few bitches a month about my Clomid + Medicaid rant. About every other one is written by a complete idiot. You make the call as to which one this is.

    Are you stupid? Welfare and Medicaid are NOT the same. We’re not bums. WQe
    work. Medicaid is to help those who cant afford the high costs of
    insurance. So you’re saying someione who is dissabled and on ssi or welfare
    or medicaid is a bum?? Get your facts straight dummy. And you shouldnt be a
    pharmacist.

    Oh yay! Where should I start:

  • Welfare and Medicaid are not the same? Well according to Wikipedia: Medicaid is the United States health program for individuals and families with low incomes and resources. It is jointly funded by the states and federal government, and is managed by the states. Among the groups of people served by Medicaid are eligible low-income parents, children, seniors, and people with disabilities. Medicaid is the largest source of funding for medical and health-related services for people with limited income. That sounds pretty much like welfare to me.
  • I dont know where you got the bum idea. Obviously you are so ignorant that you walk around with a Medicaid chip on your shoulder looking for a fight. The whole rant you were complaining about was that Medicaid patients (who you say are “dissabled and on ssi or welfare
    or medicaid”) should not be entitled to fertility drugs. So am I mean for making a legit point? Or are you just an idiot for wanting to bring children into this world that you self-proclaim you cannot afford.
    I’m not against having children (unless you’re 14, more on that later), just not while you require society’s dime to survive. I guess common sense like that is why I’m a pharmacist and you aren’t.

  • Perils of checking out the hotties

    Mike sent me a comment regarding the post about the Certainties part Duex and hot chicks walking into your store.
    For once, I am without words. His comment speaks for itself.

    Don’t forget about the downward crotch stare from the drive-thru window while you’re pretending to be concerned that they’ve retrieved everything from the drawer!
    However, with each of these methods there are risks…. Not only of being caught, but of getting a different view than you expected! The ‘over the monitor’ trick fails when the apparent hottie gets close and you realize that she’s an original AARP recipient….. and her ID number is probably “12”. Then there’s the ‘down the shirt’ fiasco when the nice rack is so saggy when she leans over that they rest on the counter like two overfilled water balloons stretching from gravity. But the nastiest is the ‘drive-thru crotch shot’ when the thighs look like an interstate road map with all the blue and red vessels….. Or worse yet, the bulge you happen to spot is too big to be cameltoe or a winged maxi pad…. And you realize you’ve just waited on Dragzilla!!!

    I have no more to add other than I think my testicles just shriveled up and fell off.

    Heather the Human Shield

    I just wanted to comment/elaborate/etc on a post made by the recent post by theDrugMonkey about the “Heather” of insurance companies.
    For all of those too lazy or stupid to click the link above and read DrugMonkey’s post, “Heather” (as he called it, so they shall all be dubbed “Heather”) is the person on the other end of the phone with the insurance company who doesn’t realize that shes riding an emotional atomic bomb down upon the healthcare system. She usually has a nice voice, and has been working for Satan a whole 2 days. She has no idea about the perils of health care nor that her employer managed to get about 4.5 billion ID cards issued with the wrong group number.
    I, like the DM, feel horrible for these people. They are the human shields of an industry who cannot help but piss on their own shoes while shitting on all of the people who make up their paycheck. They sound happy on the phone, but you know after a few months of being screamed at by doctors and pharmacist (over something they did not setup, have no control over, and really have no say in to make it better) they stare down at the empty bottle of burbon and wonder why in the fuck do they put up with this abuse. They then look at their kids and realize they are taking one for the team so their kid could have a good life. They refuse to go on welfare or fake a work comp or disability like everyone does.
    So it pains me to be upset when I hear Heather’s voice on the other end. I know its not her fault that her employer is retarded, or that the wrong ID number got printed on the card. I know that if she ran the world everything would probably work smoothly. Shes there to pay her rent and buy herself food. She is probably going to college or basically cant get a job anywhere else. Here we are screaming at them for something that they have absolutely no control over just to vent our frustration. Are we any better than those asshole doctors who scream at us because expensive-drug-x is $900?
    So next time you’re all fired up about WellCare not having the right ID number, and you hear Healthers voice on the other end, think of this post and realize that its not Heathers fault. She’s there to do a job much like you are and probably goes home and rags on pharmacists like I ran on Drug Reps.
    (Yeah, I realize this post isn’t full of hate, bad words, sexual talk or anything like that. It just sorta struck a nerve that I’m sure lives deep down within all pharmacists. I’ll try better next time. Fuck insurance companies and drug reps..There.. All better.. πŸ™‚ )

    ePrescribing – Why its STILL a bad idea

    With my earlier rant about how hard it is to read doctors’ handwriting, you would think that everyone would just jump on the ePrescribing band-wagon and fix this problem. I’ve ranted before about the horrors of ePrescribing and choosing the wrong medication, now heres something else that isn’t really thought-out pretty well.
    Forgery.
    Thats right, that nice little fax you get from the doctors office using their spiffy new ePrescribing software. How can we be sure that its a real or a phony? To forge a hard-written Rx, you need to steal a pad, write your drug, write the sig in pharmacy shorthand that wont send off any red-flags, wipe your butt on the signature line (to get a realistic looking signature), and hope the pharmacist is too busy to realize a glaring error you made.
    To forge a fax over Rx, you need to obtain the computer generated paper copy (which most doctors office will give you to), scan it, and just use photoshop or some other program to fill in whatever your heart wishes, then just fax it over. Nobody is going to be looking for an ePrescribing phony, so it shouldn’t send off any red flags. There is no “signature” only something stupid like:
    James D Doofman MD
    Signed via secure terminal
    Thanks mr “Signed via secure terminal”, that really makes me feel like it makes this legit. Other have a little digital signature that looks like an inkjet printer threw up in a little text box. As if that’s going to stop people from using a xerox machine and some tape. “Secure Signature” thwarted.
    ePrescribing has taken one huge factor that makes forgery difficult. The human handwriting factor. All of us ‘know’ a doctors handwriting or writing habits. The out of town or new doctors that we don’t recognize we call on. ePrescribing takes care of that. There is no human element to Rx’s now days. Everything is generated by a computer, the same type of computer that you are reading this entry on. The same computer that can be infected by viruses, taken over by hackers, and is 100% reliant on the person sitting in front of it to not click on the wrong space or hit the wrong button.
    I could just as easily now take one of the 1000 rx’s that I receive on a daily basis for narcotics via ePrescribing, use a copy machine, Microsoft word, and some tape, and send out forgeries that nobody would give a second thought to. In fact, I would be really surprised if someone hadn’t made a web page that will allow you to fill in your name, address, pharmacy name/fax, and what drug you want (via easy click menu!) and have it auto-fax it to the pharmacy of your choice. I’m sure it would be very trivial to make, and pharmacists wouldn’t even suspect it to be a phony (maybe a mistake by the doctor, but not a phony).
    So whats the solution? Easy, doctors need to know your pharmacist and pharmacists need to know your doctor. If you deal with one doctor on a frequent basis, invite him/her out to dinner or drinks after work. This applies to doctors to. You deal with the same pharmacy day in and day out? Go out for a beer or cocktail after work with them. Don’t give me this whole “I’m too busy” bullshit. All it takes is for that pharmacist to save your ass from one DEA investigation (because your dipshit office staff infected your office network with a virus, and every computer-literate crackhead now has full ePrescribing powers right under your nose) to make a few drinks a month/year completely worth your time.
    I love how we toss out a system of Rx writing that has been working perfectly fine for hundreds of years to a system that has been out for 5 that our licenses and practice rely on. Way to go.

    Pharmacy Certainties – The Hot Patient

    This particular certainty needs its own section, because its true no matter what. I know my fiance’ is going to murder me when she reads this. This applies to the single male pharmacy population.
    Hot girl walks into your store. Usually they only make themselves noticed during the dead of summer when they are wearing nothing more than a bra and panties. You’re swamped with work (as always) but a quick nudge by your male tech next to you grabs your attention. The transition from a hot summer day to a very cold A/C’d pharmacy makes things.. Uh.. noticeable. You try to keep your mind on work, but you cant seem to keep your eyes off of the hot piece of ass standing there at your counter. You do the whole “look over the top of the monitor” trick to make it appear you’re working and not checking her out.
    I know all of the females are going to get upset, but hey, its instinct.
    She hands you an Rx, you punch her central profile up, and the certainties start flying:

  • She is ALWAYS too young. You wonder if her mother knows she is out flaunting the goods trying to bait guys into statutory rape-ville.
  • You see the following on her central profile: Valtrex, Acyclovir, Zithromax 1gm x 50 dispensings, PlanB x 3000 dispensings, Birth Control (filled but RTS’d), Prenatal vitamins #300 filled 4 times about 3 months apart and of course, some nice expensive HIV meds.
  • The largest, ugliest, dirtiest mexican guy walks right up next to her, and they start to violate each other with their tounges right there in front of your staff
  • Hickeys. Lots and lots of hickeys.
    Suddenly, you are able to concentrate on your work a whole lot more as your soul dies just a little. You can hear your single male tech next to your breathe a sigh as his soul dies just a little bit more than yours did.