Everyones a Fucking Genius

So I got some hatemail in response to this entry

They may be corporate assholes, but at least they hold nobel intent.

Nobel intent would be charging a fair price for /all/ generics. Not $4 for amoxicillin yet $40 for a month supply of lisinopril or HCTZ.

People are dying; antibiotics save lives. No company *has* to give this type of break to anyone since the parasitical lobbyists from healthcare industry have penetrated both aisles of Congress. Yet they do.

Actually inappropriate use of antibiotics kill people (MRSA? VRE? VRSA?). Maintenance drugs that cost pennies will save more lives than all of the antibiotics combined. Why aren’t they giving all those away for free?
You’re right, no company /has/ to give this type of break however it looks really, really good for business if they do. Plus guess what, if you transfer all of your drugs there for 2 or so drugs at $4, you get to pay 10x what an independent charges for the remaining 5 of your Rx’s. Bait-and-switch. Bend over and grab your ankles. They are making up for the loss somewhere.

Get over it.
And when a universal coverage system hits, get over it too. You may have to put your new Porsche up for sale and switch to a Honda (get a hybrid and you can save the environment and maybe someone’s health, all that the same time).

Nah, myself and all the other pharmacists will be out of business at that point. We’ll determine that the cost of our schooling outweighs our income and we’ll just all do something else that makes money. Then as the pharmacies start to dwindle, the ones remaining can charge whatever the fuck they want or just refuse to serve you. Then what? You’ll just bitch that pharmacists are a bunch of greedy bastards because they don’t wish to work for free to fill your trade name Coreg for $1.50 profit.
Oh, I dont drive a porsche. I think fancy cars is just pissing money away. I prefer to spend all my money paying taxes so welfare folk don’t have to work and for this website so you’ll have something to bitch about at work.

If you wanted to make money, you should have went to work on Wall St not a place where reimbursements have been dwindling for years. Did you think that was going to change?

You think money is on wall street? I should of opened a PBM and started raping the system a long time ago, however anally raping the sick and poor isn’t really my cup of tea. Maybe to you wall street types its okay.

You’re a self-loathing narcissist; get over yourself.

You’re just a retarded douche who has totally made an ass of himself in front of a few hundred pharmacists.

N.B. I have been reading other comments on here and it’s somewhat nauseating. I think, instead of rx’ing myself Zofran 8mg tid I’ll go with Phenergan 25mg q4-6h off the $4 menu. Where’s your pharmacy.

Zofran is pennies now. Its generic, so yes, I will be Rx’ing myself some Zofran because it costs about the same a Phenegran and doesn’t have all the sedation side effects. My pharmacy however does not have a $4 menu because we charge a fair price for /all/ medications, not cheap out over a few to draw people in to rape them on the other ones. Fair prices and good service, like all pharmacies should be.
Plus what does my post have to do about anything that you are ranting about? Did you even read my post? Let me recap because I know I used some big words.
My rant was about these pharmacies giving away free/$4 generics away setting a precedent to the insurance companies to cut our reimbursements due to the fact that if we can get by selling things for $4, then obviously their reimbursements are way too high. They are fucking it up for the rest of us who cannot afford to sell medications for $4. Its a marketing scam and its going to draw the opinion of all the major PBM’s to make that AWP-30%+1.50 sound like a wet dream.
Wait to see how many pharmacies are left when the PBM’s make all the reimbursements $4/rx, and next time read my damn post before flaunting your ignorance.

Arguing that water is indeed not wet

Before I get into my usual rant about the stupidity of the common-folk, if you wish to get email notifications about new entries here (rather than refreshing my website 1000 times a day), just enter your email in the area on the right hand side of your screen marked “Subscribe to this blog”.  No, I’m not going to sell/use/molest your email address.  If you are paranoid about that, then get the sand castle out of your vagina and waste lots of time refreshing my site for content that others will get emails about.

Now, onto the stupidity.

Have you ever noticed that some people just like to argue?  Not the usual ‘I think I have a valid point, so I shall argue with you’, but ‘I am so retarded and cannot understand the big words that you speak out of your mouth’.  What’s sad is that no matter how clear you make it, they just dont get it.  Usually this involves refills in one way or another.

  • Person comes in and wants a refill for an Rx for some TAC cream that was filled over a year ago.  The Rx had 5 refills on it, but was over a year old so the Rx is expired.  Even though I am really clear (how much clearer can you get than “the Rx is over a year old, it has expired, the refills are no longer good”) the idiot just sits there and argues that he has 5 refills on the Rx and he wants it filled.  Eventually I get frustrated and make some really vague analogy to drinking expired milk (which he probably does) and eventually the neurons fire and he ‘gets it’.  My soul died a bit to realize that this idiot is reproducing.
  • No refills on C-2 narcotics always seems to completely throw everyone for a loop.  Every month the same idiot wants you to fax the doctors for a refill for Methadone and every month you tell the idiot that a C-2 narcotic cannot have any refills and you need a new Rx.  Once in a while you’ll get a new doctor on the phone (or mostly a seasoned PA/NP) arguing with you that since the little Rx blank has a refill bar that C-2’s can now be refilled.  They are completely oblivious that their Rx pads are for /all/ controlled substances, not just C-2 narcotics.  Most of the time just telling these people once will solve the problem (misunderstanding/confusing/didnt know that percocet was a C-2/etc)  however its the repeat offenders that worry me.  These people have prescriptive authority too, that makes my heart sad.  If you tell a dog to stop eating his own shit enough he eventually will learn.  Jury is still out however on these idiots.
  • I’m not going to get into the whole 30 day supply of medication.  The calendar is a vague and confusing thing, and depending on how you split it, saying that something needs to last 30 days could vary between a week to a few months.  I guess when you need a “Must Last 30 Days” warning on your Rx, your definition of a “day” can shift depending on how much of Prince Valiums cock you have sucked.
  • Copays.  You have been paying a $25 copay for the last 5 years, and every time you must argue with me and have me look up how much you have been paying in the past.  Surprisingly I come back with….. $25!  Thank you for wasting my time.  Double thank you for sitting there and arguing with me about it.
  • Trade name medication and DAW-1.  Patients still feel doctors are the magical do-as-I-say deities that everyone should listen to.  They feel that if the doctor writes DAW-1 on their Coreg Rx that the insurance company is forced to cover it.  No matter how many screen printouts of the insurance company saying “I DONT CARE ABOUT YOUR DAW-1” they still will sit there and argue with you about it.  They don’t wish to pay $100 for their medication, but feel the insurance company should because of a small checked box.
  • Everyone has heard the “Doctor told me to take this twice a day” as they come in with a new written Rx for the same drug at once a day.  They will sit there and argue that they were told twice a day despite you having a new Rx there showing it at once a day.  Once I even used the line “Since you aren’t going to listen to me or the doctor, you just take it however the hell you want, but doctor has here once a day and thats whats going on the bottle.”  Guess who got his ass chewed by the doctor for not taking it correctly, it wasn’t me!

When did they start putting lead in the water?

Pharmacists are NOT DOCTORS!

Reading the DrugNazi’s site, I came upon this gem of a rant regarding a comment from ‘Dr. Anonymous, PharmD’ (More like Dr Dipshit, PharmD).
I couldn’t agree more with what the DrugNazi has to say. Given that I personally have a PharmD, I would never ever call myself a doctor (and are the first to say that I am not a doctor). Why? Because I’m not a fucking doctor. I’m a pharmacist. I don’t wish to be called a doctor because I am not a doctor! I get down on NA and MA’s for calling themselves Nurses, now I’m getting down on my own for calling themselves something they are not.
Most lawyers have a JD, but do they call themselves Doctors? No. Where do all of these fucking uppity pharmacists get off by calling themselves ‘Doctor So-And-So’ because they have a stupid PharmD after their name? Are they so socially retarded that they feel like they have something to prove to somebody? Do they not realize that most every pharmacist out there that has graduated within the last 10 to 15 years has a PharmD? You are not special compared to the BS crowd. Do the PharmD crowd have special powers or licenses? Hell no! We are all in the same boat, so quit flaunting your perfectly measured out PharmD penis (vs the BS folk who just work and just know they have a big penis) and just get to fucking work!
Let me spell this out if you are a PharmD and do not understand.
Any pharmacist who calls himself a “doctor” needs to stop going to those mutual-masturbation circle-jerk pharmacy association meetings and actually work in the ‘real world’ for a change. If I call for a copy, and you call yourself a doctor, I’m going to call you a fucking retard who should of settled for medical school vs going to pharmacy school.

MRSA is going to end the world…

Another typical example of the media getting a hold of a medical concept and completely instilling fear and chaos into the unwashed masses.
Everyone is playing chicken little throwing MRSA around and implying that its somehow a death sentence if you get it. This magical strain of staph is resistant to everything short of a blowtorch and will not only kill you, but kill your children and make your minority cousins horribly disfigured.
Lets be realistic here. MRSA is nowhere nearly as bad as people are making it. For those at home living in a box, MRSA stands for Methicillin-resistant Staphylococcus aureus. Yes, it sounds extremely scary. People think that MRSA is resistant to everything, and there is no hope of treatment.
They are wrong. They are in fact extremely wrong.
First off, I have never ever seen a MRSA case that has been resistant to everything under the sun. Yes, MRSA is resistant to all of the penicillins/cephalosporins, but we aren’t living in the dark ages here, we have a shitpot more antibiotics than those two classes. Of the dozens and dozens of Culture and Sensitivty reports that I have gotten trying to get Zyvox covered, I have found that in 99% of the cases the “evil” MRSA infection is perfectly suspectible to the Fluroquinolones (Levaquin/Cipro/etc), Tetracycline, Clindamycin, Rifampin, SMZ/TMP, etc. If you want to go IV route, Vancomycin.
Seriously, its not that big of a deal. The problem is that people want to throw Zyvox at everything instead of doing a proper C&S report to determine what else they can use other than the biggest bacteria bazooka that is on the market (at $60/tablet no less). Give them Zyvox, send them home and forget about them. Right, you try to explain that to the insurance company when they are staring at the C&S report that I faxed them showing that clindamycin has exactly the same efficacy as Zyvox in this case. Retarded I tell you, utterly retarded. The PA’s that I have gotten for Zyvox involved a ton of confirmed type-1 allergic reactions to what was effective. If you have drug allergies then you start stripping of available agents and things get a bit complicated.
So I blame the media here (as always) for clipping out only choice words that will cause the most fear and panic (read: ratings) and have patients come in to me in a tizzy thinking their life is over because they have a stupid minor MRSA infection.

The wonderful world of drug handouts

Once in a while, you’ll get a patient handout for a drug that just cant help but make you laugh. Patient handouts are meant so even the village idiot can get their meanings. Lets take a look at Xeloda’s patient information sheet and angrypharmacistize(tm) it.

Your tech starts giving you lip.


You start to have conversations with your poop.


You decide to only communicate with your tech using the universal pimp-slap.


You decide to take a poop without pulling up your nightgown.


You can only poop in your nightgown under the moonlight.


You kick all the crackheads out of your store.. Literally.


You grow an evil villan mustache

For Sale: WellCare, gently used, only $5

This post should of been titled “Putting the ‘oh shit someone told on us’ in WellCare”
See what happens when you cross The Angry Pharmacist ™? You get raided by the FBI, your stock tanks like a post-thanksgiving turd, your exec’s abandon ship and put their business on CraigsList, and Pharmacists everywhere are digging your grave. Remember that.
On a more serious note, if you have lived in a barn the past week, Wellcare (the one we all know and love) got raided by the FBI/Government/Granny/etc. Their stock promptly went from $130 to ~$27. Dont believe me? Click here.
Why did Wellcare get raided? Well, people aren’t saying much. I read somewhere on that yahoo link (that I cant seem to find the article now, interesting) that they were misrepresenting their earnings, especially when dealing with officials in charge of reimbursement (meaning OUR reimbursements probably). Something about contracts with an off-shore business or something to lower their overall profits. For some reason actually making a profit of 49% higher than reported rings a bell somewhere in my head.
What does this all mean? That the “Fair” reimbursement we have been getting of way too low like cost+$1.50 is bullshit. Wellcare obviously was rolling in the dough, so why couldn’t they up our reimbursements? Oh, because they were funneling their money around so their company looked less profitable thereby giving them an excuse to fuck over the pharmacies and our shitty reimbursements. “We cannot afford to reimburse you more” they spew as they light their cigars with fresh $100’s.
Since Wellcare’s crap-ass reimbursements were just in jive with the other big-hitters of the Medicare Part D crew, I wonder how many exec’s of the other big Medicare Part D providers (Caremark, etc) are currently forging their books expected to be investigated next? Are the Exec’s cleaning the turd stains out of the boxers bought with their $400,000/yr salary? Are we magically going to see new contracts appear in our fax machines with higher reimbursements? God I hope so.
Stockholders are suing. I would sue too if I had my retirement invested i Satan at $130/share to barf down to low 20’s. I wonder how long until the pharmacies class-action WellCare’s ass over reimbursement rates generated from an incorrect profit statement (not just a little 2% incorrect, but probably ~40% incorrect, whoops). We can only hope. You can be sure that I’ll have more commentary as the info comes rolling in.
Happy 1st everyone. I hope your day wasn’t as shitty as mine.