Cherrypicking

I hate cherry-picking pharmacies.  If you are new to this term, this is what it means.

Cherry-picking is the act of filling a bunch of easy Rx’s for a patient, then giving the Rx back (with the filled Rx’s crossed out) to the patient telling him/her to go to another pharmacies to get the other (harder) Rx’s filled.  99% of the time the unfilled Rx’s require a prior-auth or paperwork to be filed for payment.

This pisses me off to no end.  Give me the shit-work while you get money for the easy ones.  I hate pharmacies who do this.  If you are going to make me fill the hard ones, then give me the easy ones as well.

So say a patient hands you an Rx which another pharmacy has pulled this shit on you.  What do you do?

  • Do the paperwork to get the hard Rx covered?
  • Call the other pharmacy and bitch at them as to why they got the easy ones while you are stuck with the hard ones?
  • Give the Rx back to the patient and tell him/her to go back to the other pharmacy and make them do the shit-work?

There’s no real right answer here.  Pharmacies who preform this bullshit backstabbing should be fucking firebombed and their pharmacist strung up by his testicles/labia.  If you are going to fill an Rx for the patient, then do all of them, not just ones that are the easiest for you.  Not only is this bullshit for the patient, but bullshit for the pharmacy that has to face the patient and tell them that their Rx is going to need a prior auth.  Just because I do prior auths does not mean that I’m your bitch for you to walk all over me.

Typical how chains are notorious for doing this.  Fuck your company policy about not doing PA’s.  If thats the case then just send them to me with ALL of their Rx’s and I’ll do what your lazy ass wont.

PA/NP/CNM/Janitors with Rx Authority

Why is it that 9 out of 10 Rx’s with a huge glaring mistake are written by NP/PA/CNM/Janitors who somehow got prescriptive authority before the people who actually went to school to learn about drugs?

Maybe its just where I’m at the PA/NP cribs are painted with lead paint, but its to the point now where when I see an Rx from one I just sigh and prepare to be frustrated.

Real life shit I deal with on a daily basis:

  • Amoxicillin 250/5 –  4.5mL q8 x10d
    • Come the fuck on, 4.5mL?  What the fuck is 25mg of amoxicilin going to do?  You can’t make it an even teaspoon?  A palm pilot is not a substitute for common sense.  Get your head out of your ass.
  • Amoxicillin – 158mg q8 x7d
  • (Just from today) Amoxicillin 648mg q8 x10d
    • This makes me want to murder people.  You get 1s, 1/2ths or 1/4ths of either 125, 250, 400.  Those are your only choices.  Choose wisely.

You know, dosing amoxicillin isn’t rocket science.  What the problem of PA/NP’s have is that their common sense is in the little electronic device that spits out a dose when you put in the patients weight.  The entire concept of having a mother who is barely able to wipe her own ass by herself is NOT going to be able to measure out anything that does not have easy to read numbers and big lines.  Thats 1/2, 3/4 and 1 teaspoon.  Case closed.  If this somehow involves fucking and having children you cannot afford, then maybe she’ll be competent enough to be okay, but dosing amoxicillin doesn’t fall into that group.

So I call the PA/NP and ask if they have a syringe they can give the patient that has readings out to the hundredth mL.  When they get the bitchy “Why would they need that?” I respond with “To measure out the amoxicillin dose that you wrote for.”  Once in a while they’ll get the idea, but usually it just goes right over their heads.  Rx authority people, this is who you are giving it to.  A fucking monkey can use a palm pilot and get a dose.  Some days I think I would have a better chance with a money.

  • Nebulizer, Ventolin HFA, Xopenex neb solution (DAW-1 of course), prednisone 60mg x5d with a huge note “DX: ASTHMA”
    • Steroid?  What the fuck good is this person going to get from all this shit with no steroid.  Lets just take care of the symptom without taking care of the cause.  I bet they would just throw vicodin at pneumonia without even thinking about antibiotics.
  • Metformin 750mg bid
    • 1.5 of the 500mg tablets? 100mg isn’t going to kill someone, just do one of the 850’s and save the patient the hassle.

The list just goes on and on and on.  Its gotten to a point now where if I see an Rx, and see that its written by a PA/NP I expect to spend about 20 min trying to sort out their fuckups.

Airborne, wasting your money since around 1998

So, it has come to my attention (a few days ago) that Airborne must pay 25 million due to a lawsuit claiming that it didn’t work.

Some highlights include:

  • Airborne not proven to work
  • The “clinical study” was preformed by a couple of random dillholes and probably was just made up
    airborne_200.jpg
  • If you purchased airborne, you can get a refund
  • Making medical claims without FDA approval

Now, I know that any self-respected pharmacist would never ever suggest airborne to anyone that they cared about.  Why? Because it doesn’t work.  We all know this, you all know this.  Its vitamin-C and a bunch of other OTC shit all in a fizzy alka-selzer tablet that makes you feel all warm inside.  Its like donating $0.75 a day (the price of a cup of coffee) to starving African kids when its just going to feed Sally Struthers.  Rich folk do that just so they can get a hard-on by ‘helping people’ as they bitch at me about their $30 copay.

The only person you would sell Airborne to is that retired teacher who always calls you out front for an OTC recommendation only to tell you how wrong you are and buy something else.  Those fucks you are happy to see waste money because they have no problems wasting your time.

Which brings me to another point.  One of the major selling points of Airborne is that it was “CREATED BY A SCHOOL TEACHER!”.  Now just not any teacher, but a 2nd grade teacher.  Someone enlighten me as to why I would trust anything a school-teacher made?  How is that even a half-way valid selling point?  Some of the most ignorant people I know are school teachers (mostly because they think they know everything and are very vocal about it).  If it were made by a pharmacist it might have some basis because at least we know how the body works, but a 2nd grade school teacher?  Is this shit going to work based upon the vast knowledge of social studies? Cursive writing? Multiplication tables? Is this teacher applying their vast knowledge of shit-stupid physical science to prevent my cold?  What qualifications does he/she have (being a 2nd grade teacher and all) that would actually give her some real-world claim to actually know something about medicine?

Victoria Knight-McDowell, please inform us pharmacists what your methods were to determine what does and does not work to prevent colds as well as any relevant research and study data?  What? No I do not wish my name on the chalkboard. What?!? Detention?  Aww!!!  I’m sorry for implying that you are a fraud preying on the stupidity of the uneducated population, can I go to recess now?

I’m confused as to why people waste their money on this shit.  I’m actually shocked that people swear by something that is proven to not work and has every pharmacist in the country saying that it does not work.  Its the “#1 best selling” because people are stupid.  Not because it works, but because people are piss-stupid.

Of course they also buy “Head On” which is chap-stick for your forehead so I guess I should just shut my mouth.

Taking my red-wagon and going home.

Now before all of you Chain guys and gals send me anthrax and bombs in the mail, let me say a few things.

  • That rant was targeted.  Some of you know who it is, most of you dont.  Those who know are probably saying “oh damn” but the rest of you just took offense and are storming my house as we speak.  As you all will point out to me, chain life is not the devil, but some people are making it sound like it is.  Stop your bitching, if it were fun it would be called FUN and not WORK.  I’ll leave it at that.
  • 3 independents have closed this year just around where I work.  If the Medicaid/Medicare cuts go through the rest of them (including myself) might be joining them.  Think about that for a second then wonder if whining about your store manager is really as bad as you say it is.
  • That post was fueled by a number of factors that put chains on my shit-list over the past few days, some of which include:
    • Making a long-term CASH customer of mine wait at 11:30pm for an ER written Z-Pak for 2 hours while she said the pharmacist just sat there and talked on his cell phone while wandering around the drug isles.  She didn’t want to disturb me at home to open the store even though she has my cell number.  This was at a store that initials start with an upside-down M.  Don’t give me this backlog shit, its a z-pak ran as cash.  Run the label, slap it on there, let her get home and get better.  I doubt shes going to spend much time shopping in the front-end shit.
    • Me waiting on hold for 20 min for copies yesterday when the store does about 1/2 the volume as we do and has twice the staff + a scriptpro.
    • Having said pharmacy decide to not just fax me the transfer sheets, but the entire screen printout which tied up my fax machine for a half hour.
  • Its fun to stir the shit pot once in a while. Wait, its not fun I guess when its directed at some (if not all) of the readers, but fun when its directed at doctors, nurses, crackheads, welfare patients, etc.  Funny how that double-standard works.

Now, to all the people who emailed me calling me an asshole, and they are never going to read my site again, wah wah wah:  Go ahead, leave.  Heaven forbid I rag on doctors, PA’s, welfare people, and the world in general for you to agree and be on my side with only to have you take your red-wagon and leave once I rant about something that maybe hits close to home for you.  See this website? Notice the word ANGRY in it?  I make no money off of this, it costs me an arm and a leg to keep up, and to be honest I’m not going to censor what I write on here because it might *gasp* offend you.  This site isn’t called “The angry (but-only-when-its-not-directed-at-you) pharmacist”.

So I’m going to make a rule now that I’m not going to make fun of any more groups of pharmacists because feelings got hurt.  Thanks a lot.

Chain Pharmacists have it SO HARD

Theres some talk about how bad pharmacists that work for chains have it.  Be it under staffing to bad working conditions to a store manager that only dealings with a pharmacy is buying extra small condoms.

There is one aspect and benefit that Chain Pukes have that us Independents don’t, and I think that its something huge that they take for granted and really shut their mouths when its brought up.

Job Security

Thats right, Job Security.  You see, with an independent, we don’t have a multi-billion dollar company backing us up.  We don’t have a corporate office that we can just defer shit to.  We don’t have a guarantee that our paychecks will cash every two weeks.  When huge Medicare/Medicaid cuts happen and the reimbursement goes down to shit, we don’t have the luxury of over productive stores to help float us during the bad times.  Our bank accounts are not tied to a place where people in suits crunch numbers and fancy lawyers give us advice.  We’re out there on our fucking own doing it the old fashioned way, the “old school” way.  The way our grandfathers did it.  Our “corporate office” is the owner of the store trying to get the fucking payroll done in the back room while handling calls from doctors office so we don’t die up there in front.

You know what we get when the shit turns sour? Walking papers and a chance to search for a new job.  Thanks for fucking playing.

Furthermore (to make you all look like a larger big whiny sandy vagina), we are just as overworked as you, and we still have to deal with the same shit that you do.  Same patients who want and demand everything, same insurance companies that fuck us over (only WE have to do our OWN recon sheets and we don’t have the “power” to negotiate), and we shafted by the same expensive drugs (which is coming out of the OWNERS pocket, not a corporation pocket).  We watch reimbursements and what we order so we don’t put the business under.  We can’t hire more help not because “corporate office says that we need to hit x/day” but because we cant fucking afford another pharmacist.  Do we get to hide behind “corporate policy” or “well the corporate office says we HAVE to do this”? No.  Our “corporate office ” is usually the guy working next to you who has owned the store for 30 years and has his whole livelihood invested in not only his staff and store, but in his patients as well.

However you go to bed every night after bitching to everyone about how overworked you are knowing that your store is going to be open in the morning, while we sometimes have to wonder if our wholesaler bills will get paid, payroll will be made, and if Humana/WHP/Argus/etc will be on time with their payments.  We have to deal with the stress of not only running the pharmacy, but running a business as well; down to payroll, taxes, workman’s comp, everything.  Even buying the fucking bags that we put the drugs in with our names on them.

New graduates don’t want to deal with the shit of running a business.  They want to work in their nice chain store jobs with their stock options, vacation times, sign-on bonuses and the satisfaction of knowing that the business aspect will be taken care of someone whom they will never meet, and their paycheck will magically get direct deposited on the 1st and 15th.  On top of that they have the balls to sit there and bitch about how working for the chains is so fucking hard.  Hear that? Thats me playing the smallest violin for you.

So quit bitching.  I’m tired of it.

Fuck Copays

Copays are the bane of our existence.

There isn’t a day that goes by that I don’t get into an argument or discussion with some retard about their copays.  Be it too high (even though they paid the SAME amount last month) to the infamous rocket-science-level deductible, its like we spend 99% of our time explaining something that should be common knowledge.

Why do people think that WE have anything to do with their copays? As if I pull a number out of my ass and slap it on the label for them to pay.  Are people really that fucking stupid? Oh, wait, dumb question.

What really pisses in my cornflakes is when someone is getting a $300 prescription, say #60 Aciphex, and has a $10 copay.  Then has the balls to sit there and openly complain to me that they should NOT have to pay that $10 and how much their insurance sucks.  Heres a typical conversation:

Them: WHAT! I have to pay $10! This can’t be right!
Me: Well, according to my system here you paid that last month.
Them: THATS OUTRAGEOUS!  HOW MUCH IS THE CASH PRICE?
Me: Uhm, close to $350 dollars
Them: $10 is way too high for this Rx! I want it lower
Me: Uh, I dont set your copays, you’ll have to call your insurance.
Them: IM GOING TO WALGREENS

Now this is what I wish would happen:

Them: WHAT! I have to pay $10! This can’t be right!
Me: Listen here you fucking ungrateful moronic fuck.  You are getting $300 worth of medications for fucking $10.  /MY/ copays aren’t that low, and you have the fucking balls to sit here in front of me and my staff and whine over paying $10.  You are a fucking moron, and I am embarrassed to be in your presence.  Take your fucking prescription and go somewhere where they give a fuck, because I have better things to do than to sit here and listen to the diarrhea babble flow out of your mouth.  You are an ungrateful fuck and I hope you die in a car fire.  Eat shit you whore.

However business and that crazy ethics crap dictate that I can’t really fly off the handle at them while they are in the store (but I do tend to do it when nobody is in the store).  It really does however piss me off when people whine about copays that cost less than a good meal at McDonalds.  If your copay is $150 bucks, sure, bitch away.  $10 not so much.