Just give it to my kid…

It annoys me how some people send their kids in to pick up their medication.  Not like grown-up teenage kids, but like 8 year olds while they sit in the comfort of their car parked right in front of the pharmacy.

Now, its quite often that we need to talk to you about your medication.  Stuff gets changed, discontinued, added, etc.  Do you really trust that your 8 year old will relay the message?  Should we show your 8 year old how to test his/her blood sugar so he/she can show you how to do it? Will your daughter be intelligent enough to point out the huge highlighted note saying that your metformin dose has changed?  Should I give your daughter the calendar so she can point to the date when your Soma is due?  Will a size 12 boot fit nicely up your ass or should I use a size 13?

When you call us on the phone from the parking lot, and refuse to come in with the excuse of “Just show my kid”, I want to go take a dump on your windshield.  I’m not going to trust YOUR life and MY career to your 8 year old daughter who has a hard enough time remembering what her last name is (because all the kids have different last names).  I realize that 30′ is a long way to travel, and if it wasn’t for drive-through fast-food and A/C you would probably starve, however if I need to talk to you I expect for you to walk your fatsomyalgia ass over to the counter so I can SHOW you what I need to show you.  If you still refuse thats fine, but so help me if you call in 30 min and expect me to walk you through using a test machine that I just showed your daughter how to use I’m going to piss in your next filling of Prometh with Codeine.

A new name for every provider

The way that I was raised is that people have a First, a Middle, and a Last name.  However, in certain cultures, its customary to take your mothers maiden/uncle/second cousin removed/mothers uncle’s dog/etc name and cram them all into one name that’s about 20 words long.

If you wish to have a name that takes 4 pages to write out, more power to you.  However when it comes to medicine  you need to use the SAME NAME EVERYWHERE.  That is your doctor, your pharmacy, and your insurance company for those at home who are a bit slow (or still typing out their name to comment to this entry).

I get really annoyed when you scream at me that your Rx is not ready to go because you decide to use names 1,2 and 3 at the doctors office, while being in our system with names 1, 4 and 6 WHILE your insurance card has names 2, 3 and 4 on it. Choose a First, Middle, Last.  It’s not hard, and even though you may be showing disrespect to some family member that you have never met, it will save both headaches (and your life) later on down the road.

Why?

How am I supposed to know that Jose Gonzalez Guadalupe Hernandez in our computer is REALLY the Juan Guadalupe Ortega that the doctor called in the Rx for?  I mean it really doesn’t help that the insurance card that you just handed me has Jorge Juan Hernandez Ortega written on it since it doesn’t match what we have in the computer nor what the doctor called in.  Sure I can look you up by your birth date, but do you know how many Maria Hernandez’s we have in the computer that were born on that date?  If you choose a different name combination every single time you come in, how can we scan your profile for any interactions?  Its hard enough when you go to multiple doctors and multiple pharmacies, but if you have 4 different profiles in our system alone? Are the bells ringing here? Am I making any sense?  Am I the only pharmacist in the world who has to deal with patients that have 15 fucking names?  Its frustrating, and its even more frustrating when you blame ME that YOU don’t use a consistent name throughout the health-care system.

Drug Reps, 30 Day Free Cards and Hatchet Murder

What could make drug reps even more annoying and obnoxious?  Arm them with little plastic coupons for free drugs, that’s how.

I want to go on record to say that I hate 3/7/10/30-day one-time-use drug freebie cards.  These bane of my profession entitle the member to a free fill of a certain drug.  We input all of the data into our system as if its their insurance, run a set quantity of tablets through, and after cost + $2.50 their “insurance” magically covers whatever the rep is pimping out.

The intention is to replace the act of the doctor getting samples and giving them to the patient.  However there’s a huge reason why I hate these cards and why the drug companies/reps absolutely love them.  In fact, there are a few huge reasons.

Take a bottle of the latest and greatest drug.  Runs in the neighborhood of about $400 for #100.  Now give the patient a coupon for 5 free days.  Who gets to have $380 (or #95 tablets) sitting on their shelf wasting money rotting until they expire (and only get about $150 when they are outdated and returned).  Me.  Not the patient, not the doctor, I get to eat the entire cost of the bottle minus what the stupid fucking coupon paid for.  Sure, maybe if hell freezes over someones insurance may cover this drug, but unless you’re on the state tit (Medicaid) no sane insurance company will cover the latest and greatest without a prior auth.

Now, this brings me to my second point.  Doctor gives them a free month of this shit because some big-titted drug rep sweet talked him.  Completely eludes the doctor that what they are pushing is just two existing (probably generic) drugs that cost pennies shoved into one tablet and given a cool name like CADUET or EXFORGE.  Cool trade names give better results (ask your local drug rep).  Anyway, patient is on this new and greatest drug for an entire month because the doctor gets his/her drug information from walking whores (like getting sex advice from pimps, but I digress) only to (surprise) have the patients insurance NOT cover the drug after the 30 day coupon is used up.  So not only did you piss off the pharmacy by making them stock a medication they will never dispense ever again, but now you need to alter your patients therapy because that little coupon didn’t magically buy them a prior auth. Big Pharma – 1, Doctor/Pharmacist – 0, Patient – 0.

So the take-home message to doctors is to just give the patient samples from your office.  If for some reason the drug company will not furnish you samples (and just these stupid coupons) then throw him/her out of your office (which you should anyways).  That way, if the drug isn’t covered you only screw the patient and not your local neighborhood pharmacy (but call us so we can tell you what IS covered or what we can do to help you continue therapy).

The take-home message to the patient is that these coupons are evil.

The take-home message to drug-reps is that you need to whore out the real goods instead of just pimping plastic cards.  You still may have the wool pulled over the eyes of the doctors, but we’re all onto your bullshit and scam tactics to make us stock expensive shit that nobody will cover.  If you made a GOOD product and sold it at a REASONABLE price, then maybe insurance companies would cover it.  Think about that next time you’re at your million dollar corporate parties.

Here we go again…

I posted the below comment on Dr. Dino’s blog. You can choose to
publish it or silently agree:
“Good on you Dino! Pharmacists are glorified cashiers that get a sense
of satisfaction because they feel they are ‘saving lives’ from poorly
or ineptly written scripts from MDs.
P L E A S E pharmacists, stop using this bullshit excuse that you are
saving lives!!!
YOU COUNT PILLS!!!! PERIOD!!!!
Keep on Dr. Dino. Remember, your work and status as a physician is
respected; pharmacists have cashier-level status and zero respect. (as
it should be)”

You know, you’re right. We dont save lives. When that GP writes an Rx for Viagra when his cardiologist has him on Isordil we aren’t in fact saving his life. Drug interactions are just a “made up” thing by the drug companies to sell more of the same type of drug. Glad you decided to blow the whistle, I was actually having a hard time hiding the fact that I just stand there and drink coffee while counting by 5’s all day.
I bet you think that nurses are just glorified janitors who clean up shit and piss for a living. Nurses don’t save lives either. Hell, I dont even know doctors who save lives because when lives are truly in danger people just take a ride to the local hospital.
I hope that you never have to rely on us lowly pharmacists to serve someone as smart and obviously well informed as yourself.
Obviously the person who left this comment was pissed off that he/she couldn’t get a refill of Vicodin ES 3-weeks early by the evil mean cashier pharmacist.

Professional courtesy and shitting where you sleep

angryPharm.jpgAm I the only one who gets disgusted quite frequently at our own profession?  Take professional courtesy for example.

When a pharmacy calls me for a copy, even if its a chain whom I hate, I always make sure that copy goes into the fax machine as quickly as possible.  When a pharmacist is on the phone to ask a question or to request said copy, I treat that phone call as if its a doctor holding.  I drop everything and answer the phone. 

Why? Because its called professional courtesy and I strongly believe in not shitting in my own bed.  Eventually I will need a copy from that pharmacy, and I much rather would treat my colleagues how I would like to be treated. 

However, there are pharmacies in town who make me wait on hold for 20 min to request a copy, then take their own sweet fucking time faxing the information over (sometimes 2-3 hours).  After waiting by the fax machine (as the patient is pacing around the store), I call to get the “Oh, we’re really busy”/”I’ll get to it” excuse.  I’m fucking sorry, I’m /just/ as busy as you are however I tend to put people in my own profession (and doctors) a notch above the village idiot who is calling for his soma early.  Hi? Remember me? A pharmacist JUST LIKE YOU.

I’ve been tempted to drive down the road to the local chain(s) and go take a steaming dump on their counters for how some pharmacists they employ treat their own.  Sure, we might be competitors and by faxing copies you are in fact taking business away from your store, but take a step back on how this looks to the patient.  You make it seem like you really don’t give a flying fuck about the patient if he’s not getting Rx’s filled at your store (which if you work for a chain you very well could not).  Now, after 4 phone calls from me and wasting the patients (and my own) time, do you really think that patient will ever go your chain again? Of course not.  Do you think that I’ll go out of my way to help you out in the future? Of course not.

Time after time however I promptly answer copy requests from the chains in a prompt and courteous manner even though deep down I know that they really don’t give a rats ass about someone who they’ll see at the CE dinners, at the pharmacy association meetings, and the person who will advance them a box of Duragesic patches late Friday for a long-term patient of theirs.  Its really fucking disgusting at the lack of professional courtesy that some of the “pharmacists” show.  You put your own before anyone else, because by not doing so you are doing not only a disservice to your own, to your patients, but to someone who will cover for you in case you want some vacation time, insurance information/tricks, or someone who is going through the exact same shit you are going through.

So to the chains who take 4 hours to fax over one fucking piece of paper: Go fuck yourself, I filled that copy off of the bottle that your former patient brought in because you didn’t take care of business before sipping that coffee as you stare at your $100k script-pro that will soon replace you.

Oh, and see that awesome logo someone made for me up in the corner of this post? Yeah, those are pills he’s shooting out of that gun with the bandoleer of pill bottles.  Cool huh? Don’t steal it, its mine.  Coming to a coffee cup near you as soon as my fellow pharmacists stop pissing me off.

Pet Peeves, number eleventy-billion

Hoverers.
You all know the type. They hand off their Rx’s to your clerks, then stand there staring at you. They don’t sit down, wander around, or do anything but stand there at your counter and stare at you.
You try to work, but every time you look up, you catch them staring at you. What could be so fucking interesting that it requires you to intensely stare at me all throughout the process of filling your Rx? You have a counter covering a good 2/3 of your body? Are they playing mental whack-a-mole with us and our always-shorter techs?
A few times I just want to shout “WHAT!” at them as they stand there staring at me. Its not exciting, trust me. I’m just typing information into the computer. Hell, I could be writing a TAP post and you would not even know it! Oh, wait, I’m on the phone now. HOW EXCITING! Watching grass grow or golf on TV is worth more than watching me work.
People like that stress me out. I don’t know why, but I really don’t like people standing there and staring intently as if studying my every move. Sometimes I duck down and pretend I’m hiding, hoping that the patient will either wander away or wonder what I’m doing down there. Once in a while I rip a huge fart while down there and hope my tech takes the blame for it.
Maybe they are wondering if I’m wearing pants. Who knows.

If first you dont succeed…

luvox.jpgAs I was taking my customary pharmacy-dookie this morning, I was flipping through the latest Drug Topics when I saw a nice little advertisement for Luvox CR.  Like Disco and bath-houses, someone is trying to bring back Luvox.  Luvox is one of those red-headed stepchildren SSRI’s that never really caught on.  Paxil, Prozac, Celexa, Zoloft all managed to get the ball rolling in the PR department.  Luvox however sank in the shadows and never really caught on.  It only got a little bit of press that one of the Columbine shooters was on Luvox.

Now, why someone would want to market Luvox CR is beyond me.  Luvox is dead! Deal with it! Why don’t we just bring back Reserpine?  Here you have a market of SSRI’s that cost pennies (Paxil, Prozac, Celexa) and you’re bringing a Continued Revenue formulation of a drug that did not catch on back in the day?  The company making this must be hiring Vegas Hookers as their drug reps to go deep throat every doctor in town to get him to write this shit.

What gets me is the whole “THERE IS NO GENERIC ALTERNATIVE” warning on the advertisement.  You’re right, but a quick phone call can give the patient a generic alternative that does the SAME thing and doesn’t have the trade name copays.  You know, if it came in bottles of 30 and the insurance would cover it, I might of just dispensed it and moved on, but since you had to point out that there IS NO GENERIC ALTERNATIVE like I’m some 4th grader who pooped his pants; it will be my duty now to switch everyone OFF of Luvox CR to either plain generic Luvox or some other generic SSRI.  Fuck you very much.

“But Angry Pharmacist, Luvox CR is DIFFERENT! ITS INDICATED FOR Social Anxiety Disease (SAD) and Dripping Anus Syndrome (DAS)”.  I’ll let you all in on a little secret.  An SSRI is an SSRI.  Ford and Chevy both make cars, but both will take you to the exact same spot.  Don’t give me the “This is indicated for this and our competitor is not” bullshit.  Doctors don’t listen to what a drug is “indicated” for (Uh, Neurontin?) just what works.  A $200 drug is not going to magically work better than a $20 generic.  You remember when reps were pushing Celexa? Remember when Lexapro came out the dumbass reps did a 180 and said how BAD CELEXA was? Yeah, its all about the Benjamins, don’t let the reps fool  ya.

So that Drug Topics advertisement? It was tempting, but I threw it in the trash vs using it to wipe my behind.