Medicare Part D – D-Day all over again.

No no, I’m not going to give our dear friend Ken a good beat-down like some of you have been hoping.  I’ll get my revenge when he asks for his Vicodin and Soma a week early and his doctor and I (in some “fuck fuck paternalistic plot fuck fuck” tell him to go “paternally fuck” himself).  Besides, you all have shown him the errors of his life way better than I could.  Seriously, 50 comments and counting wasting this douche bag surprised the hell out of me.

Before I start bitching about old people and Medicare part D, I would like to bring to light the best comment I think I have ever received.

All you people who think TAP is so funny and so smart. You know who you
are. The ones who come here daily and encourage him and his behavior.
Will you still be proud of yourself when this human time bomb goes to
work one day and shoots up a group of innocent people? There is no one
more psycho and disgruntled than TAP. You people couldn’t care less
about him. If you did you would try to help him with his displaced
anger, instead of being the enablers that you are. I hope when you read
about him in the newspaper one day, you take your share of the guilt.

Wait, are you saying that there is nobody on this earth more psycho and disgruntled than me?  Oh how my heart flutters with bile and hatred!  Take that Angriest Pharmacist and DrugMonkey!  Have you gotten a comment saying that you’re a time bomb? Have you gotten anything that predicts you murdering a bunch of innocent people?  No!  Me – 1 and You – 0!  But realistically, “try to help him with his displaced anger”? Give me a break.  This isn’t a self-help group therapy site!  Lets all sit around the ScriptPro and sing songs of peace.  Obviously Marcia W, poster of the comment above, needs a big helping of the clue-bat to realize what kind of site this is.  Of course she agrees with Ken, so shes probably with Ken asking if he can get his narcs early if she pays for them with a two-party check.

Anyway, since this isn’t the Ken and Marcia show, and all of you “enablers” out there (50+ comments and counting!) are about to get fucked over on the first of this year, lets get back to the task at hand.

I have an idea.  Lets take a insurance plan and make it as complicated as possible.  Lets add shit like deductibles, a coverage gap (aka: doughnut hole), catastrophic coverage, multi-tiered copay systems, the works.  Now lets force the one class of people who have the least amount of understanding: The Old.  Now lets pawn the explanation of everything to our local pharmacist who we will pay $2.00 above cost for this service.  Lets send out ID cards with the wrong information on them as well send deceptive ads and salesmen around to complicate and confuse things even more.

That boys and girls, is Medicare Part D, and its the utter-clusterfuck of pharmacy.  They have made the absolute complex insurance plan possible and forced the old and stupid to use it.  Lets face it, the 65+ crowd aren’t the sharpest crayons in the box and are the most willing to bitch and moan.

On the first of the new year, retail pharmacy as a collective will either stick the proverbial shotgun in their mouths and pull the trigger, or will drink themselves into oblivion.  On the first is when all of the deductibles reset (and yes, you WILL have to explain what a deductible is to the same patient for the nth time in a row), plans merge, shuffle around, Argus and Wellpoint go down, etc.  Its going to be a mess.

However seniors, being old and confusable, forget about a few years ago when there was no Medicare Part D and they had to PAY OUT OF POCKET FOR EVERYTHING minus that measly discount the Medicare card gave them.  How quickly they bitch about $3.10 COMPLETELY FORGETTING they were paying $65 just a few years ago.  “I’m old and I deserve something.”  Yeah, well I’m not old, you’re using up the Medicare money that I put in but will never see, and I hope your little electric scooter shorts out in the parking lot so I can laugh at you.  You would think they would learn the routine now that Medicare part D has been out for 4? 5? years.  Yeah, you would think.

I’ve said it before and I’ll say it again, that Medicare Part D is a mean and cruel joke on the old and stupid and revenge on pharmacists.

I’m dreading the first

Deck the halls with Vicodin and Soma

I hate the holidays.  I’m serious!  Christmas time is the most horrible time for retail pharmacists.  Why? The blatant lies, excuses, and just whining to get pain pills early.

Now normally dealing with people who need their stocking stuffed with CIII’s is pretty soul killing, but add on a good dose of holiday cheer and you have a prescription for a bottle of Jack and a nebulizer treatment of 00 buckshot.

I realize that some people do have legit holiday plans and need their stuff filled early.  Thats fine. However when you call me on XMAS EVE and demand to have your Soma filled a week early because you are “leaving town for the holidays” and neglect to want all your other medication filled early as well (you know, blood pressure, diabetes, unimportant shit), that really doesn’t work.  Whats that saying about a lack of planning on your part doesn’t constitute an emergency on my part?  I should have that tattoo’d on my forehead (since most of my patients think I have the word STUPID tattoo’d on there as well).

Whats even more soul killing is when the patients sit there and say “I didn’t pick up my pain pills a week ago”.  I pull the security tape and signature logs, and sure as shit its them.  If its not them all I have to do is just mention calling the police and suddenly they realize who picked up their pain pills! AMAZING!  I mean really, did they expect me to go “Oh, shit, that wasn’t you, it was a random person off the street who KNEW you had vicodin and soma ready to go HERE that was just called in this morning!  Heres a refill plus a stock bottle of soma for your troubles!”  Pulling shit like this only makes you look like a fucking addict, and
idiot, or a fucking idiot addict.  Thanks for wasting my time, I hope
you OD and die.

(Cue the 100 people who have “legit pain” bitching about how I think everyone is an addict.  Heres a tip, unless you prove it to me otherwise; you are, case closed.  I’m a big hammer and I pound in nails in all day every day, so everything is a nail to me.  Don’t like it? Go to pharmacy school and get lied to for 9 hours a day.  Then, after you get burned on a few early refills, thank me for being right.  If I were in “your shoes” I wouldn’t call the pharmacy 4 times a day asking when my pain pills are due; I’d be able to divide 90 pills at 3 times a day and make 30 days; and for gods sake I would be an active part in my care and not wait until I’m leaving town to ask for a fucking refill when I know I need a new Rx for that methadone script!)

The holidays are an absolute nightmare, and there isn’t enough gin in the world to fill the void that the unwashed addict masses have caused to my soul.

Merry Xmas and a Watson/QT/Mallinckrodt/Teva/Barr/whoever makes the narcs your crackheads like/etc New Year!

Truth about DAW-1

I really get angry when I see a DAW-1 on a prescription.  To me, a DAW-1 without a good reason is like saying “Hey pharmacist bitch, do what I say right now because I’m the doctor and I know whats best in drug-land”.  Bzzt, welcome to AngryPharmacyLand.

For those who don’t work in medicine, a DAW-1 means “Dispense as Written code 1” (There are a bunch of DAW codes to signify different things like “Generic not available”, “Brand dispensed as generic”, etc).  However a DAW-1 is doctor speak for “I want this Rx to be exactly how I want it, I don’t want any changes/substitutions made”.

Now some doctors are confused.  Lets indulge ourselves into what a DAW-1 means from a pharmacist standpoint.  You see, DAW-1 (to us) is meant to be used when a doctor wishes a BRAND NAME medication used instead of a FDA approved generic.  Most (if not all) states allow the pharmacist to auto-substitute a generic when the Dr writes the brand name on the pad.  This is great because I’d rather have doctors write Maxide instead of  triamterene/HCTZ.  Brand names are shorter and (especially with birth control) a whole lot easier to deal with. 

If a Doctor gets a wild hair up his/her ass and wants trade name Maxide (HAHAH!), they would write Maxide (DAW-1) while checking and initialing the little box by where they sign their name (which NO doctor can seem to get right) to prove that they indeed want the brand name dispensed instead of the generic substitution.  This also can be noted by putting “DNS” for “Do Not Substitute”.  Again, the checking & initialing the little “Do Not Substitute” is beyond an MD education.  If you cannot get this right, then obviously there should be some question as if the DAW-1 is education driven, or some big-titted drug-rep driven.

Whats funny, is when doctors (but mostly PA/NP’s) put DAW-1 on EVERYTHING thinking that it means something.  Diovan (DAW-1), Lipitor (DAW-1), Zyvox (DAW-1).  Now you (and only you) may feel like you are doing the world a favor by putting DAW-1 on a bunch of Rx’s for brand-name-only products, but you’re just looking like an idiot to us pharmacists.  You may think you are actually doing something via the DAW-1 code, but I hate to tell you, most states do not allow us to substitute completely different drugs, only a brand name drug to its FDA-approved generic.  So you are telling us DO NOT SUBSTITUTE a generic for a drug you wrote that has no generic out.  Way to go! You’re a winner!

Wait, you think that the patients insurance company will give 2 fucks about your DAW-1? Hate to tell you, but for all they care you can take that DAW-1, roll up really right and shove it straight up your ass.  99% of the insurance companies laugh at your DAW-1 and make your ass fill out prior-auth paperwork in lieu of putting DAW-1 on the Rx.  Even if they do take the DAW-1 code, they just make the patient pay full price (or just flat out refuse to cover the medication).  Now the patient gets no medication because you are too hooked on the pharma-pot-pie to “settle” for a generic (and the patient cant afford the brand name).  A winner is you! Thats patient care right there!  Remember, patient care does not start with you, it doesn’t start with me, it starts with whoever is footing the bill.  Who pays for the drug makes the rules for the drug (unless your patient wishes to pay for it, but we all know the F in Pharmacy stands for “Free”).

All kidding aside, I’ve seen loads of doctors do DAW-1’s for really stupid shit (like psycho endocrinologists for Glucophage, Glucovance, Amaryl, Glyburide, etc) only to have the patient be SO noncompliant that I could fill the vial up with cow-shit and get more therapeutic response than your DAW-1’d drugs.  Is it my job to make sure they take their medications? Sure, I blow them shit when they are 2 weeks late getting it filled, but I’m not their fucking nanny.  Teachers are also notorious for wanting trade-name stuff because they “deserve it” (and know SO MUCH MORE THAN WE DO).

Really, if you prescribers in the audience really want to get your point across with this DAW-1 bullshit, you are better off telling us WHY the generics cant be used or WHY the formulary cannot be used (brittle blood levels with warfarin/tegretol).  It’ll make it seem less bossy than DAW-1 (bitch!), but maybe (just maybe) we can save you a ton of time by faxing you the proper forms to sign or point you where to get that prior auth.  Give us more “here is why I want this” vs “I just want this because I can”.

So what do we do when a patient brings in a DAW-1 Rx that the patient cannot afford, and the doctor refuses to change it to something else?  The patient is now put into a position where he/she feels they need this super-expensive medicine that their “Obviously” intelligent doctor wants for them.  Never mind the fact that the pharmacist has about 3 alternatives up his sleeves that might not work quite as well as what the reps spout, however its affordable and wont take food off of the patients table.

Here is something else to consider.  Patient brings in a prescription for Drug-X that is DAW-1 for some reason.  Patient cannot afford the $200 cost and the doctor (being an ass) refuses to change it to something else that costs less.  Now the patient either forgoes treatment because the doctor wants THIS and ONLY THIS (even though a $12 generic might not work as well, but its better than nothing) or forgoes buying Xmas presents for their children or some other Quality of Life lowering factor due to the $200 they dropped for this drug.  Or worst case they just go without and get nothing.  Pisses me off when I call the doctor asking to change, and him/her (or one of their front end ‘staff’) says “Nope, we’re not going to change”.  My response is “Good idea, the patient can’t afford this, so now they will take nothing.” Asshats.

There is /always/ some sort of drug alternative in medicine. Sure it may not work as well or be exactly what you are looking for, but having the patient not take/cant afford the medication due to some drug-rep telling you that “this is new and better” when you had been using drug x for the last 20 years before it went generic last week is (to me) bad medicine.

Solodyn and the dumbass Dermatologists who write for it

Stupid drugs piss off pharmacists, its a known fact.
Stupid doctors who listen to drug-reps as if they were the second coming of whoever piss off pharmacists.

Combine the two, and you get 2 classes of doctors:
Dermatologists and Dentists.  Notice how they both start with D as well as the word Dumbass and Dipshit.

Take a completely stupid new drug that is out, Solodyn (Website complete with 1 recall!).  That’s right, they took Minocycline, made it 90mg and ER, sucked the FDA off to give it an ‘acne’ indication, and now they are selling it for $1573.82 per bottle of 100.  Thats right, 1500 bucks for minocycline.  Go look at your shelf at that $20 bottle of minocycline 100mg in generic and tell me what 10 fucking milligrams in an “Extended Release” is going to do (and is it worth the 100x price increase).

What gets me are the Dermatologists who write for this shit.  Are you fucking kidding me?  Are you so incredibly stupid to believe that this bullshit will do ANY better than the 100mg they have had on the market for decades?  Why do you believe that 90mg ER is better than 100mg bid?  Is it because the big-titted reps tell you so?  I don’t even know how you can even justify this! What are you going to do? Show me studies that are made BY THE DRUG MANUFACTURER that show this to be better than Minocin 100?  Yeah, I’ll also show you evidence BY CHEVY that MY CHEVY TRUCK is better than YOUR FORD.  That’s okay, I consider Dermatologists to be on the same level as voodoo witch doctors.  No offense to those out there who actually boot drug reps out and use actual *gasp* knowledge, but your fellow colleagues are stupid and make my life difficult.  Most of you guys/gals are more than willing to switch to generic Minocin (especially when I tell you how much this cost, a figure the rep ‘accidently’ left out), however a handful of you need to lay off the Medicis Kool-Aid Crackpipe.

So instead of having this sleazy me-too producing drug company (Medicis, producer of overpriced shit like Benzoyl Peroxide Pads) hand out samples to the doctors, they hand them these trial cards. Yeah, I’m going to stock a 1500 dollar bottle of your shit on my shelf so I can dispense 30 and have the rest rot.  Go fuck yourself.  If you cared about anything other than your profits/what nationality of imported hookers for the next board meeting you would make this shit in unit-of-use bottles of 30.  On behalf of pharmacies everywhere, you make it in 30’s and we’ll stock it.  Until then, I’m sorry but “our wholesaler is out of it/we don’t stock that drug” because its FUCKING STUPID.  Doctors, if you wish to plop down the 1500 beans and carry this shit in your office, oh, I didn’t think so.

This is yet another reason why medication costs so much in this country, because there are STUPID drug companies who will make this shit, and there are even stupider Doctors who gobble up the bullshit studies and actually write for this and get it sold!

Dental drugs are also notorious for being so overpriced and stupid (uh Periostat?).  At least most dentists are so insecure in their pharmacology that you can get them to change it to something that is not going to cost the patient their first born child, but Dr Dermatologist WD (Witch Doctor) and their chicken-bones (Elidel/Protopic) are hard headed.  I’m sorry the other MD’s made fun of you in school, doesn’t mean you need to take it out on the pharmacist and the patient with the bullshit you get from your big-titted friend with the free pens and clipboards.

I can go on for ages about the stupid these these two classes of doctors write for under the all-knowing direction of some clueless PDR using sales rep, but I think you get the point.  If you stock this shit, let me know so we can laugh at you.

On another note, since the economy is taking a nosedive, I’m sure a bunch of these big companies are going to be laying off some drug-reps.  Anyone around want to spearhead a Drug Rep Porn site?  Its like Pharmacy Hotties (NSFW)  but with drug-reps!  There are going to be a ton of hot big-titted reps that are going to be hungry for work to pay off their boob-jobs.