Why I hate Plavix Reps

Bristol-Myers Squibb/Sanofi Plavix reps are on the top of my drug-rep shit list.  Lets take a trip down memory lane a few years ago. A long time ago (2006 to be exact),  there was generic Plavix on the market.  While Plavix remained at $5/tablet, the generic was (if I remember correctly) $20/#100.  I know it was a huge huge difference, like when Zocor went generic.

Why/how generic Plavix (clopidogrel) managed to hit the market is unimportant. What is important is that now you didn’t have to drop $150/month to get the drug.  People had generic copays, cash patients could actually afford something that they couldn’t before, the public rejoiced and the clopidogrel flew off the shelves like Plan-B on prom night.

Fast forward a month.  Clopidogrel is no longer available.  Bristol-Myers Squibb/Sanofi (herein known as douches) pulled out the legal card (ie: probably bribed the FDA) and got the affordable generic withdrawn from the market.  If I remember correctly they somehow magically got a new indication which prolonged their patent (ie: probably bribed the FDA).

The short amount of time that clopidogrel was available wasn’t long enough for word to spread to the doctors that a generic was available.

Now here is why (to this day) I refuse to speak with Plavix reps, they totally left the pharmacies out to dry when questions were asked about Clopidogrel by the doctors.  In other words, they didn’t inform doctors that there was a generic out for a short period of time.  So doctors, in their infinite wisdom and yell-before-asking fashion, starting pointing fingers at the pharmacies.

We had doctors claim that we were illegally importing medications from Mexico/Canada.  Doctors were making claims that pharmacies were selling illegal generics because “Plavix didn’t come in a generic”.  Did the reps stop these rumors and set the doctor straight? FUCK NO.  They just SAT THERE with smug little looks with their studies as doctors were throwing accusations around regarding pharmacies and where they get their drugs.  At this time there was a bunch of bullshit regarding counterfeit drugs, so guess who lumped us all in with that clusterfuck.  Trying to explain this whole FDA legal bullshit to a doctor or a patient is like trying to explain Medicare Part-D to a Phillipino home-health nurse.

Then the safety and WHY it was taken off the market was brought up.  Patients and doctors couldn’t accept that it was yanked off the market due to legal douche-baggery, obviously the generic was ‘inferior’ and it ‘put their patients at risk’.  Did the Plavix reps come to our aid? No, of course not.  Anything to sell their fucking overpriced wanna-be aspirin even at the expense of the reputation of those who dispense it.

To this day I refuse to talk to Plavix reps for not stepping up and taking care of the shit-storm that their douchebag company caused at the expense of the pharmacists and the patients.  You don’t want to be there for us, so in return I’m making damn sure that I’m not doing any favors for you.

Calling ahead – How hard is it?

Every retail pharmacist in every pharmacy around the world have dealt with this issue.

Patient comes in to the pharmacy and wants a refill.  He has 0 refills left on his medication.  You tell him that you need to request refills from the doctor. He gives you a blank stare with the response “but I’m out! <sadface>”.  Of course he wants his seizure or di-a-beetus medication (that he cannot go without).  It can’t be something stupid like Zantac or Vicodin.

When it comes to refills and calling ahead, patients fucking fail every single time.  I mean the number of refills you have left on the bottle isn’t a secret, it says right on the damn container.  However patients, being the most retarded creatures on the planet, just don’t “get it” that sometimes a little planning ahead goes a long way.   Even if you put a big note on the Rx that you must call ahead to get refills they still pull this stunt!

Moreover, this puts pharmacists in a very interesting situation.  Technically its illegal for us to fill an Rx that has no refills remaining without a doctors approval.  The patient obviously doesn’t have his bottles (you think he’s going to make it easy for you?) with him, so you can’t just put a few in there to last him.  You have the following choices:

  • Use a typical TAP Response:  “Tough shit.  I warned you the last 5 times you pulled this shit that you need to call ahead.  A lack of planning on your part does not constitute an emergency on my part.  Maybe after you seize or end up in the hospital you’ll get the simple concept of calling ahead when you have 0 refills remaining.  Quit crying, I don’t care!”
  • Waste the money on your labor, yet another vial, and another label for a whopping 4 tablets to advance him (since you obviously just cant dump tablets in his hands) until you get the OK from the Dr
  • Fill the Rx anyways and deal with the doctor if he denies/changes it.
  • Run and hide and let your tech deal with it.

Can’t say what the right answer is.  Obviously for controlled stuff (vicodin, etc) the backlash of filling it without an OK is greater than shit you can justify (BP, diabetes, seizure, etc).  I mean really, if a patient has been on the same Tegretol dose for the last 5 years, there is a good chance that the doctor will okay it, however, that’s illegal by the letter of the law, but allowing someone to seize because they are a dumbass is ethically not-right. 

Breaking the law vs caring for your patient, where do you draw the line?

Patient Handouts – Medicare Part D (With No Medicaid)

As part of my “Dedication to Pharmacy”, I am going to create some patient handouts that you can give to your patients to explain things that you don’t want/have to.  Whether you give these out is by your own professional judgment, HOWEVER I will not be responsible/feel bad if your patient takes his/her business elsewhere.

—— 8< CUT HERE 8< —–

Dear __________________________,

You have been given this information handout courtesy of “The Angry Pharmacist” (http://www.theangrypharmacist.com) because you are unable to understand simple spoken concepts.  Your caring pharmacist:
__________________________________________________    BS     PharmD (circle one)
has decided that you are not worth    his    her   (circle one) time to explain this concept to you.  They have probably explained this to you for the past 4 years, but since you are old and dense, they are unable to take the blank cow-eyes(tm) stare yet again as they waste their breath.  Talking to the sky or filtering pee out of the ocean would be a less monumental task than trying to explain Medicare Part D concepts to you, so they have given you this handout so you may study it during the commercial breaks of Jag reruns.

Since January 1st (the start of the new year, the last big party you attended where people said HAPPY NEW YEAR), your deductible has reset.

***TAKE  DEEP BREATH, AN EXTRA ARICEPT, AND PREPARE YOURSELF FOR SIMPLE YET SOMEHOW CONFUSING CONCEPTS***

cuteold.jpgDEDUCTIBLE (DEE-DUCT-A-BULL) is a dollar (meaning money) amount that YOU MUST PAY before your insurance kicks in.  Think of it as PAYING $15 before you EAT AT HOMETOWN BUFFET.  That’s right, you must PAY MONEY (COPAYS) BEFORE YOUR INSURANCE KICKS IN.  Usually DEDUCTIBLES range from 200 to 300 dollars.  If you have no idea what your deductible is, your pharmacist cannot help you, call the 1-800 number on the back of your card (the plastic thing with the colors and numbers on it.  No, not your red-white-blue one, the other one.  No, not the one from last year, THE NEW ONE YOU JUST GOT. That one!)
Remember that no matter how angry you get, and how much you ask, your pharmacist does NOT KNOW what your deductible is!  We can guess; but you can also crap your pants, both of which benefit us mutually.

*** WATCH OUT!  HERE COMES THE HARDEST CONCEPT OF THEM ALL! ***

DOUGHNUT HOLE (PASTRY – WHAT YOU POOP OUT OF).  When you hit a set dollar amount, your insurance cuts out until you have reached another dollar amount, then it kicks back in.

Using made up IMAGINARY/MADE UP NUMBERS lets see how this works:

  1. January 1st hits (Remember? Happy new year? Party?)
  2. You pay $250 IN COPAYS to get your insurance to work (DEDUCTIBLE).
  3. You can get drugs FOR ALMOST FREE until the cost of the drugs (NOT YOUR COPAYS) hits $2400
  4. Your insurance CUTS OFF AND YOU PAY EVERYTHING until the cost of the drugs (NOT YOUR COPAYS) hits $5100.
  5. Blame the pharmacist and the world for taking food out of your mouth because you are on a fixed income.
  6. Once you hit over $5100 in DRUG COSTS (NOT YOUR COPAYS), Your insurance MAGICALLY RETURNS LIKE JAG and pays ALMOST EVERYTHING!!!!!!!! until the end of the year.  Break out the Geritol and Viagra!

Your pharmacist will circle where you are in this easy-to follow chart!

Stolen from Wikipedia (the new thing all the kids are doing now days)
http://en.wikipedia.org/wiki/Donut_Hole_(Medicare)
Total Drug Spend TrOOP Out of Pocket Cost Portion Covered by Medicare
$0-$250 $0-$250 Deductible is out-of-pocket No Medicare Coverage of Costs
$250-$2,250 $250-$750 25% out-of-pocket 75% Covered by Medicare
$2,250-5,100 $750-$3600 All costs are out-of-pocket No Medicare Coverage of Costs
over $5,100 over $3600 5% out-of-pocket 95% Covered by Medicare
Note: In 2007 the $2250 amount was changed to $2400 and the $3600 became $3850.

** OH NO! CONFUSING WORDS! **

The TrOOP above stands for True Out Of Pocket (Get it?) cost.  That is YOUR COPAYS!

  • Total Drug Spend = How much the medication costs if you were to pay cash like only chumps and idiots do
  • TrOOP = Your COPAYS.  The TRUE Out of Pocket.  What you pay the nice pharmacist to pick up your medication!  Cue Fixed Income/I cant afford $1.10/whining and bitching.

grandpa_pear.jpgREMEMBER (hahahaha), The pharmacist is here to make sure that YOU DON’T DIE FROM MEDICINE (*sigh*), not FIX YOUR INSURANCE.  That is YOUR JOB because you decided to listen to the nice salesman who lied to you and got your plan all messed up instead of your nice pharmacist who TOLD YOU TO STAY WITH YOUR CURRENT PLAN.  Remember that? Of course you don’t.

Hand-Holding with the last tobacco banning post.

I really hate doing clue-bat entries, but from some of the comment/emails I have received regarding my previous post about tobacco sales in pharmacies some/most of you ‘don’t get it’.  Either I worded it wrong, or people just saw “Tobacco + Pharmacy + Stupid” and jumped to conclusions.

I’m not saying that pharmacies should sell smokes and other tobacco entries.  I think that if a pharmacy does that its not only unethical but retarded (however nobody has a problem with gas stations selling beer/liquor, go figure).

The issue that I thought I made clear in the last post was who gets to make the decision as to what LEGAL product you can and cannot sell in your store which is LEGAL in every other store.  Its not really about if a pharmacy should sell, but who gets to make that decision.  Now remember that Tobacco is a 100% LEGAL substance.  Yes it has no health benefits and is dangerous, but that’s not what I’m arguing about.

Now, personally, I should be able to sell whatever legal substance (that can be sold anywhere) I choose.  If I wish to sell tobacco and be a total hypocritical pharmacist douche, that’s my right.  Its also your right to not trade with me because of my choice in what I sell.  With me so far?

However SF now has drawn the line in the sand.  Since nobody really fought it, they have set precedence that the city can dictate what individual classes of businesses can and cannot sell.  Products that the GOVERNMENT not YOU have decided  “for the best interest of the public” cannot be sold in a business that YOU OWN AND RUN.  This is the start of SOCIALISM in pharmacy with decisions made by people who are NOT PHARMACISTS.

This is super bad news here.  You may think that allowing them to ban tobacco is nothing big, but replace tobacco with any of the following and you have Pharma-riots.

  • Birth control (if you’re so bent on pressing your religious beliefs on those who do not share the same views as yourself and would want to BAN something, then yes, you are a “shit-eating psycho religious type”)
  • Plan-B
  • Soda/Candy (see below)
  • Sudafed (as if putting that behind the counter did anything what-so-ever)
  • Anything that a combination of whining/money/politics can ban “for the children”.

Pharmacies in SF got bent over by the city, and given the dildo of justice on their rights.  The city is putting their nose in what you can and cannot sell, but ultimately has no responsibility if your business goes under.

If SF banned tobacco within the city limits for EVERYONE, this whole rant is a non-issue.  Everyone gets screwed, everyone is on an even playing field, SF sucks, move.  Nanny-SF says that you are too stupid to live your own life, no cancer-sticks for you.  But SF is selectively targeting pharmacies and preventing them from selling a legal product.  Like HIPAA, COMMON SENSE DOES NOT NEED TO BE PUT INTO A FUCKING LAW!!!!!  Now the socialism slope is greased up, how long until you must clear with the city what inventory you stock?

Here is the list that no pharmacies should carry (according to SF)
Tobacco

  • Lung Cancer
  • Mouth Cancer
  • Second Hand Smoke
  • Fetal damage

Sugar/Candy/Soda

  • Childhood obesity
  • Dental caries
  • Exacerbation of Diabetes
  • Caffeine Addiction

Pork Rinds

  • Lipid Disorder
  • Heart Attack
  • Stroke

Alcohol

  • Addiction
  • Liver Failure
  • Bad Dancing
  • UNWANTED CHILDREN
  • Fetal damage

See all of the above? NONE ARE 100% GUARANTEED TO HAPPEN.  Stop with the weak “tobacco is bad mmm-kay” arguments.  These are all on the “should not sell” list using the same rationale that SF did with banning tobacco.

Don’t say that I didn’t warn you when this case gets brought up and something that YOU care about stocking gets banned using this tobacco bullshit as a case study.  By the time that happens however the battle has already been long lost. 

I hope that clears up some confusion.  Go ahead, call me paranoid, laugh at me, but deep down you know that I bring up a damn good point.

Tobacco ban in pharmacies is STUPID

Most (if not all) of you have heard in the news about banning the sales of Tobacco products in pharmacies.  Now I’m sure some of you non-retail people are sitting back in your big expensive chairs and are saying “Well that’s great!  Smoking is bad! Hooray for common sense!  I’m a health care professional and I think smoking is poopy”.

Now I don’t smoke and probably never will (although how work has gone lately, a crack habit might be in order), but I feel the choice to sell or not sell something is up to the store owner/corporate office, NOT THE GOVERNMENT.

What if the psycho shit-eating psycho religious types got a bill passed in your city/state that said “No more birth control shall be sold in pharmacies”?  Pharmacists would revolt and riot!  Amazing how that double-standard of “its okay to ban something that -I- don’t use/doesn’t apply to me, but god forbid if someone else tries to ban something that I use (even though they don’t)!”

So, when does the point come where what you can-and-cannot stock be decided NOT by your professional judgment but by the lawmakers of your city and state (who are influenced by bribes and ‘incentives)? 

Think about that, then let me know if you still think having a city-wide ban on a product is a good idea in the long run.

MediCal pissing in our cornflakes.

I’m sure this post is full of grammar and spelling mistakes. To all the people who like to point them out, go fuck yourself.  I’m a pharmacist, not some soft-science English major douchebag.  If you are the type who likes perfect English and grammar, then go to a squishy website that reeks of deep literary self-masturbation.  If you are the type that wants to see the ‘real story’ of pharmacy, read bad words, have dirty sex with multiple Thai hookers while drinking Jack Daniels from their unwashed hoo-hahs, welcome to the party and ignore the shitty grammar.  Remember, PHARMACIST not PROFESSIONAL WRITER.

As of the first of February, MediCal (that’s California Medicaid for those out of state) decided to take a big steamy dump on the faces of pharmacies/pharmacists.  No, these are not the 10% cuts that I wrote about before, but something equally as stupid.

Before 2/1/09, if you had the patient’s Social Security Number, you could query either by POS device (a little credit-card looking machine that dialed into Medical) or their phone Automatic Eligibility Verification System (AEVS).  The little tape/magical voice on the phone would tell you the patients MediCal ID number (because we cannot use the Social for billing anymore).  Took about 1 min to do, and saved a bunch of time/trouble when the idiot forgot his/her card (or lost it (surprise)).

Now everyone who deals with Medicaid patients realizes that these people can’t even manage a $5, let alone be responsible enough to carry their MediCal card with them.  I mean shit, their Vicodin and Soma get lost every other week!  The POS/AEVS system made it easy.  They tell you their SS#, you get their MediCal number, no card required!

Well, they shitcanned that service.  That’s right, if you do not have the patients MediCal number you cannot get it via their Social Security number.  Let me tell you why I’m writing about this.

See that patient coming in the pharmacy at 6:30pm on a Friday night with that Rx for Levaquin?  He can’t get that because he doesn’t have his card on him (and he’s not in your system).  Doesn’t matter if you call MediCal and talk to a person, they refuse to give out MediCal ID number over the phone INCLUDING TO THE PATIENT THEMSELF!!!  This means the patient must GO TO THE SOCIAL SERVICES OFFICE and get a paper printout with their ID number on it.  Since MediCal is a government operation, lets put money on their hours of operation including weekends and all major (ie: every damn made up) holiday off.  Their social workers (for having ‘worker’ in their title, I have yet to see one actually ‘work’ or is worth the air they breathe)  can also provide them their number.  Yes, entrust someone with a few semesters of useless squishy classes with access to their ID numbers, not their pharmacist.

Now here we are at the rubber meeting the road.  You have a teenager or child with expensive antibiotics/medication that MediCal usually covers but they have no card (and obviously are not in your computer) Are you going to trust a MediCal patient with $200 of antibiotics to come in Monday morning with his card so you can bill for them?  Fuck no!  They have no incentive to help you out even though you helped them out.  Face it, its a fact.  Laziness beats ‘whats right’.  Fuck this ‘give some now and hold the rest’, you wont see them again!  Most of these people need to prepay for their Soma that is due TOMORROW because they don’t have the self control to keep that money in their pocket UNTIL TOMORROW!!  For the majority of them, if they had any ounce of responsibility in them, would they be in the situation they are in now?  I know I’m infamous for making blatant blanket statements on here, but how many hundreds of dollars must be lost on “whats right” before you put your foot down?  Why don’t you just dispense #100 vicodin/soma every other day because the patient is “in pain”.

You want to complain about this? Good luck, the MediCal office hires the most stupid, ignorant, minimum wage retarded dropouts on the planet.  You know all the “stupid people” in the Health Care profession I rant about?  Yeah, all of them are GENIUSES compared to MediCal phone operators.  It took 4 (FOUR!!) people to try to get the idea across how much of a BAD IDEA eliminating this service is for not only the patients but the pharmacies that service them.  They just didn’t get it.  One of which told me “I don’t see why you pharmacists make a big deal about this, just ask them for their card”.  *sigh* I almost died.  In fact, as I type this my soul died.

Requests for a complain phone number/email gave me a “There is none”.    I guess MediCal patients have no rights to voice a complaint about the care they are getting (but to be honest, why would a MediCal patient complain?  Their formulary is beat only by the magical CASH insurance).

So I told them “I am going to turn away every new patient who does not have their card because you have forced me to make the choice to either take a loss on their Rx’s, or to not give them medicine.”  They just said “uh huh” a lot.  I must of used too many words too fast for their small brains to comprehend.

Now the ironic part of it is that I always bitch about how we need to make the Welfare folk more responsible, and them not having their cards (and thereby not having their medication and dying) would in fact pound some responsibility into their brains.  However what kills my soul (more) are the kids who really need antibiotics and due to mommy and daddy being ‘winners of life’ (by losing their ID card) get doubly fucked over by this change.  You are forcing their medications to ride on a card given to someone who can’t be entrusted to always have the card, however I guess that’s the same argument with a child isn’t it?

I’m hoping this is just a huge oversight that will be taken care of.  However if you, your staff, or your patients have been effected by this, please comment and maybe MediCal will get the idea (hah! right).

A Clinical Pharmacist Error.

Once in a while I get a rather bitter comment from a “Pharmacist” who just got his shiny new degree and license and thinks he knows it all.  Now I was going to let you (the readers) be ‘The Angry Pharmacist’ for the day and give this guy a new ass-chewing, but I figured that I cant let this comedy gold go untouched.

Well, I think you were a little too harsh on the intern. I have been a
pharmacist for 3 years and if you had called and asked me to give a
copy, i wouldn’t have had a clue what you were talking about. The
funny thing is that, I still don’t know what you mean by giving a copy.
If you mean to give a transfer, i can understand that.

A few hints for the next time you put your clinical foot in your clinical mouth, don’t tell people how long you’ve been out of school (unless its like over 15) ESPECIALLY when responding to a rant about something you SHOULD OF LEARNED IN SCHOOL (did you even read my rant?).  Plus the fact that you cant put transfer/copy together is just shooting yourself in the foot.

I am typically a clincal pharmacist and i work in the ICU and emergency room setting and
so may not be familiar with all the details regarding a retail store or
how the insurance is run and all that extra things. I have filled in a
retail store before and yes I was lost but I don’t consider myself dumb
because of that.

So why in the fuck are you responding to this rant?  Oh, you’re a clinical guy who probably talks just to hear himself sound intelligent.  You responded to a rant about the lack of core retail pharmacy skills being taught in school by saying that you don’t work in retail.  Tell me if that makes any fucking sense what so ever?

I don’t think the intern was dumb because she or he
didn’t know what the term is, maybe he or she is used to a different
term. As much as I hate to say this, the dumbest pharmacist I’ve seen
in my life are the retail pharmacist.

You know that feeling that you would get when you see a retarded toddler run out into the middle of traffic after a ball? Yeah, I just got that feeling right now.  Its the feeling of pity, horror, but morbid amusement as to how this is going to resolve itself.
 

I hate to use the word dumb
because, I think it’s very inapporopriate and disrespectful. I think
it’s just a different forte.

Then why in the fuck are you responding if you know nothing about retail?

Most of them have no concept of the
pharmacology, basic clinical knowledge, disease states and
pharmacokinetics (a bit surprise you think it’s dumb). Giving a copy
will not save someone’s life, anyone off the street could probably give
a copy, kinetics saves a lot of lives everyday if you really and trully
understand it.

You’re right, us retail folk are all clinical dropouts who couldn’t cut it in the ‘labcoat lunches with the doctors’.  In fact, why aren’t all pharmacist just dropouts who couldn’t cut it in medical school so we had to ‘settle’ for pharmacy?  You’re a fucking idiot.  You are a huge fucking idiot.  You are one of those idiots who can recite the kinetic data for anything but can’t hold a fucking conversation with anyone to save your life.  You know what kills most people? Clinical pharmacists with huge fucking egos who fuck up, thats who.

I also want to mention that this is a free country,
foreigners are welcome here and we should not make fun of the way they
talk. Some of my best pharmacy professors were foreigners. As much as I
think it’s funny the way they talk, I don’t take it upon myself to make
a spectacle of them. I think you are very immature and should not be
practising pharmacy.

Yeah, they are welcome here, I’m not saying they shouldn’t.  However I should have the expectation to have clear and easy to understand English being said to me when dealing with people’s lives and medication.  So tell me Mr Clinical Guy, would you rather offend someone or kill someone because you guessed what the person was saying.  I don’t make a spectacle of them, I tell them that I CANT UNDERSTAND A FUCKING WORD THEY ARE SAYING.  Let me take your mother’s medication over the phone by someone who can’t speak a clear word of English and see how you like that.

You have forgotten that you were once an intern
and there is still a lot of things you don’t know. I have retail
pharmacists that switch to hospital work and have not a clue what’s
going on. I calm them down and try to re-assure them that it will get
easier and that everything will be fine and that’s exactly what you
should be doing.. I have a retail pharmacist once try to enter an order
for 40mEq of potassium IV push, another entered an order for cefepime
and rocephin and zosyn for treatment of psuedomonas. these things are
pretty basic knowledge but it honestly did not cross my mind to call
the pharmacist dumb because I know it’s hard concept to grab if you’re
not used to doing all that. A doctor once asked if vanco would cover
for bacteroides fragilis and one the new retail pharmacist said “I
think so”. Well, bacteroides is an anaerobic bacteria, completely wrong
answer.  If everyone of us treated interns like you do, then we will
have no interns or no one will want to get into the profession of
pharmacy. You sound like one of these jackass arrogant surgeons at the
hospital, that knows nothing about drugs but thinks they are the alpha
and omega.

 Well don’t you get the Nobel peace prize for being the most compassionate and understanding pharmacist on the planet. Wait, did you realize what site you are on?  Did your huge clinical knowledge of kinetic data tell you that you are on THE ANGRY PHARMACIST site?  Guess not.  Maybe its like the copy-transfer thing.  If I made the site THE MAD PHARMACIST or THE MEAN PHARMACIST would you understand?

I know my fellow readers are going to rip you a new asshole for being such a douche, but seriously, your little comment was probably the most embarrassing thing I have ever read.