Category Archives: Insurance Companies

Paying the PBM’s to service them.

So I had this nice 2014 post queued up that involved:

  • Me shutting down the site and hanging it up.
  • Me meeting this awesome hospital pharmy named Michelle who has (of all else) a totally awesome cooking website that (used to) throw down f-bombs worse than yours truly AND wrote a kick-ass cook-book (plus she was all “OMFG FAMOUS PHARMACIST” when she met me).  Every fucking pharmacist is published but me.  At least hers involves food porn and fucking tons of delicious bacon.  Uh.. Fucking as in the adjective, not the verb of her having sex with bacon.  Sorry NomNom, didn’t mean to imply that you have sex with bacon.  Fucking bacon is delicious though.. ARG FUCKING AS AN ADJECTIVE GOD DAMMIT.  You get the picture.  Her website is http://www.nomnompaleo.com and go buy her book, its awesome.  Her little cartoon of herself has no nose, which sorta bugs me, but I will certify, under penalty of perjury, that in real life she DOES have a nose.
  • Me getting pissed off at this derpy douchebag patient and reviving the smoldering blaze of TAP that lives in my soul.  No, really.  I almost brained this fucker with the cash register I was so fucking pissed off at his utter waste of a life, and a resulting waste of my time.  Then his mother got all involved.  He is 40 by the way, that should speak enough right there.
  • How in the past few years, I have taken into consideration not offending anyone (ie: Crackheads) with my ranting, and by doing so I am doing you all a grave injustice.
  • How gasoline cans in California fucking suck with the safety valve (instead of a direct spout) and as a result you spill more gas on the ground (and all over yourself) then you get in the tank, thereby making the “save the world” mentality that California wants to impose on people a fucking waste of effort, not to mention a huge safety hazard.  Plus you smell like fucking gasoline for a few days and must resist the urge to light yourself on fire to end it all.
  • Other shit that Im too lazy to type because Im fucking livid about the topic below.

However, this topic came up and is far more important (and involves far more swear words).

We all know that drugs are like stocks, the price goes up and down (mostly up).  However recently, a ton of shit has just skyrocketed in price.  Take various creams.  They used to cost 10 bucks a few months ago, and now they are just shy of 100.  Digoxin ranges from 900-1000 dollars for a bottle of 1000 where a few months ago it was 50 bucks for 1000.  Morphine ER has jumped from pennies to fucking hundreds and Endocet is almost 100 bucks a bottle.  Nobody knows why the price is going through the roof, and nobody has any answers other than the generic drug manufacturers must enjoy raping the American public so they can sell their shit in Mexico for reasonable prices.

Now usually this isn’t a problem, because as the price of the drugs go up, the PBMs (The companies that YOUR insurance companies hire to do the processing/computer shit and pay US, the pharmacies) adjust their prices and pay us more.  Its done on a contract basis like Cost + shit + a crap fee.  Its not the greatest, but it keeps the doors open and paychecks from bouncing.

HOWEVER, due to some fuckery or just plain greed, as the price of medications go up, they PBM’s are paying based upon the OLD price.  That means that little ms crackhead who gets Morphine ER that now costs me $200 the store is getting a fat check for $40, the price of the drug from 5 months ago.  In other words; under cost.  Thats right, I’m expected to dispense medications and take a $160 dollar loss.  Then the fucking twat has the balls to bitch about her $3 copay and take up 20 mins of my time as she bitches about what she can take (for FREE) because her turds resemble a fucking piece of plaster-of-paris.

So whats a pharmacy to do?  Take care of the patient so they don’t die and take a $100+ loss? Or tell her to take her shit elsewhere? The choice is easy, give her back the Rx, tell her it pays under cost, and you dont know where she can go to get it filled.  Per your contract with her insurance company she can’t pay cash (HAHAH PAY CASH!! AS IF!!).  Only rich fuckers and chumps pay for their medications now days.  Its not called Freemacy for nothing.

There are two huge points to be made about this:

  • Unless I can pay my fucking house payment and put food on the table using “Good Deeds” as a currency, Im not going to take a loss filling a prescription.  That little lady, when push comes to shove, doesn’t really give two dicks about you, your kids, your store, or the good deeds you do for her.  She wants her fucking dope, plain and simple, and she doesn’t want to pay for it.  By you taking that loss, you have just shown her that your time/profession/skills are worth nothing to her.  In fact, you’re just a fucking whore to her and her insurance who takes a fucking and then gives $100 for the privilege of getting your asshole reamed out.  Its reverse prostitution, and we as a profession are better than that.  Well, I used to think better than that, until the chains started handing out gift cards to PITA patients instead of backing up their abused staff and showing these fucks the door.  Grow a fucking pair chains!
  • By refusing to fill the Rx based on losing money, you are putting the ball in her court.  The insurance companies dont give a fuck about the pharmacies, but they give a fuck when she gets on the phone and cries that nobody will fill her medication.  SHE pays their paychecks, not us.  A problem with HER insurance reimbursing is not OUR problem, its HERS.  Does the grocery store give a fuck that your credit card was stolen by hackers who got into the Target systems and thereby wont work? No, because its YOUR credit card through YOUR bank so its YOUR responsibility to take care of that shit.  If enough patients complain and whine then maybe they will do something about it.  Yeah, and I can pull gold out of my asshole.

Now this all sounds fine and good, however the chain stores (and the pharmacists who staff them) really don’t give a shit if they lose money on an Rx.  They hand out gift cards to whiny fucks who complain that their prescriptions weren’t fill in 2 seconds or less.  The chains are so afraid of losing business they will gladly take that loss with a smile on their face.  The chain stores are killing the profession of pharmacy.  By having the chains put up with this bullshit, they are just showing the PBM’s that we are nothing but fucking whores who’s time and education are worth absolutely nothing (because we will fill the Rx even if we lose money on it AND reward patients for abusive behavior).

I’ll just make another point, that the PBMs, the insurance companies that hire them, and the pharmacists who work for these companies are nothing but fucking idiots.  They are so blind to the big picture, that they have NO CLUE that independent pharmacies are the counterweight to a huge big deep dicking thats on the horizon.  Let me elaborate:

You cut your reimbursement so much that it drives all the other pharmacies out of business.  Sure you make a zillion dollars and your CEO can afford that beach-house.  Sure you traitors to the profession get that fat bonus for saving “all this money” and the CEO strokes your cock a bit for being a “good little insurance-company pharmacist” for saving their plan a ton of cash with your bullshit cost-analysis and P&T handjobs.  However now all there is left are Walgreens, CVS, and Rite-Aid.  Three huge companies that will gladly pay that million dollar anti-trust lawsuit fine for the sole ability to COMPLETELY FUCK OVER YOUR INSURANCE PLAN AND RUIN YOUR PBM.  How?  Easy.  The men in suits from Walgreens come to your insurance company and want to talk about their contract:

“So, since there are no independents left, we want to renegotiate our contract.  We want cost + 25% + $15 for EVERYTHING.  Oh? You don’t like that? Well then I guess you’re going to lose a few hundred stores in your network.  Oh, and see CVS and Rite-Aid? They want the same deal that we want.  Man, its going to suck for you when the members who use your plan cant go ANYWHERE ELSE to fill their prescriptions because your shit reimbursement rates put the independents all out of business.  Why don’t you think about that for a few hours while we go to lunch with the CVS and Rite-Aid execs and discuss if your plan fits within our business model.  Oh, and we don’t care if you sue us for anti-trust, because we’ll make up that fine in a month from this revised contract.  Im sure that your members will understand.  Chao!”

You have painted yourself in a corner with only a few HUGE chains left.  Huge chains with a TON of stores that your members are forced to go to because there are nobody left.  Your penny pinching now cost you your anal-hymen.  It fucking kills me how people shop at Walmart because they have done the exact same thing to the manufacturers of household items because there are no little mom and pop shops around anymore to offer any competition.  They can name their own price, and that price is a few steps up from FREE.

So when you fill that Rx and see the fat negative reimbursement and your pharmacy system blows up with warnings that you’re losing your ass; think of me.  Think of where you are going to work when the toilet of pharmacy finally flushes and we’re all out of a job.  I’ll see you fuckers in the unemployment line with a huge smile on my face and a huge bowl of “I FUCKING TOLD YOU SO” for you to eat.

A pharmacist example for non-pharmacists.

Holy shit, its almost been a year.

No, Im not dead.  Just took a small vacation from the site.  Family, work, etc.  It happens.

Ive been going through the (years worth) of comments posted to this site, and from what I can see, they seem to follow a common trend:

  1. Im an asshole, and all pharmacists are assholes.  All of them, but when its time to refill your Norco they are your savior and best friend.
  2. Fibromyalgia is real, I’m an asshole for thinking otherwise.  Santa is also real.  Ever notice how spell-checkers always get hung up on fibromyalgia like its a word that doesn’t exist?  Interesting. (OH COME ON, LET ME POKE SOME FUN)
  3. Tell me your entire life story to justify your usage of pain pills to try to convince yourself that you’re not a crackhead.  If you don’t think you are a crackhead, then you probably aren’t. Convincing the internet with some 10 page paper on how you got hurt, and SSI denied you, and you’re on ALL THESE MEDICATIONS and the mean pharmacist wont refill them early because your crackhead kid’s friend “stole them”, blah blah blah isn’t going to help your issue.

That pretty much sums it up.  Im sad for humanity.

On a lighter note, I want to put something into perspective for those non-pharmacists out there who think we just stand there, drink coffee, and deny your pain pills while laughing manically.  Just bare with me.

Imagine you own a small cell-phone dealership.  You carry all sorts of cell-phones, from the latest Android, to the iPhone, to the big bricks in the bag from back when we all had mullets.  So many fucking cell phones people come in and go “holy fuck! you have a lot of cell phones”.  You also have a big button to make them all ring at once just because you are that much of a badass.  Is your dick hard from cell-phone envy? Mine is; I’m typing this one handed actually.

Anyway, a customer comes in with a letter from T-Mobile.  The letter says “Dear badass cell-phone dealer, please allow my member to purchase ONE iPHONE”.  You happily take the letter, and give your customer a shiny new iPhone.  Your customer is so fucking happy because his baby-momma keeps on calling, and his old phone just isn’t working as well as it should be.  You go to the cash register;

“That’ll be $200 for the phone please” you ask with a smile.

“What the fuck! I don’t have any money! This is supposed to be free! I have a VISA card” the customer yells rudely like you insulted his mother

“Okay, do you have the card so I can process it through VISA?” you respond.

“No.  Call up VISA and get the number for me” as the crackhe..er..customer caresses his new iFre..er..iPhone.

Let me pause the exercise right here.  Would you, as a customer who goes ANYWHERE make the store clerk/cashier/etc CALL YOUR CREDIT CARD COMPANY for your credit card number?  Am I the only one who thinks if you asked this you would be laughed all the way out the front door?  No? Good.  Lets continue.

After 20 mins, you finally get the VISA number of your BELOVED customer.  You punch it into your little device and an error spits out:

“TRANSACTION DENIED, VISA CUSTOMER MUST USE ANDROID PHONE”

Oh shit, looks like Google is fucking Visa.  You gingerly tell the customer that his card will not pay for his nice iPhone because his credit card company wants him to use an Android phone.

“WHAT THE FUCK DO YOU MEAN! T-MOBILE SAID I NEED AN iPHONE!”

You kindly explain that if he wants an iPhone, that he would either have to pay for it, or you can contact T-Mobile to see which Android phone would be the best fit for you so Visa will cover the cost.

The customer throws the iPhone at you, and storms out mumbling that the cell-phone shop down the street will get him his iPhone.  You restock the iPhone and proceed to repeat this same conversation about 4 times before you get to go home.

So the story ends.  That customer was a dick right? I mean it wasn’t the pharmaci..er..cell store owner’s fault that his insur-….credit card company didnt cover his iPho..damn…medications!  I mean what kind of asshole would blow up at someone who is doing their best to help them out?

One word answers this question: EVERYONE.  EVERY-FUCKING-SINGLE-ONE.  Welcome to retail pharmacy, here is your tough skin and alcohol habit.

It sucks to get yelled at, and it sucks even more when you are getting yelled at over something that is 100% out of your control.  If you are one of those “Oh, well they make 100k a year to get yelled at” idiots go fuck yourself.  Any decent human-fucking-being with a soul doesn’t like to be yelled at day in and day out while doing their job of helping people.  Especially when you are getting yelled at while you are trying to HELP them.  The money is there for our knowledge to keep you from doing something stupid and dying, not to be your own personal fucking punching bag.

Its good to be back bitches.

The FDA obviously hates the public and needs to lay off the crack pipe.

Submitted by a shitpot full of people, the FDA has gotten this wonderful idea to allow people (read: idiots) to buy Rx prescriptions OTC using a kiosk rather than a Doctor to issue the Rx.

http://www.washingtontimes.com/news/2012/apr/29/fda-may-let-patients-buy-drugs-without-prescriptio/?page=all

The jist of the article (for those too lazy to read it), is that you would go to a kiosk, and via a handy flow chart be able to obtain an Rx for antibiotics (!!) hypertension medication, cholestrol medicine, etc without seeing a doctor.  Your helpful pharmacist would help you from then on out.  Yeah, as if that’s going to magically make you become more compliant.  I’ll get right on that after my job as the vicodin-police, insurance agent, and your personal fucking nanny are done.

Lets take a journal into sarcastic TAP-land:

I think this is a completely fucking great idea!  We all know that Rx medications are completely safe, require no professional monitoring, and can cause no harm to the patient.  I mean who in the fuck cares if your potassium goes through the roof when you’re on an ACE-I, or if you get rhabo while on that statin.  This whole Rx concept is obviously a cartel plot by the medical industry to milk you out of copay money to line the pockets of BMW driving doctors as they light their cigars with your crisp $100 bills gotten from your copays.  Its not like those doctors know any more than the crackhead off the street…..

Shit, this whole idea of people just making shit up at kiosks to get a truckload of antibiotics is such a good idea!  We all know that antibiotic resistance is just a big fucking lie made up by the pharmaceutical industry so they can push their ‘newer’ expensive antibiotics to leech the consumer dry.  In fact, all of medicine is a big fucking lie meant to milk you out of your hard earned cash.  See this MD/PharmD degree? Thats just made up letters that we got from a mail-order school.

Travelling back to real-life common-sense land:

This whole clusterfuck was meant to save the patient money they would have spent seeing a doctor.  Because thats SO MUCH FUCKING LESS than say a hospital admit because your potassium shot up to 12, your kidneys stopped working because you have renal issues and had to get that ACE-I, or because MRSA is eating your face off.  Not to mention the tons of other issues that come with taking A CONTROLLED FUCKING POISON that externally influences certain enzymes and receptors in your body thereby circumventing your body’s own natural regulation pathways.  Oh shit, you didn’t know that most (if not all) drugs did that? Actually I’m sure you probably thought medications were made from unicorn farts that magically made you better.

Here is a fucking great idea, why don’t you use your doctor to DIAGNOSE whats wrong with you, and have the pharmacist PICK OUT THE RIGHT MEDICATION.   I mean we all know that 90% of our time is just faxing the doctor for a drug change because its the insurance company, not your doctor who decides what drug you get.  Tell us whats wrong with you, any lab values that we might find useful, and let US pick out the most effective and affordable drug.  Pharmacists are immune to the drug-rep masturbation, we (for the most part) know our shit, and our ass is on the line with you by default if the shit goes south.  The hard cold fact is that MD’s are good at figuring out whats wrong with you, and WE are good at what drugs to use.  Same coin? Different side? Sound familiar?  Obviously not to the FDA.

If the APhA is all about this, its just more evidence that they are focused at planting new pharmacy trees while the retail pharmacist forest behind them is burning to the ground.  Why are they always ignoring what needs to be fixed in lieu of added work for no added money for us?

Oh, and if you are thinking “Well it works in Mexico”, take a second and think about what happens if you take something and die in Mexico.  Do you get to sue someone? Do you get compensation from the manufacturers? Nope, you get a dirt-nap and a “Oh thats too bad”.

But really, what the fuck do I know.  I just count by 5’s all day while watching Dr Oz and drinking coffee.

Shooting yourself in the foot, 10% at a time.

Something bad happened in California this year.  Something very very bad.  Something so improperly thought out that it could ONLY happen in California.  Something so horrible that it forces you to wonder if the person who came up with this was drunk, stoned, or just an absolute fucking idiot.

I’m of course, talking about the MediCal 10% reimbursement cut.  For those not in the Stupidty State, MediCal is our implementation of Medicaid.

Let me back up to explain some stuff before I go on this rant so those not in pharmacy will understand.

You know when I bitch about getting paid $1.50 over my cost of the medication fee?  Thats called our dispensing fee.  Thats the amount that I make over the cost of the medication that covers my labor, the vials, the power, the tech who fills it, the clerk who has to take your annoying phone call, etc.  I’m hesitant to call it a ‘profit’, because in most cases its not.  It allows us to stay in business.

Now, back to the rant.

Usual reimbursement from MediCal is our drug cost (give or take a few percent to account for wholesaler markups, etc) plus a dispensing fee of a single digit number (less than 10 bucks for those drunk at home).  If I dispense, say, Fukitol, with a ballpark (yet entirely reasonable) price of $200, I can expect to make about $210 bucks.  Those slow out there may be saying “HOLY SHIT, YOU GOT $210 BUCKS FOR THAT PRESCRIPTION! PHARMACY IS A GOLD MINE!”  For those who think this, go work for the State of California, because you are a fucking retard.  Yes, we did get reimbursed by the state a whopping $210 dollars, but unless I can wave a magic wand and make drugs out of thin air, my wholesaler wants $200 out of that $210 so he can pay HIS bills.  So I get $10, which really is fucking good.

So California; despite having Silicon Valley, Google, dot.millionaire companies, San Francisco and LA (that combined pay more taxes in one second than we will all make in a lifetime) is broke.  Go fucking figure.  They decide to whack the MediCal reimbursement for drugs by 10% to stem the bleeding of throwing the baby out with the bath water.  This first was voted into effect on June 1st.  Us pharmacy and medicine peeps said “HOLY SHIT, YOU CANT DO THIS” and did what Americans typically do, tie it up in the courts (read on and you’ll see why).  Well, recently they lost the injunction, so the cuts happened.

Now you may be thinking “gee TAP, 10% cut in your fee isn’t so bad, thats only like a buck”.  Therein lies the problem.  MediCal didn’t cut our dispensing fee, they cut THE WHOLE FUCKING REIMBURSEMENT.

Quick and Dirty:

Drug costs 200 bucks.  We get paid 210 bucks.  Take 10% off of that 210 bucks and you’re left with 190 bucks.  The drug still fucking costs the pharmacy 200 bucks.  We make a whopping -10 dollars.  Thats right, the pharmacy LOSES 10 dollars (in this case) with EACH FUCKING HIGH DOLLAR TRADE NAME FILL.  Throw in some chemo drugs like Xeloda that costs the pharmacy THOUSANDS or HIV drugs at 600 bucks each, and you have yourself a closed pharmacy.

But no, it gets better.  You see, MediCal is in bed with the drug manufacturers.  The drug manufacturers give “kickbacks…er..REBATES” to the state to use THEIR  product.  Why else do you think Nasonex is the ONLY nasal steroid instead of generic Flonase.  Why do you think generic Morphine ER isn’t covered, but BRAND ONLY Kadian is?  The state is getting a rebate for having these on their formulary.

So not only do we lose money on each brand-name prescription, but we are forced to use brand name for certain drug classes.

See how absolutely fucked this is?  So whats a pharmacy to do?

Easy, send the patient somewhere else for brand name drugs.  California Business and Profession code prevents the selling of products for less than what it costs you.  Its part of the anti-predatory pricing laws.

Does this suck for the MediCal patients who need HIV/Actos/Nexium/Kadian/etc? Yup, it sure does.  Our hearts are out to those patients who can’t get their drugs filled, but what other choice do we have?  The chains can absorb the cost for a time until they pull the plug, and the independents cant absorb any of that.

Oh no, it doesn’t stop there.  You know how I said that the cuts were put into law June 1st but got held up in court?  Well they made the cuts retroactive.  Pharmacies are going to get a BILL from MediCal for the 10% difference for EVERY FUCKING PRESCRIPTION they filled since June 1st.

If you are an independent store owner, give money to the Pharmacy Defense Fund (if you haven’t already).  If you’re a district manager for the chains, get your head out of your ass and tell your people to STOP FILLING BRAND NAME DRUGS or you might be out of a job.

I’ll leave you with that.  Don’t send me the bill to cleanup the mess of your head exploding.

How to succeed at retail pharmacy according to the chains

So during my 0.004 second lunch during the clusterfuck of a day after a holiday, I checked out this article on DrugTopics.  Nothing special at face value, however this paragraph really bugged me:

Several factors led Morton’s executives to make the decision to sell most of its retail pharmacy business. “It’s the declining reimbursement environment, mandatory mail-order plans, the closed networks that are starting to become popular across the country, $4 generics programs, and predatory audits,” Morton said.

Both health insurance companies and government programs are slashing reimbursements, according to Morton, a practice that is “not providing enough margins for us to serve patients.” In addition, the purpose of audits conducted by pharmacy benefit managers (PBMs) has changed from detection of fraudulent claims to making extra money for the PBMs, according to Morton. “They are looking for administrative mistakes so they can look to recoup claims. It is a revenue-generating technique,” Morton said.

For those not in the industry, Walgreens has a Pharmacy Benefit Manager called Walgreens Health Initiative.  This is similar to how CVS/Caremark work, and the infamous Merck/Medco.  Now for those of you who work retail, this whole article makes perfect sense.

  1. Have your PBM give ridiculous low reimbursement rates to kill the independents.
  2. Be first in line to “take your failing pharmacy off of your hands for you”
  3. If they refuse, audit the shit out of them for every little fucking thing until you bankrupt them
  4. See step 2
  5. Profit!

Funny, how it’s technically illegal for a bunch of independents to meet to discuss if they are going to take a PBM contract due to antitrust laws, but the major chains and their PBM backers can pull this kind of bullshit.  Of course the major chains can bribe (yes, I said bribe…er.. LOBBY) the corrupt government to look the other way.

Having gone through a dozen+ audits, the article is 100% right.  The auditors aren’t looking for blatant fraud and abuse, they are looking to generate profits.  When you fill an Rx, if you mark a faxed back OK as ‘written’ in your software (instead of a ‘faxed’), that’s grounds for them to take the entire cost of the Rx out of your next check.  I bet, with a bit of digging, you’ll find that these auditors actually get an incentive-pay based upon how many ‘errors’ they find on the pharmacy end.  I will also bet that Caremark doesn’t audit CVS stores, WHI doesn’t audit Walgreens, and Merck doesn’t audit the Medco mail-order chains.  Even if they did audit them, do you really think they would take the money out of their next check? Isn’t that taking money away from themselves?

Sometimes the audits pick up things that are just mistakes, like when you have a Robatussin-DM in your computer as 1 bottle of 273mL and your floater bills 273 bottles by mistake thinking that it’s in the computer as per-cc instead of per-bottle.  Those I can see, but taking back the ENTIRE reimbursement over a 28 day supply vs 30 day supply for eye drops is petty and bullshit.  We have the Rx, its legit, yet you are back-charging us for the entire amount due to a clerical error (and a stupid one at that).  The Rx wasn’t filled fraudulently, and it was filled in good faith with no intent to fraud.  However try to argue this point with the auditors and you’ll just get a blank stare and 100 more ‘errors’ that will make your next reimbursement turn into a bill.

So the million dollar question is: Where is APhA in this mess?

Antitrust, Chain/PBM’s, Independents and You

Think of this senerio:

The owners of 3 independant pharmacies go out for dinner.  During the dinner they talk about how (for a very accurate yet hypothetical example) low MedImpacts MAC’s are compared to other insurance companies.  During the discussions they rabble on about how they cannot do business at COST + $0.75 and jointly decide to fax their contract termination letters into MedImpact.  That, right there, violates the Anti-Trust laws.

Now think of this:

CVS/Caremark (a pharmacy/PBM merger) decides that MedImpact doesnt cut the mustard.  They threaten to terminate their contract which will effect a couple hundred stores.  MedImpact tries to play the hero and refuses to negotiate, and now 300+ stores are off of MedImpacts provider list.

Three independent pharmacies get dinged for Anti-Trust behavior, while CVS/Walgreens/Rite-Aid(?) can nix hundreds of their stores without violating anything.  Tell me if that was the intent or spirit of that law.

Since we’re talking about the exploitation of the Anti-Trust laws that were made to protect citizens from such behavior; lets take CVS/Caremark.  Now a while ago we (meaning every independent in town) underwent a Caremark audit.  Now considering those auditors are paid by the infraction, and they will cancel out any prescription that was written for tablets but filled will caps (even if the medication did not come in cap dosage form) among other totally bullshit non-fraudulent-act (like the MD instead of the NP checked off), do you really think CVS gets held to the same exact standards by Caremark as us non-CVS stores?  Have you ever thought about how shady and corrupt a PBM looks taking money away from the direct competitors of their affiliated pharmacy (probably in a futile hope of putting them so far under they will sell out to *their* affiliated Pharmacy chain)?   CVS Pharmacists: Do the Caremark auditors come into your store and audit your records?  Since you’re affiliated, aren’t they just taking away from themselves? Or do you guys write off the store losses by filling ‘fraudulent prescriptions’ thereby making your store less profitable and thereby pay less taxes?  Marvel at my TinFoil hat and how its shiny!

I wonder if Medco audits its mail order pharmacy, god knows they love to audit us independants.  I wonder if all of the big PBM/Retail anti-trusters have some sort of unspoken fraternity-boy truce going around leaving the independants/grocery-outlets/walmarts on the audit chopping block.

Naaaaah, that would be in violation of the anti-trust laws that prevented 3 small pharmacies from speaking out against a dont-give-a-shit-about-you PBM.

HealthNet & CVS/Caremark – Screwing the pooch for 2010!

Sorry for the lack of updates.  Between vacation, work/life, and lack of good and funny rants things have been sorta slow here.  I intend to fix that for 2010. One rant twice monthly if it kills me.  Too many posts don’t get the awesome comments, and too little makes people lose interest in the site.  Twice a month is a happy medium.

On with the rant!

As you all well have known, we are in 2010 and we are one week past the dreaded first of the year mayhem.  If you are a pharmacist, and have not died from alcohol induced liver failure you obviously have first hand experience about HealthNet (Or their processor, CVS/Caremark) screwing up SO bad that I can’t even believe that they are still in business.

For those not “in the know”, lets set a few things straight so people don’t get confused.

  • You have Medicare + Medicaid
    • You have no deductible (of usually $250 – $300 depending on plan)
    • You have little to no premiums
    • No doughnut holes (ie: the coverage gap)

Pretty much if you are on the state tit because you cannot take care of yourself, you get all the benefits of a Medicare part D plan without the annoying doughnut hole, deductibles, and screaming high copay tiers.  Nice isn’t it?  The rest of us however have the initial deductible, blah blah blah.

Now, lets rewind to HealthNet’s Medicare part D plan oh, a week ago.  At least in California, NONE of the “Dual Eligibles” (the people with Medicare AND a state welfare insurance) were flagged in HealthNet’s computer system as being on a state welfare program.  Which means that almost all of the people who should of had NO deductible suddenly got one (with a $200 copay for their Advair)!  Compound this with the usual first of the year plan changing clusterfuck and you have yourself a 2 hour hold time with HealthNets pharmacy help desk!

Oh, lets not forget that HealthNet also didnt flag generic Vicodin and Septra DS as being covered items.  So for one insurance company, we have a shitpot full of welfare-recipients pissed off at us because “we” want to charge them more than $1.10 or $3.20 AND their vicodin is no longer covered.  So whats a pharmacist to do?

Easy.  Let the fucking patient get off of their asses and take care of it themselves.  Why should we have to suffer the fallout because some computer idiot over at CVS/Caremark (which I wonder if CVS pharmacies had this problem) totally fucked up the data import from California MediCal.  Yeah, I’m a heartless asshole but I’m tired of being the human fucking shield for these PBM’s who make more per prescription than I do.  What happened with HealthNet was completely unacceptable and embarrassing.  Of course HealthNet/CVS/Caremark will continue to collect their fat ass subsidization checks from California as they tinkle in our faces with their whopping $3 above cost reimbursement.  Here me now HealthNet, unless I see some MAJOR lawsuits from you to CVS/Caremark over this bullshit, I will do everything in my power to switch my Dual Eligible patients to any plan that is not administered by you.

Oh, and just icing on the cake, I got the fax yesterday evening from HealthNet that everything was fixed.  Thats 8 days of chaos due to  a company that makes more in 1 week than I’ll see in 10 years.

Post your hateful HealthNet comments (or funny first of the year stories) and lets see if I get a response from them (and hopefully not a C&D letter).

The big socialized medicine post

Here I will give my thoughts and viewpoint on the current push to give people socialized medicine in the US.  Feel free to chime in on what you think.

As all of you are quite aware, there is a push in this country to give every man-woman-child government sponsored health-care.  Here I will tell you why this is a horrible idea and is doomed to fail.

Here in the wonderful USA, we already have 2 forms of socialized medicine:

  • MediCare – Given to citizens over the age of 65, or to those under 65 who qualify (renal disease, disability, etc)
  • MediAid – Welfare

Both of these are wholly sponsored and paid-for by Uncle Sam.  Sure Medicare Part D plans have a small premium, but usually those are taken out of your MediCare check (and are no where near the cost of private insurance).

What this socialized medicine bullshit wants to do, is to give “universal health-care” to people who do not fit within those two categories.  Now mind you, that anyone can go to any county hospital (paid for by the taxpaying citizens of that county) and receive medical care without having the ability to pay.  Most private hospital ER rooms will also give you stabilizing treatment without you showing proof of ability to pay.  That seems pretty damn awesome if you ask me, however people want more.

The big idea that some Americans throw around is that access to health-care is a right.  Let me clarify this for everyone who thinks that way:

HEALTH-CARE IS NOT A RIGHT!

Access to a Doctor is as much as right as having access to a Plumber, a Roofer, an Electrician or anyone else in a specialized trade.  Until the government FORCES AND PAYS people to go to medical school, it is not a right. You see us Doctors, Nurses, Pharmacists? We chose to go into this profession, we weren’t forced into doing it.  Do you see an amendment in the Constitution showing the right to see a medical professional? No. Do you know how to re-shingle your roof, install a shower, fix a rotting foundation, lay brick, or do a bunch of other jobs that you have NO PROBLEM hiring someone to do; but the moment you can’t get in to see the doctor RIGHT NOW (because his/her practice revolves around YOU) the “I HAVE A RIGHT” card gets thrown down as you throw a 2 year old tantrum?   Quit fucking whining about your “right” to see a doctor and be thankful there’s more than 1 doctor in 300 square miles like in some 3rd world countries.  Be thankful we even have people who choose to be doctors, pharmacists and nurses after dealing with shit-ass people like you.

Now that we cleared up that “confusion” that some entitlement douches like to throw around, we can move on why socialized medicine will not work here:

IF ITS FREE, USE UNTIL CANNOT USE ANYMORE!

Irresponsible humans have a nasty of habit of seeing “free” and totally abusing the shit out of it thinking it is indeed free when its not.  Its free to them, but costly to someone else.  Let me give you a situation:  You have a sore throat.  You should probably go and see the doctor but you might want to wait another day.  Judging that you can see the doctor “RIGHT NOW”, are you more willing to go if its going to cost you a $100 copay, or $0 copay?  Now imagine EVERYONE doing this to the same doctors office.  Now get really mad when your appointment is 3 years away, and the doctor sees you for 30 seconds.  Now bitch about something that you get for free off of the backs of the working class.

As evidenced by the MediCare system (why do old people need so many fucking lab tests.. OH ITS FREE!) and the welfare system (I need my Nexium, Diovan, but I only really take my VICODIN), if something is perceived as free it will be used, abused, and taken for granted.   Just look at e-mail and the internet for example.  People believe that email is free, so as a result I get thousands of spam messages a day to my inbox.  People believe that its free for me to run this site, so they have scripts setup to check it every 30 seconds for new content (if you’re slow, you wouldn’t realize that I try to post something every SUNDAY).  Humans abuse what is free.

I’m sure the Canadian and the UK readers will share how most of them have PRIVATE insurance because the socialized stuff has a 4 year waiting list for appointments for the socialized docs.  Hate to say it, but copays filter out the “I must see doctor!” from the “Eh, im bored, lets go get drugs”.  If you don’t believe me, go sit in the ER and see what piddly shit comes in to waste our dollars.

THIS COUNTRY IS BROKE

Yeah, we’re broke.  We bailed out every corporation that should of failed (will Obama bail out my pharmacy and the other independents when the insurance companies force us under? No) and have a few trillion dollars of unaccounted free money (our money) floating around.  Now how exactly are we going to pay for this?  I’m paying into a MediCare system that will be long dried up before I ever get to get a lab or appointment covered by it.  Medicare part D has to have the ‘coverage gap’ to keep it from going broke (faster), and now we want to give subsidized health care to everyone?  Reading above how people abuse what is free doesn’t really make much sense that this is going to financially fly.  The government couldn’t throw a 5 year old’s birthday party without tons of red tape and spending 100x what is would normally cost and there is talk about making them have a hand in our health-care?  I think this whole ‘universal healthcare’ is just a government ploy to give new jobs to the idiots who work on the federal dime so they can keep their meaningless pointless jobs.

So I don’t really know what the future holds if we have socialized medicine in this country.  It might look good on paper, but I think its going to flop.  At least I’ll get my opinions in before the government forbids me from giving them (or maybe the’ll just take over this website like they are taking over everything else in this country). 😉

UPDATE: Look, less than 24 hours and already I’m trying to explain what I wrote.  So this post was to clarify on how I think that healthcare is not a right (which it’s not, disagree if you will)  and two huge issues that any government subsudized plan is going to have (which could apply to ANYTHING that ANYONE pays to service that someone else uses)  It wasn’t “YAR YAR NO SOCIALIZED MEDICINE” like the words some of you are putting in my mouth.  Since /any/ plan that is made by our broke government is going to be 1000% funded on the backs of taxpaying citizens (since obviously doctors aren’t going to take a huge pay cut, pharmacies aren’t going to take a huge pay cut, where is the cash going to magically come from?) these are the concerns I have (and rightfully so).  Like one reader said, we can’t take the usual government approach and throw this together, dust off our hands, and pat each other on the back.  You would think that most of you who dealt with the Medicare Part-D bullshit would understand that.  This is huge, and its with our money, so we should demand that it be perfect, well thought out, or we’re just throwing money away.  And to the federal workers to got offended by my joke about the ‘government conspiracy’, get back to work, quit wasting time reading my website, and dont be so easily offended by the unfaulting sweeping brush that I make jokes under.

Workmans Comp – The working mans welfare

Every pharmacist has had to deal with Workman’s Compensation prescriptions at some point in their careers.  They usually involve paper billing (although now Express Scripts, RESTAT and others have made them electronic) and a lot of begging/paperwork to get paid.

Pharmacists see this all the time, but its a little known fact that work-comp has become the “richs mans Medicaid”.  It has spiraled so out of control, and gotten so outrageous that now I view it as just another form of welfare.

How its supposed to work:

You get injured on the job via some fault other than you being an idiot.  Equipment fails, your employer had something go wrong, some freak accident happens.  Work comp then pays  for your doctors visit and medications.  If you cannot perform that job any longer, you find another job doing something that doesn’t require a bad back or missing fingers, etc.  You continue to work, your (former) employer’s work comp insurance premiums go up, and life goes on.

How pharmacists see it work (ie: how it really works):

You were at work and get injured because you’re a fucking lazy idiot (with your head firmly planted up ass) and go to the ER for a smashed pinky finger.  They give you an Rx for 40 vicodin and some ibuprofen and keep you off work for 3 weeks.  You (and your work comp lawyer) then sue your former employer giving you full paid time off.  You relax and go on vacation and do other fun stuff with your wife and kids while receiving a fat work-comp check (and free medications).  You OBVIOUSLY cannot work any longer because of the MENTAL ANGUISH of having a mangled up pinky finger.  It is SO HORRIBLE that you then obtain full disability and never have to work again.

Yeah, its really like that.  I’ve seen people get a few medications (like ibuprofen and like 20 vicodin every other month) and continue to work.  All the work comp pays for is just a few doctors visits a year, and 2 measly prescriptions that are filled once every 45 to 50 days (and they are 20 day supplies at that).  I’ve also seen people who have basically nothing happen to them, go off work fully, get medicare prematurely because they are “disabled”, then have me try to get vacation overrides for their cruise to the Bahamas.

It all comes down to how well you can play up your “injury” and how good of a scumbag work-comp lawyer you can hire.  Work comp is raped to the point where the premiums are outrageous for employers, and more and more people (read: police officers; that’s right, I’m calling your ass out) are comping out just before retirement so they can collect their fat retirement check along with their work-comp check.  Their reason? MENTAL ANGUISH.  Yeah, try to work as a pharmacist for 30 years and see what kind of mental anguish you get from dealing with the same ghetto public without a bulletproof vest, a gun, backup, and a radio to call for help.  Another reason why hanging your head in the public trough of state-worker is the way to go.

If dealing with the scamming-free loading work-comp abusers wasn’t enough (as they brag to you about their next vacation, knowing that you’re working hard and they are just freeloading from a system that cant say ‘no’); processing a work-comp prescription is a nightmare all in itself.  Some companies make you call a 800 number EVERY TIME YOU FILL AN RX so the processor can get approval from the comp adjuster (the person who decides if your drugs are needed for your comp condition, a position that is filled by an idiot with zero medical knowledge what so ever).  Now I admit that it was better then the old days where the pharmacist had to track the adjuster down, but you also got paid a whole lot more for those paper billings vs electronic billings.

Personally, if I was king of the work-comp world, unless your injury left you permanently handicapped or mentally disabled (ie: a vegetable), all of you leeching fucks would be at a desk job, a greeter at Walmart, or any of the 100 million jobs out there that does NOT INVOLVE THE PART OF YOU THAT WAS INJURED.  Just because you are a lazy fuck who got hurt because you had your head up your ass, it doesn’t mean that us HARD WORKING PEOPLE (including those who are on comp yet find another job) HAVE TO PAY FOR YOUR FREELOADING LAZY ASS.

Maybe your injury wasn’t your fault, but sure as shit it wasn’t mine, so why should my premiums go up because of your fuckup?  Sounds more and more like the welfare system to me.

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).