Category Archives: Medicare Part D

Paying for our time, making money, and screwdom

Currently the only way that us pharmacists get paid in a retail setting is by filling a prescription. The store makes zero dollars directly on phone calls, walk-in advice, or anything other than filling a prescription. Now I realize that being nice and giving advice = more patient support = more Rx’s for that patient filled at your store vs other stores = more money in your pocket. However, taking that phone call to help Ms. Jones find out what white pill is her lasix = 5 less Rx’s you can fill/day = less money made vs if Ms. Jones had not called.
So we already are giving away a valuable service for free rather than just machine-gunning Rx’s out and making the store some money. Here is where the insurance companies take a good natured thing that we do for society, and bend us over for it. Medicare Part D is forcing many of the smaller independents out of business. AWP-95% + 0.01 (here is your 1 cent dispensing fee, just hand the pills out in ziplock baggies with the drug/patient name written in sharpie on the outside).
So, stuck in a clusterfuck between the Insurance companies and being the most benefit to society, we have painted ourselves in quite a corner. Our choices?

  • Screw patient care, hammer out the Rx’s as fast as you can, and stay in business. Possibly fuck up and kill someone in the process by a medication error.
    vs

  • Maintain patient care, be the most trusted profession, and flip burgers on the side because your store went out of business.
    vs

  • Charge for services, have patients go to corpo-chain X where they get treated like shit, but dont have to pay the pharmacist for sorting out their pills because they dumped them all into a candy dish and forgot which ones is which.
    Pretty screwed arent we? But alas, here is the kicker:
    Insurance companies are the cause of this. They are the driving factor in why we need to hammer out at least X Rx’s a day to break even (but cutting reimbursement rates). However by making us do this, they are increasing the chance of medication errors which will land their patients in the hospital costing them /more/ money in the long-run. So they force us to fill more Rx’s per day with less staff, yet they gladly pay out the ass when we fuck up and someone lands in the hospital! Ingenious!
    So how do we fix this? Obviously the insurance companies are reporting record high profits year after year, so the answer isn’t to increase our reimbursements. Medicare part D has that patient care thingy (where they pay us like $65 bucks for an hour of consultation or something like that). But if you get a net profit of $10/Rx (HAHAHA! Quit laughing you guys!!) you can do at least 20 Rx’s an hour and make more than that. Plus you have a set amount of time to bill for the Medicare part D consulting before it sunsets and you cant get anything. Not to mention its probably paper-billed and not online billing.
    Answer? We’re screwed. Plain and simple. Short of selling the narcs out of the back door (or not taking any insurances and just charge patients your usual&customary) we will never truly be paid for our time and knowledge.

  • Medicare Part D – 1 year later

    If you’re a pharmacist, and reading this, you’re probably drunk (or hung over). I just had about 5 shots and a bottle of wine with a dentist friend of mine, so this might not make too much sense (im pretty hammered). But you’ll understand why (if you’re not a pharmacist) if you read this entry.
    Needless to say, today was chaos, hell, and a bit of clusterfuck all rolled into one. Words cannot describe it. All I can say is that if you were working in pharmacy 1 year ago (when Medicare part D shit hit the fan) it was like Deja Vu.
    Prescription Solutions was down for a good majority of the day. In fact, it was down the entire day. I must of gotten less than 50 prescriptions transmitted through them, and god only knows how big my switching bill is going to be from all the failed transactions and retransmissions that I did today. I got error messages from ‘Server Busy’ to ‘Non Contracted Pharmacy’ to ‘Please process with 2007 card if in 2007, 2006 card if claim is in 2006’ to getting paid.
    To make matters worse, some Medicare Part D programs decided it would be a good idea to issue 2007 cards that have a different ID number than the current 2006 cards. Way to go! Lets really drive the pharmacists crazy!
    This combined with the 1+ hour wait time on hold makes for a really really drunk pharmacist.
    Seriously, the PBM seriously need to get their shit together. I mean lets take Prescriptions Solutions (RxSoln) for an example. As of 1/1/07 they took over processing for the AARP Medicare Part D program. Common sense would tell you; “Hey! As of the first we’re going to have a fuckload more traffic! Lets put more servers in place, and hire more staff, etc to take the increased load!”. Did they do this? FUCK NO! So as a result they were down all fucking day. They must of learned from Argus how to be a shitty PBM. So in my drunken haze, I have written them a letter:
    Dear Prescription Solutions,
    This is The Angry Pharmacist. Most of my patients use you for their Rx Processing. Unfortunately today (since your systems were offline) they could not get their medications. As your CEO’s are sleeping soundly in their beds, most of your customers are in the ER without medication because of your lack of server scaling and planning for the increased load of the AARP customers you took over (like hell i’m giving them any medication, you’ve fucked us over last year on the first, what makes us think you’re not going to fuck us over this year on the first). I hope you sleep well knowing that you have just fucked over a good majority of patients, and pissed off a ton of pharmacists who took the brunt of your ignorance and lack of planning. The same pharmacists who are going to suggest that their patients move off of plans administered by you and your shitfuck cronies. But of course you are making record high profits, so obviously you dont need our business to afford your sailboat, RV and your house in Maui. I pray that your own family does not use your processing company for their prescriptions.
    Love,
    The Angry Pharmacist
    PS: Fix your fucking shit.
    Oh, and if you havent already; Drop Humana. Seriously, they pay cost + 1.50 for all of their prescriptions. If you work for a corpo-chain, talk to your district manager about it. If we keep on accepting shitty plans, the other PBM’s are just going to walk all over us.
    Im too drunk to type any more. I hope you all have a good first week of the new year; and remember, when slitting your wrists its ‘down the road not across the street’ (and if you do it under hot water, you wont feel it) 🙂
    I <3 scotch. Mad props to my homies in Ohio. You read this blog, you know who you are.

    Medicare Part D – Aftermath

    Sorry I havent been posting much. This medicare part D bullshit has finally stopped hitting the fan, so now I have a breather.
    Things are pretty bad in the retail biz now. The reimbursement rates are a staggering low. I mean, i tip my fucking pizza boy more than I get paid for filling your mothers prescription. Patient care took a backseat to paying the bills and putting food on the table.
    President Bush burned his bridge with me. Yeah, I voted for him (Kerry was a douche), but saying that we need to protect our seniors from those greedy pharmacists was the final straw. His administration trusted our senior’s care to a bunch of dipshit private companies who cant pour piss out of a bucket. We picked up the ball after they dropped it and worked our asses off to cover their fuckups. Now he’s got the balls to say that we’re greedy? Thanks a fucking lot! We’ll see how long you have to wait for your next prescription!
    At least the insurance companies that totally fucked up are giving us a little respect and kind words. Now if they’ll just take the dagger out of our backs and look us in the face as they are fucking us over we’ll be happy.
    Not good, really really not good.

    Medicare Part Diaster. The saga continues

    After a nice relaxing dinner, a few drinks and a puff of some fine pipe tobacco, i’m ready to bitch more about Medicare Part D(iaster).
    Things are getting a bit better. Not by much, but a bit.
    However Argus/Prescription Solutions have totally screwed the pooch yet again. Their servers are STILL unable to handle the load and are going up and down like a $2 Thai Hooker.
    Prescription Solutions powered by Pacificare still hasnt added our pharmacy to their program, so we’re encouraging everyone to switch over to someone else (and we’re also leaving a message to their contract dept everytime we do it too, just to encorage them to return our call, which they havent). If they want to play that game, then we can play it too. We moved over 40-50 people just today off of their plan to ones that have their shit together.
    Im reading on all the other blogs on how people are blaming Bush and the Republicans for this whole clusterfuck. However, what do they have to do with private insurance companies completely dropping the ball? Last I checked the government didnt run Argus, PacifiCare, Health Net nor any other Privately/Publically owned company. The government didnt issue wrong ID cards to people, or completely understaff their call centers. They arent responsible for the long hold times or help desk reps that cant tell their asshole from their nostrils. What they /are/ responsible for is trusting (and paying) idiots to run the show for them.
    I think the whole Medicare part D system is one of those ‘Looks good on paper, but totally blows in real life’ bits. Although I have seen people who have been paying cash for kilo-buck drugs such as Aricept whom are now just shelling out a $35 copay thanks to Part D. If I were saving $150+ a month, i’d put up with the bullshit, however thats not the case.
    So be aware what you read on these other “blogs” from people bitching who arent there in the trenches. Anyone can be an armchair quarterback and put the blame on the nations scapegoat; but take it from a person who spends 9 hours a day on hold with privately owned companies, its not totally the governments fault. Its all Argus’ fault.. 🙂
    This entry isnt very angry, and I apologize. Its been a little over a week and i’m tired of dealing with the whole situation. Im not to the point of giving up yet, but im getting there really really quickly.
    If you’re a pharmacist and want to help out with a collabrative info warehouse, go to http://www.partdrphinfo.com and contribute any information you have. Everyone seems to need to pool their knowledge to help get through this.

    Medicare Part D – Week 2

    Welcome to the start of Week 2 of hell, er.. Medicare Part Diaster!
    Today we have a very very special award. It goes out to Prescription Solutions powered by PacifiCare.
    Today is the start of week 2, and my place of employment is STILL not enrolled in their Medicare part D program. Last week they were backlogged, this week they really dont know whats going on and why we’re not signed up. I left voicemails to their contract department telling them that they better act on this to stem the outflow of patients that soon will be switching to a medicare part D carrier that has their shit together.
    Do they care? nah. Just another random voice after a 20 min hold time giving another BS excuse.
    Its besides the point that we faxed over our contract not once, but twice, about 2 weeks apart, plus mailed the hard-copy to them. All this was the first part of December.
    Typical insurance run-around. They arent suffering any; the patients are because they dont wish to change pharmacies (bless their hearts) yet their insurance company completely dropped the ball.. ROCK – ME – HARD PLACE
    Argus is still on the crap-list for having slow/unresponsive servers. Get with the program dudes, its been a week. BUY MORE FUCKING MACHINES TO TAKE THE LOAD. QUIT SPENDING YOUR MONEY ON HOOKERS AND BLOW AND BUY MORE GODDAMN SERVERS SO YOU CAN SERVICE THE PEOPLE WHO PAY YOUR DAMN PAYCHECK! (i feel better now). If thats not the case, then tell us WHY your service sucks, and why companies that use you for Rx processing (like Health Net) shouldnt sue your ass into oblivion for making them look horrible. Ive worked in the computer industry, I know how things can get, and I know that keeping everyone informed. Plus I love how their main webpage (http://www.argushealth.com) has a huge area about KickBack..er.. Rebates! Way to go! Why dont you use that and BUY MORE SERVERS!
    Shouts out to Mike in IN, stick with it man, we’ll get through this! Once in a while you get that pearl in the rough that makes your job worth while. I know I get mine on a daily basis.. If this site would be about all the good parts about pharmacy it wouldnt be called ‘theangrypharmacist’ now would it.. 🙂
    Friend of mine from school made this website to help you all with the ins and outs of Rx processing through MediCare part D. It has stuff like what person code to put, ANSI BIN numbers, PCN numbers, etc. Its a wiki, so anyone can create an account and add information and stuff (there is a hand holding page to help out). He’s put a ton of time in so let him know how you like it. Heres the address
    http://www.partdrphinfo.com
    Tell your friends and co-workers.

    Medicare Part D – Day 2

    Day two of the MediCare part D fiasco has come and gone.
    I must say, that this is the biggest clusterfuck in the last 40 years of pharmacy.
    For example: Argus Health Systems (a billion dollar company) had its servers taken down for some reason all day. Unfortunally Humara and HealthNet uses Argus’ servers to process their prescriptions.
    This means that nobody who was signed up for HealthNet could get prescriptions today. Only 1/2 of Humara patients could get their prescriptions today.
    Pharmacies are turning people away without medication because they dont know if the cards are good, and arent going to risk the 100 bucks worth of medication to find out.
    Patient care has taken a back-seat to gun-shy pharmacies who are getting fucked over by cost+$2.00 reimbursement fees. Cant say I blame them, patient care doesnt put food on the table or pay for the power.. I tipped the pizza boy more than we get per Rx via MediCare part D.
    So the pharmacies get fucked and the patient gets fucked.. Who comes out ahead? The insurance companies thats who (who are recording record high profits last quarter).
    I’m amazed at the lack of preparedness that the insurance companies have shown. You would think that a good 6 month prep-time and “record high profits” could prepare them with the necessary hardware and personel to take the phone and transmission load that was expected on the first.
    I’m waiting for the blame on Bush or the republicans to come out, even though its the private sector that totally fucked over everyone. Last I checked the government didnt have control of HealthNet, Argus, Blue Cross or any private third party. But I guess someone has to have the finger pointed at them. If the government would of just managed it itself like they did the state welfare program, everyone would be in the same boat, and we wouldnt have 50 companies with 50 standards and 50 formularies to deal with.
    There is no excuse as to why Argus’ computers were down all day today. If this was a single man operation, then I could see. But this is a multi-billion dollar corporation. You would expect a bit of forethought and preparedness.
    But it gets better! Who gets blamed for Argus’ systems being down, the copays where there was none, and all this chaos? ME! Thats right, your local neighborhood pharmacist who has nothing to do with this whole batshit gets blamed. People want to blame someone they have access to, so they blame us. As if I control argus’ systems (I could probably do a better job administrating them) or control their copays.
    So fuck you Argus and fuck you Heath Net for dropping the ball during the time of need. People will die because of your fuckups, its the blood of the elderly (and the frustation of every pharmacy out there) will stain your ‘record high profit’ reports (as if you care).
    Its a sad sad day for pharmacy today.

    Medicare Part D – Day 1

    In the words of my boss:
    “More people will die because of MediCare Part D than Hurricane Katrina”.
    In the words of me:
    “This is a complete and utter clusterfuck”.
    Its horrible, examples:

  • Patients are being sent to the pharmacy with cards that have the WRONG ID number on them, which forces us to call the insurance company to wait on hold for a half hour or so.
  • The central eligibility server is down, so you cannot online check to see which of the 90 plans the patient is signed up for.
    Furthermore:
    Since all of the Medicaid (welfare) patients with Medicare are moved over to Medicare part D now, they have copays. They are used to getting their medication for free, so they bitch and moan when they have to pay a measly $1 for generics and $3 for brand name. My reponse to them: “Get the fuck over it, you should of saved your money when you were young. I’m tired of paying into a system that will benefit you and no longer be around for me. Personal responsiblity begins young and at home. Remember the story of the grasshopper and the ant. You douchebags are the grasshopper and i’m the ant. My grandparents came to this country with nothing and have enough investments to retire on. They didnt even speak english when they came here! So suck it up, be a man/woman and forgo the one night eating out at hometown buffet to pay the $17 for all of your monthly medications. People who dont qualify for government assistance have to pay cash, and you dont see them bitching about it you fucking whiners.”
    I feel better now.