Category Archives: Insurance Companies

Medicare Part D – D-Day all over again.

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

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

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

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

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

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

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

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

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

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

I’m dreading the first

Fixed Income Medicare Blues

I know I haven’t been posting lately compared to my DrugMonkey and Angriest counterparts.  Don’t feel like getting into politics here and I dont like to rehash stuff (too much).  Had to reprime the angry-reserves. 🙂

People always sing to me the ‘I’m on a fixed income” blues when they are paying their Medicare Part-D $3.10 copays for their $200 Nexium Rx.  Oh, how soon these idiots forget what life was like before Medicare Part-D took effect.  Did they somehow forget paying full price out of pocket for their medications?  Why is now $3.10 so much of a financial drain on their “fixed income” when just 4 years ago they were paying 10x that amount with a smile on their face.  I really do get a huge hard-on when I bring up how much they were paying before Part-D and how they are only paying $3.10 (which makes them feel like huge ungrateful douches).

Medicare Part D has spoiled seniors, plain and simple.  They are so hung up on their “fixed income” that they have completely lost sight that the people who are footing the bill for their expensive medications are the same people who will never ever see a dime of the money that they contributed to the system.  They also fail to see how Medicare is pretty much socialized medicine for people over 65, and we can see how well THATS going.  Medicare recipients complaining how we should have socialized medicine in this country just makes my irony meter fly off of the chart.

What do you expect from old people other than cow eyes, the same question asked every week, and bitching about $3.10 copays.

When chains rule the world…

Although they sure as hell don’t realize it, PBM’s (like  really do need small independents to continue their existence.

Imagine if you will, when all of the PBM’s have driven all of the little guys out of business.  No more mom and pop stores as far as the eye can see.  Sure, this might make the PBM’s happy because their executives got a 4.5 hochillion dollar bonus this year off of the backs of the little guys they put under, but now they have to deal with the two big angry gorillas of the pharmacy world:  CVS and Walgreens.

Now, when MedImpact/Argus/etc sends their contracts to these retail giants with their AWP-25%+0.07 rates, do you think that the two big boys on the block are going to sign that?  Hell no.

You see, now they sorta have to, because independents are still around to take care of the patients if the big “evil” chains refuse to sign that contract.  Its illegal under anti-trust acts for true independents to collectively refuse to sign a contract.  So you’ll find at least one pharmacy in town who’s enough about “Patient Care” to sign that horribly low reimbursement rate.  However when we’re all gone? It’ll just be the big boys, and they have a LOT of stores and don’t like to use much lube when it comes to the bottom line.

MedImpact will waltz up to CVS and offer something horribly stupid (because thats how PBM’s roll).  CVS will look at the contract, send it around to each store for the pharmacist to wipe his/her ass on it, then return it to MedImpact.  If they terminate CVS’s contract, then MedImpact’s patients just lost about 1/3 of the stores they can get their Rx’s filled.  Walgreens will do the same thing, and eventually you’ll have a PBM that has no pharmacy to call home.  See, the PBM’s will have eliminated all of the competition of the chains vs independents.  They don’t realize it yet, but its slowly happening.

So whats a PBM to do?  Easy, stop fucking over pharmacies.  Take a REASONABLE fee for processing the prescription (ie: don’t make more per Rx then the person who is filling the prescription like you are doing now), PRINT THE RIGHT INFORMATION ON THE FUCKING ID CARDS (so we don’t have to call), and stop being fucking slimy crooked piece of shit banes of the pharmacy world.

Which brings me to my second issue:  At what point do we throw down the gauntlet and put ‘patient care’ aside for our own livelihood and well being?  At what point to we refuse to sign the new contract that these pieces of shits send our way and collectively stand as a profession against the abusive-husband that we call PBM’s?  When do we grow the balls to tell Mrs Smith “I’m sorry, but we no longer take your insurance because doing so will cause us to go under.  Go and complain to your insurance company about their processor”.

You know how I rant on here about how annoying and stupid patients can be?  Now imagine them not yelling at me, but having them collectively yell at the PEOPLE THEY PAY to manage their pharmacy benefits.  Of course trying to get pharmacists to do anything collectively is like herding cats; and we probably need a committee, a fancy name that has a cool acronym like DILDO, yearly meetings with pharmacy school students, a publication, lots of pictures of people who have NEVER WORKED A FUCKING HONEST DAY IN THEIR LIVES with fancy letters after their names, award ceremonies for “Something” of the year (which means absolutely nothing), scholarships, more publications, requests for membership dues, etc.

Thats right, I’m ragging on CPhA, APhA, ASCP, and the other alphabet soup organizations who want me to join their organization in exchange for magazines full of pictures of students who don’t have a fucking clue and old-guys trying to re-live their glory college days.  WHY AREN’T ANY OF THESE “organizations” DOING SOMETHING ABOUT THE PBMS!!!  Oh, because they have no idea about PBM’s because THEY DON’T WORK RETAIL.  Before you can “Advance the Profession of Pharmacy(tm)(r)(wtf)” why don’t you try to fix the insurance clusterfuck that we have going on now.  I know that its hard work shaking hands and getting your picture taken at the latest convention at the Marriott, but seriously, DO SOMETHING or we’re going to have to take your “patient care” that you so dearly hold true and preach to everyone about (btw, whens the last time you even SAW a patient? How about actually worked in a pharmacy?) and throw it aside so we can pay make payroll.  Roll up your sleeves, put your fancy labcoat (with your name embroidered on it and has never seen a pink amoxicillin stain) aside, and GO AFTER THE PBMS!

The organizations should be going to the PBM’s and say “The cost of doing business is $x.  At your reimbursement price, pharmacies CANNOT survive.  We are going to recommend to ALL OF OUR MEMBERS to not sign up with your plan.”  Anti-Trust? Sorta, but this is to all the members, most of which who are chain pharmacists and non-owners.  Bah, its a pipe dream.  Maybe they are doing this, but seriously to the guy in the trenches whom it effects, I see zero.

Realistically, I’m betting on the chains to do the dirty work based solely on their monopoly on the industry vs the people that I pay dues to represent how I see the profession.

When bad PBM’s get even worse

Over the last 200+ entries, I have fought for truth, justice and AWP -5% + $6.50.  I’ve laid down the smack against doctors, other pharmacists, drug-reps, insurance companies, Liberty Medical (fuck you) and even myself.  Now someone else is on the angry chopping block.  This rant is a magical mix of useful information and gutter-talk.  My mother is probably so ashamed right now, however like most of our readers she forgets this is the ANGRY pharmacy and not

Like a pimp who never loved you, these assholes of our profession both give us money, and screw our asses when we’re not looking.  Can’t live with them, cant work with them, but like a case of herpes wont ever be completely gone.

Yes, I’m talking about PBMs.  Pharmacy Benefit Managers.  The people who process your prescriptions and write out your checks every month.  WellPoint, Argus, Medco are all examples of PBM’s.  See on your insurance card at the Bin and PCN (Processor Control Number)? Thats so we can transmit to the correct PBM to get paid for your Vicodin and Soma.

You look confused (surprise surprise), let me use an example.

For those not in the profession (and 99% of the doctors out there), most insurance companies don’t administer their own pharmacy benefits.  Say for example we have a small Medicaid plan called “HealthPlan of AngryLand” (HPAL) that has hired a PBM called PillConcussion (PC) to process the pharmacy benefits.  When your local pharmacy processes that Rx for Soma, our computer systems contact PillConcussions servers (whom have a list of medications that HPAL has deemed “covered”) and right then we get a response if its covered and how much we are making.

PillConsussion pays the pharmacy for the Rx (say, $15).  HPAL pays PillConsussion what they paid the pharmacy ($15) + a handling fee (remember this!, more later).  So the flow of money goes:

State -> HPAL -> PC -> Pharmacy -> TAP -> Webhosting Bill/Booze/Hookers/Blow/Therapy.

Now, the big boys (BlueCross, Medco) process their own Rx’s, so the actual insurance company and the PBM are one in the same.  However smaller insurance companies cannot afford the infrastructure to process their own prescriptions so they hire a PBM (like PillConcussion) to mange their Pharmacy Benefits (hence the term Pharmacy Benefit Manager).  Now, this all may look fair and good, but what if PC goes crooked?

Example 1:
Brand new generic comes out.  Say its Paxil CR.  Now imagine that you have your head up your ass, and you processed the script for the trade name (because the patient has been on it for years) without switching it over to generic (which until this point you had no idea it was out).  Unless you look carefully at your reimbursement screen, the PBM will silently accept the transmission for BRAND NAME and reimburse you the price of the GENERIC (remember, you are transmitting the NDC of the TRADE name product).  No warning from their end, no “BRAND NAME NOT COVERED”, just a normal billing acceptance for about 95% under-cost.  That means that the pharmacy is getting the generic reimbursement ($4.00) when the PBM knows they are billing for the brand name ($200).  Your store just lost a shit-pot full of money because you blew past the reimbursement screen (although most pharmacy systems will blare warning lights at that point).  What makes this whole ass-raping even sweeter is that usually this shit happens when a new generic is released that the PBM’s know about long before you do.  Its pretty sad when the pharmacies find out that a new generic is available by the PBM’s gently patting your behind while softly telling you to lube up and bend over.

Example 2:
Say we take something random and stupid like Prilosec OTC and its generic Omeprazole OTC.  Now what if PillConsussion /only/ covers Prilosec OTC (the brand name), but reimburses the pharmacy the cost based upon Omeprazole OTC (the generic) and at the same time charges HealthPlan of AngryLand the cost of Prilosec OTC?   PC is billing HPAL the cost of the BRAND name, but reimbursing the pharmacy a cost based on the GENERIC.  Is this fraud? Would this be like the pharmacy billing trade name Cipro to the insurance company but dispensing the generic?  Its not as uncommon as you think, however most pharmacies are too busy/stupid to look at how little they are making and not speaking up.

Now in this example say that HPAL and the pharmacy talk and compare notes.  Like a guy who realized the girl he just nailed was 16, PillConcussion starts to do damage control.  They state that generic Omprazole OTC is not covered because the BRAND name is Omeprazole Magnesium and the GENERIC is just Omeprazole and they are not equivalent…

….Must ….Resist ….PBM ….Backward …Logic

Still doesn’t explain why they will not cover the generic but reimburse based upon the cost of the generic.. They then say that it was a computer error, and to BACK OUT AND RESUBMIT ALL CLAIMS FOR THE PAST X MONTHS.  Now here is what really confuses me.

If PillConcussion audited you, and realized that you were overcharging for a certain drug, would they have you BACK OUT and RESUBMIT all of the incorrectly billed claims? FUCK NO! They would just take ($difference x claims) out of your next check.  Now why can’t they do that with the errors that THEY made?  They know how much the price was off in the computer, and they know how many claims were processed, so why cant they just issue refunds to the Pharmacy (whom they were under-reimbursing) and to HPAL (whom they were overbilling).  Its bullshit that they make US do the work for something THEY fucked up on.  “I’m sorry that we fucked you, now get fucked even more with the $0.20/transmission charge you will get to BACK OUT and RESUBMIT to get an additional $0.50/rx”

Yeah, hear that sloshing noise, that’s coming from your backside.  Someone is getting the good end of this deal, and its not HPAL nor the pharmacy.  The processor is making MORE per Rx than the pharmacy, and all they have to do is just have a handful of servers setup to do processing.  The patients don’t even call them (nor know they exist).

This rant was started by an email I received about a PBM that is plaguing a good friend of mine.  I sent off a few emails to people in the area (I know a metric (not imperial) buttload of pharmacists everywhere, ah, fame) asking them about said PBM, and I received the same gripes/complaints from all of them.  This one however took the proverbial cake.

    I knew I was getting
fucked, but didn’t realize whose dick was in my ass.  All this time, I have
been blaming the insurance companies (who are not innocent by any means),
but it is the PBM that is really putting it to pharmacy and the health
plans.  These cock-smokers lower our MACs on a whim.  Hell, they
are lowering them before the fucking generic hits the
market.  Mean while you would think they would be lowering the
cost on those same meds to the health plan–no fucking way, the PBM pays us less
and doesn’t pass on the savings to the health plans.  Try to get
these same assholes to raise the MAC when
price goes up — good luck Charlie.  If you forget to dot an
i, they point that out without addressing the problem.  The cock-suckers
must be deaf and mute, because they can only communicate by email. 
If you work up the ladder at the PBM you begin to find
older pharmacist who at one time had their own pharmacies.  I have
to think they either couldn’t cut it without daddy’s money or tried to
fuck the public too much.  It is an IMPACT
we cannot afford to ignore.  You owners out there have a
choice–either stand up or lay down like a beaten dog.  Take the time to go
after these assholes now.

Now I’ve been sitting on this post for a long time, because this PBM decides to shoot themselves in the foot time after time (and I don’t want to make 100 posts about how shitty they are).  I just received an email from this same pharmacist saying that this PBM he is talking about (the one that has made an IMPACT on him) is doing an on-site audit at the end of August.  However they just audited him in March and found no significant errors (only stupid shit like a 1oz tube of cream being billed at 29gm instead of 28.95gm).  Now, I realize that sometimes we can be a bit slow, but since when do PBM’s audit you TWICE in 4 months unless you call them out on something huge and they want to get even.  What does a call to the auditor result in? “Oh, we’re sorry, this is a COMPUTER ERROR we will cancel the audit right now.”  Right, a “mistake” and a “computer error”.

So I’m just going to post this now, because I doubt that this PBM can shoot themselves in the foot any worse than they already do.

You’re either with us or … a huge douche!

As you have read before, California instated a 10% cut for its Medicaid Rx reimbursement.  However, last Saturday the courts overturned the ruling until 8/11/08.  Their computer systems still have the 10% cut, but they will let us know how they wish to deal with that ball of wax once the shit stops falling from the sky in the legal department.

Now, I don’t do this very often so you might want to bookmark/take a picture of this page.  The doctors have done a tremendous job in helping the local pharmacies keep their doors open and their paychecks from bouncing.  They have been more than receptive and more than helpful in switching their patients to generic drugs with little to no prior notice.  For how much shit I talk on doctors on here, they really helped us out.

However (you knew this was coming):

There seems to be a few doctors in town who did not get the memo.  You see, when we fax you a nice little note explaining the cuts and if we can switch our patients to something that cost less (so we wont lose money when we fill what the drug reps sucked you off to prescribe), and you write a big NO on it, that really upsets us.  Its not like you’re a cardiologist or writing for weird stuff like Tekturna.  Denying our request  from Nexium to OTC Prilosec isn’t rocket science, and obviously you must of slept through that class to realize how much power pharmacists have.  In fact, blanket denying everything that we send you to switch with a NO means that you are either:

1. Lazy
2. A dick
3. Think so little of us that you don’t give two shakes of a mouses dick what happens to us.
4. Have some ill-gotten god-complex that fell out of fad about 20 years ago when managed care/insurance companies snipped off your scroatum and dangled it in front of your face while saying ‘HAW HAW’
4. All of the above

Like I said before, this isn’t rocket science.  If I would of said that the insurance didn’t cover this medication you would of switched it in a hot second, but because we asked for a professional favor you decide to shit in your hand and rub it in our faces.

However, Pharmacists (believe it or not) like to take the high road.  So when your patient has a stupid medical question like what to take when they are constipated, we will not refer them to you and waste your precious doctor-time.  When potential new patients come and ask what we think of you, we won’t say that you are a flamboyant small-penis douche who hates pharmacists.  We wont make you wait an hour on hold or happen to forget to fax over that med list that one of your dropout front-end girls called and sorta-asked for in something-that-resembled-english.  I’ll look the other way when your minimum wage hired help totally fucks up.  Oh, and when you call me personally for a favor, I will (with a smile on my face), not bring up the time you totally FUCKED us when the cuts happened.  You see, we have professional courtesy, and even though you may bad-mouth us to your patients, we spend 10000x more time with them than you, so they’ll STILL come to us regardless what you say.

To all the doctors who stood up to help small pharmacies stay in business during the cuts, we love you.  We’ll refer patients to you, we’ll sing your praises from when the gates open until the gates close.  We’ll buy you drinks at the CE dinners (heh, they reps buy the drinks, but they dont know that) and run medication by your house late at night when your kids are sick.  We’ll cover for you when you write that Amoxicillin Rx to someone that you knew had a Pencillin allergy but just brain-farted.  We will drop everything to happily look up something that you just as easily could of looked up on your palm-pilot.  We’ll give you our cell phone numbers and open the store at night for those once-a-year emergencies involving a screaming grandchild, zithromax suspension and some auralgan (the original cheap one) drops.

To all the doctors who decided to not answer our pleas for help.  Eat shit.  The cards are down, and we know where you stand.  We will still treat you with respect, but excuse us always looking over our shoulder for the knife when the shit hits the fan.  We are more than just pill counters, and you are damn lucky that (unlike you) we have the moral and ethics to show you exactly how much influence over the patients we have.

California Medicaid Cuts – Ground Zero

Yesterday the California Medicaid system (Medi-Cal) cut reimbursements by 10% across the boards for Doctors, Dentists and Pharmacies.  For pharmacies this was both the dispensing fee AND the drug cost reimbursement.

Yesterday is also the day where if your MediCal Rx costs over $150, pharmacies will lose money due to the state reimbursing below the dead net cost.  See that Risperdal prescription that cost the pharmacy $200? The pharmacy lost $30 on that deal (reimbursed $170).  What makes this obvious clusterfuck more amusing, is that the state has under the table “rebates” ie: kickbacks that mandate certain trade drugs.  See generic prilosec? The state only reimburses for Nexium and Prevacid (now at $30 BELOW NET COST per Rx!).  If the state and Big Pharma would stop space-docking (go look that one up), maybe the state would not be in such a money-hole.  Wait, that makes sense.  What also would of made sense is a 5% cut on trade name drugs and a 15% cut on generics.  Hold on, does the state have any actual “real” pharmacists working for them or are they just “advisors” (ie: couldnt cut it in the ‘real world’ so they had to ‘advise’) who shake hands at the APhA meetings while giving back-room handjobs.  Was this 10% cut just an arbitrary figure by some suit in Sacramento who obviously doesn’t have to deal the fallout? Sure is.  Again, retail pharmacy is the human shield for the idiots in power.

No doubt that California is in a money-hole, but instead of sucking up some form of balls and a backbone and kicking people OFF of the welfare system who obviously should be out working (and contributing to the society that they gleefully suck the life out of (and make more babies for)), they just cut the reimbursement to the people who actually take care of them.   Is there a real legit reason why the 27 year old male who walks into my store should be on the state system with his car stereo blaring the bass out in front?

The state probably thinks that pharmacists and doctors are all rich, they can just work for free!  Yeah, fuck you.  I didn’t put the time and effort to go to school and make something of myself to work for free.  At this rate I should of just been on welfare like everyone else.  California’s tried-and-true idea of a “solution” is to just throw money at the problem and hope it goes away.  Well, I’m sorry, it didn’t and now people EXPECT the state to hold their cock while they pee, wipe their asses when they shit, and $0 copays for everything!  You created this situation and now you expect US to take it in the ass for you.  Again, fuck you.  Its common knowledge that you don’t shit in your own bed, and you dont cut down the trees that provide you with food.

Oh, and because shitting in the faces of the working professionals wasn’t enough, the other insurance companies will look at us and say “Well, if the State can pay you shit, and you deal, then WE can pay you shit and you can also deal”.  Can you all see where this is going?

Heres something else that the State obviously didn’t consider.  What are the highest dollar medications we have.  Ones that there are next to zero generics and people obviously cant switch to something else:

  • Retrovirals (HIV baby!)
  • Cancer/Chemotherapy
  • Atypical Antipsychotics (sorta, haldol is always an option. We can always bring back Clozeril! heh)

So the state now have put pharmacies in a very very tough spot.  Does the pharmacy lose $100 on that $700 HIV medication for their patient, or do they tell the patient “sorry bud, you up shit creek”.  Do those fucked up politicians need to look at that patient in the eyes and tell him/her “Sorry.  You cannot get your medications to prolong your existance because the store cant afford to lose $300 on your 4 HIV meds”.  No, they dont.  Maybe they should though.   Pharmacies (and their patients) that do a ton of mental health/HIV/Chemo drugs are absolutely fucked beyond belief.  Not just a little fucked, but full-on bend-over-bubba fucked. 

So to the California representives who made this clusterfuck:
I refuse to fill an Rx for below cost.  You know those expensive psych meds like Risperdal, Zyprexa, etc? Those aren’t going to get filled.  Maybe you should use your powers of penile stimulation on Big Pharma or just grow a pair of balls and start booting people off of the system.  Doctors aren’t going to take MediCal anymore, pharmacies are going to refuse to fill (ie: not stock) expensive trade name drugs and these people are going to go to their nearest ER at $500/visit to get care.  You shit in your bed, YOU think of a different way to fix it other than letting the shit roll downhill on retail pharmacy.

I forsee many MediCal patients not recieving their medications unless the State pulls their collective heads out of their asses and do something.  Stay tuned for more F-Bombs directed at the People’s Republic of Kalifornia.

Fuck Copays

Copays are the bane of our existence.

There isn’t a day that goes by that I don’t get into an argument or discussion with some retard about their copays.  Be it too high (even though they paid the SAME amount last month) to the infamous rocket-science-level deductible, its like we spend 99% of our time explaining something that should be common knowledge.

Why do people think that WE have anything to do with their copays? As if I pull a number out of my ass and slap it on the label for them to pay.  Are people really that fucking stupid? Oh, wait, dumb question.

What really pisses in my cornflakes is when someone is getting a $300 prescription, say #60 Aciphex, and has a $10 copay.  Then has the balls to sit there and openly complain to me that they should NOT have to pay that $10 and how much their insurance sucks.  Heres a typical conversation:

Them: WHAT! I have to pay $10! This can’t be right!
Me: Well, according to my system here you paid that last month.
Me: Uhm, close to $350 dollars
Them: $10 is way too high for this Rx! I want it lower
Me: Uh, I dont set your copays, you’ll have to call your insurance.

Now this is what I wish would happen:

Them: WHAT! I have to pay $10! This can’t be right!
Me: Listen here you fucking ungrateful moronic fuck.  You are getting $300 worth of medications for fucking $10.  /MY/ copays aren’t that low, and you have the fucking balls to sit here in front of me and my staff and whine over paying $10.  You are a fucking moron, and I am embarrassed to be in your presence.  Take your fucking prescription and go somewhere where they give a fuck, because I have better things to do than to sit here and listen to the diarrhea babble flow out of your mouth.  You are an ungrateful fuck and I hope you die in a car fire.  Eat shit you whore.

However business and that crazy ethics crap dictate that I can’t really fly off the handle at them while they are in the store (but I do tend to do it when nobody is in the store).  It really does however piss me off when people whine about copays that cost less than a good meal at McDonalds.  If your copay is $150 bucks, sure, bitch away.  $10 not so much.

A plea from a fellow independant

Working for an independent gives you sort of a bond with other independent pharmacists. From shitty reimbursements to dealing with patients; we don’t have the luxury of a ‘corporate office’ and people in suits with fancy lawyers to cover our asses.
So I recieved this letter from a pharmacist in California. Since he claims he has bitched to everyone he can get his hands on via phone, I think its time to give some good ole public harassing.

My name is [Name Removed] from [Store Name Removed] in [City Removed]. California. Long time listener, first time caller. First off love your website. I was wondering if you could light a fire under a problem that I’ve been having.
In case you are not from California, our Medicaid system (Called MediCal) has a 6 Rx limit per patient per month. Any Rx over 6 needs to have a Treatment Authorization Request filled and sent in (Think of it as a retarded prior auth that they approve for like 6 months to a year). Since it is being done electronically now vs fax, the usual turnaround time was a day or two for maintenance medications and a bit longer for stuff that was non formulary.
Over the past few months, I have been getting TAR’s back for stuff like Lisinopril, HCTZ, glyburide with only 3 authorizations. Now why they would only give 3 fills for something the patient is on chronically is beyond me. To make matters worse, the turnaround times for maintenance meds is now approaching close to 14 days in some instances. Imagine if I did not dispense insulin or digoxin to a patient until I got that TAR back so I could get paid.
So I call the TAR office, and they say the delay is because they are “Really Busy” (yeah, who isnt?). Them giving us only 3 fill units on a lisinopril Rx is like if I dispensed 10 tablets at a time then used the “Really Busy” bullshit when they bitched as to why its taking so long.
I think they are giving away a low amount of refills for approved maintenance medications to save their own jobs. Unfortunately their shortsightedness is giving them such a backlog that approvals are not being sent out in a timely manner and people are not getting their medications.
I hope you publish this letter to your site to light a fire under the MediCal TAR office and to see if any other pharmacist from CA is having the same problem. I can be reached at [email TAP for address].
[Name Removed] RPh

Thats pretty shitty if the MediCal TAR office is screwing over TAR’s that THEY THEMSELVES REQUIRE in order to save their jobs. I always thought that PA approvers are just pharmacists/techs who could not cut it in the “real world” so they have to get some desk job hiding from the public behind an ID number so they cant be called out for being a fucking retard. If there is anyone from the MediCal office reading this, why don’t you get your own shit in order before you force your problems down the throats of the pharmacists who actually work for a living. I have his email address if you wish to get a hold of him and explain your case. 3 fills for a maintenance med, thats fucking absurd. “We’re busy” is also fucking absurd. Wah wah wah, cry me a fucking river and let me powder your balls while we’re at it. Hate to break it to you, but we ALL are busy, and judging from this letter you are just adding more shit onto this poor independent.
I’m just glad that there are still some people out there like myself who will fill an Rx even though they will not get paid this very moment just so they don’t end up in the hospital (actually, I think all pharmacists will do this, huge $ items excluded of course, we’re kind but we need to eat too).

HIPAA Primer for BravoRx

Dear BravoRx,

Please get your collective heads out of your asses and research what is and is-not information that is protected by HIPAA.  Today I had to spend 20 min on the phone yelling at one of your representative because they would not give me the birth date they had on file (which was wrong) because they said it was a HIPAA violation.   Because your company sucks and you are lazy, I will spell it out for you.

If I fill Rx’ for a patient, I fall under “patient care” therefore no medical information can be withheld from me in the name of HIPAA.  Go look it up.

Here, I’ll do it for you:

Yes. The pharmacist is using the protected health information for
treatment purposes, and the HIPAA Privacy Rule does not require covered
entities to obtain an individual’s consent prior to using or disclosing
protected health information about him or her for treatment, payment,
or health care operations.

See that? FOR TREATMENT PURPOSES.  However this clause does not apply because a birthdate is not MEDICAL INFORMATION!!!  Its a fucking birthdate! Get your head out of your ass!  Its not a SS# but something that is pubically available!

So thank you BravoRx Rep, for wasting my time with your shitty substandard service and lousy reimbursement rates.

May the pox of Argus be upon thee,


Medicare Part D – 1/1/2008

Did it go smoothly? No.  Was it a complete clusterfuck? Yes.  Am I suprised? No.

Today was a diaster.  I had some insurance companies publish the completely wrong information on the cards, bunch of stuff that isnt formulary, “card? what new card?”, and a shitpot full of people whom a deductible = rocket science.  Lets not even get into how fun it was to try to get through to any helpdesk.  The only shining moment is that Argus did not go down, and to be honest most of the big processors were not down for any length of time.  They had 3 years to figure this shit out, good job boys.

Yes, please bitch at me a bunch because you have a $0.05 increase in your copay for your $100 medication.  Plus, just to show how much fate hates TAP, it made one of my printers blow up today, and our pharmacy software glitch like mad.  Wonderful.

I barely have the ambition after a good night of drinking Jack Daniels to even write more.  I’m just so happy that today is over.