Category Archives: Insurance Companies

Medicare Part D – Mexican Food and NPI

First off, Merry Xmas to everyone.

The 1st is looming closer and closer.  For those in you not in pharmacy, the best way I can describe the feeling is as such.

You just ate at this Mexican food restaurant.  The food was good, but you have this feeling in the back of your mind that you will be spending the evening peeing out of your butt.  However you aren’t 100% sure that you’re gonna expode out of your backside, you’re just 98% sure.

Thats how we feel right now.  I’m about 98% sure this is going to be total clusterfuck, but there is a small hint in the back of my head that it might be okay.

Now something that complicates this whole clusterfuck even more: The dreaded NPI number.

How many doctors have you gotten an NPI number from?  How many insurance companies are going to ‘suddenly’ require an NPI number on 1/1/08 without any prior warning or notice?  How many doctors have you asked “Hey, whats your NPI number?” only to get a “Whats an NPI number?” answer?

For Xmas, all I want is a 5th of good scotch, a few cigars, a box of fentanyl patches and a well-heated hot tub.

Medicare Part D 2008 – Please Not Again

Does anyone but me have this feeling of impending doom about the first of the year?  For those not in the know, a whole bunch of Medicare Part D plans are changing/merging/switching/etc as of the first of the year.  I know that HealthNet (I think its HeathNet) is switching processors, and there are about 4 or 5 new plans to replace the 4 or 5 that are going away.  People are getting switched around, new cards issued which means new ID/Group numbers (if they have the card AND its printed correctly).

It’s going to be hell all over again.  New cards, down systems (*ahem*Argus*ahem*), confusion, copay changes, formulary changes, hour long help-line hold times, everything hitting us all at once.  The Medicaid/Medicare people are getting auto-switched into new plans, there are confusing letters flying all over the place along with salesmen who will promise golden turds to any senior who will sign on the dotted line.  Add onto that a system that is horribly complex and confusing thats targeted at the population segment that is confused by the most simplest things.  Breaking out the booze yet? 🙂

I hope after the first I quote this post and say “You know, I was wrong, I was really wrong”.  Somehow I don’t think that will happen.

However, aside from all the lost reimbursements, forwarded medication, confusion and swearing, we will again show the rest of the world that us retail pharmacists are the most stubborn, determined, hard working and just outright relentless healthcare professionals out there.  We are the glue that holds the industry together.  Its times like these that retail pharmacists and their staff show their true colors to all of their patients.

I can’t speak for all the retail folk out there, but I know there is a good majority that sat there after Jan 1st of 2006 and 2007, looked deep down into that tall glass of booze, and felt a sense of pride in their profession that wasn’t there before (or it might of just been gas, or psychosis setting in).

For Sale: WellCare, gently used, only $5

This post should of been titled “Putting the ‘oh shit someone told on us’ in WellCare”
See what happens when you cross The Angry Pharmacist ™? You get raided by the FBI, your stock tanks like a post-thanksgiving turd, your exec’s abandon ship and put their business on CraigsList, and Pharmacists everywhere are digging your grave. Remember that.
On a more serious note, if you have lived in a barn the past week, Wellcare (the one we all know and love) got raided by the FBI/Government/Granny/etc. Their stock promptly went from $130 to ~$27. Dont believe me? Click here.
Why did Wellcare get raided? Well, people aren’t saying much. I read somewhere on that yahoo link (that I cant seem to find the article now, interesting) that they were misrepresenting their earnings, especially when dealing with officials in charge of reimbursement (meaning OUR reimbursements probably). Something about contracts with an off-shore business or something to lower their overall profits. For some reason actually making a profit of 49% higher than reported rings a bell somewhere in my head.
What does this all mean? That the “Fair” reimbursement we have been getting of way too low like cost+$1.50 is bullshit. Wellcare obviously was rolling in the dough, so why couldn’t they up our reimbursements? Oh, because they were funneling their money around so their company looked less profitable thereby giving them an excuse to fuck over the pharmacies and our shitty reimbursements. “We cannot afford to reimburse you more” they spew as they light their cigars with fresh $100’s.
Since Wellcare’s crap-ass reimbursements were just in jive with the other big-hitters of the Medicare Part D crew, I wonder how many exec’s of the other big Medicare Part D providers (Caremark, etc) are currently forging their books expected to be investigated next? Are the Exec’s cleaning the turd stains out of the boxers bought with their $400,000/yr salary? Are we magically going to see new contracts appear in our fax machines with higher reimbursements? God I hope so.
Stockholders are suing. I would sue too if I had my retirement invested i Satan at $130/share to barf down to low 20’s. I wonder how long until the pharmacies class-action WellCare’s ass over reimbursement rates generated from an incorrect profit statement (not just a little 2% incorrect, but probably ~40% incorrect, whoops). We can only hope. You can be sure that I’ll have more commentary as the info comes rolling in.
Happy 1st everyone. I hope your day wasn’t as shitty as mine.

WHI Downtime – Walgreens again screws over everyone.

Turns out that Walgreens Health Initative ( not Walgreens the Retail Outlet. Same Bat-Time, different Bat-Channel) decided to do a “system upgrade” on a Monday that resulted in downtime all of Monday and Tuesday.
Gee. You would think that with their bazillions of dollars they are making (since they pay us retail folk jack-and-shit) they wouldn’t be down for a whole 2 days. Furthermore, you would expect that they would do a “systems upgrade” at like 2am on saturday morning when all sane pharmacies are closed.
But no, I had to deal with a huge stack of claims that needed to be billed today because WHI screwed the pooch and decided to take themselves out of pharmacy gene pool for a whole 2 days.
Sorry this isn’t very angry’ish. However I will leave you with a bit of fun information. Take your usual Gin and Tonic. Now instead of drinking it right away, put a slice of cucumber in it. Now sip and taste the wonderfulness. Some chap from Australia dropped me that note, its magical.

Heather the Human Shield

I just wanted to comment/elaborate/etc on a post made by the recent post by theDrugMonkey about the “Heather” of insurance companies.
For all of those too lazy or stupid to click the link above and read DrugMonkey’s post, “Heather” (as he called it, so they shall all be dubbed “Heather”) is the person on the other end of the phone with the insurance company who doesn’t realize that shes riding an emotional atomic bomb down upon the healthcare system. She usually has a nice voice, and has been working for Satan a whole 2 days. She has no idea about the perils of health care nor that her employer managed to get about 4.5 billion ID cards issued with the wrong group number.
I, like the DM, feel horrible for these people. They are the human shields of an industry who cannot help but piss on their own shoes while shitting on all of the people who make up their paycheck. They sound happy on the phone, but you know after a few months of being screamed at by doctors and pharmacist (over something they did not setup, have no control over, and really have no say in to make it better) they stare down at the empty bottle of burbon and wonder why in the fuck do they put up with this abuse. They then look at their kids and realize they are taking one for the team so their kid could have a good life. They refuse to go on welfare or fake a work comp or disability like everyone does.
So it pains me to be upset when I hear Heather’s voice on the other end. I know its not her fault that her employer is retarded, or that the wrong ID number got printed on the card. I know that if she ran the world everything would probably work smoothly. Shes there to pay her rent and buy herself food. She is probably going to college or basically cant get a job anywhere else. Here we are screaming at them for something that they have absolutely no control over just to vent our frustration. Are we any better than those asshole doctors who scream at us because expensive-drug-x is $900?
So next time you’re all fired up about WellCare not having the right ID number, and you hear Healthers voice on the other end, think of this post and realize that its not Heathers fault. She’s there to do a job much like you are and probably goes home and rags on pharmacists like I ran on Drug Reps.
(Yeah, I realize this post isn’t full of hate, bad words, sexual talk or anything like that. It just sorta struck a nerve that I’m sure lives deep down within all pharmacists. I’ll try better next time. Fuck insurance companies and drug reps..There.. All better.. 🙂 )

Pharmacy Certainties

There are some things that go on in a pharmacy that are set in stone like the sun rising in the morning. Pharmacy school should publish this list for their students. Seriously, its all true. Lets examine a few:

  • Drug reps/Headhunters/Pharm Companies/etc will always call you/stop by at the absolute worst time. Much like the tuesday after a three day weekend, or on the first of the month. During the slow times of the month you wont hear a peep from them.
  • Your most important tech will make a doctors appointment on the tuesday after a three day weekend and be gone for half of the day. You wonder why he/she couldn’t make that appointment for some day when you aren’t contemplating suicide.
  • The patient who you thought you filled that Rx correctly for ended up having another last name and the same birth-date as someone else in your system. Of course they don’t tell you this until after they have received the Rx and loudly proclaim that you filled it for the wrong person with a store full of people. I mean aren’t we supposed to know that her full name is Maria Consuelo Rodriguez Maravilla Hernandez Guadalupe AIAIAIAIA ARRIBA?
  • That bottle of expensive-drug-x is exactly one tablet short to fill that Rx, and the patient wants you to order a whole new bottle of #100 so you can fill the balance of 1 tablet. Oh, and the patient is the only person you have on this medication.
  • Someone will always come into the store with a fistful of Rx’s at exactly 1 min until closing, and want them all right now. This is after most of your staff have already left leaving you alone to do all the work.
  • Your bazillion dollar counting machine will blow up only when half of your staff calls in sick, and you really really need it.
  • Insurance cards + correct ID number = HAHAHAH RIGHT!
  • Argus and Wellpoint will be down, but not at the same time. We cant have you do absolutely nothing all day, so we’re just going to fuck up half of your day.
  • Your computer system/network/DSL goes out when your computer guy is on vacation.
  • “This is not the ID card you are looking for” *hand wavy jedi trick*
  • When you call out a patients name to tell them their Rx is ready, the wrong person will come up and claim it. Then get pissed off because to them “John” sounds like “Steven”.
  • 30 min into a phone call to the pharmacy help desk of the insurance company to get an ID number, the patient will magically pull a current ID card out of his/her ass then wonder why you are upset at them.
  • The “Nurse” calling in the Rx wont be able to read doctors handwriting, then spend 10 min taking a poll in the front office as to what that sig looks like. Heaven forbid she couldn’t read over the Rx before she got you on the phone.
  • When looking at a doctors scribble, you will always pick the wrong doctor in your system. We are expected to be able to read sloppy signatures much like we are able to tell our own shit-smear on a piece of toilet paper.
  • The one doctor who does not know about the iPledge program or NPI numbers is the one you deal with on a daily basis, and the only one that you can’t really tell to go eat a dick.
  • The pharmacy calling you for copies doesn’t have a pharmacist, and the two-bit clerk who called you doesn’t know their fax number or have any Rx numbers.
  • A patient brings in lunch for your staff, but you cant eat it because you are up to your eyeballs in work. It smells really nice though.
  • There is only 1 scoop of coffee grounds left in the container, so you just drink brown water all day.
    Last but not least:

  • That bottle of gin that you were so looking forward to after days like yesterday will be sitting on your bar empty when you need it the most.
  • Taking the CARE out of WellCare

    This is a directed bitch at WellCare. Yes, WellCare. I hope they read this, and I hope they give me an ‘offical reply’ to their stupid ass policies as you’ll see below. If you have a bitch about WellCare, then comment below. If I’m going to get a subpoena or court order to take this entry down (which I’m not, because its the truth), we mine as well go down swinging.
    Its 5:30, right before closing. One of our terminal cancer patients (11159.2) came in with an Rx for some Duragesic Patches. He is out of oral meds, so doctor figured now would be a good time to put in him on the patch. He has WellCare. So we try to bill the Fentanyl Patches. Not covered. Hm, what about trade name? Nope. No fentanyl patches are covered. So we call the wonderful WellCare customer service number only to be told that there is NO provision for early, lost, or emergency override fills. We pleaded and told the douche that the patient has terminal cancer, and if there was any way to fill the Rx.
    Short answer: No.
    Long answer: No.
    Who the fuck does NOT cover fentanyl patches? Its not like fucking that new quinine thats out. Fentanyl patches are used for one thing: Chronic or cancer pain. I bet they require a prior auth for all HIV medications too (because those arent important)! Anyway, back to the story:
    They would fax to the doctors office a prior auth form which needed to be completed and sent back. This is on a Friday, at 5:30pm. Yeah, snowballs chance in hell of that being done. Even if he doctor did it that very moment it probably wouldn’t be processed until Monday.
    Thats right, this terminal cancer, no pain medication, all because WellCare is ran by a bunch of fucking heartless idiots. The patient ended up shelling out a few hundred bucks for his patches so he wouldnt be hospitalized over the weekend.
    I hope someone from WellCare reads this, and realizes how fucked up they are, what a shitty program they run, and how bad this makes them look. Figures they are processed by WHI AKA Wallgreens. “Pharmacy America Trusts” my ass. So to any of the big CEO’s or important people at WellCare: I, The Angry Pharmacist think you guys are fucking assholes and I hope someday when you get cancer from those $100 cigars and top shelf booze that YOU get to spend the weekend in pain because your insurance company dicked you over like you dicked over my patient.
    Fuck Off and die.
    The Angry Pharmacist

    NPI – Someone needs to get a real job

    Who thought this NPI (National Provider Identifier) would be a good idea? What bored non-working bureaucrat with too much time on their hands (and has never held a ‘real’ job) decided to bring hell down upon us hard working pharmacists? Oh wait:

    The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard unique identifier for health care providers. The National Plan and Provider Enumeration System (NPPES) collects identifying information on health care providers and assigns each a unique National Provider Identifier (NPI).

    Thanks Hillary, you fucking twat. DrugNazi set me straight (for once). Hillary is still a twat for reasons not gotten into here (this is a pharmacy blog, not a place to voice my political opinions).
    For those of you not in pharmacy, currently Providers are identified by insurance companies as so:
    Pharmacies: NABP/NCPDP number. Its 7 digits long.
    Doctors: DEA Number. Its 2 letters and 7 digits long. Or a Tax ID Number.
    Easy isnt it. Short, sweet, and has been effective for the last 100 years.
    Now everyone has to apply for a NPI number. Thats right, a NEW number that we all know ALL insurance companies will have installed flawlessly in their software so there will be NO slowdowns in processing. Right, until you get that doctor who has not gotten his yet, and refuses to give it to you. So for this to work, EVERYONE needs to get an NPI number, swap it amongst each other like Garbage Pail Kids cards and assume that the insurance companies have their shit together and everyone added.
    So lets take a solution, and run madly around finding a problem. Sounds like HIPAA

    Medicare Part D – The Donut Hole, Your Doctor, and You

    I’m not dead! I swear! I just have been busy with work and not drinking myself into a coma.
    The Donut Hole.
    Those three magic words that all Medicare Part D patients hope they never hear. The gap in coverage where you must pay out of your own pocket for your medications.
    I hold Doctors partially to blame for the shit we have to go through when patients hit their donut hole. Before you give me hate-mail-o-rama, lets elaborate:
    You have a patient who is on Medicare Part D. Suddenly, all of these new and spiffy trade-name medications are only $3.10! So what does the doctor do? He starts writing for that ARB when a generic ACE-I is okay. He starts writing for Lipitor when the patient has been on generic Zocor for months. He starts getting blowjobs and lapdances from the drug reps in return for prescribing Levaquin when generic Cipro would be okay. “Hell! Its only $3.10! Why not! The patient only pays $1 for generics, whats another $2.10 for a drug that works ‘better’!!!”.
    In reality, the doctor is screwing over the patient, big time. In fact, he’s screwing over the patient more than anyone else could. You see, all of those big expensive trade name medications are going on a tab. A tab that pushes the patient further and further towards the donut hole. So their $2400 allotment of ‘coverage’ is now burnt up in 3 months because Mr “Its only $3.10” Doctor switched them all over to trade name medications. How many doctors realize this? About 10. How many doctors care? Zero.. “Its the pharmacists responsibility to take care of this, even though I’ll deny any generic request he submits!”
    So who’s sitting there with their puds in their hands. Isnt the doctor, he gets his from the drug companies regardless. Its the patient and the pharmacist. The patient because he now has to pay out of pocket for $2,000 or so dollars until he hits “catastrophic coverage”; and the pharmacist because WE have to explain all of this shit to the patient and hear their whining.
    Sure we can switch them all back to generics, but its a catch-22. If you switch them all to generics they’ll be in the donut hole longer (because their total cost of drugs per month decreased due to generic switch). If you keep on the expensive trade name medications, they’ll be out of the donut hole quicker, but will pay more per month. Wonderful isn’t it?
    In the defense of doctors, they really have no clue how much stuff costs now days. If you’re a doctor, and reading this, the cost of the drug is directly proportional to how many annoying drug reps come and visit you. Why would a drug that cost pennies be pushed so hard by men in suits and women in short tops? Think about it.


    Who here wants to drop Humana? Seriously. 2 friggin buck profit from each Rx. Where does Humana get off paying us this?
    See, this is the inherit problem with the system(tm). Our best customers, the cash paying ones, have to subsidize the losses we take from taking retarded insurance plans like Humana. So who does this punish? Not Humana, they are reporting high profits this year (gee, wonder why). Not the patients, they pay their $3 copays while bitching the entire time. Its us and the private pay patients.
    When are we going to put our foot down and say “I cant operate making $2/rx!” and stop taking Humana? Humana needs a good kick in the teeth to realize that if nobody takes their shitty plan, they are boned. Seriously. I hope Humana reps actually read this to realize that they are costing pharmacists their businesses. They need to get with the program. Their exec’s dont work for minimum wage, so neither should we.
    Now I know you all may be saying “ho-hum, we’re used to it, same shit different day” but is it really? There are a bazillion Medicare part D plans out there, and the MediCare/MedicAid patients can change monthly! No excuse for them to switch to a similar plan that isn’t going to bend you over without lube! We aren’t dealing with the private insurance patients (obtained through their work) that are pretty much unchangeable. I realize that the non-Medicaid patients are pretty much screwed until November, well, cant win them all.
    Send a comment if your pharmacy terminated their Humana contract. We’ve sent ours a bunch of times to their contract department, but so far no confirmation. Lets give Humana the bitch-slap they deserve for being the flithy whore of the Plan-D’s.