Category Archives: Insurance Companies

Albuterol HFA – What the hell?

As you all probably know, good old albuterol (with CFC’s) are no longer being made. No longer can we get an Albuterol MDI by Warrick for 9.95. Now we get “environmental friendly” pieces of shit for $20/each.
I recieved a phone call from a friend of mine who works in the People Republic of California. He told me that the state Mediaid (Medi-Cal) program decided (with their infinite wisdom) to take every albuterol MDI off of formulary. Thats right, he said no Ventolin HFA, no Proventil HVA, no ProAir HFA, nada.
You know whats covered? Xopenex HFA. 29.99 a pop too. What makes it even better? The company cant supply them fast enough to meet up with the demand of California! I laugh at him! Ha Ha! Oh, get this, they wont accept prior auths for albuterol either! Ha Ha^2! Guess patients are screwed there! Ha Ha^3! Who needs ‘clinical data’ or ‘efficacy’ or ‘studies’ when you put on your formulary the product that will give you the biggest kickback, er.. rebate. California (like Camelot) is a looney place!
So the FDA is saying that you cannot switch a patient from a CFC MDI to an HFA MDI without a new Rx. They are not equivalent and require a doctors OK to switch. They also say that all of the different HFA MDI’s arent interchangeable. I laugh at that too! You know how much bitching we would get if we faxed every doctor saying “Is it okay if we switch this CFC MDI to HFA MDI?” They’ll say “Are you retarded?”. I mean think about it; what doctor is going to say “NO! I DEMAND A CFC MDI! I KNOW THEY AREN’T BEING MADE! COMPOUND IT PUNY PHARMACIST!” Pretty retarded if you ask me.
But what do I know, I only have to hear the complaints.

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.

  • Welfare + Clomid = WTF?

    I got this comment from Sandi, and could not believe it:
    This patient takes the cake.
    I normally do a fair amount of grumbling over how much stuff is paid for by Medicaid, but this time I had to be proud of what was not covered…
    A lady came in with a prescription for Clomid. I did not ever in a million years expect she would be on Medicaid, so I had to look twice and still ask her if she had a new insurance card. Nope, she really is on Medicaid. Then she was just downright surprised that Medicaid would not pay to get her pregnant! Yeah, sure, why don’t you bring a few more into the world…on us. Not.

    For those at home: Clomid = Makes women have babies. Just don’t stand downwind of a guy, you might become his baby-momma.
    Sandi, you showed restraint unknown to those of us in retail. I personally would of called up the doctors office and asked them why they were writing a fertility drug to a patient that obviously could not take care of her self, but for some reason thought that bringing a child into the world would magically make her problems go away. What kind of dipshit retarded doctor would write for this? Oh, one of those “Everyone has a right to a family, blah blah blah”. Yeah, you pay for that fucking kid so we don’t have to.
    I would of just told her it wasn’t covered, and if she asked if I could call the doctor to get it changed or get a prior auth, I would just say “If you cant afford this medication, how can you afford a child?”. Tough questions, tough love, only here on the angrypharmacist.
    What i’m most surprised from this story, is that there really is an infertile welfare female out there. I thought that the cure all for infertility was to just go on welfare. In no time you’ll have one on each tit and another in the oven.
    Yes, i’m going to hell. Straight to hell.

    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.

    Express Scripts, Zocor, and taking it in the butt.

    Express Scripts gets the gold medal for screwing over pharmacists across the country (shocking! I know!).
    If you’re filling Zocor (trade or generic) for an Express Scripts patient, take a look at your reimbursement rates. I have a dollar that says its about 33% below your cost. If you didnt notice the big flashy red signs that say “YO DUMBASS! THEY ARE REIMBURSING BELOW OUR COST!” then you need to take more pride in your work and stop working for Walgreens.
    Well, here at the store of The Angry Pharmacist decided to confront Express Scripts on this issue.
    The first call resulted in some talking head saying “We have done extensive market research to show that the reimbursement rates are correct”. This is completely beside the point that Generic Zocor is only made by a company called Dr Reddy, which is in part owned by Merck Medco (surprise surprise) so its a single source generic. This is also beside the point that they are reimbursing 33% below cost on both the Trade and the Generic product. I can see a company getting kickbacks from Merck so they wouldnt cover the Generic, but below cost on the Trade name?
    The second call resulted in some very interesting information. The person on the other end said that “Since our reimbursement rates are so high on our other products, we feel that you (pharmacists) can take the financial loss on Generic/Trade Zocor”. They also admited that they have recieved calls from all over the country complaining about this issue!
    Is this an attempt by Express Scripts to move people to their shitty Mail Order Pharmacy where they get substandard service (and expect me to bail their asses out when they fuck up the mailings)? Hard for me to feel sorry for them when their stock is through the roof this year.
    If you must know, we’re switching everyone over to Crestor. There arent any real good generic statins out that are “covered”, and contrary to what Express Scripts thinks we actually do care about our patients. Plus Crestor is the most expensive one out there, and despite the kickbacks that Express Scripts is getting I think this will do more damage to them than just eating the loss of Trade/Generic Zocor. Or maybe this is a plot by Merck to force people to move to Vytorin.
    Regardless, fuck Express Scripts. I’d be happy to take back this bitch if some talking head from Express Scripts can provide some documentation as to where they are getting Trade/Generic Zocor at 33% cheaper than what I am getting at it. They can email me and i’ll send them my fax number.
    So look at your Zocor scripts and let me know if Express Scripts is bending you over as well. You can comment here and ill add you to a list. Or better yet, comment here and then call Express Scripts (800)235-4357 and tell me what the talking head tells you.

    Yes! More hate mail!

    Heres a hatemail response to my Indian Customer Service Rant a while ago. I’ll put my comments in.
    Oh, this was also posted by someone at an IP that resolves to internet.walgreens.com. Someone is surfing my website at your local walgreens! Naughty Naughty!
    I understand the anger in outsource but come on grow up! I can understand being upset at the insurance company but why be upset with the help desk person.
    Because if the help desk person says to their manager: “Gee, we’re getting a ton of complaints about X, maybe X will change” Change has to start somewhere, and unfortunally in the customer service industry the shit rolls downhill. If they give me their managers direct line, or better yet the CEO, then the customer service reps wont get as much flak.
    They are doing their job!
    And I am doing mine, so their customers can get drugs so they (and I) can get paid and their patients dont take a trip to the ER.
    They work for a living and can not help that they have accents, try getting people in the phillipines or brazil!
    You’re right. They cant help they have accents. You have me there.
    Just grow up and don’t blame people who work for the f’d up companies. Yes, in case you are wondering, Yes, I am Indian. If you knew anything you would realize why companies outsource. The conversion rate for $1 is to 50 Rupees. Do you understand that?
    Uh, why not blame the people who work for the fucked up companies. I dont think they are being forced to work at these places. I’m sure they damn well understood when they took the job that they would be the human shield against the pharmacist -> insurance war. I know damn well why these countries are outsourcing. Unlike some people who surf websites that openly bash their employer while at work (i assume you work for Walgreens, coming from internet.walgreens.com), I do have two cents in my noggin. And you’re Indian, congratulations, heres a cookie for your life accomplishments. Why should I give special treatment to an Indian who cant speak english vs a Chinese who cant speak english; an African American who speaks ebonics, or a Shit-Kickin Oakie who speaks in er.. Okie? If I cant understand whats coming out of their mouth, then theres a problem.
    If you had a business how else would you save money?
    Stop taking insurances administered by Walgreens Health Initative.. 🙂 These insurance companies are saving money by paying me cost + 1.50 on all Rx’s, changing info on the cards without issuing new cards, then hiring bargan basement help. Pretty shitty move for everyone involved except them (who are reporting record high profits this (and last) quarter). Eh, you wouldnt understand, you probably just sit there, drink coffee, and check off Rx’s coming from a Script-Pro belt while your Techs do all the work.
    Forget that, my defense is b/c of how your reaction is to the help desk person. So what if they are somewhere else and so what if they have an accent. Grow up and do your job. And if you don’t like what you do, leave the stores, go work as a drug rep since you have such a wonderful accent and wonderful way of talking to people.
    I’m pissed because I have to deal with them, and their accents are so horrible that it takes 20 times repeating for me to understand what the hell they are saying. Its a waste of time for me, the rep, and our employers. I’d work as a drug-rep, but I absolutely hate drug reps. I rate them as one step below a used car salesman, because thats pretty much what they are. I used to be tolerable when they gave out free pens and stuff, but a ton of them stopped doing that.
    For the record, when I get a rep in India, I dont fly off the handle saying “You dirty foreigner stealing our jobs! I dont want to talk to you”. Im usually pissed off because I need to call the insurance company over something thats completely out of my control (and 99% of the time their fuckup) for a whole 3 bucks (I tip my pizza boy more), and then have to deal with the frustration of not being able to understand the person on the other end on the phone. I shouldnt have to repeat myself 1000 times or ask them to repeat themselves. The shit should be done right the first time. That means correct info on the cards, correct published formulary, and for petes sake better hold music!

    AARP, WHI, and Argus. Paving the way of shitty Rx processors

    Who here is angry that WHI’s Rx processing was slow/down all week? Who here is tired of paying 7 to 10 cents per Rx transmission only to have WHI’s shitty servers eat up your $1.50 of profit?
    I think that when Rx processors are slow/down, and there is a known system-wide issue, we should get some compensation for the extra switching fees that we have to pay in order to transmit Rx’s.
    I swear, nothing pisses me off more than having to transmit an Rx 5 to 10 times just to get paid. Whats worse is when their servers are so shitty that it accepts the billing from us, but doesnt respond back with the acknolgement. Therefore you have to transmit again to get the stupid “Duplicate Billing” error.
    Heres a suggestion: When your servers are down, instead of just accepting requests in a half-ass fashon, make them all 100% completely down, and respond with an error that tells us the ETA as to when they will be back up. Quit jerking our chains with timeouts, and duplicate billing errors, etc. Up or down, very simple.
    Blah, this entry wasnt less on the funny and more on the angry.. 🙁

    Walgreens: The Pharmacy that Screws America

    Gee, where do I start bitching about Walgreens. Oh, I know!
    AARP Medicare part D was down for most of the day. Guess who processes them? Walgreens!
    Come on guys, get your shit together. I have to pay about 10 cents per transmission and I really hate having to transmit about 10 times per Rx because your servers have shit the bed. You’re probably taking a cue from Argus arent you?
    To add fuel to the fire, I saw this on the int0rweb:
    http://www.grassrootsrx.org/node/165
    Now for those of you out there who want the cliff-note version, here ya go:
    Basically Walgreens sent out a pity letter a few months ago to most of the independant pharmacies in the country. I got one, my friends got one, everyone got one. The letter basically stated that if you wanted out because of shitty Medicare part D reimbursements, Walgreens will happily buy your business, blah blah blah.
    Guess who’s on the top of shitty and late reimbursements? WHI (Walgreens Health Initative) who processes for AARP. Hmm, the plot thickens. So let me paint the picture here:
    WHI gives low/late reimbursements while a sister company (Walgreens) sends these “we’ll help ya out if you sell out to us” letters. Sort of like if the oil company offers to buy your car for $20 bucks because fuel that they produce is $10 a gallon.
    Now comes the million dollar question: For Rx’s filled by a walgreens store that are processed by WHI, are the reimbursements higher than your local independant pharmacy? I believe to avoid a “conflict of interest” lawsuit, there has to be some division between the retail Walgreens and WHI. Agreed?
    These are some tough questions, and I hope an official Walgreens or WHI rep can get to grassrootsrx.org to give them some info to make them look like less-douches.

    AARP, screwing seniors since 1958

    Today AARP was a bad bad boy!
    It turns out that due to a computer glitch between AARP/WHI/Argus, a ton of AARP Medicare part D patients got “disenrolled” or some crap like that.
    Meaning that a shit-ton of our patients had to call AARP to get their coverage reinstated. Of course is there any notice on AARP’s website? Nope. Surprised? I’m not! Took only 3 calls to AARP/Argus to determine what the problem was.
    Again, pharmacists are taken to the front of the battle lines to explain to the ignorant unwashed elderly masses why their cards didnt work, and they need to call AARP to get their cards reactivated. This is all the while AARP execs and staff are hiding behind their call centers collecting “record high profits” like every PBM has for the last few years.
    Shame on your AARP! Should rename you to the American Association of Retarded People.

    Argus, the $1.50 hooker of the pharmacy processor industry.

    Heres a simple question.
    Take a company, say, Argus heath systems. A huge company that processes Rx’s for such big names as Humana, Health Net, Blue Shield. You would expect a company of this size to have their shit together when the first rolled around.
    Nope. Guess again.
    Not only was Argus’ servers down for the whole day, but when you could process an Rx through you would sometimes get rejections for a completely different patient than whom you transmitted for! Talk about frustrating.
    Lets write them a letter.
    Dear Argus,
    if you are reading this fix your shit. Myself and every other pharmacist is tired of covering your ass when your servers take a dump. Spend the extra 100k on some decent hardware and some people who know what the fuck they are doing so you can provide a service that the people who PAY your bills (Health Net, Humana, etc) would be proud of. As it is now, if I were a PBM you would be the LAST person on my list to do my Rx processing. In fact, I’m going to be writing letters to all of your customers telling them how much you suck, and how they should go to CareMark or any other Rx processor who has their shit together. I dont care how big your load is, I dont care how many Rx’s you do a day. If you cant handle the load, then terminate half of your clients so you can do a GOOD job with the few you have remaining. You make more money per year than I make in my lifetime, and for that you should provide a stable service even on the first of the month.
    This is 100% true, so dont try any funny business with any slander/libel threats. You know your shit was broken today, you said it on your overloaded phone line recordings. Now be a man, admit you suck, and apologize to everyone who spent an extra $100 in retransmission switch fees because of your fuckups.
    Love and Kisses,
    The Angry Pharmacist.
    PS: You better send Health Net a fruit basket, because their managers and staff are not happy with your preformance, and I sure as shit made that known to everyone whom uses you for Rx processing. You give them all a bad bad image. Shame on you! Bad Processor! No cookie!