Category Archives: Pharmacists

Paying the PBM’s to service them.

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

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

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

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

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

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

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

There are two huge points to be made about this:

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

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

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

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

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

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

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

Im dreaming of a Crackhead Christmas.

I hate the holidays.

There, I said it.  We should take the Christ out of Christmas and throw in Crack.  Call it Crackmas from here on out, because that is the kind of shit myself and other retail pharmacists need to deal with on a daily basis this time of the year.  Soma and Norco are the reason for the season, and when you can’t take your fucking life or family any more, you need your pills.

The holidays, to me, are a really shitty time of the year.  Let me sing you the song of my people and whine about why I wish tomorrow was Valentines day.

  • Christmas started well before Thanksgiving this year.  My co-workers, full of holiday fucking cheer, demanded we put on the 24/7 Xmas radio station for the “holiday season”.  I’ve been listening to “holiday music” for 9 hours a day, 5 (sometimes 6) days a week, SINCE THANKSGIVING.  I’m no longer dreaming of a White Christmas; I’m dreaming of a hot-tub, some fentanyl patches, some cocaine, some Viagra, and a bunch of fucking Thai hookers.  I’m dreaming of tossing that fucking radio into a wood-chipper and doing a fucking victory dance as the parts rain down on my head (knowing my luck the speaker magnet would crack my skull).  I’m dreaming of an ice-cold bottle of vodka and Simply Orange (no pulp) sitting in front of a roaring fire.  I have grown to hate the 5 fucking Xmas songs that are remixed 100 times each and played on a gigantic fucking loop.  Grandma got ran over by a reindeer because she put on Xmas music before Thanksgiving, thats why.  Bitch had it coming.
  • It gets dark early here, and for those of us who work behind the counter (and have access to the narcotic safe) that means it gets really scary once the sun goes down.  You see, there are 2 ways to get a prescription medication filled in this country.  With a prescription, or with a gun.  Unfortunately, with the GunRx ™ there’s no quantity limit, no refill limit, everything is covered with 0 copay, and you get to self-serve.  Most of the Indy’s (and a few of the chains) have already been hit in the last few months.  Fortunately nobody has been hurt, only nerves rattled and holidays shattered by having a gun shoved in their face for a handful of narcotics.  People want money this time of year, and oxycodone makes good stocking stuffers.  Keep your local Pharmacist in your thoughts when it gets dark, because for some of us, we put our personal safety on the line to make ourselves accessible.
  • On a lighter note; when it gets cold here, people (read: old people) decide that since they don’t sweat, they don’t need to shower.  The smells range from cat-piss (because cat’s aren’t going to fucking piss outside in the cold, fuck that!) to what resembles like an onion wrapped in gauze and baking in the cavity of a chicken that’s been sitting in a car for about 2 months.  I have no fucking idea what twisted part of my brain that description came from; but I must say, I’m pretty proud.  People just don’t fucking shower, and its ALWAYS the little old confused lady with the dull cow-eyes who has to ask for the 10th month in a row what her hydrochlorothiazide is for.  Ignore the simple fact she has been taking this since it was brand-name only.  At this point you pull rank and make the new pharmacists go, or better yet send an Intern so they can have a “learning experience”.
  • People, as a whole, have their asshole-dial set to 11 this time of the year.  Yes, I get you are stressed from all that christmas shopping.  However don’t complain that I am taking too long to fill your 20 Rxs (that you need RIGHT NOW) as you bitch to the crackhead next to you about waiting in front of Walmart 5 hours before they open so you can get $10 off a fucking TV.  Then have the fucking balls to whine at me about why your copays are so high because you’re in the Medicare coverage gap.  Everyone in retail is busy this time of year, I get it.  Be part of the solution and shut your fucking face and stop being part of the problem.  Usually these assholes get the price of their Soma raised.  Merry fucking Xmas.
  • Staffing can be a real issue this time of year.  My coworkers deserve days off to be with their families (or take trips).  Hell, they work with me for a living, they deserve a fucking medal and a parade once a year.  This leads to short-staffing, which means the gaps need to be filled.  This really isn’t a whine, just an observation, because I will gladly be a clerk for a day (or even come in on my day off) to give a hard-working employee some much needed time off with their family during the holidays (awwww).
  • However, I am NOT a fan of stupid game shit like Secret Santa.  Every fucking year we all draw names to play this stupid fucking game that just drips awkwardness and poor gift selection.  This year the queen of festivities (ie: my tech) decided that we shall have no gift cards, and everyone needs to write what they want on a fucking secret santa list.  My exact words to her were “What the fuck, why do you hate me and my fellow male coworkers, fuck this noise!”.   THEN I was forced to write what I wanted.  Well fuck, guess putting down “blowjobs” would be a bit out of line, so I left it blank.  Then the smart-asses come out of the woodwork and put down “A life”, “A personality”, “A sense of humor” next to my name.  When I am eventually forced to write something, I put something really vague down so someone asks me about it.  That person, in 100% of the cases, drew me for secret santa.

Sitting here in my half-drunk state writing this, I can think of some reasons why I put up with this shit.  It’s the little old ladies who come in just to bring you a Xmas card thanking you for all you did for them.  It’s for the families who drop off a box of candy, or make you cookies.  It’s the kids who made you something at school saying “thanks for making me better”.  It’s the smiles and the thank-you and the Merry Christmas that make all the above seem sorta pointless and petty (except Secret fucking Santa, I fucking loathe that game).

So from my cold bitter angry heart to yours, I wish you the merriest of Crackmas and fuck Secret Santa.

Angry Tweets for 2012-09-29

  • All in favor of putting winning lotto numbers on the Rx label so the pts will actually READ THE FUCKING THINGS say Aye… AYE! #
  • "Have my meds been ok'd yet?" *Looking through 5 non-narcs and one vicodin thats not been ok'd* "Nope, not your vicodin" "DAMN OKAY BYE!" #
  • If you call more than 3 times a day nagging me about your narc refills, you get a complementary CURES report faxed to all your doctors. #
  • You want to fix the profession of pharmacy? Allow us to drink on the job, allow us to charge a restocking fee, and dump gift cards. #
  • No joke, QOTW: "But Walmart filled 240 soma for me last week, why cant I get these from you today." Soma, killing brain-cells since 1959. #

Angry Tweets for 2012-09-22

  • I hate it when random idiots walk up when we call someone elses name as if its them. Learn your fucking name dipshit. #
  • Even my fucking dog knows its own name. Theres no reason why you cant learn how your own name sounds. #
  • And dont give me this "Well its not their native language" bullshit, they know enough to collect a fucking check every month. #
  • Unless you're a fan of giving an idiot someone elses medicine because they walk up all derpy when its busy to someone elses name. #
  • Warning stickers have done more harm to the human race than anything else put together. Way to shit in the gene pool warning stickers! #
  • Jesus fuck its been an uphill day today. Fucking shit be over please. #
  • FUCK! Friday after all the MD's have their phones rolled over. Cue the PITA pt who needs his shit OMFG RIGHT NOW. #
  • Some days all we need to keep from drinking ourselves to death is a smile and a thank you. Thats all. #
  • Okay, tell me twitter, how fucking hard it is to read on your bottle "0 refills remaining"? #
  • Its like we're asking the patients to do quantum physics by calling in early when they have no refills left. #
  • Is it really that fucking hard? They can work the lotto machine but cant read a fucking pill bottle? #
  • But oh, they sure can remember how many refills they had on their fucking vicodin and soma Rx's can they. They call those in 4 weeks early. #
  • I mean for crying out fucking loud, READ THE FUCKING BOTTLE. You can buy the right brand of Cigs so I know you can fucking read. #
  • I swear, sometimes I think the only way to get a simple concept through their brain is write it on a scratcher or a pack of cigs. #

Angry Tweets for 2012-09-13

  • Theres no mistake why Fentanyl, Friend, Fantastic, and Fabulous all start with the same letter. Oh, Versed is good too. #
  • QOTD during my procedure "I need more fentanyl. My face isnt numb and I haven't asked for an early refill yet" <– WTF? #
  • Then I got Versed, and the next thing I remember I was drinking out of a juice box while eating Wienerschnitzel. #
  • I dont remember how I got dressed, the car-ride home. My wife just said that I just repeated "I LOVE FENTANYL" over and over and over. #

Angry Tweets for 2012-09-12

  • Alright bitches, its almost showtime. GoLytely is chillin in the fridge.. The 4 docusate are ready to go, and im fucking starving. #
  • Alright, 4 ducolax are down, time for glass #1 #tapLytely #
  • Oh sweet jesus, this stuff tastes like ice cold piss #
  • Like seriously, this crap tastes horrible, and the flavor packets just give it a nasty after-taste. #tapLytely #
  • I have this sorta full bloaty feeling like my insides are going to have sex with a garden hose any moment. #taplytely #
  • You should see me. Shirtless (dont wanna hold it up the entire performance, pants around ankles, with magazines and OH SHIT. I FEEL SMTHING #
  • fuck you trilyte flavor packets, I bought green gatoraide powder. I want to use a blacklight afterwards to see how bad i splattered the can #
  • Good seal around toliet seat.. CHECK. Good hand holds for leverage.. CHECK. Plenty of TP.. CHECK. Phone so I can call for help.. CHECK. #
  • Pre-Lytely checklist is done. Waiting for launch. Currently waiting on the launchpad. #tapLytely #
  • Almost time for glass #2 The green tint of gatoraide makes this appear half way appealing. #tapLytely #
  • Oh my god its like the incredible hulk just came in my mouth. This shit can't be made palateable! #taplytely #
  • I just ran to get the power adapter to my laptop and a spoon. Its like the hot-potato game but with fluid in my asshole. Daring! #taplytely #
  • Man, I dont like this.. Nothing yet and im almost glass 3 in. When it goes, its going to be like a sewer main breaking #taplytely #
  • Glass 3, this time i actually stirred in the gatoraide and OH FFS WAY TOO MUCH POWDER #
  • fuck pants, im sitting on the can butt naked with just my socks on. I feel like a male porn star. #
  • If my wife comes in seeing me butt naked on twitter with just my socks on, im going to have a lot of explaining to do #tapLytely #
  • Oh damn Gina. I think its showtime! #
  • Glass 4. HULK SMASH! HULK FINISH IN TAPS MOUTH! HULK MAKE TAP PEE OUT OF BUTTHOLE! #tapLytely #
  • I swear that APhA should give me an award for the advancement of pharmacy via social media. #tapLytely #
  • glass 4 and nothing.. Oh.. wait.. I think its time for launch? #
  • I must say that #tapLytely is a whole lot more entertaining than the typical twitter politics and 9/11 rehashing thats going on today. #
  • Glass 5. Thats 40oz of fluid in my GI track #
  • My gut holds the same quantity of fluid as a bottle of Old English. Probably tastes the same too. #
  • So for drinking 40oz i dont feel nearly as bloated as you would think #
  • OH MY FUCKING GOD. #
  • I can see why the non-compliance of this treatment is so high. #
  • I'm going to post a full write-up of my experiences on my site when i get done. Patients need to be informed on what to expect. #
  • 10 min's go by so fast, and the fluid level in this jug goes down so slowly. #tapLytely #
  • I'm still alive. Its pretty anticlimatic. Sit around, asspee, sit around.. asspee. I think the exciting part has passed. #
  • I have never been so afraid to sneeze in my life. #tapLytely #