Category Archives: Pharmacies

One pharmacy to rule them all…

Going along with my previous (and popular) socialized medicine post, I have a solution from the pharmacy aspect that I thought of while reading some responses to it.

You see, we shouldn’t have the folks like Walgreens, Rite-Aid (if they are still around), CVS, and the hundreds of independents profiting off of the pain and suffering of our aging and sick population.  We all know that Walgreens charges like cost + $30 on most of their generics, that’s just pure profit and its wrong!  The $4 menu is just suckering you in so they can pass the “savings” off on the bigger ticket items.

The federal government should open its own pharmacy, a huge one, and go 100% mail order for everyone.  They can negotiate directly with the drug manufacturers to drive the cost down, and people will just have one flat copay regardless of drug (the rest will be subsidized by the government).  All citizens will use this pharmacy because it’ll be cheaper than anyone else.  Most insurance plans require mail order anyways, so what would be the big difference doing consultations over the phone (since we do them now anyways).  Sorta like how the VA or Kaiser does it, only on a much larger scale.

Since its the government, it can make its own rules with regard to how many pharmacists/techs it can have.  50 techs to 1 pharmacist?  Sure!  Huge warehouses of nothing by filling machines and techs certified to check off prescriptions? You got it!  You want Cozaar? Too bad you’re getting Diovan and LOVING IT.  Got a complaint? Call this 800 number.  Meds get lost in the mail? Call this 800 number again!

Just think, $5 for Zyvox since the government can tell the manufacturers to either lower their cost or take a hike.  I’m sure they would get a deal also since they run the postal service.

Except… most of you (including myself) would be without jobs because the price would drive down so low that you couldn’t stay in business.  Much like what WalMart did to the local mom-and-pop shops.  At least the cost of drugs (brand name) keeps the chains vs independents in line with each other.  Obviously pharmacists are all about ‘helping the patient’ so our jobs really mean little in the whole grand scheme of things.  Techs on the other hand are set!  You only need a bare staff of pharmacists to just sort through the massive amount of medical data the government would be collecting from filling your prescriptions.

Drug reps would be a thing of the past because doctors wouldn’t have any choice in what they prescribe, it’ll just be what the government approves of.  Hell, maybe they can pay-per-view drug-rep battles to see who’s PPI gets on formulary!

Just a thought you know, because some of you feel that having the government play the healthcare game is a good idea (which I don’t expect you all to agree with me ALL the time, just most of the time when it involves crackheads and Soma).  In fact, the government stepping in is a great idea until they bottom out most of the private insurances (because what private company can compete with the government?  A private company backed by a few billion in shareholder cash that people choose to invest in vs the federal government which is backed by every working citizens taxes that they are forced encouraged to pay.  Lets see who’s going to win!); which turn cause a bunch of layoffs (cue whining), and give them a 4.8 trillion dollar bailout like every other failing corporation gets. But hey! Those laid off people will have AWESOME health benefits regardless if they are contributing taxes or not!

Just a thought I had.  Continue your discussions.

ePrescribing for eIdiots

ePrescribing is the stupidest thing to come to pharmacy to date.  It serves no point, it causes MORE errors, plus it costs pharmacies upward of $0.30/rx to receive each prescription.
Lets take a realistic look at this.  Next time you are at work, tally up how many refill requests you send to doctors a day.  Now multiply that by $0.30 and figure out how much a month that surcharge will cost you.  You think that the doctors are paying thousands of dollars a month for this “service?” No! The brunt of the cost is placed firmly on the backs of the pharmacies who get forced into this service by the doctors.  Wait, it gets better.  You know that idiot in the doctors office who points-and-clicks their way to that eRx? Well if they screw up and make any changes (and resubmit it to you), its another $0.30!  Oh, but this time you’ve already filled the Rx and now have to RTS and redo everything.

Despite what SureScripts (and the pharmacies who suck their dick, mostly Good Neighbor Pharmacy and the infamous AmerisorceBergen) claim;  eRx provides absolutely no cost or time savings for pharmacies or pharmacists.  This is because:

  1. We have to retype /everything/ due to a lack of a standard sig code table between the 1000’s of pharmacy software vendors out there.  Not to mention that every pharmacy system has the drugs entered in differently as well.
  2. It costs us $0.30 for the “privilege” of receiving an eRx, $0.25 for the NCPDP transmission, another $0.50 for the vial and label, another $2 for the labor, and when you’re dealing with horrible PBM’s (mostly MedImpact, MedImpact, MedImpact again, MedImpact and BlueShield), you only make $drugcost + $2.  You lose money with every eRx you get!
  3. If the person typing in the eRx makes a mistake, its another $0.30.  If you fax it back for something that’s not covered and they respond via eRx, another $0.30.

If you can get your hands on the Good Neighbor Pharmacy bulletin, you’ll see how much GNP and AmerisorceBergen sucks the sweaty cock of SureScript.  Pharmacists just like you and I voiced their concerns in the GNP newsletter; and ABC and GNP pretty much said “well, deal with it.  You’ll make money we promise”.  Yeah… “Hi! I’m you’re wholesaler, bleed out money because I want to make sure SureScripts looks good”.  I hope GNP pharmacies are getting a huge cut on their wholesaler bill since now ABC is making business desisions for them.

Bruce Roberts, RPh, executive vice president and CEO of the National Community Pharmacists Association (NCPA), today hailed the move by AmerisourceBergen Corporation to enroll its Good Neighbor Pharmacy® network of independent community pharmacies as Founding Members of SureScripts, the nation’s largest network provider of electronic prescribing services.  The move will add more than 2,400 pharmacies to the SureScripts network.  NCPA co-founded SureScripts in 2001 to improve the quality, safety, and efficiency of the overall prescribing process.

Don’t say that your pharmacy associations don’t do anything for you! Now GNP pharmacies get ass-raped by their own for the low-low cost of only $0.30/eRx.  Here’s something about “quality, safety, and efficiency”: I have seen more errors, decimal point, and unit fuckups via SureScript eRx in one week than YEARS OF PAPER PRESCRIPTIONS.  In fact, I keep a file of all of the eRx fuckups that I get (it gets about 2-3 a day, that’s 15 a week) so when doctors say how WONDERFUL it is, I show them how many lives I have saved.  I’ve seen injection dose written instead of an oral dose, blatant overdoses, everything you can imagine.  I’ve even had controlled substances faxed to 2 different pharmacies 1 min apart for a cash paying patient MULTIPLE TIMES.  Hows that for safety and quality!

Now here’s the dirty secret of eRx’s, and why doctors have their panties moistened by its computer goodness.  You see, the “old fashioned way”, doctors had to sign each Rx they gave out to the patient.  However those days are long gone thanks to ePrescribing.  Now all some idiot has to know is the doctors password and ANYONE IN THE OFFICE CAN SEND OFF PRESCRIPTIONS.  That’s right, this bullshit doesn’t save the pharmacies any time, but it saves the doctor a bunch because its pretty much giving anyone who works in the office the power to sign and give patients legit prescriptions (even for controlled substances!)  Before, you had to steal the doctors pad and write out phonies, now anyone in the office with access to the eRx terminal can splatter out narcotics to every pharmacy that takes eRx’s and nobody would be the wiser.  Oh wait, SureScripts is all about safety and quality.

Did you also know that our omnipotent legislatures are trying to make ePrescribing mandatory for MediCare?  Boy, doesn’t that look really good for SureScript.  I wonder who’s hand is in who’s pants now.  Oh wait, remember Bruce Roberts of NCPA and co-founder of SureScripts?  He’s sucking the big O cock.  I wonder what sort of kickback he’s going to get if SureScripts becomes the ONLY ePrescribing outfit that is raping the backsides of pharmacies.  TRUST YOUR PHARMACY ASSOCIATIONS BECAUSE THEY ARE LOOKING OUT FOR YOUR OWN BEST INTERESTS.

An astute reader sent in the following (Thanks Angry Tech!):

You didn’t even go into how the government is MANDATING doctors to use E-Prescribing to avoid getting a reduction in Medicare reimbursement. (Best link I’ve been able to find is here)

Oh great, so now we’re FORCING the doctors to prescribe in a less-safe and unproven manner to prevent them getting a reimbursement cut.  Looks like the SureScript screwing is all around!  Lets see what Bruce Roberts says about all of this:

“I urge all independent pharmacists to get on board,” Roberts said. “Adoption of electronic prescribing is a critical step in moving the pharmacy profession forward.”

Wait, let me fix the quote so it reflects the writing on the wall:

“I urge all independent pharmacies to get on board.  Adoption of electronic prescribing will make NCPA and myself NOTHING BUT LOTS OF MONEY HAHAHAHAHA! *ahem* This is a good step forward for patient safety and moving the profession (retail is still around?) forward!”

SureScripts and ePrescribing is a solution in search of a problem.  This is how I would fix it:

  1. Flat fee.  Make it $50/month for unlimited transmissions.  If you can’t do this then stop lobbying congress, you’ll save a bunch of money by doing that.  Pharmacies are not going to shell out an extra $3-4k/month (unless you’re forced to by AmerisourceBergen) for the “privilege” of receiving what they got for free.
  2. Publish standard drug/sig codes and influence software vendors to work that into their software.  If we have to retype ANYTHING coming from and eRx, then its not worth a damn thing to us.  This includes typos from the doctors office.
  3. Don’t be such a douchebag money-grubbing company that is making up a problem to fix with its own expensive solution.

Pharmacy has existed for hundreds of years with sloppy handwriting. Why try to reinvent something better than will just end up being more expensive and more costly than an Rx pad and a fax machine.  I wonder what the legal fallout will be when we get mistakes injected directly into our pharmacy software vs putting them in ourselves.

Update: Dr Grumpy gives what this is like from his side of the fence.

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.

Professional courtesy and shitting where you sleep

angryPharm.jpgAm I the only one who gets disgusted quite frequently at our own profession?  Take professional courtesy for example.

When a pharmacy calls me for a copy, even if its a chain whom I hate, I always make sure that copy goes into the fax machine as quickly as possible.  When a pharmacist is on the phone to ask a question or to request said copy, I treat that phone call as if its a doctor holding.  I drop everything and answer the phone. 

Why? Because its called professional courtesy and I strongly believe in not shitting in my own bed.  Eventually I will need a copy from that pharmacy, and I much rather would treat my colleagues how I would like to be treated. 

However, there are pharmacies in town who make me wait on hold for 20 min to request a copy, then take their own sweet fucking time faxing the information over (sometimes 2-3 hours).  After waiting by the fax machine (as the patient is pacing around the store), I call to get the “Oh, we’re really busy”/”I’ll get to it” excuse.  I’m fucking sorry, I’m /just/ as busy as you are however I tend to put people in my own profession (and doctors) a notch above the village idiot who is calling for his soma early.  Hi? Remember me? A pharmacist JUST LIKE YOU.

I’ve been tempted to drive down the road to the local chain(s) and go take a steaming dump on their counters for how some pharmacists they employ treat their own.  Sure, we might be competitors and by faxing copies you are in fact taking business away from your store, but take a step back on how this looks to the patient.  You make it seem like you really don’t give a flying fuck about the patient if he’s not getting Rx’s filled at your store (which if you work for a chain you very well could not).  Now, after 4 phone calls from me and wasting the patients (and my own) time, do you really think that patient will ever go your chain again? Of course not.  Do you think that I’ll go out of my way to help you out in the future? Of course not.

Time after time however I promptly answer copy requests from the chains in a prompt and courteous manner even though deep down I know that they really don’t give a rats ass about someone who they’ll see at the CE dinners, at the pharmacy association meetings, and the person who will advance them a box of Duragesic patches late Friday for a long-term patient of theirs.  Its really fucking disgusting at the lack of professional courtesy that some of the “pharmacists” show.  You put your own before anyone else, because by not doing so you are doing not only a disservice to your own, to your patients, but to someone who will cover for you in case you want some vacation time, insurance information/tricks, or someone who is going through the exact same shit you are going through.

So to the chains who take 4 hours to fax over one fucking piece of paper: Go fuck yourself, I filled that copy off of the bottle that your former patient brought in because you didn’t take care of business before sipping that coffee as you stare at your $100k script-pro that will soon replace you.

Oh, and see that awesome logo someone made for me up in the corner of this post? Yeah, those are pills he’s shooting out of that gun with the bandoleer of pill bottles.  Cool huh? Don’t steal it, its mine.  Coming to a coffee cup near you as soon as my fellow pharmacists stop pissing me off.

DEA is useful as tits on a boar

I hope the DEA is reading this, because they are not only a burden, but a tax drain on pharmacies and on the public in general.  Thats right DEA, I’m talking to you.  Lets show the whole world why you are as useful as tits on a boar.

In California, every pharmacy must transmit weekly a log of its controlled Rx’s that it has dispensed.  These are transmitted directly to the state as part of its CURES program.  Good idea right? Sorta.

Whats nice about this is that I can fill out some paperwork, fax it in, and in 1-2 weeks I get a nice printout via mail of all the narcs a certain patient is getting.  Of course this is after I can do absolutely nothing about it, but hey, its better than nothing.  To be honest these reports are downright useful. I would give lapdances if they would have an online system where I
could query in real-time my patients who might be narc-shopping.  It
wouldn’t even be hard, just limit it to patients that have gotten
something filled under the pharmacy’s DEA number in the past.  No HIPAA
problems there.

You should SEE the look on a patients face when you slide the report in front of them after they have given you both barrels about how you wont refill their vicodin early.  It makes it even sweeter when you say that you have faxed EVERY doctor on the list this report.  One woman even cried in front of me.  I almost felt sorry for her if she wasn’t a raging bossy commanding bitch who would go from calm to insane if you told her no.  See what happens when you lie to your pharmacist and doctors about pain pills?  Don’t give me this “She was in pain and it wasn’t controlled” sob-story bullshit.  If she took what the report said she received, her liver would of been blown out long by now.  Guess the Escalade is going to be repo’d now.  Pity.

Now, you may be asking why I think the DEA are useless with regards to the profession of pharmacy.  Well, they collect this information, but do absolutely nothing with it other than collect it.

In the past, when I was out of school and ‘Out to Change the World(tm)’, I would call the DEA when I saw doctors with “funny” prescribing habits.  Say like a month’s worth of vicodin written out every 10 days.  You know, stuff that your pharmacy will blacklist a doctor for (not piddly stuff like an oncologist giving an early fill once in a while).  I call the DEA and the Bureau of Narcotic Enforcement to get some ignorant dillhole who had no idea why I was calling.  5 transfers later, still nobody who had any CLUE as to why I was calling or who I should talk to.  Wonderful.  Fuck you DEA, I tried to help so now you can do your own fucking job.

To make matters worse, they are cracking down on the wholesalers.  Did you know that I can order 80 bottles of concentrated oxycodone solution with no problems, but the DEA is forcing my wholesaler to only allow me to buy 2 x 1000 count of soma and 2 x 500 count vicodin per working day?  They say its to prevent pharmacy diversion, but lets take a closer look at this.

1. The wholesaler knows how many I buy (obviously).
2. The DEA gets weekly reports as to how many I dispense.


Per month/year/whatever, they take the quantity from the stuff I transmit (#2) + whatever stock I have on hand (my vico-dans, let me sho u demz) and that SHOULD be ballpark to what my wholesaler sells me (#1).  Since we have to do stock-on-hand estimates every 2 years, that can be the ballpark starting inventory before the tally takes place.

However the DEA, in their infinite wisdom, is mandating my wholesaler take PICTURES of the pharmacies (to which my boss promptly flipped off, there were patients in the store so I couldn’t hang my bare ass at them) as well as sign a quadzilloin pieces of paper that say “I AM NOT AN INTERNET PHARMACY”.  They punish the wholesalers and the pharmacies because they are too stupid and/or lazy to use the information that THEY MANDATE WE GIVE THEM to determine who’s selling under the table and who’s not.  In a high volume pharmacy, 1000 vicodin is what, 10 rx’s?  Soma is 20 rx’s? Oh, did I mention that Soma isn’t a controlled drug? Tell me how that works and tell me why the DEA is sticking their noses into what I can and cannot stock and how much of it I want to stock.  What if there is a rumored price increase for soma and I want to buy a 6 month supply? Too bad.  Guilty until proven innocent.

So day in and day out we are the vicodin police living in fear of the dreaded DEA audit.  Those aren’t fun, when hell freezes over and the agents get off their asses and actually do one.  Do they care about phonies? Nope.  Does anyone care about phonies? Nope.  Even the doctors don’t care when the patient decided to give themselves 3 refills on their Vico-Dan ES prescription; “Oh, the’re in pain, fill it anyways – no refills”.  Yeah, write me out a check for $100 and after I add about 4 zero’s behind it you can tell the bank “Oh, he’s just poor, cash it.”

Don’t get me started at the whole logging Sudafed transactions.  What roomful of non-medical politicians decided to jerk each other off and pass such a shitty hole-ridden law such as this is beyond me.  Yay, I have a book that has every Claritin-D Rx in it.  So does every other pharmacy out there.  Doesn’t prevent the 18-wheeler full of sudafed thats being trucked in from MEXICO that the crank-cookers use.  Again, we can check our little books and realize that Juan Jose Carlos Maragariga VIII has been to every store in town to buy sudafed.  Will work really great after he’s arrested (or dead) after his lab blows up; BUT HEY WE HAVE THE LOGS TO SHOW HE BOUGHT SUDAFED (as if busted in a lab wasn’t enough).  The FDA shot themselves in the foot by pulling PPA off of the market because fatties were OD’ing on the stuff to lose weight – did they somehow not see this coming?

So DEA, after you are done subpoenaing me, auditing my store, ruining my life and wasting your time to find I’ve done NOTHING wrong, realize that pharmacists all over the country think that you pretty much suck and should stick your nose out of our business unless we call you.  We went to school to deal with this shit, you didn’t.  Oh, and give us a web-interface for all of the HIPAA violating data that you collect on a weekly basis. We can do *your* job a whole lot better if we can get the information NOW rather than after the patient has shopped every pharmacy in town (as if you will do anything about it anways).

ATAP: Medication changes and how I deal with them

I received this question from a doctor who frequents the site:

I have a question regarding changes in medication. I am a physician.
The way I usually handle it is that I tell the patient the new dose and
then write a prescription to reflect that dose. I then tell them that
they’ll have to go in earlier than usual to get a refill and to use the
new prescription to let the pharmacist know that the dose has been
changed. Is that the best way to handle it?

This is an excellent question. I far far too often have patients tell me (when they are out of medication) that doctor has changed the dose. Usually this is on a Friday night about 10 min before closing.
In the case above, you, Dr, are doing the correct thing. Seriously, I cannot express this enough that writing a new Rx for the patient to bring in (or fax over from your office) is the absolutely best thing to do. Telling the patient about the new dose is like talking to the sky (or filtering piss out of the ocean). I have seen more mistakes with patients getting their pills mixed up and taking double on something they shouldn’t have. Usually things turn alright, but when they get instructions to double up on their HCTZ and instead double up on warfarin, things turn sour really quick. If doctors always assume that their patients cannot wipe their own asses without written instructions, the world would be a better place.
This is what I do with a sig/dose change for which the MD has done “The right thing(tm)”:
When the patient comes in, I get the new Rx in hand, and right then I have verification that the dose has indeed been changed which I input into the computer and fill the Rx (if they are out). If the patient comes in and still has some medication at home I put the changed Rx on file, and if the drug & strength are the same I print out a new label and tell the patient to apply it to their old bottle (I write the Rx number down which to apply the label to). Usually the patient is smart enough to match 2 numbers together and apply a stupid sticker. However this is a huge judgment call, and on more than one occation I have told them to come back with all of their medications so I can do it myself. I instruct the patient to come in when they are out upon which I fill the Rx that was put on file and everything is happy in pharmacyland.
So if you are an MD/NP/PA/DO/CNM/Janitor who is reading this, here is a few tips on how to make your pharmacist love you.

  • Any changes in dosage or sig, write the patient a new Rx. Using a sharpie on my pharmacy label is just going to waste both of our times with a fax over confirming what you wrote.
  • If any medications are DC’d, let us know. Nothing annoys us more than to have to wait for a fax-back asking if the patients Lotensin needs to be DC’d because you wrote an Rx for Diovan. Its not that its a waste of our time, but the patient obviously has no clue what’s going on, and the terms “possible therapy duplication” is like speaking chinese to them. They have to come back to the pharmacy, or wait an unknown period of time until we get an answer.
  • Write down any and all information on the Rx that might save a phone call or fax when switching to formulary alternatives. Unless you really want Protonix for some god-forsaken reason (like the reps are giving you lapdances), writing “or equiv” will save us both a ton of time. A PPI is a PPI for gods sake.
  • If you have any questions about whats covered, a rule of thumb is that if its cheap and generic; its covered. Prilosec vs Aciphex, Lotensin vs Aceon, etc etc etc. Have you tried generic Mobic vs Celebrex? You should! If you don’t really care what NSAID the patient gets, then state “Feldene, but whatever is covered, therapeutic sig”. Any pharmacist worth his salt will take care of your patient and not bother you. We may fax you what we gave so you can keep your records updated, but we’re not going to ask you a bazillion questions if its okay. Remember, we went to school to learn about drugs; have a bit of trust in us.
  • Hate to tell you, but most NEW drugs now days are just knock-off me-too’s that are out because their replacement is going off of patent soon and will be dirt cheap. Look at Paxil CR, Coreg CR, Adderall XR, Lexapro. All came out shortly after Paxil/Coreg/Adderall/Celexa went off patent. You have been using these agents for 10-15 years, and all of a sudden they suck because something new came out? Think of it this way, if they were so “new” and “breakthrough” and “revolutionary”, then why weren’t they out when there was 5 years left on the patent on the drug they are meant to replace?
  • If you have any questions about pricing, call us. Seriously. Nothing makes me happier than churning my workflow to a grinding halt to answer a phone call from a local doctor wanting information vs some crackhead asking for their vicodin a week early. Believe it or not, we’re in the same boat, and we cant exist without each other, so lets actually talk once in a while.

Doing other people’s jobs

Now I don’t mind explaining to people how their medication works, how to take it, and what it does.  Its part of the job, and to be honest /most/ pharmacists really enjoy doing things like that (if they arent swamped to all hell).  We go to school to learn stuff to share with the general population and a more educated patient is a happier (and more dangerous) patient to both themselves, the doctor, and us.

However when you bring fucking filled Rx’s in from ANOTHER pharmacy or mail order place (fuck you Liberty Medical) and expect me to take time out of MY day to explain Rx’s that someone else made some cash off of, I start to get upset.

Mail order joints (fuck you Liberty Medical) are the absolute worst of them all.  I don’t get paid by Liberty Medical (fuck you)  to sit there and explain to you how to work your nebulizer or some proprietary piece of shit blood glucose monitor that only YOU can get the strips for.  You got it from Liberty Medical (die) so YOU can call them up and have them explain to you over the phone how to use this piece of shit.  I don’t care if you saw a TV commercial and called the fucking number, YOU deal with it, not ME.

Where in the fuck do mail order places get off thinking that I’m their bitch.  What pisses me off absolutely the most is when they TELL the patient to bring their drugs/devices/etc into their local pharmacy and receive instruction on how to use it.  You know what, FUCK YOU AND DIE.  You dispensed it, so YOU TELL THEM HOW TO FUCKING USE IT.  Oh? You’re in another state? Wait, let me bring a fucking 2L of ‘I dont give a fuck’ to your pity party.

The best is when the patient comes in with a blood glucose monitor and has no idea how to use it.  The patient gets maybe 1 Rx, 2 at the very most from you (and even then it was filled 3 months ago).  They come up with a Nation-Wide-Chain Rx label on the box the monitor came in and tell you “the pharmacist was too busy at Nation-Wide-Chain to explain to me how to use it, can you show me?”

At first glance I want to say “No, go back there and MAKE the son of a bitch cock-sucker show you how to use it.  What do I look like? His fucking lackey bitch who does the grunt work while he makes the money?”  Alas common sense and ethics kick in and I end up being a big pussy and showing him/her how to use the machine.  ALTHOUGH I do stick in the rib-jab of “You know, if you get your stuff filled here you won’t have to deal with someone who obviously doesn’t care about your well being to show you how to use it.”  TAP – 1 / Dildo Chain – 0

Really, this post makes me sound like a grade-A asshole that shouldn’t of gone into pharmacy.  However take a second and think of all the time we spend on the phone answering questions FOR FREE, how must OTC advice we give out FOR FREE, and the only concrete way to earn money that will pay for food on our table is by filling Rx’s.  Its bad enough that we’re one of the only professions that gives out tons of information FOR FREE that we went to college to exclusively learn (why cant Lawyers or Doctors be the same way?), but do we also have to deal with the lazyness factor of our own profession?  Do I have to take up the slack because someone ‘didn’t have enough time’ to explain something (and made the dispensing fee off of it) or is in some warehouse in another state?  Its not that I nor the people who agree with me don’t wish to help people, but we have our hands full with OUR patients who come to US and ONLY US  without having to deal with the overflow of shit from mail order places that dont give 2 flying fucks to Sunday about patient care.  Patients are just an ID and an Rx number to these mail order places.  There is no patient contact, no patient care.  They make pharmacy look like a fucking industry rather than a profession.  Fuck mail order joints, and fuck Liberty Medical with their fancy commercials that trick old retarded folk into getting their shit from them.

PS: Fuck Liberty Medical, the horse they rode in on, and their fucking commercials.  I’m tired of cleaning up their shit and doing their job.