Category Archives: Pharmacies

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.
  • CPhT – Why?

    One of my staff has recently taken the CPhT exam (thats Certified Pharmacy Tech for those at home).
    He showed me the sample test and study booklet. There is NO way a tech should know all of that. Think about it, the law states that a Technician is to preform the remedial tasks of a pharmacist under the direct supervision of a pharmacist.
    Why are these overpriced classes teaching them about Cushing Disease, how coumadin works, and other horseshit. Why doesn’t it just test them on a bunch of brand/generic, sound-alike drugs? For 99% of the pharmacy techs out there, thats all they really need! If you need specialized training for a hospital, then get certified in a hospital-tech cert.
    All this testing does it gives the technician enough knowledge to /think/ they know the correct answer without taking into consideration the tons of background information thats only acquired in pharmacy school. The tech now has enough information to sound like he/she knows what he/she is talking about, but really doesn’t.
    I know all of you CPhT folks out there are going to chew my ass over this, but seriously. How much of that test actually applies to real-life retail pharmacy (where most of the techs are going to work)?

    NPI – The aftermath

    The NPI deadline has come and gone. Whats the verdict?
    Well, the insurance companies seemed to have their shit together (for once). I expected the same shit as when Medicrap part D hit the fan but only encountered minor bugs and glitches.
    Doctors however need to get their heads out of their asses. Either that, or inform their front staff what the hell an NPI number is.
    You have no idea how many times I heard “All the pharmacies are calling me for this NPI number! I don’t know what it is, and I don’t have it!” from doctors offices. Yeah honey, I realize your high school education didn’t prepare you for “real life”, but when everyone and their brother are calling you for something, don’t you think you should ASK someone else in the office so you don’t sound like a total ditz on the phone? Oh, I’m sorry, I didn’t realize you’re the doctors daughter, now you really have no excuse.
    Also, if you are in hospital administration, and I’m calling you asking for a list of all the doctors in the hospital and their NPI numbers, don’t give me some bullshit excuse on why you cant fax me the list. Unlike you, I don’t like to sit on the phone (among my other pharmacy breatheren) and waste time calling your fat lazy ass 10 times a day for something on a list that would take you 2 seconds to fax to me. Seriously, its not a HIPAA violation to send me the list. You’re a friggin idiot for even thinking so. So I’m going to call you, 20 times a day, and every time I’m going to YELL at you for not sending me the list.
    However many hospitals were on the ball, and immediately said “Whats your fax/email, i’ll send you the whole list”. To them, I (and the rest of the pharmacies in town) are grateful.
    The best nut-kicker of this whole ordeal, is that to bill for Medicare part B stuff (and State Medicaide) we do NOT use the NPI numbers. Thats right folks, the feds make us switch to this new number, but they themselves dont use it. Why am I not surprised.
    Oh, and have any of you seen how to calculate the checksum digit for the NPI number (to see if its valid). My small pharmacist brain cant handle that much mathmagic voodoo. Go look it up. Why cant it be as easy as the DEA checksum?

    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

    Dos and Donts when asking for Copies/Transfers

    Usually my rants are about patients, doctors, the system, etc. This one is about other pharmacies and other pharmacists.
    We all get copy requests from other pharmacies. For those of you who are playing along at home, when you want your Rx filled at one pharmacy transfered to another pharmacy, there is an unwritten procedure that assures that your Rx gets safely transfered to your pharmacy of choice.
    Now as easy as this sounds, there are some real assholes out there who just grind my gears. Let me elaborate.

  • The biggest unwritten rule is that the pharmacy that is getting the copy (the one who is going to fill it) initiates the phone call. That means that if your Rx was filled at Rite-Aid, and you want to get it filled this month at Bob’s Discount Drug, then Bob’s would have to call Rite-Aid.
  • The proper way to ask for a copy is: “Hello, this is NAME from PHARMACY, wondering if I could get a couple copies please.” The incorrect way is: “Hello, this is NAME from PHARMACY, I need these Rx’s transfered over”. Usually when someone is really blunt and demanding, I tell them to go fuck themselves. You are ASKING another pharmacy to give up business so you can fill this Rx. Ask don’t assume or demand.
  • If you are calling another store that you are on good terms with, demand to speak with your pharmacist friend, then say “Gimme a copy you fucker”. Don’t be sad if they hang up on you.
  • If the pharmacist asks you if you wish to have it verbally, or via fax; the correct answer (if the patient isn’t waiting) is via fax. Hard copies beat hand-scribbled copies any day. This is especially true for narcotics. Make sure when you request fax, you follow with “when you get a free moment”. Now if you are calling an independent pharmacy, a “free moment” may be within the next 15 min. If you are calling Walgreens, a “free moment” may be a week from next Tuesday.
  • If you want a copy via phone, have your pharmacist make the call and wait on hold. Nothing pisses me off more than when a dumbass tech calls me for a copy, then has ME wait on hold for THEIR pharmacist. That usually ends up in me hanging up the phone. If I have to take my time out of my day to transfer an Rx to you, then you can take some time out of your day to make the phone call.
  • If you want your copy via fax, then don’t call up in 5 min asking where it is. It’ll get to you when it gets to you. Obviously you were not in a hurry, or else you would of asked for it to be over the phone.
  • If you fax something over, make sure it has the least amount of writing on it. Don’t be like Walgreens and take a computer screenshot that takes 20 min and all of my fax toner to recieve and print out. All I need are words, I could care less how pretty your pharmacy software screen is. In fact, doing so after I specifically tell you not to usually ends up with your fax machine receiving 100 pages of pure black pages overnight.
  • When talking with your patients about transfering your Rx over, inform them that if the other pharmacy has already filled it, they may not want to transfer it over. I get really annoyed when a dipshit patient calls in their refill to me, I fill it, then they want it transfered to some place down the road. I spent the time and money to fill your Rx, so you can get it here. Unless you are in another city or state, if you call in the refill, you’re getting it here. Im not backing out or RTS’ing anything.
  • “Hi! I need for you to back out something” is asking for trouble. Some tech said this to me this week and I responded with “Well, I need a blow job, a steak dinner, and a back rub” then hung up. You don’t call up pharmacies and demand they back out something. You ask. This also goes true for Prior Auth Numbers for Medicaid. You ask for the prior auth number, not demand it. If the pharmacy says “No”, then you just tell the patient and deal.
  • Always ask if there are any patient notes before you get the copy. You have no idea how many headaches I have saved by refusing copies from known crackheads. If the transferring pharmacist thanks you and offers to buy you a beer, you just got fucked.
    I’m sure there are more of these. Feel free to comment and i’ll add them to the list.

  • The Angry Pharmacist needs YOUR help!

    Like what you read here? Do I put a smile on your face? You wish you could help your old angry buddy? WELL HERES YOUR CHANCE!
    My store has 3 pharmacists, 2 techs and averages about 370-450 rx/day. We’re looking into getting some robotic automation going. We’re looking at ScriptPro, Parada, etc etc etc. Something to carry our top 100 drugs so I can spend more time yelling at crackheads than counting out the vicodin and soma.
    All the machines basically do the same thing being in the same price range with the sales drones saying the exact same shit. The sales tards dont use the machines, they arent pharmacists, and are about on par with Drug Reps. The’ll suck ya off to get a sale, and to make matters worse, the’re all males! Im confused and frustated!
    So i’m asking you, my faithful readers, for your input as to which machine. Feature pissing you off? Feature pissing your techs off? Let me know! Let me learn from your mistakes!
    Seriously! Not joking, I really do need help. No annoyance is too small or too insignificant!

    Angryness and Me

    So i’ve been doing some self thinking as to why I get angry at work. I mean it cant be normal for me to get really upset when I waste my time filling someones Rx (that they bring the empty bottle) not realizing that he wanted some other Rx filled (that wasnt the empty bottle).
    I mean would any ‘normal’ person get pissed off when you’re on hold for 30 min before the patient says “oh, do you need this insurance card?” after you ask them 100 times if they have any insurance cards.
    I mean a 14 year old getting prenatal vitamins shouldnt get your blood boiling. I mean what if it is their second kid? Thats no biggie right?
    Getting yelled at because the doctor wont okay soma early shouldn’t bug me too much, but it does. I think you get the point.
    I think I get frustrated because I dont think of myself as ‘better’ than anyone around me. Just because I physically stand a half foot above you, doesnt make me any better than the person who cleans the toliets, or the person who bags my groceries, or the kind fellow who pumps my gas. These people have jobs just like me, pay taxes just like me, and drag their asses to work just like me. Im sure they have a unique skill that they are awesome at. Mine’s pharmacy, and happens to be what I do for a living. Just because im a pharmacist doesnt make me better than you, its just what I do for a living.
    But then I see stupidity in its rawest unearth form. Stupidity so intense that if it wasn’t for the kind state upon which I live wiping these people’s asses, they would be unable to live. I cant wrap my brain around how a person could be so utterly useless and stupid.
    I dont expect you to understand how your medication works. Thats not your job, thats mine. I dont expect you to know what the proper dose is, or if your doctor is trying to kill you or not, thats also my job. I do have some sort of expectations that when the bottle says “One Tablet Daily” you will put one tablet in your mouth a day, and swallow. For some people, this mental feat rivals quantum physics.
    How hard is it to follow simple directions? Even a dog knows not to shit in on its own bed, and can follow simple commands. I absolutely hate to talk down to people. It makes me feel like an idiot and makes the other person feel like a child. However im forced to do that on a daily basis. Thats the language they understand. Do I really need to tell you to remove the foil off of a suppository before you shove it up your ass? When a bottle says “SHAKE WELL” do you really need to ask me if you are supposed to shake it? That 3/4 is three-quarters of a teaspoon, not 3 to 4 teaspoons. That 1 mL (which is clearly marked on the dropper) is NOT the same as 5 mL.
    Sometimes I feel like the patients are just screwing with me. You know, asking me stupid questions to be funny. Then I realize that they arent being funny, they seriously dont have the mental capacity to read and follow simple instructions printed out in plain english (which is the only language they speak). It boggles my mind so much I want to walk down there and shake them saying “WHATS WRONG WITH YOU! WHY DONT YOU UNDERSTAND!”. Seriously kids, cribs + lead paint = not good. Paint chips are not food, and not your friend.
    I already have a very limited patience for people, however I expect people to not know how the human body works, or what that rash is growing under their boob. Those people I will spend as much time as I can explaining things in a language they can understand. However simple instructions like ‘twice daily’ or ‘leave this nix in your hair for 8 to 12 hours then rinse out’ should be universally understood no matter what education level you have.
    So all in all, my ethics/tact/respect/how i was raised say “person is equal, must treat as equal” on one side, but then the patient is a complete and utter moron. So that makes my brain go into overload thinking “if person is equal, and person is idiot, then I am idiot! I am not idiot!”. Its not my intention to look down upon people (forget for a second what you read here) but maybe I might have to learn to.

    Kids in the pharmacy

    Who here hates kids in their store?
    You all know the type. The mother walks them in, proceeds to turn right around and shop and completely ignore them. Its like the pharmacy is their little playground. The kid is either:

  • Screaming his head off because his mom wont buy him a candy bar
  • Tearing the shit off of my shelves onto the floor
  • Building a fort with the OTC cold boxes
  • All of the above
    Whats best of all, the mother just ignores them!
    It takes an act of God to keep me from walking over to the mother, giving her a whole hearted bitchslap across the face, and kick the kid in the ass so hard he does a faceplant.
    Now i’m not anti-child. There are some very well behaved children that sit patiently until their prescription is ready, then politely get a candy bar (which their mother buys for them for being good), and walks out. I love those children, and on more than one occation i’ve even let them choose a candy for free just because of how well behaved they are. Good behavior needs to be rewarded.
    Now this isnt a racial dig, just my experience, but Hispanic male children seem to be the worst of them all. I dont know if its a cultural thing, or the mother just doesnt care, but 9 out of 10 hispanic male children are totally out of control. A hispanic woman told me that its really their culture to allow the males to do what they want, because they are “keeper of the name” or “man of the family” blah blah blah.. They can do that all they want at home, but in MY store they need to play by MY rules.
    I’ve actually yelled at the mother and the children before. The mother sorta gets embarassed (even though she had no idea what I was saying) and the child just sorta looked at me. Whats great is when the Father is there, and it suddenly becomes a pissing match between myself and him. I politely tell him that if he wants his prescriptions filled, his child would either have to stand outside, or settle down. After some grumbling they usually comply or they get their Rx’s wadded up and thrown at them.
    What also bugs me are moribly obese kids. You know, the ones that cant even see their toes at age 5. They run in the pharmacy to the candy section, and whine at their mother until they buy half the damn rack. They then sit their plump ass down in a chair and proceeds to make a choclate mess all over everything as they consume the candy bar as fast as their little fat fingers can shove it in their mouth… Someone in this whole relationship needs to grow some balls, and when the child pitches a fit about not getting any candy, 5-across-the-eyes does wonders.
    If these mothers wish for me to watch over their kids, then its my rules the’ll have to play by.

  • 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.

    FDA shot themselves in the foot.

    All this Sudafed hooplah really has my panties in a bunch.
    There is some stupid ass law that as of like 9/06 we need to log all sudafed sales in a book, blah blah blah, etc.
    One question. Who the fuck cares? Just put the raw bottles of sudafed behind the counter (like all sane pharmacies do) and just be aware that its being abused. You dont need more laws to do this, its like HIPAA, its fucking common sense!
    But no, the FDA needs to do something about the “problem” about meth production. I think its time to write them an angry letter:
    Dear FDA,
    I’m concerned about your position about sudafed and its diversion to make methamphetamines. Unfortunally you shit in your own bed on this one. You see, pulling Phenylpropolamine (PPA) from the market was a bad idea. If you would of read the study for yourself rather than cave in to the retarded media (whom last I checked were NOT doctors or pharmacists) you would of learned that yes, PPA did cause brain hemmorages in women aged 16-39 (or something like that). Now dont you think thats a bit odd that it only occured in women between those two ages? Lets assume that you monkies can read english. Second lets assume that your actually have free thought and can make basic decisions. But since obvously you cant i’ll summarize it for you.
    The women who were dying of brain hemmorages were taking well over the labeled dose in an attemtpt to lose weight. Makes sense doesnt it?
    In fact, here are some papers that you might want to read that shows that incidence of stroke in PPA vs Sudafed is pretty much equal in recommended doses:
    Drug Safety
    Mostly this part
    Stroke related to over-the-counter sympathomimetics was associated with acute hypertension and/or vasospasm or angiitis mechanisms, most related to the use of PPA; however, stroke also occurred with the use of other sympathomimetics, particularly pseudoephedrine. Although stroke complications occurred when doses were used that were higher than recommended doses, apparently there is also a stroke risk when these agents are taken properly.
    Pubmed is full of articles like this. You guys know what pubmed is right? www.pubmed.gov? Scientific paper search engine? God I hope so.
    Will you pull Tylenol off the shelves next for liver failure at higher-than-normal doses? How about ASA and all the NSAIDS for ulcers? Why not encase everyone in a little plastic bubble and put corks on their forks so they dont poke out their own eyes.
    FDA, you are not my babysitter and you need to stop caving into media pressures. You created this meth nightmare by pulling PPA off of the shelves and forcing sudafed to take up the slack. You shit in your bed and you’re expecting the pharmacists to clean it up.
    So this letter isnt all ranting and bitching, i’ll offer some suggestions:

  • Limit sales to only pharmacies. Not gas stations, whore houses or truck stops. Pharmacies are all over the place now and many are open 24 hours.
  • Take a gander at the US/Mexico boarder. I think you’ll be in for a surprise when big-rigs full of sudafed roll into this country without even a second look from immigration.
    Other than that you’re doing a great job! Now approve more generics before i stab you in the face with a spork.
    Love,
    The Angry Pharmacist.
    Aah, that felt better. 🙂