Category Archives: Pharmacies

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.

How to succeed at retail pharmacy according to the chains

So during my 0.004 second lunch during the clusterfuck of a day after a holiday, I checked out this article on DrugTopics.  Nothing special at face value, however this paragraph really bugged me:

Several factors led Morton’s executives to make the decision to sell most of its retail pharmacy business. “It’s the declining reimbursement environment, mandatory mail-order plans, the closed networks that are starting to become popular across the country, $4 generics programs, and predatory audits,” Morton said.

Both health insurance companies and government programs are slashing reimbursements, according to Morton, a practice that is “not providing enough margins for us to serve patients.” In addition, the purpose of audits conducted by pharmacy benefit managers (PBMs) has changed from detection of fraudulent claims to making extra money for the PBMs, according to Morton. “They are looking for administrative mistakes so they can look to recoup claims. It is a revenue-generating technique,” Morton said.

For those not in the industry, Walgreens has a Pharmacy Benefit Manager called Walgreens Health Initiative.  This is similar to how CVS/Caremark work, and the infamous Merck/Medco.  Now for those of you who work retail, this whole article makes perfect sense.

  1. Have your PBM give ridiculous low reimbursement rates to kill the independents.
  2. Be first in line to “take your failing pharmacy off of your hands for you”
  3. If they refuse, audit the shit out of them for every little fucking thing until you bankrupt them
  4. See step 2
  5. Profit!

Funny, how it’s technically illegal for a bunch of independents to meet to discuss if they are going to take a PBM contract due to antitrust laws, but the major chains and their PBM backers can pull this kind of bullshit.  Of course the major chains can bribe (yes, I said bribe…er.. LOBBY) the corrupt government to look the other way.

Having gone through a dozen+ audits, the article is 100% right.  The auditors aren’t looking for blatant fraud and abuse, they are looking to generate profits.  When you fill an Rx, if you mark a faxed back OK as ‘written’ in your software (instead of a ‘faxed’), that’s grounds for them to take the entire cost of the Rx out of your next check.  I bet, with a bit of digging, you’ll find that these auditors actually get an incentive-pay based upon how many ‘errors’ they find on the pharmacy end.  I will also bet that Caremark doesn’t audit CVS stores, WHI doesn’t audit Walgreens, and Merck doesn’t audit the Medco mail-order chains.  Even if they did audit them, do you really think they would take the money out of their next check? Isn’t that taking money away from themselves?

Sometimes the audits pick up things that are just mistakes, like when you have a Robatussin-DM in your computer as 1 bottle of 273mL and your floater bills 273 bottles by mistake thinking that it’s in the computer as per-cc instead of per-bottle.  Those I can see, but taking back the ENTIRE reimbursement over a 28 day supply vs 30 day supply for eye drops is petty and bullshit.  We have the Rx, its legit, yet you are back-charging us for the entire amount due to a clerical error (and a stupid one at that).  The Rx wasn’t filled fraudulently, and it was filled in good faith with no intent to fraud.  However try to argue this point with the auditors and you’ll just get a blank stare and 100 more ‘errors’ that will make your next reimbursement turn into a bill.

So the million dollar question is: Where is APhA in this mess?

Be a dick, get a gift card!

A wise man (OK, its my employer, fine) told me that the smartest investment a business can make is in its employees.  That’s right, happy employees mean productive employees which are good for the customer, business, everyone.

I sure as shit wouldn’t be happy if my employer rewarded complete dickhead patient behavior with gift-cards.  In fact, I’d feel like my employer feels that a shitty patient attitude is more of an asset than the feelings of its employees.  A feeling that my professional opinion/ethics is worth less than a $10 STFU gift-card.  Chain pharmacists, I don’t know why you put up with it.  Oh, its because they blew a bunch of smoke up your ass when you were in school (when you thought you knew everything), offered you a fat sign-on bonus in return for years of slavery, and now you’re stuck with a tech who paid $20k in schooling but asks you daily what the trade name of hydroxyzine is.  Lame.

So I hope Walgreens, Rite-Aid (15 mins!), CVS and the like need to listen the fuck up, because I’ll tell you why the profession is going down the shitter (and why we are treated so).  The mighty cards.  CorpoChains are shitting in their own beds for the sake of ‘loyalty’.

At my store, we have no gift-cards.  You treat me (or my staff) like shit and we politely ask what pharmacy you would like your Rx’s transferred to.  If you continue, you get the front door opened with your face.  We don’t reward asshat behavior (unless we REALLY REALLY FUCKED UP, then we deserve it), most (if not all) independents operate the same.  Its just common business sense!  If the pharmacy fucked up – sure, throw them a gift card to say that we’re sorry.  However word from the trenches is that they are throwing gift cards away to people who have complaints that are in no way the fault/responsibility of the pharmacist nor the pharmacy itself!  Chains, grow a pair of nuts and realize that the customer is usually dead-fucking-wrong!

Hey, if you are pissy because your doctor hasn’t responded to your vicodin request then you are FREE to go get a new Rx directly.  Upset because you have 0 refills? Your bottle clearly stated that fact when you picked it up, try reading it for once.  Don’t like this whole novel concept called “responsibility” and “planning ahead”? Go get your own MD license and you can write your own prescriptions.

Unhappy that we didn’t have all 120 of your Xeloda?  Are you unhappy that the pharmacy TOLD you that this was a special order and to call a week ahead (which you promptly forgot/ignored)?  I’d be happy to order you a year supply if you want to foot the $20,000+ tab and I’ll keep it safe for you.  Maybe a little inconvenience will pound into your thick skull to do what we tell you next month.

Pissed that we didn’t have the full amount of a trade-name item that only YOU take (and you didn’t call ahead like we asked)?  Well, I’m unhappy that my grocery store doesn’t have a certain brand of salad dressing in stock, yet you don’t see me raising a stink and demanding compensation via gift-cards.  Call ahead.

Pitching a shit-fit that you drove “all the way across town (2 miles)” to find that we’re still waiting for the refill authorization on your pain pills (even though the 10 maintenance meds are ready to go)?  Its called a phone, you have one in your pocket, its nicer than mine.  Amazing how you can know everything that your baby-daddy is doing behind your back yet you are unable to make a phone call to the pharmacy to see if your crack got approved.

Whats the solution to all of these scenarios?  Gift-cards to the loud-mouth crackhead by some ignorant store manager who couldn’t be a pharmacy tech if his/her life depended on it.

The chains are doing nothing but demoting the profession (if you still want to call it that) of pharmacy by rewarding patient complaints.  If your dog pissed on the carpet do you give him a treat?  The chain stores do! Rewarding such piss-poor behavior just breeds more bad behavior.  Shit-hole patient chainitude (that’s chain attitude, I’m so clever!) behavior spills over to independents, and god dammit we don’t give out fucking gift cards nor do we want your douche-canoe “Eye wanna gyft carrrd” patients!

So my in at the Low-Stock-Price-Leader says that Rite-Aid has this 15 min guarantee for when your vicodinprescription will be done.  If you don’t get your Rx in 15 mins you get a $5 gift card (insurance problems don’t count, some restrictions apply, see your friendly Rite-Aid associate for details, blah blah blah).  Now considering how short staffed most chain stores are, I’d rather them keep the $5 (the going rate for almost 5 shares of stock, no bullshit), have them take as long as needed, and have my Rx be correct (ie: not killing me).  In fact, this whole 15 min bullshit really pisses me off.  Who cares if your Rx wasn’t done in 15 mins or less (sounds like pizza delivery).  Guess what Rite-Aid; people die due to medication errors, people don’t die from a cold pizza. If you want to hold your pharmacists to the same standards as a pizza-worker, then expect the same quality of service of a pizza-worker.  Hope the impending lawsuits don’t push your stock to the point where you need to PAY people to claim ownership of it.  Oh wait, its $1.11 a share, strike that last statement.

In all honesty, I really do feel bad for the pharmacists, tech, and clerks who have to deal with their employer who puts the opinion of the public over their own employees.  Its one thing to offer something to a patient as compensation for a mistake, an oversight, or just plain forgetting (nobody shit smells better in this regard), but for a 15 min guarantee?  Way to value patient safety at a whopping $5.

We wish you a merry Crackmas!

Here are a few things that I have written to celebrate the overly-medicated holiday season:

The 12 days of Crackmas:

On the twelfth day of Crackmas, my pharmy sent to me: Twelve Prior Auths,
On the eleventh day of Crackmas, my pharmy sent to me: Eleven Screaming Patients,
On the tenth day of Crackmas, my pharmy sent to me: Ten Grape Drank,
On the ninth day of Crackmas, my pharmy sent to me: Nine Viagra,
On the eighth day of Crackmas, my pharmy sent to me: Eight Valium,
On the seventh day of Crackmas, my pharmy sent to me: Seven Tussionex,
On the sixth day of Crackmas, my pharmy sent to me: Six Xanax,
On the fifth day of Crackmas, my pharmy sent to me: Five VIKE-O-DAN,
On the forth day of Crackmas, my pharmy sent to me: Four DAN soma,
On the third day of Crackmas, my pharmy sent to me: Three OC 80’s,
On the second day of Crackmas, my pharmy sent to me: Two Percocet,
And a pissed off Pharmacist!

The night before Crackmas:

Twas the night before Crackmas, when all thro’ the store
Not a creature was stirring, except the neighborhood whore;
The C2 were locked up in the safe with care,
In hope that St. CrackClaus soon would be there;
The crackheads were all asleep and unconscious in their beds,
While visions of Suboxone danc’d in their heads,
And my tech in her smock and I with a frown,
Had just put my 5th of Jack Daniels down –
When out in front of the store arose such a clatter,
I sprang from my ranting to see what was the matter.
Away to the gates I flew like a flash,
To see that toothless whore pocket some cash.
The spunk on the breast of the happy hooker,
Even in my drunken haze she was not a good looker;
When, what to my wondering eyes should I see,
But a minitature crackhead and eight 80mg OC’s,
With his bottles of pills and not a tooth in his maw,
I knew for a moment it must be St CrackClaus.
More rapid than a crackhead spending his cash on the first,
He yelled and stammered and threw me a curse:
“Now! Vicodin, now! Soma, now! Xanax and Diazepam!
“On! Suboxone, on! Percocet, on! Oxycontin and Lorazepam!
Since TAP is tired of translating this long rhyme,
He will wish you all a good Xmas, and to have a good time!

Merry Christmas to All!  May all your early refill wishes come true!

Im leaving town right now, will it be ready in 10?

The truth about California pharmacy tech licenses

Pharmacy tech schools/programs are cropping up around here in California like herpes after the prom.  I, for one, am sick and tired of these schools duping young ignorant students into handing over their hard-earned money to get some half-assed education when they can avoid it all together.  Thats why my friends, I am going to tell you how you can get your pharmacy tech license WITHOUT setting one foot in some useless program that costs 20k bucks.

Back before 1/1/2004, one could work in a pharmacy as a tech-apprentice and get a license after completing 1500 (or something like that) hours of real-life work.  Personally, I think this is the BEST way one could be a tech since you are being taught exactly what you need to know, what you can and cant do, and all of the things that you will be doing on a daily basis.   These were the glory days when men were men and the generic quinine flowed like cheap booze!  All of this is different now, read on.

Now this is California specific and information that the schools do NOT want you to know.  Here we go.

According to the Calfornia Board of Pharmacy tech license requirements.

Effective January 1, 2004, there are only four ways to qualify for pharmacy technician registration (California Business and Professions Code section 4202). California law now requires that an applicant for a pharmacy technician permit must meet one of the following criteria:

  1. Have obtained an associate of arts degree in pharmacy technology.
  2. Have completed a course of training specified by the board (typically provided by employers under requirements of California Code of Regulations Section 1793.6 (provided below)).
  3. Have graduated from a school of pharmacy approved by the American Council on Pharmaceutical Education or recognized by the board.
  4. Be certified by the Pharmacy Technician Certification Board.

California Code of Regulations section 1793.6 describes the training courses acceptable to the board (item 2 above)

This training is:

  1. Any pharmacy technician training program accredited by the American Society of Health–System Pharmacists,
  2. Any pharmacy technician training program provided by a branch of the federal armed services for which the applicant possesses a certificate of completion, or
  3. Any other course that provides a training period of at least 240 hours of theoretical and practical instruction, provided that at least 120 of these hours are in theoretical instruction in a curriculum that provides:
    1. Knowledge and understanding of different pharmacy practice settings.
    2. Knowledge and understanding of the duties and responsibilities of a pharmacy technician in relationship to other pharmacy personnel and knowledge of standards and ethics, laws and regulations governing the practice of pharmacy.
    3. Knowledge and ability to identify and employ pharmaceutical and medical terms, abbreviations and symbols commonly used in prescribing, dispensing and record keeping of medications.
    4. Knowledge of and the ability to carry out calculations required for common dosage determination, employing both the metric and apothecary systems.
    5. Knowledge and understanding of the identification of drugs, drug dosages, routes of administration, dosage forms and storage requirements.
    6. Knowledge of and ability to perform the manipulative and record-keeping functions involved in and related to dispensing prescriptions.
    7. Knowledge of and ability to perform procedures and techniques relating to manufacturing, packaging, and labeling of drug products.

Laws are stupid and boring.  Lets go through the possible avenues you can be on to become a Tech in California.

1. Get an AA degree in Pharmacy Technology.  What the fuck is Pharmacy Technology and why is it even an AA program?  It requires school and thereby money, moving on.

2. Have completed a course of training specified by the board (you can read the boring law as to what “Training” is).  Here is where all of the pharmacy tech “programs” come into play (along with #1 above).  They dupe you into thinking that you need to take their class to become a pharmacy tech.  Most schools tuition range from 15 to 20k bucks and will suck up a good 6 months of your precious life.  All to work in a retail pharmacy counting by 5’s.  Go you.

3. Have graduated from a school of pharmacy approved by the American Council on Pharmaceutical Education or recognized by the board. Translation: “You graduated from pharmacy school with a PharmD but you can’t pass the boards to save your life”.  Congratulations, you are the most overqualified pharmacy tech on the planet, here is your certificate on waterproof paper so your tears don’t smudge the ink.

4. Be certified by the Pharmacy Technician Certification Board.  Wait, whats this?  What is this strange PTCB you speak of?  Well, its a test.  Its a 90 question multiple choice test given at a hochillion testing centers around the state year-round.  Here is their online application to apply for this test.  Their requirements to take the test?

High school diploma or its equivalent (e.g., a GED or foreign diploma).
• No felony conviction.
• No drug or pharmacy related convictions, including misdemeanors. These violations must be
disclosed to PTCB.
• No denial, suspension, revocation, or restriction of registration or licensure, consent order or
other restriction by any State Board of Pharmacy.
• No admission of misconduct or violation of regulations of any State Board of Pharmacy.

So, pay 15k and have information spoon-fed to you, or spend $200 bucks (the test is $129 of that) to get a PTCB study-guide from Boarders/B&N (search for PTCB exam), read it at home, take the practice test, then go to a testing center and get THE EXACT SAME THING.  PLUS if you pass the test you get a fancy CPhT after your name!  Just that information alone is worth it for you to buy Drugmonkey’s book with all the money you saved!

That’s it!  That is all you need to do!  Take a 90 question test and you’ll have your license!  No teachers! No books! No $20k financial-aid’s dirty looks!

Why am I doing this?  This is why; the pharmacy tech market in California is saturated to hell.  I get at least 2 applications a month from people looking for pharmacy tech jobs.  I feel horrible for some idiot who spent 20k bucks to have some washed up pharmacy-tech yap at them in a classroom to get a license that there isn’t any job demand for.  Its that simple.  These schools are swindling these students out of their money with promises to “get in on the pharmacy action” when there are already TOO many techs LOOKING for jobs.  I don’t think its right because the schools make it sound like their program is the only way to get a tech license, and that’s an outrageous lie.

I’ve worked with CPhT’s that just took the test, and externs who are close to finishing these ‘wonder-schools’.  I’ll be honest, both of them are shit-worthless walking in the door, with the CPhT’s a bit more useful than the externs solely because they have the ambition to study on their own.  I spend more god-damned time doing brand-generic translations, telling them they pulled the WRONG drug, and fixing their mistakes for them to be any worth to me.  What the fuck are these schools teaching these externs?  If you studied at home, I can sorta give you some lee-way.  But if you spent 6 months in a CLASS getting LECTURED on shit, you should damn well know what Keflex and Vicodin’s generic names are.  It’s gotten to the point where I refuse to take any tech-school externs because they end up COSTING me more time than SAVING me time by having them be there.  Yes, they are there to learn, but I am there to work.  Teaching time was in the classroom, “you should of learned this there”.

Now granted, some people learn better by having the information spoon-fed to them via a talking-head and homework than reading a book on their own, but is it worth 15-20k?  Honestly I want a tech that can read, understand, internalize, and apply on their own rather than asking me the same pointless questions every day.  I don’t have TIME to be a talking-head explaining them shit they should of learned at these fancy programs! I have work I need to do; and although these externs aren’t getting paid, they are preventing ME from doing what I need to get done with their should-of-learned-“How many mL’s are in a teaspoon?”-in-school questions.  At least intern pharmacists can take new prescriptions!

I’m waiting for the “Well, we all have to start somewhere!” excuses.  My preemptive response to your bogus statement: “You went to a SCHOOL to LEARN how to do this and you are SHIT-WORTHLESS.  You have FORMAL INSTRUCTION in this field and you don’t know your ASSHOLE from a 30 DRAM VIAL.  If I have to tell you one more time why HYDRALAZINE is not the same as HYDROXYZINE I am going to shove Drugmonkey’s Book (Go buy it) UP YOUR ASS.”  That’s right, his book up your turd-cutter.  Harsh, I know.

Another unrelated point on my refusal to take externs is a trust thing.  With a CPhT licensed tech, he/she is an employee.  We have paperwork on them.  We know where they live.  With an extern, its just a name from the school.  What prevents them from pocketing a handful (or a bottle) of vicodin during their X-hour externship stay at my store?  I don’t have the time to watch him/her like a hawk, and its my license on the line if something comes up missing. I’m not going to do a narc inventory after EVERY extern rotates out, so one of 12 externs/year could nab a bottle of vicodin and nobody could pin it on exactly who did it.  So I choose to just not deal with the situation at all.  Yeah, its a shitty outlook that really isn’t justified, but at the same time its my ass.

Bribing patients with gift cards

Unlike some angry websites out there, I will never make you send money to a politician campaign fund for articles (who will just be bribed by your employer to sit there and do nothing like most politicians.  More Kool-Aid anyone?)  No needed here, we only serve raw recycled rants with some filler thrown in for roughage and some ads thrown in for good measure.  Not that I’m against anyone sending me money or you your money to someone…. Of course I work for an independent so what the shit do I know about anything?

Anyway, I’m sure you get the point.

Does anyone else find it a bit sad that our profession has sunk to a level where the chains have to bribe patients to get their Rx’s filled?  Oh, its disguised as “gift cards”, but its really bribery.  Lets call a duck and duck here.

Rite-Aid is now offering $25/rx (max of 4) for prescription transfers.  Wait, Rite-Aid?  They are still in business?  Drugmonkey said it best: New Rite Aid slogan: “We are the Chrysler of health care”

Obviously Rite-Aid/Walgreens/CVS/Whore-Chain-Y has some real winners running the show to think of these bribe cards.  Now let me ask you this, is the patient who transfers his Rx’s over for a $25 gift card (max 4) a patient that you really want?  Is this patient going to be loyal to your store and come to you no matter what?  No! This patient is going to call in his 10 medications, wait until you have them already filled and ready to go, then want them ALL transferred to Walgreens because they are offering free blowjobs with every Rx transfer!  These are the patients who view pharmacy as McDonalds (which most chains I believe have the same outlook.  Drive thru anyone?) and don’t give a rats ass about you, your store, your job, or what you say.  They are only fueled by what they are getting for free (and last I checked, it was illegal to give gift-cards to MediCal patients since the state is paying for their Rx’s).  This is the patient that will fuck you over the moment you let your guard down.  This applies to any store that does the gift cards/$4 generics/free antibiotics/etc bullshit.  You will end up spending more labor costs on these pain-in-the-asses than you will get back with their shitty insurances/$4 plans.

How about this novel idea:  Why doesn’t Rite-Aid/Walgreens/CVS lower the cash price of its generics to a REASONABLE level (ie: a price that’s based upon actual cost, not AWP) so they wont need to bribe idiots with gift cards.  Why don’t they offer SERVICE (Rx’s in say, 10 min vs 3 hours) rather than a CASH BRIBE to lure people in through their doors.  You know why In-and-Out burger is so damn popular? Because you get a smiling (and always cute) face, good food for not much money, and your order is ALWAYS RIGHT.

However the execs at Rite-Aid (way to drive that plane into the ground boys!) are a whole lot smarter (and higher paid) than me, so that means they obviously know what they are doing (*crash!*)  You can have all of the gift-card freeloaders.  I care about my patients, and my patients care about me.  If thats worth less than $25/rx (max 4) then so be it.  Better off without them.  The’ll come crawling back once the freebie well has dried up, they always do (and like an idiot I always take them back).

A profession of fighting

Has anyone but myself noticed how pharmacy has turned into a profession of nothing but fighting?

  • Fighting patients: Early refills, lost medications, the lies, the bullshit, “Do you have any other insurance cards?”, “What do the pills look like again?”, “There is no way you should be out of those yet!”, “Who told you to double up, and why didn’t you let me know!”, ARGH!!!  It seems like no matter who walks into the store its going to turn into a stressful conversation.  The happy patient who brought their refills in on-time with a smile on their face and a compliment are long gone.  Patients are the number one stressor in any pharmacy.  From bitching about copays (that they think we set) to the pills looking different, they are both the boon and the bane of pharmacy.
  • Fighting doctors/staff: Cheap front-end staff, people who cant call in medications correctly, sloppy handwriting, ignorant doctors and their drug-rep propaganda, the list goes on and on.  Most doctors are pretty good about listening to what we suggest (because they know they really have no choice) but it takes a fight with one to ruin your day.  “Yes, doctor, EVERYWHERE is short on generic Toprol XL” to “Are you sure you want Soma 250 or that new Prevacid???” at least doctors are mostly on our side.  Fighting with the office staff is more of a problem, especially the ones who think they know as much as the doctor (“No, I want this!” when the doctor says “I dont care”) when in fact they know nothing.
  • Fighting insurance companies: If there was a top-10 list of places to blow-up before you die, I’m sure that every pharmacist would have insurance companies as numbero-uno.  Shitty contracts, reimbursing below cost, unavailable products, rejects, wrong shit on insurance cards, mystery person codes (like person 88), prior auths, “Plan Limitation Exceeded”, quantity limits, sig limits, day supply limits, limits on the limits on the limits, this list never ends!!  It costs a pharmacist $1/min to stay on the phone, it cost the insurance company $3/hr (if that) for that Indian call-center person to answer your call.  Who do you think is getting the deep dicking on that deal?  Fighting with automated systems which require you to say your NPI number 4 times to be transfered to a live person who requires your NPI another 2 times.
  • Fighting other pharmacies: Waiting on hold for a transfer for 10 fucking hours or calling every place around town to see if Cracky McCrackhead is doctor shopping.  Pharmacist doesn’t speak english/is too busy to talk to one of his own/is off for lunch/the list goes on.  Yes, it does take 4 hours and 2 phone calls to get that copy faxed over.
  • Fighting technology: The fax machine jammed, the printer needs a new fuser, the pharmacy software crashes randomly as you feel like you’re talking with an insurance company when you call your corp help desk.  Some days when the shit rains it pours.  You hit your coffee and dump it into your keyboard or some tech sneezes all over your monitor you wish you could just crawl in a hole and die.

At the end of the day, when you sit down for the first time in 9 hours, you realize that it all is just going to repeat the next day.

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.