Medicare Part D – Aftermath

Sorry I havent been posting much. This medicare part D bullshit has finally stopped hitting the fan, so now I have a breather.
Things are pretty bad in the retail biz now. The reimbursement rates are a staggering low. I mean, i tip my fucking pizza boy more than I get paid for filling your mothers prescription. Patient care took a backseat to paying the bills and putting food on the table.
President Bush burned his bridge with me. Yeah, I voted for him (Kerry was a douche), but saying that we need to protect our seniors from those greedy pharmacists was the final straw. His administration trusted our senior’s care to a bunch of dipshit private companies who cant pour piss out of a bucket. We picked up the ball after they dropped it and worked our asses off to cover their fuckups. Now he’s got the balls to say that we’re greedy? Thanks a fucking lot! We’ll see how long you have to wait for your next prescription!
At least the insurance companies that totally fucked up are giving us a little respect and kind words. Now if they’ll just take the dagger out of our backs and look us in the face as they are fucking us over we’ll be happy.
Not good, really really not good.

This is a true story

Actual conversation between a pharmacist and a nurse.
-Phone Rings
RPh – “Hello, this is the pharmacy.”
RN – “Yes, hello. I am calling to inquire about Mr. Xs medication.”
RPh – “OK, what’s going on?”
RN – “Well, the problem is this: He’s supposed to get 20 mg of this medication, but you guys sent me a 40 mg tablet.”
Rph – “OK, so what’s the problem?”
RN – “Well now, that’s not the correct dosage.”
Rph – heavy sigh…. “Here’s what you do… Take the tablet, break it in half across the score in the middle and give half the tablet to the patient.”
RN – long pause…. “Which half?”
This is the type of crap that scares the hell outta me.

Medication and Lawsuits

So now there are some lawsuits pending against Ortho for their Evra Transdermal Birth-Control Patch.
They claim that the patch has a higher concentration of estrogens which can lead to a higher incidence of blood clots and strokes.
There is so far at least 1 lawsuit pending for it.
I got $20 that the woman suing is one (if not all) of the following:

  • Fat
  • Smoker
  • Family Hx of blood clots
  • Low Income
  • Sedimentry lifestyle (just lays there when shes getting plowed)
  • Fits 9 out of the 10 risk factors for blood clot development
    Lets use our heads here. There are implied risks with taking anything with the Rx label on it. Thats why only Doctors can prescribe and only Pharmacists can dispense. If a drug had no risk then it wouldnt be a prescription item now would it? Of course Evra has a higher concentration than an oral tablet, it has to absorb through your skin! If she doesnt like taking a higher dose, then she can deal with taking a pill once a day than changing a patch once a week. News to woman! Smoking causes cancer, water is wet, and the sun rises in the morning.
    People then wonder why the cost of medication is so high in this country. Its because of fucking lawyers and fucking lawsuits and lame-ass people who want to sue for 5.4 gazillion dollars in damages. In other countries, if this happened to you they would say “Well, thats unfortunate, but that is why these are Rx only, you should of known better”. I really do think that if nobody fucked up (like prescribing/dispensing a medication for a blatantly wrong indication) then you’re on your own.
    Listen up people, Rx items are just that, PRESCRIPTION ONLY! Why are they PRESCRIPTION ONLY? its because there are RISKS in taking the MEDICATION! You realize that the FTC (not the FDA) mandates that if a drug is shown on TV, and the drug use is given, they have to state all the side-effects in the mile-per-min speech. Thats why you see commercials like “Ask your doctor if blahblah is right for you” that are 4 seconds long, and “Ask your doctor about paxil and depression.. Commonsideeffectsincludedizzynessdeathimpotencecombustioblahblahblah”… Not many people know that, so now you do.
    People really fucking annoy me.

  • Medicare Part Diaster. The saga continues

    After a nice relaxing dinner, a few drinks and a puff of some fine pipe tobacco, i’m ready to bitch more about Medicare Part D(iaster).
    Things are getting a bit better. Not by much, but a bit.
    However Argus/Prescription Solutions have totally screwed the pooch yet again. Their servers are STILL unable to handle the load and are going up and down like a $2 Thai Hooker.
    Prescription Solutions powered by Pacificare still hasnt added our pharmacy to their program, so we’re encouraging everyone to switch over to someone else (and we’re also leaving a message to their contract dept everytime we do it too, just to encorage them to return our call, which they havent). If they want to play that game, then we can play it too. We moved over 40-50 people just today off of their plan to ones that have their shit together.
    Im reading on all the other blogs on how people are blaming Bush and the Republicans for this whole clusterfuck. However, what do they have to do with private insurance companies completely dropping the ball? Last I checked the government didnt run Argus, PacifiCare, Health Net nor any other Privately/Publically owned company. The government didnt issue wrong ID cards to people, or completely understaff their call centers. They arent responsible for the long hold times or help desk reps that cant tell their asshole from their nostrils. What they /are/ responsible for is trusting (and paying) idiots to run the show for them.
    I think the whole Medicare part D system is one of those ‘Looks good on paper, but totally blows in real life’ bits. Although I have seen people who have been paying cash for kilo-buck drugs such as Aricept whom are now just shelling out a $35 copay thanks to Part D. If I were saving $150+ a month, i’d put up with the bullshit, however thats not the case.
    So be aware what you read on these other “blogs” from people bitching who arent there in the trenches. Anyone can be an armchair quarterback and put the blame on the nations scapegoat; but take it from a person who spends 9 hours a day on hold with privately owned companies, its not totally the governments fault. Its all Argus’ fault.. 🙂
    This entry isnt very angry, and I apologize. Its been a little over a week and i’m tired of dealing with the whole situation. Im not to the point of giving up yet, but im getting there really really quickly.
    If you’re a pharmacist and want to help out with a collabrative info warehouse, go to http://www.partdrphinfo.com and contribute any information you have. Everyone seems to need to pool their knowledge to help get through this.

    Medicare Part D – Week 2

    Welcome to the start of Week 2 of hell, er.. Medicare Part Diaster!
    Today we have a very very special award. It goes out to Prescription Solutions powered by PacifiCare.
    Today is the start of week 2, and my place of employment is STILL not enrolled in their Medicare part D program. Last week they were backlogged, this week they really dont know whats going on and why we’re not signed up. I left voicemails to their contract department telling them that they better act on this to stem the outflow of patients that soon will be switching to a medicare part D carrier that has their shit together.
    Do they care? nah. Just another random voice after a 20 min hold time giving another BS excuse.
    Its besides the point that we faxed over our contract not once, but twice, about 2 weeks apart, plus mailed the hard-copy to them. All this was the first part of December.
    Typical insurance run-around. They arent suffering any; the patients are because they dont wish to change pharmacies (bless their hearts) yet their insurance company completely dropped the ball.. ROCK – ME – HARD PLACE
    Argus is still on the crap-list for having slow/unresponsive servers. Get with the program dudes, its been a week. BUY MORE FUCKING MACHINES TO TAKE THE LOAD. QUIT SPENDING YOUR MONEY ON HOOKERS AND BLOW AND BUY MORE GODDAMN SERVERS SO YOU CAN SERVICE THE PEOPLE WHO PAY YOUR DAMN PAYCHECK! (i feel better now). If thats not the case, then tell us WHY your service sucks, and why companies that use you for Rx processing (like Health Net) shouldnt sue your ass into oblivion for making them look horrible. Ive worked in the computer industry, I know how things can get, and I know that keeping everyone informed. Plus I love how their main webpage (http://www.argushealth.com) has a huge area about KickBack..er.. Rebates! Way to go! Why dont you use that and BUY MORE SERVERS!
    Shouts out to Mike in IN, stick with it man, we’ll get through this! Once in a while you get that pearl in the rough that makes your job worth while. I know I get mine on a daily basis.. If this site would be about all the good parts about pharmacy it wouldnt be called ‘theangrypharmacist’ now would it.. 🙂
    Friend of mine from school made this website to help you all with the ins and outs of Rx processing through MediCare part D. It has stuff like what person code to put, ANSI BIN numbers, PCN numbers, etc. Its a wiki, so anyone can create an account and add information and stuff (there is a hand holding page to help out). He’s put a ton of time in so let him know how you like it. Heres the address
    http://www.partdrphinfo.com
    Tell your friends and co-workers.

    Medicare Part D – Day 2

    Day two of the MediCare part D fiasco has come and gone.
    I must say, that this is the biggest clusterfuck in the last 40 years of pharmacy.
    For example: Argus Health Systems (a billion dollar company) had its servers taken down for some reason all day. Unfortunally Humara and HealthNet uses Argus’ servers to process their prescriptions.
    This means that nobody who was signed up for HealthNet could get prescriptions today. Only 1/2 of Humara patients could get their prescriptions today.
    Pharmacies are turning people away without medication because they dont know if the cards are good, and arent going to risk the 100 bucks worth of medication to find out.
    Patient care has taken a back-seat to gun-shy pharmacies who are getting fucked over by cost+$2.00 reimbursement fees. Cant say I blame them, patient care doesnt put food on the table or pay for the power.. I tipped the pizza boy more than we get per Rx via MediCare part D.
    So the pharmacies get fucked and the patient gets fucked.. Who comes out ahead? The insurance companies thats who (who are recording record high profits last quarter).
    I’m amazed at the lack of preparedness that the insurance companies have shown. You would think that a good 6 month prep-time and “record high profits” could prepare them with the necessary hardware and personel to take the phone and transmission load that was expected on the first.
    I’m waiting for the blame on Bush or the republicans to come out, even though its the private sector that totally fucked over everyone. Last I checked the government didnt have control of HealthNet, Argus, Blue Cross or any private third party. But I guess someone has to have the finger pointed at them. If the government would of just managed it itself like they did the state welfare program, everyone would be in the same boat, and we wouldnt have 50 companies with 50 standards and 50 formularies to deal with.
    There is no excuse as to why Argus’ computers were down all day today. If this was a single man operation, then I could see. But this is a multi-billion dollar corporation. You would expect a bit of forethought and preparedness.
    But it gets better! Who gets blamed for Argus’ systems being down, the copays where there was none, and all this chaos? ME! Thats right, your local neighborhood pharmacist who has nothing to do with this whole batshit gets blamed. People want to blame someone they have access to, so they blame us. As if I control argus’ systems (I could probably do a better job administrating them) or control their copays.
    So fuck you Argus and fuck you Heath Net for dropping the ball during the time of need. People will die because of your fuckups, its the blood of the elderly (and the frustation of every pharmacy out there) will stain your ‘record high profit’ reports (as if you care).
    Its a sad sad day for pharmacy today.

    Medicare Part D – Day 1

    In the words of my boss:
    “More people will die because of MediCare Part D than Hurricane Katrina”.
    In the words of me:
    “This is a complete and utter clusterfuck”.
    Its horrible, examples:

  • Patients are being sent to the pharmacy with cards that have the WRONG ID number on them, which forces us to call the insurance company to wait on hold for a half hour or so.
  • The central eligibility server is down, so you cannot online check to see which of the 90 plans the patient is signed up for.
    Furthermore:
    Since all of the Medicaid (welfare) patients with Medicare are moved over to Medicare part D now, they have copays. They are used to getting their medication for free, so they bitch and moan when they have to pay a measly $1 for generics and $3 for brand name. My reponse to them: “Get the fuck over it, you should of saved your money when you were young. I’m tired of paying into a system that will benefit you and no longer be around for me. Personal responsiblity begins young and at home. Remember the story of the grasshopper and the ant. You douchebags are the grasshopper and i’m the ant. My grandparents came to this country with nothing and have enough investments to retire on. They didnt even speak english when they came here! So suck it up, be a man/woman and forgo the one night eating out at hometown buffet to pay the $17 for all of your monthly medications. People who dont qualify for government assistance have to pay cash, and you dont see them bitching about it you fucking whiners.”
    I feel better now.

  • Math is HARD! Im not SMRT!

    I’m far from being a mental bigot. I understand that a ton of people did not go to college and dont have the in-depth knowledge that I have with regards how medications and the human body work.
    But some people act so stupid, that a 4th grader could out-do them. For that, I must make fun of said people. I’m sorry, but read on and you’ll see what i’m talking about.
    Example 1:
    You get 90 tablets of Vicodin. You take 3 per day. How long will this supply of vicodin last you? ***BONUS! It says on your bottle “Must last 30 days”***
    Now all of you at home, since you obvously are reading this over a computer will say that the supply will last 30 days, because 90 / 3 = 30. HOWEVER ghetto-math says otherwise. Ghetto math says to call the pharmacy after 10 days and ask for the refill, because you sold 9 vicodin a day, thereby leaving you short.. Oh, and also you need to get really mad when I say that you cant have them early and threaten me. Pharmacists like to be threatened when you your narcotic refills early.
    Example 2 (this one is harder):
    Today is 9/25/05. The pharmacist says that your Somas are due in 1 month. What day would that be?
    Now a normal person would guess 10/25/05. Even if one of the months had 31 days, you would be within 1 day and close enough. However ghetto-math says that 1 month has exactly 10 days, so thats when you should get your pain-pills refilled. Ghetto-math is never wrong, remember that!

    Help! Bail me out!

    Nobody can honestly say that they dont like culture. Coming from the United States we are a hodge-podge of different cultures all mingled together. However when your culture ends up costing me money is when I start to have a problem with it.
    Within the past 10 years or so, there have been a massive influx of pacific-rim type folks coming here. Now thats 100% cool with me, everyone needs a chance for a new beginning, and just because your own country is fucked, why not come here and do the same to ours. Its the American way.
    Now I draw the line when you come into my pharmacy looking for 10cc syringes and 18G(!!) needles for which to inject your herbal shit. It bugs me even more when you are asking for these so you can inject your pregnant wife/daughter/goat/etc with this shit.
    On more than one occation i’ve seen a few very fucked (medical wise) children being brought in this world. When we ask the mother what happened, she tells us that she was taking this herb or mystical shit that caused all of these birth defects. Now I feel sorry for the poor kid, but I also feel sorry for the state that has to PAY for this womans fuckups for the rest of this poor babys life.
    I rate all of said people on the same field as crackhoes with their crackbabies. We have to pay for their mistakes and their fuckups.. So let all now take a big swig of Bicardi 151 while pregnant for the great USA! Because we know the land of milk and honey will cover our ass no matter how stupid we are!

    Rants from the most trusted profession.

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