May
There’s a “Kick-Me” Sign on Pharmacy’s Back
Posted by The *Angriest* Pharmacist as Disgusting, Doctors, Drug Companies, Hospital Pharmacy, Insurance Companies, Laws, Me being a dick, Me hating others, Money, Patient Education, Politics, True Story
I guess we’re the flavor of the month as the douchbags and assholes are coming out of the woodwork to take a cheap shot at our lovely profession. A loyal reader, known only as Bond, sent me the link to an article titled, “The Great Drug Switcheroo.” This piece of shit article published by “Prevention Magazine” (which has been around since the 50’s). The tagline is, “Your pharmacist may be changing your medication without your knowledge–and what you don’t know could hurt you. Here’s how to stay safe.”
Once again, the man behind the counter in the white coat is trying to KILL you — not trying to help you achieve optimal results from your drug therapy. It begins with a story of a lady diagnosed with epilepsy who had troubles finding an effective drug regimen. After she had gotten stabilized, she fell of her bike and broke her leg — all because of an evil conniving pharmacist!
Her pharmacists, she learned, had exchanged her Tegretol for a generic that worked a little differently. “Just imagine what could have happened had I been behind the wheel of a car,” she says.
What’s wrong with this sentence besides everything?
The article then goes into THERAPEUTIC substitution and not GENERIC substitution. The article makes the point with statins as well. The problem with this entire bullshit, whacked-out piece of journalism is that therapeutic substitution does not exist outside of the inpatient setting. I cannot think of a situation where that would be legal, and I seriously doubt it is allowed in any state.
For readers not in the know, here’s an example of THERAPEUTIC substitution: I am working a shift at my local hospital. I receive an order for a patient to receive Crestor 10mg at bedtime. The hospital doesn’t carry Crestor because it’s silly expensive. They do, however, carry Lipitor because they have a contract with Pfizer for a good price for it. The Pharmacy and Therapeutics Committee at my hospital did a review and based on their specific protocol, I can swap in Lipitor 20mg for Crestor 10mg as their lipid lowering effects are very similar (based on the results of the CURVES trial). I don’t need the permission of the MD or anyone else as the P&T committee represents the MDs and they have okayed this sub. There are hundreds of places where this happens — IN HOUSE! It does not happen in a pharmacy as Walgreens does not have a P&T committee…:-)
Here’s an example of GENERIC SUBSTITUTION: Your doctor writes for Vicodin 5/500mg. Name brand Vicodin is really expensive, and I don’t carry it. Luckily, he signed the prescription on the side of the blank that says, “Generic Substitute Allowed.” This means the doctor has given me the authority to dispense a generic drug, Hydrocodone/APAP 5/500mg which has been rated AB by the FDA (meaning it is recognized as equivalent therapy by the United States Government).
I’m pretty fucking sure our seizure chick was getting Tegretol or Tegretol XR for some time and the pharmacists switched her over to an AB-RATED generic equivalent. Can we say that this was the cause of a seizure? Fuck no. This bitch has epilepsy. She can have a seizure after a loud fart — did the fart do it? The time frame fits! I just drank a cherry coke. Can we say that Cherry Coke made me a dickhead? No. I’m a dickhead and it’s expected. Anywho, I SERIOUSLY doubt the pharmacist here said, “Well, she’s been getting Tegretol for quite some time. Let’s give her some Phenytoin. It’s okay…I’m a Pharm.D.!” —- No way….They are sensationalizing this and trying to compare dissimilar things.
The article specifically says, “A generic that worked a little bit differently…” — I know it’s semantics here, but generics are the same drug that work in the same way.
The second page of the article talks of a switch done by a mail order pharmacy. This I don’t doubt happens. They know exactly what drugs their plans will cover, but by the letter of the law, they shouldn’t be making changes. I’d bet they call the MDs and say, “You wrote for Prevacid. We’ll pay for Nexium. Is it okay if we fill the latter?” — Of course the doctor doesn’t care and the patient gets the new drug in the mail without ever being told of the switch. Is that okay? It’s bad customer service as the patient is likely going to be scared and ultimately pissed, but they most likely meet the legal requirements of the law.
Ask your pharmacist to put a blanket statement in your records that you don’t want any medications switched unless you and your doctor approve. “It’s a way of getting your pharmacist’s attention,” says Catizone. “When pharmacists know more, they can do a better job of advocating for patients.”
We’ve all got a few of these assholes in our system. “I want brand name everything! Generics don’t work for me.” It’s these type of assholes that make me lose money on a bottle of name brand Vicodin when 70 tablets expire in a 100 count bottle. But, if they wanna pay for it, that’s fine by me. I’m not gonna lie and put DAW1 — I’m putting DAW2 and you can pay the difference.
Each section in this pissass article says, “If your pharmacist makes an unapproved switch….” — What’s the need in this statement? Is there really this much distrust in pharmacy and pharmacists? I’m blown away by this. The final section has a quote from Robert Reneker, MD, urgent care physician at Spectrum Health, a hospital system in Grand Rapids, MI. He correctly says that pharmacies are reimbursed better on generics and switches are profitable. He incorrectly states that we are motivated to make these switches by profit.
I, personally, could give a shit less about what prescription a person gets. I’m happy to get the person in the store and make the sale. Volume is volume and it all averages out. If you get name brand something, you do. I’m not going to go out of my way on each of the 800 scripts I fill a day to ensure it is generic and maximize my profit margin. That’s just silly…to think that one would do that. To change you from Nexium to generic Protonix (pantoprazole) requires a call to the MD, the wait, the recount, and the dice roll that your insurance covers it. I may make more money on it, but it’s it worth the 5-10 extra minutes of work? Never…So his claim here is valid, but off base. He also says that pharmacies have told him drugs aren’t on formulary when they are — he’s checked. This is funny to me because I have no idea what’s on anyone’s formulary, and again, I don’t give a damn. If it’s covered it’s covered. If it’s not, I try something else. I have the broad ideas of what’s covered: generics are, Phentermine isn’t, BZDs aren’t on Part D, etc. For fuck’s sake, I could process a prescription and get a rejection that says drug not covered. Then Dr. Reneker calls the insurance company, and they say, “Prevacid? Why sure it’s covered, Dr. Anything you want. Let me send you this form to fill out.”
Dr. Reneker understands that to mean that: The drug is covered. I just got the prescription for my patient. The pharmacist lied to my face. The pharmacist sees this as: I tried to process it and it was rejected as NDC not covered. The MD called and got a Prior Authorization. Now I can fill it and the patient can pay $75 while Prilosec is 20 bucks for 42 tablets. Way to go, Doc! You think you won, caught a pharmacist in a lie, and got the patient the medicine. The fact of the matter is the insurance company won (twice), you now distrust me and don’t know the whole story, and the patient can’t afford the food anymore that causes her heartburn.
Above is an example of what happens when a journalist talks out of their ass.
I’m not sure who makes the above switches. They are insinuating that you bring in a prescription for Lipitor, your pharmacist is going to send you home with Simvastatin and there’s not a damn thing you can do about it. Well, that’s fucking bullshit. While these substitutions are all fine and dandy, I certainly wouldn’t do them on my own accord. However, Prevention magazine thinks I can and do.
Read REMOVING THE WOOL to see what changes could be made where the new isomer-removed-new-drug/patent-game-type name brands exist and the generic would be cheap to use and work just as well.
I concur, TaestP. Community pharmacists generally cannot perform therapeutic susbstitutions, but hospitals have committees tha pre-approve certain very specific therapeutic substitution authorities after considerable study. For example, my hospital allows, if not compels, pantoprazole over all other PPIs ordered, and levofloxacin about all other fluoroquinolone antibiotics ordered, unless the doctor orders “do not substitute.” Same is true for famotidine over all other H2 receptor antagonists.
The idea that we pharmacists EVER perform these substitutions on our own, without any oversight, is truly a “kick-me” sign on us.
I always thought it funny that even when I would fill prescriptions actually written by generic name–the purest form of doctors’ granting the pharmacist the authority to make drug product selection–the patient wouls come back and say, “I don’t want a generic! Give me the brand name!” Sometimes I would say, in this instance, “Which brand did you want?” For example, amitriptyline, a very old tricyclic antidepressant, was once available as Elavil (Merck) or Endep (Roche), as well as products from such generic houses as Moore or Mylan. They don’t know what to say to me then (grin).
Is there a line forming somewhere to beat these moron journalist and “experts” said same morons quote in these articles. I’ll gladly stand in line to give these people an ear full, this misinformation being put out there is making my job alot harder.
This is TOTAL BS. Why are these journal articles being made? This forces distrust. I had a patient yesterday who didn’t believe me about the part D doughnut hole. He thought I was just charging him more cause I am new to that pharmacy (more hours for summer). One of the staples of pharmacy should be trust, and when that is lost, it is hard to get back.
That article pisses me off, especially that rayna person saying the article is 99% accurate just because she has seen a few doctors and met with a few pharmacists. That makes her an expert now!
What can we do to stop this bad journalism?
Man, that article is a crock of shit! I’d like to find that stupid journalist and throttle him/her. (Notice that the big fat coward didn’t even put their name on the article!) Thanks for making me aware of this; I may put something about it on my blog after I get done studying today.
If patients wish to read this stuff and act like they know something, so be it. They can contemplate their immense knowledge while waiting for 3 hours at walgreens.
Washington state has a therapeutic interchange program for Medicaid patients. My pharmacy refuses to participate, since we don’t have enough access to medical records, but it’s legal. Doc writes for Diovan? Pharmacist can change to to any ole generic ACEI he/she wants – no specific guidelines like a P&T committee would put together, then fax the doc to tell them about the change.
It’s a great concept, except for the lack of integration in access to medical records…
Who needs to worry about the Pharmacists trying to kill us. The ingredients in our drugs comes from china these days and its all poison.
I urge all those that read this article to leave a comment or write to the editor to voice your displeasure. This magazine and its author owe the pharmacists of the world a HUGE apology and I think we need to make sure they give us one publicly.
I can never understand why an author doesn’t just pick up the phone and talk to a pharmacist before writing this kind of crap. It really does mess up the trust factor.
Yesterday I had a hard time convincing a patient that the generic Protonix I use is made from brand company. Even after I opened a new bottle and showed her that the pill says “Protonix” on it. (ESI Lederle generic) Now, what kind of dip shit is this person. I should have ran the prescription with a DAW 2, filled it with the generic and charged her the extra copay. All of the DAW’s flag me for audits with PBM’s or I probably would have. When she left she still wanted to know if I would give her the brand if she got a head ache tomarrow. The real question is, what is she going to give me for the head ache she is giving me today!
Funny…:-)
Oh. My. God. That’s… that’s an outright false statement in that article.
There’s a strongly worded letter going to the editor. Fact checking. It’s your friend.
Sure, one of us pharmacists now needs to be funning around correcting misconceived half-baked attempts at shock journalism. Why, all of a sudden are Americans thinking pharmacists are doing whatever they want?
In my last several decades, I thought we were part of one of the most regulated professions around, and I was in agreement with our blogs… full of gripes of how we have to lick boots and kowtow to the rude and arrogant. Where is all the ridiculousness coming from? Maybe since people can get anything off the internet and there’s no one to sue if something goes wrong, they’re coming up with ludicrous stories.
lHow can even worthy editors at Prevention get away with this? The difference between generic and therapeutic substitution is not rocket science.
I think TAestP gives an excellent response, with discussing carbamazepine and phenytoin and AED. The patient falls off her bike with a seizure and goes to the ER. She’s going to be given IV benzos and fosphenytoin, and if a drug level is determined, there’ll be more than one factor in the explanation e.g. missed doses, drug interactions (many) including OCs, multivitamins containing nicotinamide, OTCs such as Tagamet, Metamucil, and Tylenol and some herbals, as well as Rx for which she’d stopped in an ER and had filled at $4 shop instead of her regular drugstore.
I don’t think State laws regarding generics have changed, allowing substitution only if authorized by all three involved; prescriber, patient, and pharmacist–all in agreement.
Maybe insurance companies have members sign a disclaimor about ‘agreeing’ to a generic substitution, but in retail, pharmacists are not allowed to substitute generic for branded products unless so stated on the prescription. If there’s no problem with substitution of a generic as considered by physician and pharmacist, unless the patient is opposed, the script will probably be filled with a generic. If the insurance will not pay, then the matter has to be settled by the patient in discussion with the insurance company.
I don’t understand how authors can state that pharmacists fill scripts with different drugs than what’s on the script.
When generics first came out, drug companies used to call their generic drug by a ‘brand’ name to ensure some proprietarial rights, but a generic is a generic, which means that the company hasn’t done the original research allowing the 17 years patent application. FDA requires generic companies provide products within certain set ‘tolerances’, for consistency, and reproducibility. That being said, every pharmacist knows the whole story, and it’s part and parcel of our education; if we don’t understand it, it’s not like missing the generics lecture one day.
P.S. Gotta love the imagination of the writer, though, didja catch that Carmen Catizone of Chicago had a copy of the Illinois State Law? Carmen Catizone is only the guy that signed my reciprocity to IL as executive director or NABP.
What really riles me is that in response to the libel (Pharmacists are cheats’), readers respond ‘based on their experiences the article is 99-100% correct’, and some responses from those in pharmacy (techs) seem to go off the deep end with a little exaggeration that might seem misleading to those ‘not in the know’.
Did any of you notice that one of the “experts” quoted in the article is the executive director of NABP? I checked it on the NABP website. And, he is a pharmacist! WTF? He is just WRONG.
Huh…never in my experience have I ever been able to substitute Simvastatin for Lipitor just because i please. Amazing what people will “say” is a fact without checking up on their “research”
I just had to do a little bit of study for my certification and take a small test for credit…and it was concerning the DAW and generic substitutions and all that stuff…and what I gleaned (correct me if i’m wrong…seriously…) was that a lot of drugs, when they come out generic, are actually made by the brand-namers and labled under ‘generics’. One example, i believe is Lotrel. I open a bottle of Amlodipine/Benazapril and find little capsules that are identical to the lotrel name brand capsules…they even say lotrel…fancy that!! So yeah, I too have had my share of what Dave above went through…people not believing me, telling me that i was ‘doing something behind the counter’ to switch pills or something. I’m literally rolling my eyes right now..unbelievable.
I also agree with the ole’ apothecary…90% of our prescriptions are actually written with the generic name all spelled out and everything…and then they ask for generic…and then they complain later? The only explanation is that people are just getting more stupid.
Too bad there isn’t a drug out there that is for stupidity…then when people complain about the generic for it, I can switch them to DAW 2 and laugh. But there isn’t a drug for stupid…sad, but true
Don’t you just love reading these articles? Sadly, I automatically formulate what my response will be to the poor sheep who have read this piece of shit and will assume I’ve tried to kill them with generic substitutions too.
Journalists can bite my ass…they just go for the sources that will tell them what they want to hear and who will give them the most sensational article – nevermind the truth. I have no patience for this shit, and unfortunately, the sheep think everything in print is true. So strap on your armor, comrades, we all have explaining to do. And then an angry letter to write.
I was so pissed off i left a comment on the PREVENTION article too! it is on page 2 of the comment section!
Thank you for providing a detailed analysis of generic vs. name brand drugs. I’ve always been suspicious of the generic vs. name brand product thing. Always made me think there are pharmaceutical companies pushing this “researchâ€. However, your inflammatory comments towards the woman with epilepsy are uncalled for. Yes, seizures are unpredictable. They can happen anywhere and anytime. It sucks and I know it too well (as an “epileptic†of course). I’ve searched around and found a great team of pharmacists I’ve been working with for many years. Pharmacists are an excellent and underused resource that have clarified so much information for me. I know this is true for many others. Your comments though totally put me off. Wow.
For fucks sake, I can’t go a day without some pussy slinking through here and showing us how much sand they can cram in their vagina. No matter what demographic I make fun of, you can get your fucking ass one of them is gonna find their way to this site, read the comments, and be mad for no reason.
Get the fuck over it. If you can’t get the fuck over it, get the fuck out.
FYI, they also put it on MSNBC…fools that they are. Look at the caption to the picture up on top.
“Some pharmacists legally switch a drug prescribed by a doctor in a common practice called therapeutic substitution. The new drug is in the same class as the old and treats the same condition, but it’s not precisely the same medication.”
I would bold the part if I knew how to, but saying that the new drug is in the same *class* as the new one is just plain bullshit. It’s the GENERIC substitution. I know the P & T committee at the hospital I work at makes THERAPEUTIC substitutions, but I’m 100% positive no sane pharmacist would make a THERAPEUTIC substitution when doing outpatient prescriptions. Ugh, terrible research and terrible journalism. Unless the respective state boards allow this, it’s impossible unless it’s at an institution.
The same Prevention article just got posted to MSNBC. :
http://www.msnbc.msn.com/id/30627962/
This article made it to the front page of Digg, and I’m proud to say that all of the comments I read called bullshit on the article and stood up for the pharmacists. I commented myself and left a link to your blog post there as an example of therapeutic vs. generic substitution.
I just swap everything for aspirin, and for the under 16’s paracetamol suspension. It’s much cheaper than all these over priced anti-cancer/seizure/clotting/hypertension medicines that the doctors prescribe these days, cant see what all the fuss is about.
Prevention has been the National Enquirer of health care magazines for years. The source of the “cure of the month”. Funny, after the sensational article claiming to save lives by the thousand you never see another mention of said cure. I wonder by the examples given, all brand to generic, who the main advertisers in their rag are? Can you say Big Pharma? I wonder if the author did his own “research” or just let someone feed him the info right out of the why generics are evil handbook.
This sounds like a similar article in SELF magazine. http://www.self.com/health/2009/06/dangers-of-generic-drugs
At least two people seem to agree not to blame pharmacist for everything.
I don’t know whats going on here i took my first generic esi lederle protonix today unknowing that it wasnt the wyeth brand i have been beating my self up all day trying to figure out why i am having an allergic reaction. My eyes swell my eyelids rash it is really bad i have to take steroid pills for a week after this happens i am allergic to acephex, prilosec, prevacid, and nexium and protonix is the only one that works for me. I take generic leviothroxin and thats fine i have no problems with a generic i prefer them they are a lot cheaper but i guarantee you just because this pill says protonix it is not the exact same ingredients it has something in common with the other ppi’s i am allergic to. what i want to know is how this change happened i have been using the same postal perscription service for years and they and my insurance company know how serious this is.
First off — why in the hell would you seek professional medical help from a blog? Probably because you know that I won’t skip a chance to make someone look dumb. Anyway, there’s no factor that makes a drug “generic” verses brand name. Like…you can tell that a soda is generic due to a lack of carbonation or something. They don’t add something to them to make them inherently more shitty…
It’s most likely that you are allergic to the whole fucking class of PPIs. Of course, there could also be a common inactive ingredient. Let’s compare.
Active Ingredients: Rabeprazole Sodium 20mg
Drug Description: yellow, round-shaped, side 1:ACIPHEX 20
Inactive Ingredients: Carnauba wax
Crospovidone
Diacetylated monoglycerides
Ethylcellulose
Ferric Oxide
Hydroxypropyl Cellulose
Hypromellose Phthalate
Magnesium Stearate
Mannitol
Monoglyceride
Pruv
Sodium Hydroxide
Talc
Titanium Dioxide
Active Ingredients: Lansoprazole 30mg
Drug Description: black, opaque, pink, oblong-shaped, side 1:TAP PREVACID 30
Inactive Ingredients: Acrylates/Methacrylic Acid Copolymer/Polymethacrylates
D&C Red No. 28
FD&C Blue No. 1
FD&C Red No. 40
Gelatin
Hydroxypropyl Cellulose
Magnesium Carbonate
Polyethylene Glycol
Polysorbate 80
Silicon Dioxide (Colloidal)
Starch
Sucrose
Talc
Titanium Dioxide
Active Ingredients: Esomeprazole Magnesium 40mg
Drug Description: purple, oblong-shaped, side 1:40mg
Inactive Ingredients: 1-Butanol
Acrylates/Methacrylic Acid Copolymer/Polymethacrylates
D&C Red No. 28
D&C Yellow No. 10
FD&C Blue No. 1
FD&C Red No. 40
Gelatin
Glyceryl monostearate
Hydroxypropyl Cellulose
Hypromellose
Isopropyl Alcohol
Magnesium Stearate
Polysorbate 80
Polyvinyl pyrrolidone
Propylene Glycol
Shellac
Sodium Hydroxide
Talc
Titanium Dioxide
Triethyl Citrate
Active Ingredients: Pantoprazole Sodium 40mg
Drug Description: yellow, oval-shaped, side 1:PROTONIX
Inactive Ingredients: Acrylates/Methacrylic Acid Copolymer/Polymethacrylates
Calcium Stearate
Crospovidone
Ferric Oxide
Hypromellose
Mannitol
Polysorbate 80
Povidone
Propylene Glycol
Sodium Carbonate
Sodium Lauryl Sulfate
Titanium Dioxide
Triethyl Citrate
I’ll let you do the comparing….
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