Scaring a doctor shopper straight before it’s too late
Young lady brought in a prescription today for #14 Vicodin. I'm not sure why doctor shoppers haven't figured this out yet, but one of those ignorant comments you make is, "I DON'T WANT THIS RUN ON MY INSURANCE!" That comment immediately raises my suspicion level.
Now, this young lady didn't say that -- it was a variant that can be equally suspicious, "How much does this cost? Cash Price. I no longer have insurance." The fact someone says this isn't always suspicious, but the fact she said it twice (and awkwardly at that) did set off my bullshit detector. She told me that she wasn't on file -- luckily she was -- and lookie there....A MEDICAID CARD! I, of course, didn't tell her that I had this information.
I ran it, and low and behold, it rejects. I call up Medicaid to inquire about doses, quantities and where. They tell me a Norco 7.5/325 #90 (30 day supply) filled at a nearby CVS about 14 days ago. [The Medicaid agent gave me the Fraud Line and urged me to call. She also said that the new Rx could be filled in NINE DAYS based on carryover days, etc.] The Vicodin prescription was written 4 days ago. I called CVS, verified Name, birthday, medicaid ID number, and made sure it was picked up. Now, we have a problem.
I wrote her Medicaid ID number right next to her name (very big). I also wrote a note explaining the entire situation on the face of the full page prescription. When she came back to pick up the prescription, we had the following exchange:
[The most unfortunate thing here is that while the following is occurring, there is a 4 or 5 year old little girl stumbling around in front of the pharmacy munching on a cherry Dum-Dum I had given her...unable to comprehend the gravity of what was going on in front of her...the mistakes her mother was making before her eyes.]
"We have a bit of a problem here. We had you on file, and we happen to have your Medicaid Card and ID number on file. As we ran this it came back that it was a refill too soon and duplicate therapy."
"I don't have any insurance or medicaid. I didn't fill anything at CVS..."
"Stop lying to me. I called Medicaid and they told me that #90 Norco 7.5/325 tablets were filled at CVS 14 days ago. I called CVS and verified this information. They also checked the signature logs and found your name signed to the electronic pad. Now, if you genuinely have no idea how this prescription got filled or what is going on here, I can pursue this matter further. However, if you are lying to me, of which I have ZERO reason to believe you are telling the truth, this will end very badly for you."
"No Sir. That won't be necessary."
"I was told by Medicaid that you can fill that in 9 days. I wrote that date on the prescription along with a little note in case you decided to try and take it anywhere else. I've also notified the area hospitals, clinics, and pharmacies through our area 'doctor shopping fax tree.' I also have no choice but to call the Medicaid Fraud Line and notify them of this. I hope these measures prevent you from making any more attempts to acquire controlled medications. Up to this point, you haven't been caught. In the future, you will get caught, and what you are doing is a felony, and it's fraud. Now, for your young daughter's sake, I would hope you turn over a new leaf."
"I will. I promise. You don't have to worry about me ever again. You don't have to call anyone about me. I'm sorry. Thank you. Have a nice day...." [And she scampered off as quickly as possible with her daughter in tow.]
For what it's worth, I did not call any hospitals, doctors, or clinics, and we don't have a "doctor shopping fax tree" (but now that I invented the idea of it, it sounds like a great idea!). I also have no yet called the Medicaid Fraud Line because I was on hold for more than an hour (I left it on speaker), so I gave up and hung up. I said all that stuff in an attempt to scare a 23 year old girl back onto the straight and narrow path. Maybe it was too harsh. Maybe I was wrong in doing all of that. What do YOU think?
You do NOT have *that* right
I'm filled with passion about many subjects. Not to the least of which is our wonderful country, the glorious United State of America. We are all blessed with rights, freedoms, and privileges that those from other countries can't even fathom. We are blessed to a degree that other countries are jealous of what we have -- jealous to a degree that they desire to hurt and kill us. I believe that our disregard for that which we have is one of the most disgusting things on the planet. While some walk miles for mildly clean water and may make a dollar a day, several times a day we go into the next room and piss into clean water and spend hundreds of dollars per MONTH on bottled water-- which is really no better than that which comes out of that silly faucet. We take for granted minutiae that others would die for the right to enjoy.
A few days ago was Halloween. Another right of passage for the American childhood. The under thirteen crowd walk around with Mom and Dad to all the neighbor's houses for goodies and sweet to rot away their teeth. The over thirteen to eighteen crowd is, of course, too cool and too old to trick or treat, but they want to enjoy the atmosphere. They want to be out and about on Ghoul's Night. They do what we all did -- toilet paper and/or egg friend's houses.
This time, however, one of these little bastards went too far. I was on my way home from work. It was about 4pm on Monday 11/1/2010 (A binary day!). Cold but still a bit a daylight left. I was making my way through my little town's Memorial Park -- all towns have them these days. A quaint little square for public use. There may be a little bit of playground equipment. Trees. A sidewalk path next to a dirty pond, perhaps. But, the hallmark of the Memorial Park is the source of it's name -- the memorial. This is usually in the form of a retired fighter jet, a huge tank, or in my town's case, both. I live in a small town -- actually, I live miles outside of it. It's like Mayberry. The population is about 5-600. There's not a lot of business -- just a gas station where the old men hang out and drink coffee from 4am until they hit the fields, a hair stylist place, a daycare, and a mechanic. The closest big town (population of 13-14,000) is 15 minutes away. That's the nearest grocery store / Wal-Mart.
So, you get the picture. It's a town full of pride. Everybody knows everybody. Everyone would give their neighbor the shirt off their back. I'm new to the town as we moved here about 5-6 months ago. I'm probably still known as the "snotty pharmacist" as I haven't gone out and made a huge effort to inculcate and meet lots of people. They have a Mason temple -- maybe I'll join that and meet some friends.
Anyway, as I drove through the Memorial Park that day, I saw that the entire park had been "rolled," if you will. It was hanging from all the trees. There must have been a hundred rolls used. The town only has one cop and the sidewalks roll up after 9pm, so if these punkass kids did this after midnight, there's a good chance that no one knew/saw except them and God himself. Now, what burned my ass up was the face that they covered the park's tank in toilet paper. Secondary to that -- why was this not cleaned up by the townspeople sooner as it's now 4pm. I screeched to a stop and parked next to the tank -- I snapped a picture with my cell phone planning on sending it to the newspaper with some commentary. Parents should be ashamed if their children were responsible for this. Perhaps a rant on patriotism. And definitely a photo of the tank cleared of all disrespect (while adjacent trees still bear the evidence) -- showing that I still have a shred of passion for this country and respect for the icons that made it what it is.
As I climbed on top of the tank, I wondered how could kids do this? I only have a dog, but she knows better. I guess the fact that these kids have the privilege to walk down the street at midnight on October 31st was lost upon them as they desicrated one of our relics.
Honestly, I think I blame everyone else more than the children. I blame their parents for not showing them proper respect for our country -- probably by talking on their cell phone during the national anthem or taking their own freedoms for granted. I think I blame our school system by not instilling that fire in them. Sure, they may say the Pledge of Allegiance every morning, but did we teach them what the words mean? You can read Shakespeare all day but if you don't learn what the words mean, it's useless.
So, parents out there. Instead of raising little bastards like the people in this town. Please teach your children to be respectful off all that we enjoy.
Why APhA Sucks
APhA - American Pharmacists Association - "Improving medication use. Advancing Patient Care." - Dictators of coveted domain "Pharmacist.com"
We all know they suck...but do you know why?
Is it because they are pushing all this clinical pharmacy/residency bullshit down the throat of our schools and therefore our students? Well, yeah.
Is it because they promise to lobby for pharmacy but refuse to accept that retail pharmacy is the backbone of our pharmaceutical (and entire healthcare) system? Well, yeah.
Is it because they have yet to use the power of the pharmacists they represent to achieve the goals they haven't yet set for themselves (because they failed to see the necessity)? Well, yeah!
Is it because they have taken the money of pharmacists across the nation (in the form of dues) and rather than benefit the profession, adequately lobby Congress for ANY change, or fight for pharmacists working 12+ hour shifts without a break (all the while attempting to ignore it's even pharmaceutical care in the first place) they have let the PROFESSION OF PHARMACY become a demeaning JOB? -- Where the community expects it in 5 minutes, for $4 (or free), and to be given a $15 gift card for their trouble? WELL, YEAH!
Is it because they thought it appropriate to waste time and money on THIS STUPID BULLSHIT? Oh, you'd better fucking believe it.
APhA - you had your chance. For fuck's sake, you've been at it since 1852. Now, I will admit, pharmacy has changed for the better. You might have played some role in the changes over the past 20 or so years -- you sure as shit will claim them as your victories. But, for right now, you aren't doing anything.
You've become worthless.
You've allowed yourself to be so focused on expanding on facet of pharmacy, clinical pharmacy (to you "better pharmacy"), you've completely forgotten to take care of the boys in the trenches -- retail pharmacy -- WHERE YOU FUCKING STARTED AT!
Well, now you've been weighed, you've been measured, and you have been found wanting.
There's somebody new in town. The Pharmacy Alliance knows what we want. It also knows how to get there -- utilizing the power of each individual as the source of strength for the whole. You may be the big dog right now, but guess which type of pharmacists make the most money? That's right -- the ones that you have scorned, ignored, and left for dead.
I gave you a little coin in the past. I regret that now -- seeing that you used it to make stupid ass videos and pander to your special BCPS buddies. Instead of give that little to you, I'm giving a lot to TPA (once they get that whole 501c3 thing sorted out of course...:-)
Sincerely,
TheAngriestPharmacist
PS - I realize the irony that I was moonlighting as a clinical pharmacist. My buddy's vacation is over, he's back from Midyear, and that has come to an end. They offered me the job, and I didn't take it. I'm a Retail Pharmacist, bitches.
PPS - I'd like to thank Tom, loyal reader and pharmacy student extraordinaire, for pointing this ATROCITY out to me.
The longer I typed on this, the more I RAGED
Imitrex (Sumatriptan) 100mg Tablets #9Â ---- $250.84
-Exclusivity Patent runs out Feb 6, 2009
Treximet (Sumatriptan/NAPROXEN) 85/500mg Tablets #9 ---- $222.72
-Approved April 15, 2008 - Exclusive for 3 more years on combo.
Well, Imitrex is going off patent, and Dr. Reddy's is itching to get into that generic migraine therapy market that is currently absolutely DOMINATED by ridiculously expensive name brand medications. As you can see above, these fucking things are $27 PER TABLET. As you might have expected, now that Imitrex is going to have an AB-rated generic equivalent, it is complete junk and no longer efficacious for migraine headaches (with or without aura).
So, what comes to mind when you see what GlaxoSmithKline is doing here? To me, I think of the assraping of American citizens that are already struggling to make ends meet in a time of economic hardship. I think of GSK playing tricks on Americans that may not have as much education as their local pharmacist. I see that GSK knows that people who are suffering from migraines will pay anything to no longer be suffering from migraines. They are banking on that fact. Now, they are hoping that maybe just once, Imitrex didn't provide you full relief -- just enough of a chance to get you to call up your doctor and ask for a prescription for that new drug, Treximet, that you just saw on television. [I've seen Treximet ads on 5 different channels today.]
Ya know, I wouldn't be surprised in the fucking LEAST if GSK hasn't been slowly dropping the potency of Imitrex tablets over the last few months -- in hopes that their migraines won't clear up and they'll seek out a new therapy.
But TAestP, WHAT IF TREXIMET REALLY IS BETTER????
I don't doubt the efficacy of Treximet. But, I have a few insights here. Does Naproxen alleviate your migraine symptoms? I'm sure you tried it initially as it's in every major migraine algorithm after Acetaminophen and Ibuprofen. If you're taking Imitrex, that probably means you failed Naproxen therapy. So, why are we adding it back on board now?
Does anyone know how much Sumatriptan tablets are going to cost? It doesn't really matter exactly how much they are going to cost -- we know that the generic is going to be cheaper. We also know that NAPROXEN IS DIRT FUCKING CHEAP. So, once again, big pharma has taken two seemingly inexpensive drugs, combined them, called them gold, and made them just as expensive.
Here's a few notes I'd like to share:
- Clinical Pharmacology lists "Krymchantowski AV. Naproxen sodium decreases migraine recurrence when administered with sumatriptan. Arq Neuropsiquiatr 2000;58:428—30." as a source for why the combination is better. What's wrong with this study? Well, how about the fact it was tested in 67 (56 women) people by ONE researched in RIO DE JANEIRO. It's way too brief. The methods are weak. It is a poorly done study.
- Also listed as a reference is: "Brandes JL, Kudrow D, Stark SR, et al. Sumatriptan-naproxen for the acute treatment of migraine: a randomized trial. JAMA 2007;297:1443—54." -- This one is cited because it shows that 'more patients had sustained pain free responses 2-24hrs after the dose with decreased recurrance rate in combo vs either drug as monotherapy or placebo. I didn't even read this study -- I flipped to the back page, as I always do, and saw all that I needed to see.
Funding/Support: The 2 clinical trials (MT-400:301 and MT-400:302) described in this article were funded by GlaxoSmithKline in partnership with POZEN, the IND sponsor of the investigational drug MT-400 (sumatriptan–naproxen sodium).
Role of the Sponsors: GlaxoSmithKline and Pozen Inc provided financial and material support, monitoring, data collection and management, and data analysis to the authors and study investigators.
In case you were wondering, POZEN INC is a puppet company of GlaxoSmithKline. And, as you can see, they performed the ENTIRE FUCKING STUDY.
Also of note regarding this filth of a study fabricated to bilk money from the American people, of the 10 'researchers,' two admitted to working for 'Pozen' and two for GSK --- all of which work in Chapel Hill, NC.
-The final study listed in ClinPharm boasting this drug is merely a safety and tolerability study. Well, fucking duh this drug is tolerable. How often do you think people need to take Sumatriptan? Once every other day? Once a week? Heck, the max daily dose is 2 tablets. So, the most Naproxen you could get is 1000mg -- a normal daily dose -- which wouldn't be ingested that often. Of course it's safe.
Of course it's non-inferior. Of course it's safe. But, is it cost effective? No. It's not. Because you motherfuckers at GSK have no fucking morals. You're soul-less pieces of deep fried pig shit, and I hope all of you get the pleasure of having Alzheimer's as you age. You all deserve to be beheaded on Al-Jazeera. You're nothing. You're wastes. I wouldn't shit on you if I got paid a million dollars to fill "2Guys1Face." I hate you more than I hate everything else combined. I just wish that there was some way I could just remove the money from you via osmosis and have you thank me for it -- much like the unsuspecting public is doing now.
You may give them a $20 coupon or even a few free pills, but I'm hip to your game GSK. I'm not gonna play. My pharmacy will NOT carry your product. My pharmacy will NOT dispense your product. If someone brings me a script for this bullshit, I'm going to be having a conversation with a doctor. I'll end up filling two prescriptions and having a little education session. I just pray that you don't send some fucking big-tittied Treximet Drug Rep to me. That bitch will leave in tears...
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