This is a guest post from a technician known for now as J.S. -- s/he will be responding to all comments as necessary. Should you want to send a private email, please use the CONTACT Page and I will forward it on to him/her.
"REFILL TOO SOON," GUYS. That means, in pharmacy lingo, your insurance will not pay for your prescription until the resubmit date. One late night at the pharmacy, which by the way is in the ghetto, a woman comes in to refill her son’s prescription. As I processed the prescription I explained to her that it is a REFILL TOO SOON and the insurance wouldn’t pay for the refill until tomorrow morning. She obviously wouldn’t accept that answer and went into a rant against me (a technician), the pharmacist working with me, and our drug store. As I recall it went something like this:
“My baby needs his medication! He is sick! He needs it NOW!!!!! You stupid white bitch you had better fill my prescription or im going to kick your ass! Her's too. That other bitch pharmacist! What you think yous better than me? I want it now! Ima get me suma that shit now and my momma gon' pay for it! Make it now! Get it ready, Bitch!”
I looked at her, looked at the pharmacist, and explained to the woman that if she would WAIT ONE MORE DAY [less than 18 hours, actually], the prescription wouldn’t have copay because this woman was on state assisted insurance.
I told her that the medication would be $45 and if she wanted it, she could pay for it, but that amount wouldn’t be refunded the next day. Her response, although not responsive to the information, went something like this:
“What you think I’m broke, bitch? I can’t pay for my babay's medicine? Fuck you ima just buy it ima just buy it you can’t tell me what to do, this my babay, THIS MY BABY AND HE NEEDS HIS MEDICINE NOW GET IT READY DUMB BITCH.”
You're not broke? Oh, okay. Then I guess you’re just one of those lazy folks who doesn’t work and just expects the government to pay for your prescriptions. I can safely assume you are probably on food stamps too? Welfare? You're yelling at me, and I am partially paying for your prescription by paying taxes? I have no choice but to have my tax dollars used to pay for “your babay's medicine,” and I have no choice but to abide by your every wish and want because 'the customer is always right,' right? So, I swallowed my insults, and I bottled my anger, and filled the prescription.
By this time, her mom (the "babay's" grandma) came to the counter and apologized profusely with the accurate explanation that woman was mentally retarded. MENTALLY RETARDED. And she has children? What the fuck. You can draw your own conclusions on that one. And by the way, after all that, she didn’t, or better yet, her mom didn’t buy the medication because she, having some sense about her, WANTED TO WAIT UNTIL THE NEXT DAY. By the way, the drug was for SEASONAL ALLERGIES. Not seizures, not juvenile diabetes, not horrible psoriasis, not dangerous asthma, not epi or glucagon. SEASONAL ALLERGIES. Couldn't wait 18 hours, and *I'm* the dumb bitch.
Do you want to submit a guest post [since I don't post nearly enough]? Type it up and email it to me via the same contact page. Also, let me know if you want your name/email address shared publicly, what POLL question you would like to accompany it (if any), and anything else you think is important. Guest Posts will be edited for grammar and spelling. I may also add emphasis, clarification, funny links, or other silly stuff [I might remove inappropriate stuff as well]. I will NOT alter the content/message of your post.
I got the following email from "Pat" concerning a "pain contrtact." One side of me wants to say, you're an addict and you need help from a few different doctors. One side of me wants to say this poor woman's pain is being under treated by her physician. Still yet, one side, the prevailing side, doesn't give a flying fuck. I present this email for your amusement. Readers, please tell her what you think. I get so many emails/contact notes from folks like this, that I no longer take the time to respond. It is up to this community to cull its nuts.
From: pat <firstname.lastname@example.org>
Subject: Pain Contrtact
it is with deep shame, and not a little fear, that I compose this message. I'm a woman in her late thirties, and I'm a Pharmacy Tech. I also suffer agonizing migraines. I have a PCP that I see, weekly, and I receive Rxs for #14, 40mg. Oxycontin, and #42, 20mg. Roxicodone, for BT pain. My visits are always EIGHT days apart, NOT seven. But, no matter how many times I explain the numbers to my M.D., she won't up the Script #. Tonight, I found a several months old Rx for "Percocet", 5/325, literally in a cookie jar. I KNEW it was wrong, as I have an Iron-Clad contract w/ my doc, but I did it anyway. I went to a NEW Phramacy, paid cash, and got the script. I feel like even lower dirt, b/c the RPh was SO nice and understanding; I felt like a heel misleading him. I have a question for you, sir: will this Rx show up on my profile at my reg. Pharmacy, since I didn't use my usual insurance? I asked my DAd, who is an RPH, and couldn't get a straight answer (he refuses to touch, or even discuss my meds). If my doc finds out, she'll kick me out of her practice-- and narcotic meds are the ONLY thing that make life bearable for me right now. I KNOW I should have thought of that BEFORE I did this, but, now, I need a truthful answer from someone I truly respect. Am I in horrible trouble? I am SO SCARED.
Thank You, PAt
This was emailed too me and seemed quite compelling. I don't have much to add to it except my curiosity. I was hoping to present this to the community and see what your thoughts were. Please share them with me (and the author).
From: leon <email@example.com>
Subject: too many incompetent foreign graduates
I am sorry to switch gears on you, but I felt the need to address another issue in the field of pharmacy. As most pharmacists already know, it is very tight job market out there. When I graduated, it was completely the opposite. Sign-on bonuses were common and hourly rates were very negotiable. Most employers were willing to train old and new pharmacists from the very beginning. Fast forward a few years later and all those jobs have practically vanished. Without networking, it is nearly impossible to get your foot into the door.
While I have been fortunate enough to find another job in pharmacy, I noticed a disturbing trend. Generally speaking, I will say most of my classmates were competent pharmacists. They were hardworking and eager to learn and keep up with the latest drug therapies. As I worked in the real world, I noticed some really ignorant and incompetent pharmacists. These pharmacists would not know the difference between Keppra and Keflex (no, I am not kidding). These pharmacists could not tell you the names of other drugs in the same family (ACE inhibitors, ARBs, Cephalosporins, Fluoroquinolones, etc). They could not even tell you the generic name of a drug, much less if there was even a generic on the market. Worse, I started catching their prescription errors on a regular basis and had to explain to customers why our pharmacy was making mistakes. My technicians would tell me, “That floater we had yesterday was dumb as hell. He was asking me questions about drugs.” My other regular pharmacists would shake their heads in disgust after seeing the kinds of mistakes that were being made.
Who are these pharmacists? Foreign graduates. I spent 6 years getting my Doctorate of Pharmacy degree. By contrast, most of these foreign graduates spend only 4 years in school. Unlike most medical schools in foreign countries, pharmacy schools outside the United States are basically looked down upon in their respective countries. Part of the reason is because the education is lacking and does not challenge the prospective student. A pharmacist in China, for example, would make little money and he or she would be working every day to make ends meet. As for a place on the healthcare team, you can forget about it. Pharmacists in other countries are poorly thought of and would not be considered true healthcare professionals. On the other hand, getting into a medical school in China is very difficult. After one enters and graduates from medical school, he or she would still be required to perform a residency in the United States for a minimum of 3 years. Despite all of this, it is apparently pretty easy for a foreign graduate to get a Pharmacy License in just about any state by taking a couple of simple exams such as the Foreign Pharmacy Graduate Equivalency Examination and a Test of Spoken English. Throw in a few hundred dollars and you basically have bought a Pharmacy License.
The biggest consequence in all of this is the rise in prescription errors. I have seen it over and over again at different pharmacies and settings. These pharmacists and pharmacies are a danger to public’s health and safety. Another effect these foreign pharmacists are having is that they are over saturating the job market. I can live with the fact that another pharmacist gets the job I was looking for. There are many competent and very good pharmacists out there in the marketplace. They are mentally very sharp and do their job very well. However, when I see a pharmacist make errors repeatedly, I start thinking to myself, “How can this person not know what they are doing? Where did this person even go to school?” And on most occasions, he or she did not attend a pharmacy school in the United States.
At the end of the day, this country needs to stop just handing out Pharmacy Licenses to anyone who claims to be a pharmacist. A pharmacy education in foreign countries is not equivalent to a pharmacy education in the United States. I am sure there are exceptions to the rule. I am certain there are some highly motivated foreign graduates who proved themselves over and over that they are more than qualified to handle the responsibilities of a pharmacist. I just have yet to see one such pharmacist. In my experience, some schools do a better job of putting capable pharmacists onto the marketplace (UCSF seems to do a good job, in my opinion). Personally, I think all foreign graduates should have to attend pharmacy school in the United States in order to acquire a Pharmacy License (a 3 year or 4 year Pharm.D program). Before someone thinks I am too eco-centric, I was actually born in another country, but I grew up here in America, and English is my primary language. And yes, I am a United States citizen. I just think our profession needs to have a serious discussion on what a pharmacy education in the Unites States is really worth before it is too late.
BEFORE COMMENTING READ THIS:
TheAngriestPharmacist did NOT write this post. He has not commented about the validity, certitude, or accuracy of anything written in the post or in ANY of the comments. Please stop submitting comments accusing TAestP of racism, discrimination, or having anything to do with this post. I only posted this because the author asked to use my site as a place to reach many pharmacists. I will not post accusatory comments about myself. I will delete them and ban the author from the site entirely. If you have an opinion, feel free to post it. Keep the other pointless shit off my site.
I got the following message from Steve Moore, an independent Pharmacy owner. I wasn't sure what to do with it or how to share it with the world. Therefore, I'm just going to post it here for all to see. I'm not going to post his contact info, but he's welcome to post that in the comments section (as well as links and references).
My name is Steve Moore and I am an independent pharmacy owner from New York. I am wondering if you would consider sharing your thoughts on the following topic, one I think that most pharmacists would be interested in.
When it comes to business side of our profession, most pharmacists don't have a clue as to what is going on. As an owner, it affects me more than most, and I don't comprehend all of the complexities. After speaking to some other pharmacists in my area, I came to realize that they are under the impression that mail order pharmacies were simply discount pharmacies, that mail order just filled prescriptions at a lower price than retail pharmacies. That may or not be true, the larger issue is that mail order pharmacies are able to offer deeply discounted medications because they are purchasing medication a better price than retail pharmacies. PHARMA grants them a special class of trade (COT). I attempted to find a law/rule/etc that grants mail order pharmacies these special buying privileges as a different COT and was unable to do so. I wrote to consulting companies and wholesalers and I was told that there is no such list. If there is no government approved or provided COT list, what makes mail order special other than the fact that PHARMA says so?
My question is, if mail order can do it, why can't community pharmacy designate itself as a special COT? Mail order promotes safety and accuracy, we have a robots and workflow too. We can fill antibiotics and pain meds, mail order cannot. We can deliver meds the same day, mail order cannot. Mail order simply cannot meet 100% of our pharmaceutical needs. If any group deserves a price break from PHARMA, shouldn't it be the group that can meet more needs?
There is a federal law known as the Robinson-Patman Act which specifically prohibits companies from selling the same products to competitors at different prices (order of magnitude wise). Exemptions to this act exist to allow nonprofits (such as hospitals) to purchase medication for their own use at a discounted price. In addition to the hospital COT, there is a 340b class (for now), a long term care class, and depending upon who you ask, anywhere from 7 - 23 classes. The one constant is that the retail pharmacy COT pays the most for medications. COT designations have been challenged in the past but were usually lost on the basis of own use. That meaning, the nonprofit was purchasing medications to use for its patients/employees/etc and was not in competition with retail pharmacies. Mail order pharmacies are for profit and are clearly competing with retail pharmacies, so in my mind a Robinson-Patman exemption should not apply. I understand supply and demand and that some people can pay more than others for the same product, but we are not talking about a few bucks here and there, rather exponential differences. The local hospital pays about $9 for 100 tablets of brand name Coumadin, what does the price sticker on the bottle in your store read?
The fact that mail order pharmacies are buying medications at a lower price than retail pharmacies has an impact on every pharmacist filling 90 day prescriptions at retail for mail order rates. I am not saying that if reimbursement improves, working conditions will improve, but it can't hurt to make pharmacists aware of what is going on. I have contacted our trade associations and industry publications but am also reaching out to bloggers such as yourself. If you feel that this may be something you would like to blog or post about, I can provide some links and references.
Thanks for your time.