Logical Rage

Posted by The *Angriest* Pharmacist as Courtesy, Drug Seekers, Insurance Companies, Just a question, Lazy People, Me being a dick, Me hating others, Patient Education, Rude, Stupid People, True Story, Work Sucks

I’m sitting here desperate to post something. I’ve literally stared at this empty text box for going on 10 minutes. All I’ve typed amounts t0 25 words…no 29…wait, 30.

My thoughts have staggered and stammered here and there, back and forth. I started to post about a lady, angry at me because she had to drive 8 miles both ways twice because her doctor’s office sent in 1 eRx at 1pm and another at 5:45pm….totally my fault. She also had to wait each time. Totally my fault. What was her gripe? Gas money. Gas money? I drive a car that get’s 26 miles per gallon. Even if she drives a truck getting 16mpg, she’s out what? $2.50 — That’s the cost of being sick. Going to the doctor and then them being inconsiderate and doing a crappy job at clicking OK.

I also thought about bitching about that same doctor’s office sending ALL their eRx’s for the day at 5:45pm — when my main staff was all gone and I had around 50 prescriptions to process with a young, untrained, skeleton crew at best. One called in sick. It was loads of fun. I (and every other pharmacy) let them know of our displeasure with that practice and how it would stop. I went as far as telling them I would make it known to their patients that if they continued that practice, having no respect towards my staff and business practices, those prescriptions would not be filled until the following morning. [Which is of course bullshit. I would just have 2 or 3 hour waits -- finishing most sales and Rxs up after close]

I’ve also, for a long time, wanted to write a post about some weird ambitions I’ve had for some time. I’ve considered converting some of my stories and anecdotes into a short comedy routine / spot and going to an open mic night somewhere. I know it sounds absurd. I’d probably bomb.

Ya never know though. I’m a funny guy outside of my serious job. I can make up bullshit to make people laugh on the spot. But, can I make pharmacy funny? Can I convert my anger, hostility, and, most recently, pain, into something enjoyable? Something to brighten someone else up? As a reader, you might quickly say — “c’mon of course you can this shits hilarious dood!” And it is…to us. The average reader reads my stories an empathizes with my plight. Can a layperson empathize? Can they even sympathize?

It’d be much easier to convert to a tv show…like “The Office,” which is perhaps one of my most favorite shows. Or perhaps a different concept. Maybe three short 8-minute episodes in a half-hour spot. Pharmacy is 15 minutes or less anyway right?

So, whose going to pay for her fucking gas money? I don’t know what hit me in that moment, but I was struck by the rod of golden logical rage.

“Who’s going to pay for your gas money? Well, I guess I will. But, from now on, I’m going to start charging you for all the free services I once provided. Next time you have a question about whether you should take APAP, Ibuprofen, or Aspirin, call me with your credit card number ready, and I’ll be glad to help. When your daughter has the flu and you have no clue what to do with the 7 different types of Triaminic, Tylenol Cold, Tylenol Sinus, and Motrin Cold and Sinus you have in your closet, I’d be glad to help you for a price.You see, you expect me to always be here for you — always free. You pay for your prescriptions, yes, guaranteeing you a certain set of specific services, but I’m so much more to you — whether you realize it or merely respect me so little you don’t care. I’m your “doctor said” fact-checker, your pill identifier, your prescription insurance problem finder AND fixer, your store-next-door-phone-number finder, your late-night fever buster, your icky medicine flavorer, your idea man for reducing rx costs. Always there….a phone call away. Do you really want to bother me with 3 dollars worth of gas? Is it so important to you that you simply must rant and rave until I dig a few dollars out of my pocket? I thought not. ”

PS — Go check out THE RAGING SERVER. He’s back and cooking up some good shit…

PPS — Since it’s the Christmas Season, T-shirt sales have shot through the roof. Apparently, pharmacists enjoy getting bomb ass shirts for Christmas.

The *Angriest* Pharmacist Store

Why Would I Lie?

Posted by The *Angriest* Pharmacist as Courtesy, Engrish, Insurance Companies, Laws, Me being a dick, Me hating others, PHARMACY SECRETS!, Patient Education, Rude, Stupid People, Technicians, True Story, Work Sucks

I hate how several times per day I find myself in a situation where the only possible outcomes in the mind of the patient is that I am either A) Idiotic and know nothing about what I’m talking or B) Lying.

For instance, a patient approached today (who was confrontational from the get-go) and told us he wanted all of his medicines filled as a 90 days supply rather than 30/month. I’m more than happy to do that. DUH!! Our profit margin is usually better on 90 days– especially if it is a generic drug or one of Wal-Mart’s famous 4-dollar respect killers. [One dispensing fee, one label, one count, one check, one vial/lid -- it's savings all around!]

The older gentleman, of course, had already called his insurance company and “Nancy” told him that he certainly could get ninety days for 3 times the copayment of one month. Guess what…Nancy was wrong.

The patient knew that this would happen though — Nancy told him so! Nancy told him that the Pharmacy would merely have to call after getting the rejection and the insurance company would input a code. Right…insurance companies are constantly helping people out, giving out correct information, and speaking English in an understandable accent!

At this point, my tech told him that she thought our keystone tech called the insurance company yesterday and confirmed that the 90-day option was a fallacy. He would have to use their mail order pharmacy. Whoever Nancy is was wrong or he misunderstood. This did not sit well with him — and he did what patients always do: act like an asshole and reduce yourself to the level of merely a customer.

He looked me in the eye and told me, “Now, lookie here. Ya’ll gun’ call that inshowance cumpny right herre an’ now to have’m put dat 90 day in der or he wuz gun’ take his bidness to ‘nother fahmucy that’a doo wut he say.” — This of course did not sit right.

“Now, you lookee here. There’s absolutely no reason to get nasty and make threats about going to another pharmacy. I understand you want 90 days. You see right here on this rejection that says 30 days max. However, since I cannot confirm or deny that my other tech called the insurance company for you, we will call again. Just hold on for a little bit.”

I called the insurance company. He cannot fill 90 days unless he uses their mail order pharmacy — big fucking surprise. I asked them if there was any way for me to fill 90 at the retail level, and to my surprise, there was. I would have to have the MD’s Office call and get a PA on each prescription (he has 5 total), and they will allow 3 mos.

How many offices will call at 5 different times over the course of 30 days for non-essential PAs for a patient? Luckily, this office has a nurse that will take care of this — she’s very good.

I asked this insurance company to fax me the PA form. He wouldn’t do it. Absolutely refused. The office would have to call, give their information, and have the PA Form faxed to them. Is there a portion for the pharmacy to fill out? Yes: Name, Addy, Phone, NCPDP, NPI, DEA, Rx#, and Signature Line. Why couldn’t he fax it to the pharmacy so I can fill out my portions and forward it to the MD Office? Absolutely not. Did he have a good reason? Absolutely not. He just “couldn’t do it” — or “didn’t want to do it.” Regardless of his reasoning (or lack thereof), I wasn’t getting that damn form faxed to me. Did I mention “Dut Dut Dut.” He called me MA’AM the entire conversation. I faked a very good cry at one point to try and get the form, but he didn’t know what to think. He just feigned empathy and told me he couldn’t understand me! HA!

Back to my original thesis of this post. The patient-turned-customer, holding a copy of the rejection plainly stating “30 days max” from the insurance company, and being told by a technician that a 90 day option wasn’t possible in a retail store, still challenged the facts we posed to him.

The only way he was right in the situation and we were wrong is that we are either OBSCENE IDIOTS or LYING TO HIM for some random, unknown, stupid ass reason. The thing is, we have nothing to gain by not filling 90 days — so that suggestion is asinine. Like I said, 90d in most cases is more profitable. I want to do what patients want if it’s  in their best interests and allowed by governing bodies, insurance companies, and in-line with my professional judgment.

Patient’s need to understand that things in the world, and especially in pharmacy, are not black and white. Sometimes, there is a little gray — a little bit of gray area isn’t the end of the world. Open your eyes and see it!

Customers are like poodles. The world is black and white.  There is no gray. If you even HINT that there is any gray area, what happens? Yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip, yip. Fucking Yip.

What a Putz

Posted by The *Angriest* Pharmacist as Drug Companies, Engrish, Government, Insurance Companies, Me being a dick, Politics, Stupid People, True Story, Welfare

Yup…sure would hate to see that…

To be completely honest, while I have my issues with them, Medicare and Medicaid are well-run programs. They allow their money to be spent all helter-skelter, they are the most efficient programs in the entire government. The overhead of CMS is abysmal compared to your other big players like BCBS, Paid, Anthem, and Caremark.

I’m not sure why the post office is always busy. I’m not sure why the DMV is slow as hell — these are subcontracted out anyway, so blaming the government is stupid. It’s like blaming Dr.Reddy’s for having to wait too long for your Glimepiride in my pharmacy.

• индивидуалки долгопрудный

You can see the video or the original comments in its entirety here. In all honesty, it was probably just a slip of the tongue. But, calling someone else stupid and making fun of them makes me feel better about myself…:-) просмотор порно

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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.