Two months worth of reader email
Sorry, I've been....deficient the last two months. I'm not going to promise any more, but I can tell you this. I will have a response for Mr. Plagakis pretty soon. Don't expect anything revolutionary. Don't expect anything mindblowing. Just expect a clear, concise response. Naught but the truth. I also want to look back at some older posts in which he referenced me about releasing steam (in a hilarious masturbation simile) and how/why the post titled, "Jay Pee catches Wal-Mart peeping through the window" relates directly to all of it...
Below, I'm going to post several different things that came to me via email or the CONTACT link. I'll lead with the user's name, and if you wish to reply to one, just reference that name....or don't...I don't care...
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Liz writes: In the past few weeks, our pharmacy has started checking ID for controlled drugs, scanning in new Rx and scanning in hard copies. All of a sudden, our workload has tripled, but our company is cutting tech help. Is anyone else finding this hard to manage?
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Rodney writes: I work as a reimbursement specialist at an LTC Pharmacy, and I'm writing to share an interesting exchange I've had with representatives at Prescription Solutions over the past few days.
I've had a few basic rejections which, were the representatives at Prescription Solutions even modestly intelligent by today's decidedly low standards, should have been able to resolve with much rapidity. Instead, I got stuck with slack-jawed yokels and embittered, defensive inner-city youth. They turned requests for overrides to simple rejections into drawn out, unintelligible arguments, and once they'd been cornered or otherwise became bored with the exchange, they hung up on me mid-sentence.
I may not be the bubbliest person in the world. On the contrary, I'm frank and to the point, but never did I become enraged, and never did I insult or otherwise disrespect the reps in any way. Prescription Solutions - hell, the insurance industry as a whole - has no shortage of stupid, rude, and disinterested people, but I've never had any with the gall to abruptly hang up on a service call. Now, over the past two days, it has happened to me four times.
Though I feel somewhat vindicated by the fact that return calls yielded exchanges with intelligent reps who applied the necessarily overrides with absolutely no hassle, I am perturbed by this sudden shoddy treatment. I know PS has seen extraordinarily long hold times as of late, what are the odds the reps have been granted free reign to terminate calls from "problem callers" (that is, of course, callers who question the rep's ill-informed initial judgment)?
Any thoughts? Similar experiences?
[TAestP's thoughts: I believe the reasoning behind this is, as always, money. When the question is, "Why?" most of the time, the answer is money. In this case, I'd bet if you timed your calls, you got hung up on at specific intervals....something like 3 minutes, 59 seconds. If the agents keep their calls (or a certain percentage) less than 4 minutes, they probably get higher ratings or a bonus at the end of the day. They may also have rewards/cut offs at 10 minutes or 15 minutes. Of course, the person could have just been an asshole, accidentally hung up, or hung up on you because they are lazy and/or didn't know the answer.]
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Lillian writes: I found your blog a few days ago and I love it so far. From your posts, you seem to know a lot about retail pharmacy so I was wondering if you could answer a question for me: Is it true that the field is getting very saturated, very quickly?
A few of my professors warn us that it will be much harder to find a job in retail by the time we graduate (2016). And I've been hearing a lot of people saying that retail is going downhill.
I know there will be more competition for the jobs in several years because of there are more students going into pharmacy now. And I get the feeling that maybe one of my professors is exaggerating the situation to encourage us to go into other pharmacy fields. But do you think this saturation is something to be seriously be worried about?
For the record, I would try to go into retail no matter what the situation is...I just don't want to be completely caught off guard after graduation.
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Kristin Writes:
Dear TAestP,
I know someone who filled a Rx at a CVS. The pharmacist later called and texted her saying "Remember me from CVS? Would love to get coffee with you some time?--Weirdasspharmacist [sic] " She responded that she wasn't interested. She didn't get any more fills there, but she was afraid of contacting his manager or pharmacy baord because CVS had her information on file and the pharmacist could look it up and perhaps do something scary like stalking.
TAestP, what would you recommend doing?
[TAestP's thoughts: If this is true, it is creepy as hell. You are right that CVS would have the info, and he would have access to it. But, he's already pretty much risked his license by doing this -- taking it from creepy to full on stalking would definitely result in a meeting with his state's Board of Pharmacy. If he is not the pharmacy manager at that location, I would call and speak with the pharmacy manager about the incident. Tell her it made you (or her) uncomfortable and that you would like the manager to give your information to their district manager so he/she can call you at their earliest convenience. Then discuss the matter with the DM. I'd be almost anything this would squash absolutely any issue -- cause that DM does NOT want you making a formal complaint with the board. If he is the manager at that store, call a nearby store's pharmacy manager and do the exact same thing. If this does not get you to an ends that you are happy with -- or you get blown off at any level -- google the state's board of pharmacy. One call to them with an accusation like this would definitely result in an investigation and something would be done. Tell your friend I'm sorry my text creeped her out -- she's not gonna like the photos I'm sending tonight....just kidding of course.....:-D]
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Mike writes: so...i witnessed a patient ingest 90mg of methadone...the patient's prescribed dose was 40mg...i gave him the wrong bottle
i'm getting kicked out of pharmacy school 4 months before graduation...what do i do now? should i submit my resume to the nearest McDonald's?
[TAestP's Thoughts: Either this is untrue and you're trying to waste my time, you're just a general dumb ass, or you have done a ton of other stupid bullshit. Regardless of what anyone may think, there is only one person responsible for what pill goes out the door and into the hands of a patient -- the pharmacist on duty. I don't care if the technician accidentally typed in Oxycodone instead of Omnicef for an infant, I still believe the ultimate responsibility should lay on the pharmacist that verified the prescription. (intentional bullshit and other types of lying and deceit aside -- I'm talking about true accidents by ancillary staff not caught by the pharmacist) However, it does sound like you are in some other kind of facility or setting. Since you witnessed the patient do it -- not sure what that means as a patient should never be handed a pill by pharmacy staff to take -- that changes the role from dispensing to administering which we cannot do (in terms of pills).
If the school threw you out, and this is a true story, you're probably fucked. Sorry dude. I guess you could appeal and plead to the school, but that's the thing with private universities, they can do whatever the hell they want whenever the hell they want. Other than that, see if another school will take you or get a lawyer....or get a job and good luck paying back all those loans....]
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That'll do for now....check back for the next post coming soon....
Doctor shopping and insurance fraud and asshat patients — OH MY!
Man, these folks are coming out of the woodwork!
Had a lady call me for a refill (on we'll say 3/19) on her (surprise) Norco 10/325 last week because she was (surprise) going out of town. It had been 9 days since we had refilled it. The prescription was for 50 tablets taken every 6 hours. I put it in as a 13 day supply. I told her that it would be "a few more days" before it could be filled. She, of course, did not agree with me. She tried to tell me that it was a 12-day supply and we, meaning my pharmacy, "always fill it three days early." Well, she's wrong...maybe two days early...on a 30 day supply...if the patient isn't a problem....
The fact that she argued with me about filling it early, about it being a 12 day supply versus a 13 day supply, and told me what MY pharmacy always does got me interested in her profile.
I booted up my trusted internet browser and navigated to my state's Prescription Drug Monitoring Program, plugged in her information, and I was quite shocked at what I found.
Date Drug Qty/Days Prescriber Filled by:
3-14 Hydrocodone/APAP 10/325 90/30 J. Smith CVS
3-14 Alprazolam 1mg 90/30 J. Smith CVS
3-10 Hydrocodone/APAP 7.5/325 50/13 B. Jones MY PCY
3-10 Alprazolam 0.5mg 30/10 B. Jones MY PCY
And this shit continued for the last 3 months or so. Let me share the most SHOCKING piece of information -- there was another column titled "Payee" which will say Medicaid, Commercial, or CASH. Usually, we would expect this to say CASH at one pharmacy and COMMERCIAL or MEDICAID at the other when we encounter doctor shoppers. In this instance, THEY ALL SAID COMMERCIAL!!!
This lady was doctor shopping using her insurance card...from her benefits at work! WOW! I can only assume the insurance company didn't catch it because the strengths had different NDC -- maybe even different manufacturers? Not sure....
I called and confirmed all of this with my friend Remy at CVS, and we each canceled all of her refills. I then printed all of this out and faxed it to the physicians involved (and every pharmacy in town). I heard back from both offices very quickly -- and they were pissed. They canceled the refills (of course) and each fired her as a patient.
When she called back the next day, it was precious. She said, "Well, will it go through today? It's been 10 days and it's a 12 day supply." I said, "No, it's still a 13 day supply, and it has come to our attention that you have been getting the same drugs in different strengths at CVS."
"That's just not true!"
"Oh, yes it is. And this has been going on for several months now."
"Well.......(long, awkward pause)......how do I fix this? I'm not sure I know what's going on...."
"Well.......yesterday, I fixed it by faxing this information to both doctors and every pharmacy in town. The doctors then called me back and canceled all remaining refills and wanted me to let you know you were released as a patient. Now, what they are going to do? I don't know. For your sake, I would hope they don't call the police because it appears crimes have been committed here..."
"Eck..." [Really odd sound she made here. I'd say it was the sound of disbelief.]
"If you really and truly have no idea what's going on, you need to call and talk to CVS and both of these doctors immediately...." [I said this in a really shitass tone]
"Okay. Thank you very much!" [Being nice...praying *I* don't call the police]
“I’m never coming here again!!!”
The title of this post really says it all, amiright? If you've worked in service of customers/patients, in any field, some jackass has uttered (or hollered) these words in an outlandish attempt at getting their way by bartering all of their money for future services rendered in exchange for instant gratification in the form of (most likely) you compromising your better judgment.
Obviously, this has happened to me quite recently...and it pissed me off royally because I was the nice guy being lied to and this fat bitch was the fat bitch that altered her prescription and lied to a(nother) pharmacist.
She presented a prescription from a doctor for that read as follows:
Pt: Janice Sanveritas
Hydrocodone/APAP 5/500
Sig: 1-2 tabs po q4-6h prn pain.
Dr. Ima Schmuch, DDS
Now, most reasonable people can see that this prescription LACKS A QUANTITY. She brought this to me at, we'll say 1pm on Sunday. After I IMMEDIATELY pointed out that it lacked a quantity and would require a phone call the next day, she remarked that she thought that this was the case, but she convinced herself that the word "SIG" which was scribbled was in fact the word SIXTY. Of course, this would be ridiculous because it is very UNcommon for a dentist to write for SIXTY FUCKING VICODIN. So, we argued about this a bit and decided that she was mad at the dentist for not writing a quantity and not me, but she was pretty sure he told her sixty....considering this lady had been a problem in the past, I didn't care what she thought, I wasn't even gonna give her 1 or 2 for that night (which I might CONSIDER, for a second, if she was a consistent, good, nice, polite patient).
So, she left script in tow. She came back at about 3pm. Now, the script had a convenient #60 written in right beneath the Sig. The ink didn't match. The hand writing didn't match. The story made no sense. She told me the drove over to this dentist's office and caught him just as he was leaving and he apologize profusely as he wrote in that #60 in a different handwriting from 6 or 7 days prior. I called his office the first time she came in and of course, nobody answered. In fact, it went straight to voicemail as if no one were in the office. I left a message at that time, but I knew no one would get it until Monday. Luckily he was there, right?
I told her, right when she handed it to me that I was going to have to call and verify the quantity...and the drama and bullshit began. You all know how this went.
"I have to call and verify this."
"Why? He wrote the quantity in plain as day. You can see it right there."
"Yes, but you must understand why I have to verify this. It's Sunday afternoon. I've seen this script without a quantity and you bring it back and now it has a quantity written on it. If your dentist DID write this in, he should have called or at least initialed next to the quantity that he wrote it in a different colored ink. He knows better. He knows how things are these days with all those druggies out there."
"Ohh so now you're calling me a druggie?"
"I don't recall saying that specific phrase. Did I say that?"
"Well, you might as well. I'll tell you what I'm fucking sick of this place. Every time I have fucking problems because you're a fucking idiot. I'm NEVER COMING HERE AGAIN!"
"And that's completely fine with me. I just want you to at least accept that you know where I'm coming from. I have to verify that quantity on that script. You've had it for several days. What's 18 more hours? I can call in the morning before I even open."
"No, just give it back to me. I'm going somewhere else. This is ridiculous. I've been coming here for 10 years. [Note: this pharmacy has only been open for 4-5 years] I'm going somewhere else, and I'm transferring all my meds away, and I'm never coming here again. Someone else would be more than happy to accept my business."
"Okay...fine...good bye" [and good fucking riddance]
-=+=-
I wanted to say, "Do you really think, for one second, that I'm not going to call every pharmacy in town the SECOND you walk out of here and let them know that you are leaving here with a prescription that I believe to be altered?" But, that would ruin all the fun of wasting her time! I WANTED her to take it to another pharmacy -- or several if possible -- only for her to be turned away for the EXACT same reasoning. I also wanted to write something on the prescription, but that would've also kept her from mustering up the gaul to take it elsewhere.
So, I took to calling all 8 pharmacies in my vicinity. Turns out this fat bitch was already BANNED from Wal-Mart, a Medicap, and a Medicine Shoppe. Now, she can add one more pharmacy to that list for her bullshit.
The winner of the "where this bitch ended up" contest was CVS. I'd talked to their pharmacist Remy, and she politely called me back. She let her drop it off and return 30 minutes later. Remy told her that the quantity's ink did not match the rest of the prescription and that she had no choice but to call the next day and verify it. This bitch politely said, "Okay, thanks a lot!" and putted her ass right on out of there...after showing her ass real good right in front of my eyes!
Today rolls around and I head in there and first thing call that dentist's office and apprise them of the situation. I told them that I believe that she modified the prescription, but CVS currently possessed the hard copy and would be calling. I just wanted to tell them my side of the story. Their side of the story? He intended on giving her 20 tablets and was nowhere near the office on Sunday.
Cut ahead to Remy calling me later on...She verified the script was altered by someone, and the DDS intended on 20 tablets. However, he went ahead and AUTHORIZED TWENTY TABLETS TO BE FILLED! I could not fucking believe it. Remy couldn't believe it. Hell, the fucking patient probably couldn't believe. This was the only doctor in the fucking NATION that would approve that script. He is enabling her addiction -- no doubt about it. This fucking doctor is a problem. I am debating whether or not to call the Board of Pharmacy and the Board of Medicine. I'm not sure if there's grounds for any sort of investigation -- or if I would just end up looking like a tight ass, punk pharmacist...
What are your thoughts?
Pharmacy Class of Trade
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).
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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.
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