Is there any truth to this rumor?

Posted by The *Angriest* Pharmacist as --Not Pharmacy--, Disgusting, Education, Government, Just a question, Laws, Lazy People, Me hating others, Politics, Stupid People, True Story, Welfare

The following piece of literary magic was forwarded to me from my conspiracy theorist friend. I get emails from him every week — I usually take the first sentence, google it with the word “snopes.com,” and send him back the link to the DEBUNKING of his trite. He never searches snopes first. He never sends my debunking back out to his email listserv….

I still enjoy out little chats — I’m always curious to see what will come out of his mouth next…:-)

Anyway — if you have any knowledge of these issues please post a comment. Debunk it. Post a supporting link if possible. I just cannot accept all of this as fact….

“I live and  work in a state overrun with illegals. They make more money  having kids than we earn working full-time. Today I had a 25-year old with 8 kids – that’s right 8; all illegal anchor babies and she had the nicest nails, cell phone, hand bag, clothing, etc.. She makes about $1,500 monthly for
each; you do the math. I used to say, “We are the dumbest nation on earth.” Now I must say and sadly admit: WE are the dumbest people on earth (that includes ME) for we elected the idiot idealogues who have passed the bills that allow this. Sorry, but we need a revolution.. Vote them all out in 2010.

REMEMBER IN NOVEMBER 2010, WE HAVE A GOLDEN OPPORTUNITY TO CLEAN OUT THE ENTIRE HOUSE AND ONE-THIRD OF THE SENATE!

This is an insult and a kick in the butt to all of us…

Get mad and pass it on, I don’t know how, but maybe some good will come
of this travesty.

If  the immigrant is over 65, they can apply for SSI and Medicaid and get more than a woman on Social Security, who worked from 1944 until 2004 .

She is only getting $791 per month because she was born in 1924 and there’s a ‘catch 22..’

It is interesting that the federal government provides a single refugee with a monthly allowance of $1,890. Each can also obtain an additional $580 in
social assistance, for a total of $2,470 a month.

This compares to  a single pensioner, who after contributing to the growth and  development of America for 40 to 50 years, can only receive a monthly maximum of $1,012 in old age pension
and Guaranteed Income Supplement.

Maybe our pensioners should apply as refugees!

Consider sending this to all your American friends, so we can all be ticked off and maybe get the refugees cut back to $1,012 and the pensioners up to $2,470. Then we can enjoy  some of the money we were forced to submit to the Government over the last 40 or 50 or 60 years.

Your stupid paper card is just that…

Posted by The *Angriest* Pharmacist as Drug Companies, Drug Topics, Education, Laws, PHARMACY SECRETS!, Patient Education, Robbery, Stupid People, True Story

Happy Super Bowl Day! I don’t watch much football. I’m a BASEBALL fan, myself, but I will get drunk and scre eat some wings with my wife.

I know you’ve seen these stupid ass little paper cards floating around in magazines and periodicals. They are laid out like your standard insurance card, and they do a great job at tricking stupid people into thinking they are insurance cards. What I don’t understand is how someone could be so dense as to think that, “I bought a magazine / insurance policy last Tuesday. On Wednesday, I went to the pharmacy and got all my ’scripshuns filled up for free….that insurance I bought for $3.99 was awesome! Celebrex for free? DAAAYYYUUUMMM!” [You now hear and see me beating myself about the head with my stack of bathroom Drug Topics]

I’m now going to drop some serious knowledge on the non-pharmacy people of the world. Pharmacy Secrets numero leche con wavy lays.

- Amphetamine XR 5mg has an AWP** of $100 for 30 capsules
- The true cost to the pharmacy for #30 caps is AT BEST usually around 20% less than AWP. Most of the time, it is closer to 15% these days (the bulleted list below explains that). So, we can paid $80-85 to acquire.
- So the Pharmacy will put in the computer system that we bought the drug for 80. There will also be an AWP field. We put 100 in there. [This is for simplicity. In reality, AWP is calculated by taking the AWP per the number of caps in a stock bottle. So AWP is 138.99 for a 60 count bottle, AWP is input as   2.3165 (138.99/60). Cost is the same way.
- Insurance companies get the claim and, to them, it looks like we are telling them, “Hey, this medicine COST us $100 to fill. We need that to break even.”  -- Well ins companies know how the game is played and they tell us to piss off. They know AWP is set at 20% above our cost. So, they pay accordingly. The most common equation is AWP-10% to AWP-15%. Sometimes, there is a constant put in. For instance, AWP-10%+$3. Whereas, the $3 is considered a dispensing fee. It helps increase profits for pharmacies, but usually means that the percentage is going to be LARGER…
- Going by these methods, we would get paid:   $85 to $90      if using just AWP-10/15%  [+/- $3 depending]. If I make $85 dollars on an $80 prescription, can I afford the pharmacist, technician, computers, utilities, paper, support staff, telephones, and just about a million other costs associated? Absolutely not. How does this work? Ahh…you’re forgetting the COPAY! That….she’s a mine! So, Amphetamine XR is a generic, but it’s a new generic…still made by the BARR, the brand name manufacturer. Hell, even the numbers/symbol on the cap is the freaking same. I’m not sure what the copay would be, but let’s say it’s 25 dollars. That means that I actually made $110 on the $80…which is a gross margin of  27%. That’s pretty good for a pharmacy in 2009. To really stay competitive and continue living, you need to get some 30%+ in there as well….to balance w/ the next bullet:
- $4 prescriptions. So, we are charging $4 absolute to the patient. We can say the AWP=$4 then. The cost is NOT usually 20% less on these…it’s actually MUCH less (WM wouldn’t have thunk it up otherwise). Cost on $4 rxs range from $0.20 to $2.50 for others. Average would be around $1.25. That means that we only make $2.75 per Rx average. While the gross margin appears to be good on this, at 30+%, it’s a TRICK – think economy of scale. It costs just as much to fill this single prescription that is going to net me $2.75 profit while your Amphetamine is going to net me $30. Same amber vial, pharmacist, technician, labeling, etc….and we’re filling a lot more$4 rxs than ever before due to doctors using them to dictate their prescribing habits.
- How does insurance figure in on these? They don’t. While we are required to submit the claim to them, as they track the patient’s utilization of their benefits and ensure compliance for their own records, they don’t pay us a cold damn cent. In fact, it COSTS us a nickel to 15 cents to process the damn claim – like it’s dialing a long distance fucking call…bogus! The claim submits, and comes back with the cost the same, AWP acknowledge, and third party paid $0.00. But, don’t forget the copayment! Some insurances have flat copays of $8 for generics (even though $4 is less than $8,right? Duh.) So, the patients would most likely say, “Take it off my insurance! Just bill it cash!”  Across the country this is happening for third party claims – private insurances and medicare part D. Now I’m not sure about the private ins claims and a patien’ts contract with them, but I’m 100% positive that it is illegal for a patient enrolled in medicare to not utilize their benefits – even if the benefit may be a detriment at the time. People do this like crazy to avoid “the donut hole” as if $4 is going to get them there with any haste. I don’t fight people on it because I know they’ll never charge someone for evasion, but it is certainly illegal to do this for Part D — and it’s fucking immoral if the patient is on Medicaid. If they have Medicaid and can pay cash, they need to be paying cash and removed from the Medicaid register. Why is this illegal? Because. Because medicare wants to track patient compliance. Medicare wants people to use up their eligibility and MAKE it to the donut hole – then medicare can really start letting the patient have it! I dunno if they make any money, but they certainly LOSE MONEY AT A SLOWER PACE when a patient is eating doughnuts.
-  As a funny aside, Medicare sends these old fogies these printouts of the drugs they’ve gotten, what we billed to medicare, and how much money has been changing hands. I get fucking screamed at for these stupid ass pieces of paper once a week and these dumb printouts say dick and mean even LESS than dick. What they show people is the following.

Pravastatin 40mg Rx#1234567    –    January 27, 2010
What Your Pharmacy Billed to us:   $75.29
What you paid for copays:          +    $3.30
The total of these 2 rows is:         $78.59
^{(the amount we actually paid your pharmacy is $0.00)}

I bet you’re wondering what the infinitely small line of text is:
(the amount we actually paid your pharmacy is $0.00)

What the point in sharing this information with an old person? Not a damn reason one other than to get ‘em all riled up and hope they die of a heart attack before being beaten to death by their pharmacist. All these old people see is that bottom line. Now…why did they add that column? Because that’s what you do with columns…you add the mofos!  They have nothing to do with each other. And that “billed to us” is a joke. That’s the AWP at work…being worthless. Pravastatin is a drug that the AWP has never fallen. We get it for less than 5 bucks per bottle of 100 and the AWP is still hundreds….the insurance companies are well aware of the $4 rxs as well as the COST of each medicine as it’s available to each chain – they know all and see all. They pay nothing.

Now, to finally answer your question – it’s exactly as above….except on every drug. Not just $4.

Some companies negotiate contracts with the drug manufacturers and that’s what dictates their formulary and the costs that the patient pays. For instance Amoxicillin is a $4.00 rx. We bill it to Anthem, they have a contract with us to give them discounts in specific areas. So, the copay comes back to the patient $2.75 cents. Then you look at what the 3^rd party actually paid — $0.00! This is precisely how those free cards work – only w/o the contracts. MY computer system won’t let me fill a prescription w/o at LEAST covering the cost of the medicine (what we paid)  plus 3 dollars. Well, since this Amox is 2.75, we didn’t cover that – no way! Since it’s $4, we’d let it slide, but a 3^rd party wouldn’t. But, it doesn’t say paid under cost. It’s good to go…cause of the contract my pharmacy has with anthem. We give them a discount there and somewhere else, we get a better deal – plus we get them in the store buying Tylenol and sodas and shit.

The freebies cards just manipulate the price down and hope that the pharmacist is a east Georgian Tard Hound. Hopefully, I won’t notice that this medicine cost me $50, the patient is being charged $30, and I was paid $0.00 by the third party….Well, I always notice – my computer system helps me. But, how in the hell does the free card company make money? They are in cahoots, if not MAJORLY owned by the drug companies. Bingo! So, the claim comes through when it’s filled and they know, badabing, we got a sucker. If it doesn’t get deleted after X days, they get a kickback from the drug company for essentially filling a script. The manufacturer still sells the drug to the pharmacy at the same price regardless – their only concern is to get them to buy more and more! Those cards aim to help…and aim to screw over your pharmacy.

ON AVERAGE: Calculating COST from AWP
• For single source innovator drugs: pharmacies purchased the drugs at an estimated discount of 17.2 percent below AWP.
• For all drugs without Federal Upper Limits of Cost (FULs): pharmacies purchased the drugs at an estimated discount of 27.2 percent below AWP.
• For multiple source drugs without FULs: pharmacies purchased the drugs at an estimated discount of 44.2 percent below AWP. A further breakdown of multiple source drugs without FULs showed the estimated discount for innovator multiple source drugs to be 24.4 percent and 54.2 percent for non-innovator multiple source drugs.
• For multiple source drugs with FULs: pharmacies purchased the drugs at an estimated discount of 72.1 percent below AWP.

If you don’t want to read the LONG version (attachments and info I’ve typed above and below this line, go to this link: http://www.volunteer-ehealth.org/frisse/erx/2007/05/prescription-drug-pricing-mac-can-make.html — It provides a hell of a good simplified synopsis of all the different acronyms in pharmacy costs and explains them well. Give it a look either way actually.

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.

Liberal is too Liberal

Posted by The *Angriest* Pharmacist as Doctors, Drug Seekers, Just a question, Laws, Patient Education, True Story, Work Sucks

I’ve got a problem. There’s a physician in my town wreaking havoc on the livers of everyone in the entire area. Drug seekers rejoice! If your drug of choice is Fioricet (Butalbital/Acetaminophen/Caffeine), Soma (Carisoprodol), or Ultram (Tramadol) you are in luck.

I’m not joking when I say that he has put them in the ground — 6 feet under. He’s got more people addicted to more drugs than should be possible. I’ve been told by several of his “patients” that do their trading with me that they enter his “exam room,” state a problem that they have, and he begins writing. He doesn’t touch them. He doesn’t ask any questions. I couldn’t tell you the number of times folks have gotten to the counter and not known what X-drug was written for as they aren’t having that problem at all — for instance, Detrol LA for a 24-year old male.

He’s also a big fan of Nubain, Promethazine, and Syringes. I call it the SCUZ-BALL COCKTAIL! They give they Phenergan so you can inject more NUBAIN! It’s a GREAT idea!

But, TAestP, why on earth is he writing for Nubain and Fioricet when he could write for Demerol and PERCocet. That’s because this fuck wrote so many controls (and neglected to chart a single word) that they took his DEA license from him! So, he’s been reduced to writing drugs that SHOULD be controlled rather than drugs that ARE controlled.

What I hate about this situation is that I feel like I am an accessory to his negligence. I don’t fill things early. I don’t do cash prices after insurance rejects. I make notes about an (8 per day max) on Tramadol even though his 1-2t po q4-6h prn pain #240 clearly suggests 12 per day. [Seizure anyone?]I don’t fill anything above the Tylenol limit per day.

I’m doing everything by the book on my end. What type of liability falls to me (and every other pharmacist in my area filling these scripts)? I’ve got documentation outlining reports / complaints that I’ve made to the DEA and Medicaid Fraud and Waste Department. I’m trying to get this felon off the streets — or at least get his pad taken from him!

Pharmacists are fighting tooth and nail to get just PPIs or Statins as behind-the-counter / prescriptive-authority drug classes for RPhs and this jackass can’t get his taken away fast enough!