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.

Never ask an old bittie her birthday!

Posted by The *Angriest* Pharmacist as Courtesy, Education, GUEST CONTRIBUTOR, Lazy People, Management, Me being a dick, Me hating others, PHARMACY SECRETS!, Patient Education, Rude, Stupid People, Technicians, True Story, Work Sucks

There was a comment made to my last post, SATURDAY’S SUCK! where a guy swore he called and asked me about our having a product. He swore he talked to the male pharmacist. I was the only male working in the store, and we did not talk. My response to the comment turned into a store and then a rant. So, as to not detract from the original post, I’ve taken this comment and my story/response their own post. Hope it doesn’t suck!

We get this all the time…we are a tiny ass pharmacy, i kid you not…we have 2 pharamcists and 2 techs…all week long, same peeps. So when someone says they ’spoke to someone’ it’s very easy to call them out as a liar.

As for your “loud and clear” guy…i totally feel you. We had something very similar happen to us the other day. We just get back from lunch and are opening up when a woman approaches the consultation window where I am at a computer trying to figure out the faxes that came in over lunch. She stares, I greet her cordially and ask her if there’s something I can help her with. She stares and then rolls her eyes and says “No, I just thought i’d come up here and look at you” and then she stares. I blink back at her and glance down at the empty drop off window and empty register and then ask her if she has a specific question about medications (that would require a pharmacist) or if she has a question that I can help her with. She says “Medicines..i’ll talk to him” and points at our pharmacist. He had a student that day so when he had started her on a small task, he went down to offer the woman her consultation. She proceeds to tell him that she needs to know if she has a refill on “some med on her profile” he asks her what she would like him to do specifically, because it’s something that a tech can handle and now she’s interrupted him…she rolls her eyes and tells him to “look it up on the damn computer”

He brings her down to the drop off window and the other tech and I back up about 10 feet. He asks her for her birthday. You know as well as I do that it is the easiest way to look up a patient. She stares at him for a moment and then gives him a month and day. My pharmacist waits for a beat..then asks for a year to which she scoffs and says “every year” my pharmacist waits…and at this point the phone is ringing, there is one on hold, i’m on the 3rd line and the other tech is on the register. So he politely asks for the year once more and the woman flips. Starts yelling at him that he is inconsiderate and can’t take a joke and refuses to help her. My pharmacist calmly tells her “Ma’m, i’m trying to help you, but i don’t exactly know how to respond to you right now, you’re not being very easy to help” so she spouts off that she was just joking and that he shouldn’t need any more information then the month/day of her birthday. So he snarks back “how about your name?” at this point, we back up about 10 more feet.

She finally relented to let him have her name at least and when i was checking her out at the register, it was with a final comment that she should buy us a sign that says “Do Not Joke with Pharmacist…for he has no sense of humor” and then proceeds to tell the other tech that we should spend our breaks and lunchtime out on the floor showing poor people like her where the vitamins are instead of giving them a specific aisle number and shelf.

Just goes to show that apparently no matter what you say or what you do, some people are just that stupid. I’m totally done with everyone looking at me blankly as I remind them that January means reset deductibles and shifted formularies. It’s completely my fault that their insurance probably sent out 10 notifications that they didn’t read

I have an old bitch like this too. All of the FT employees (pharmacist and techs) know who she is on sight. She is the meanest, grumpiest, rudest bitch ever born. We all know that you do not ask her birthday…However, our technicians are BEATEN if they do not acquire the birthday and write it on each prescription as well as verify the birthday upon checkout to verify the correct patient is picking up the medicine. This, for some reason, causes Ms. Bitch considerable problem.

She tries to play the “you should NEVER ask a woman her birthday”, but the problem is, she takes it to a whole new level — a weird, obscene, asinine level of fucked-up-ed-ness. Her reaction and response to the question, “what is your birthday?” is comparable to the response you would receive from other women when asking, “I bet you’ve had miles of dick in you…amiright?” or men when asked, “What were you and your wife doing last night when I was nailing your daughter on your living room couch?” If you get the simile, haha….if not — let’s just say her response/reaction is over the top negative. She is just plain out ugly (in BOTH ways…)

Last time she came in, I approached the counter and you bet your ass I asked her birthday. She gave me the usual, expected attitude — the response I was trying to elicit. I pointed to the sign that every pharmacy has that says, “We verify identity with photo identification for all controlled medications.” I told her that she could either tell me her birthday or show me her driver’s license. She snatched the pen out of my hand and wrote it on the prescription herself — only the month and day mind you — and threw both down on the counter in utter disgust. The pharmacy is completely empty at this point so the big urge for secrecy and confidentiality is unfounded — and by empty I mean REALLY empty…not even OTC shoppers.

She got about 10 feet away and I hollered to her, “I must have the year as well.” –

“You know very well that you do NOT need the year. No one else ever gives me any trouble. They never ask my birthday. Everyone back here knows me — they ALL know me. Ask them. ASK DAVE!”
[If you know me through this blog, you know that referencing DAVE, that old prick that managed the pharmacy before me for 20 years and still works a day or two per week prn is one sure fire way to get on my bad side and ENSURE your script won't be filled...I don't give A FLIPPING FUCK what David used to do for you (most of the time illegally -- based on the letter of the law and MODERN pharmacist code of ethics). I am not him nor do I strive to be him.]

“Dave’s not here. Dave’s not the boss. I’m the boss right now. The rules of this store, and the rules that I am going to follow…the very rules I expect these girls to follow when they take your prescription…is that you MUST give us your complete date of birth upon dropoff.”

DID I MENTION SHE ALWAYS WEARS A MOO-MOO? (and usually has curlers in her hair — or at least a weird showercap/hairnet) I’M NOT EVEN KIDDING. I’M SUPER CEREAL HERE!

“This is ridiculous. I’m calling your superior.”
“Well, then…here’s his business card. I’m sure that I will get in plenty of trouble for following company policy. They fire people all the time for following the rules that ensure patient safety. Why do you take such offense to someone asking your birthday? I mean, we are a part of the healthcare team here and you treat us all like dirt. Do you act so resentful at your doctor’s office when they ask your birthday? I’ve never seen someone yell at their granddaughter before — back when she worked here 5 or 6 years ago — for verifying her grandmother’s birthday (even though she knew it). Did you ever try to eat your young?”
“They may not fire you for following protocol as you call it…” I interjected like a smartass with, “Actually, I called it policy…”
“WHAT – EVER! You have no right. You have no need. You have no access. That is private information that you do not need.”
“Ma’am, you are gravely mistaken. I have a definite need for your birthday — considering some medicines may be contraindicated in certain age groups. That’s for your safety and to ensure the right person is selected in the computer and the right dose is dispensed! In fact, pharmacists have a need and a right to access your complete medical history…and you’re raising cain over your birthday.” [I've revealed TONS of information about readers just by them sending me their email address and name -- I've sent them back their name, address, phone number, map to their house, and a PICTURE of the front of their house in certain cases. You do NOT have privacy in 2010...]

“That’s it…I’ve had it with you…give me the prescription back.” [I, of course, give it right back to her] “I’ve been coming here for 20 years, and David never treated me with such disrespect. I’ll never be back here, and I *will* be calling your employer. May God bless you and let you live a long, but hopefully miserable, life.”

“Aww you’re so nice. May your children place you in the cheapest, roach-ridden nursing home available for the rest of your life.”

She, like all patients continued to come to the pharmacy. She made no effort to change or avoid me. This ordeal was a few months ago, but she suddenly disappeared. I always watch the obituaries, and I was hopeful she’d turn up. But, alas, I discovered she HAD been placed in a home…and YES, it is the most roach-ridden place available in the nearby area!

Who says dreams don’t come true?

All things being equal

Posted by The *Angriest* Pharmacist as APhA, Disgusting, Drive-Thru, Drug Companies, Drug Topics, Errors, Management, Me being a dick, Me hating others, PHARMACY SECRETS!, Politics, Stupid People, Technicians, True Story, Work Sucks

Prereading for this post:   Walgreens has POWER (80 COMMENTS!)

I was going through some server logs and discovered something. This tid bit of information was shocking to me. The above post/link was and is being heavily monitored by Walgreens themselves. As you know, the bottom of each post I type has two links these days. One allows you to email a post to a friend using my server’s resources. The other link opens a printable copy of the post along with links and annotations.

The email function is heavily used across the entire site — very heavily used…and it is also logged for security purposes. Today is the first day I’ve looked at said log since implementing the function and verifying it worked eons ago. It’s been used by a plethora of people. From students spreading the funny advice, to bikers spreading stories about our little spat, to companies seeing what’s been said about their new policies and procedures.

Such as WAG… who used it to spread the post amongst their corporate headquarters and various offices. One employee sent it to a great number of other “@walgreens.com” email addresses some time ago stating, “it’s important we know this is circulating…” and “continued monitoring is necessary.” Several were sent as, “FYI per meeting agenda.”

I don’t have more information than that. Their hits from their walgreens IP address (which resolves to walgreens.com) number in the thousands to this site in the days to weeks following that post. I’m sure it’s blocked at store level — but they were watching.

So, my POWER Pawns — did anything change? In my area, I’ve noticed nothing of this program as I’m rural and not yet touched. As I said before, I’m excited. The Walgreens I compete with couldn’t possible provide worse customer service. We’ve actually stopped advertising in the local paper as they do it for us. POWER won’t do anything but make me money. Did we rattle their cage a little bit?

One of the pharmacists working at that store actually just quit a few days ago. Just walked out. Now he’s commuting over an hour to an independent pharmacy. He was filling more than 800 per day and never allowed more than 2 pharmacists, 5 techs and 1 dedicated cashier. They had a counting machine, he said, which accounted for about 25-50% of the volume, but it was constantly on the fritz. Remember what Drug Topics said a few months ago? It’s what I remind my coworkers of every time I catch a mistake — 4 errors per 250 scripts. That’s just not good enough for me.

Commentors will be kept anonymous on this post.

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.