-=+=-

I understand the Unites States requires every pharmacist to get a doctorate prior to becoming qualified. However, in Australia, it isn’t required. It is still an undergraduate degree, so we come out after only four years of studying, do a year’s internship, pass our registration exams and we’re done. Every year, we have to enough “points” every year to remain registered as a way to encourage our ongoing learning.

As I’m still in my third year of my degree at the wonderful University of Sydney, we are required to undertake externships, where we get sent to pharmacies for “workplace experience”. I undertook my externship at a medical centre in Sydney’s north.

As one would presume, the entire purpose of my presence there was to learn. The medical centre pharmacy was small enough for only one pharmacist and pharmacist assistant to run the store.

I was questioning the pharmacist present at the time of the several of the drugs people came in for. One of them was quetiapine- as one should know- an atypical antipsychotic.

“What class of antipsychotic is quetiapine?” I asked.

The pharmacist replied curtly, “I don’t know.”

At that time, the pharmacist assistant, who is also qualified, hospital nurse, commented that he should know coz he just passed his registration exams a few months ago.

So I continued to ask: “Why do antipsychotics cause suicidal thoughts at times?”

“I don’t know.”

 Do you fucking know anything?

Let’s try something else then. “Why do topical corticosteroids thin out the skin?”

“I don’t know.”

How much did you bribe the examiner to let you pass your registration exams?!

Ok, so I dropped that topic. So I asked about shingles. “I heard shingles is called herpes zoster, but it’s caused by the varicella virus. So does that mean herpes and varicella virus are the same?”

Again, “I don’t know.”

The pharmacist did not look at me the entire time, so I looked at the computer screen he was typing away at. He was on Wikipedia searching up shingles.

WIKIPEDIA.

SURELY, THERE ARE MORE RESPECTABLE & TRUSTWORTHY REFERENCES TO TURN TO? ALL OF THEM HAVE AN ELECTRONIC VERSION AVAILABLE. MEDSCAPE. AUSTRALIAN MEDICINES HANDBOOK. MIMS ONLINE. THERAPEUTIC GUIDELINES.

“I don’t know anything. Stop asking me questions.”

That’s exactly what I did. So for the rest of my externship that day, I didn’t ask any questions. This incompetent pharmacist went on to report me with an “attitude, and is not willing to learn”.

Oh wait, what? So did not see that one coming.

I have seen a variety of pharmacists in the professional field over the three years I’ve been studying and working in pharmacies. I’ve seen the best pharmacists who are able to treat palmoplantar  psoriasis and various skin conditions better than doctors can. I’ve also seen the negligent; one pharmacist gave out Nurofen Plus to a patient with an active peptic ulcer just because they requested it by brand.  Even with my incomplete education, I know that I should have offered an alternative, perhaps paracetamol [acetaminophen] for your headache?

The pharmacist I worked with during my externship rivals the worst pharmacists simply due to his knowledge gap. I don’t think customers realise it because all he does is assume the doctor has given all the instructions to the patient, so he doesn’t have to do it, and most customers are regulars so they’ve been on the medications for many years.

Being a young pharmacist isn’t an excuse for being ignorant. Pharmacists are the second most respected profession [second only to emergency workers] so don’t tarnish our reputation!

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....

I've been working for [this pharmacy] in [the Southeastern USA] for many years (5+ let's say). Before that, I spent 12 years at Walgreens. Is there any legal issue in a company not allowing their pharmacists a legitimate, leave the pharmacy, timed, lunch break? Well, legally, it must not be, or they would not be so easily getting away with it. As far as I know, it is the ONLY corporately run pharmacy not giving a lunch break in the state in which I live. All the usual suspects, when it comes to these human rights issues, Walgreeens, CVS, Wal-mart, Sam's Club, provide lunches -- sometimes even within a CLOSED PHARMACY. Do you have any comments? How can I post such a question on your site to ask other professionals?

Well, you did it in the right way. Send your questions, comments or guest articles via the CONTACT Page and I'll see what I can do.

Anyway, readers, tell him what you know. Here's what I know. Pharmacists are sometimes listed as salaried management and therefore fall under different guidelines than your every day cashier, technician, or stocker. I'd bet my bottom dollar that is the case where you work. That's the exact story where I live. Fortunately, I'm able to go sit down, even if just for a few minutes to eat some lunch every day. Even if it's a scattered 15 minutes. I shoot for noon when I know the phone will slow down as the nurses are all out to lunch, and patient's slow a bit too -- at least the ones that have jobs. So, I woof down my lunch. If you can't do that, I'm sorry. Move to another store/chain or transfer to a slower store that would allow you more time in general for afternoon tea...:-)

Anything else for the good of the order?

This is a submitted question/dilemma from a young pharmacist known as "M" -- s/he is requesting that the community help her with some professional advice and recommendations from our little blogosphere community.

-=+=-

As a new pharmacist, I have a dilemna concerning my role/authority in the pharmacy.  Since I'm new to the store, I have a lot to learn from the senior techs as far as managing the pharmacy is concerned.  In essence, they are actually training me to run the pharmacy.  For this reason, I sometimes feel like they take advantage of that, and they do whatever they want.  They often come in late and call off last minute.  One technician doesn't like to 'fill' so I end up filling most of the scripts, verifying, and then ringing it out as well.  She claims she has other stuff to do, which she sometimes does.  I can't complain much because she will do certain tasks and help free my ear from the telephone.  However, I'm just not comfortable with her not listening when I ask for her to help in filling. I'm trying hard to learn much so I don't find myself solely dependent on them (technicians).  So far, I've been nothing but nice to them, and they've yet to call in on my shift.  But I know that day will eventually come... Regardless, this has got to stop. We must be able to depend on them as our patients depend on us.

Please help me by providing me some ideas on how I can approach the situation with both my pharmacy manager, other staff pharmacists, and most importantly, address my concerns gingerly with the technicians without alienating them and subsequently finding myself on the wrong end of a string of sick days! I've also got to consider various friendships (or grudges) between techs and pharmacists, or even techs and techs.

Any advice would be most appreciated! Thanks!

-=+=-

Do you want to submit a guest post or discussion topic [since I don't post nearly enough]? Type it up and email it to me via the 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.

"Prescription for Cal Ripkin. Zpak. No Refills. This is Dr. Johnson."

Luckily, I knew who Dr. Johnson was because he did not say his first name. I could just hear it in his voice that Mr. Ripkin called him at home or through the exchange acting as if he would absolutely die without a ZPAK STAT! And, rather than tell Mr. Ripkin to stop being a pussy and take a nap and some Tylenol, he just called in the prescription. Is antibiotic begging becoming some sort of weird variation of drug seeking?

Mr. Ripkin called me moments later and arrived mere minutes later. He needed that fucking ZPAK...

As I'm ringing him out, he doesn't ask about cough medicine. He doesn't ask about Advil or Tylenol. He doesn't ask me any REAL questions at all. He does hold out his hand and show me his palm. He's got a giant blister -- looks like it was from fighting a push mower without gloves.

"Will this ZPAK help with this blister?"

"I don't think it will. It's not super-red. It's definitely not infected. I wouldn't have torn it open -- maybe you could cover it with some super glue or Nu-skin to keep it from hurting."

"Oh. I kinda thought.....well....okay...thanks...."

So, let's recap here. Patient calls doctor for antibiotic. Doctor doesn't ask why, what for, or any questions. (It's for a blister, by the fucking way) Patient doesn't tell doctor what it's for. (It's for a blister, by the fucking way) Pharmacist fills it, patient comes to pick it up and pharmacist discovers patient wanted it for a blister, BY THE FUCKING WAY.

What a waste of time, money, resources, and my patience. This is one of the biggest examples of problems within our healthcare system -- WASTE and MISUSE OF ANTIBIOTICS. Super bug, anyone? This is how we are going to create it....

----------------------------

"I was wondering, if I brought a list of my medicines up here, could you tell me how much each of them would cost?"

"Are you on file here? And do you have insurance?"

"I've never been here before, but I have Paid insurance."

"Well then, unfortunately, I cannot. Your best be would be to look on the back of your card and call the Member Services or Customer Service number listed there. They can tell you exactly how much each prescription will cost. All I can give you here is the cash price which doesn't do you any good when your insurance will foot the bill in most cases."

"I don't understand. Can't you just put it in the computer and see?"   [Gotta love that all-powerful, "computer" that does all and knows all!]

"That's not how it works. If I had valid prescriptions on file for each one, I certainly could just push a button or two and tell you, but you aren't on file here. So, I can't do anything to help you. If you'd rather bring me a stack of prescriptions I can get you prices then..."

"Well. That doesn't make any sense. I've got a list at home with all the prices on it. Why can't you just tell me what they cost? You're a pharmacist!"

"Wait. You have a list of all the medicines, what they cost, and you want ME to tell you what they cost? You want me to tell you what that list already says?"

"Noooo....well, not exactly. You see, at the last pharmacy I went to they gave me special prices on some medicines. Not the expensive ones. They ran those [the expensive ones] on my insurance, but there were some that were cheaper if they didn't use my insurance."

"Are you talking about the '$4 list' generics?"

"Yeah! That's it. How much are those here?

"Well, they are $4...we honor that program. Unfortunately, I don't have them all memorized, but if you bring in what you got, I can figure it all out."

"Well, I've got a list of the ones that are $4 at Wal-Mart at home. Don't you have that list?"

"Wait. You have the list of what your prescriptions cost on your insurance at home. You ALSO  have the list of ALL the $4 prescriptions at home. But, you want to bring me a list of your prescriptions. You want me to look at those two lists that you have at home in your possession and tell you what those lists, that you have in your possession, say. And you want me to compare those two numbers and tell you which is cheaper."

"Exactly. Which is cheaper HERE..."

"Really? ..........[Long Pause of disbelief].......... Sure...bring everything you have to me...I've got nothing better to do. I'll show you how to do one and we'll see if you can get it from there....If not, I'll get you a quote."

What he got from our conversation: That nice pharmacist will put my prescriptions in the computer and tell me what they cost if I bring him a list.

4) REPLY TO ALL FAXES REQUESTING YOU GET A PRIOR AUTHORIZATION BY SIGNING IT AND AUTHORIZING "1+2" REFILLS. This is a GREAT way to both waste a pharmacist's time and really frustrate them. In most instances, they've told the patient 48-72 hours. By replying to the fax with refills, you show that you really want the patient to get the medicine, but it shows the pharmacy that you've got better things to do than read their stupid faxes. To really put a cherry on top of this one, schedule the fax to send at 4:55pm. This will ensure that even if the fax even goes through successfully in the first place, the pharmacy can't contact you again until the next day because the phones cut off at 5pm on the dot (and you cut out at 4:30pm in the first place)!

3) When they call you the next morning, make sure they have to leave you a voicemail. If you're feeling particularly randy, respond to that with a copy of the fax from the day before and a SNARKY  NOTE at the bottom of the fax. Some suggestions for the note are:
"Authorized (1+2) yesterday. Is your fax machine working?"
"I got your VM -- here's the auth you need. Thought I faxed this yesterday. WEIRD!!
You could also just skip the reply all together...

2) When they finally get a hold of you at the end of the second or the third day, tell them your office's standard is at least 3-5 business days on a PA Request. Tell them you'll get back with them at the beginning of next week. After you say this, don't do anything. Don't even ATTEMPT to get the prior authorization. Why you ask? Duh -- the pharmacist will probably call and remind you again on Tuesday or Wednesday when you actually need to do it anyway. Out of sight out of mind! [If you wanna be a real bitch, at this point you need to send another refill authorization in to pharmacy. No note this time -- you don't want to appear "catty."]

1) After they call you Wednesday, if it's a different pharmacist than the one you talked to the previous week you need to go off on him. Make a huge scene. Act as if everything that was sent in and you cannot figure out why the pharmacy refuses to fill the prescription. When they explain the PA Process to you, acknowledge it, say you'll get right on top of it, and completely ignore every word of it. At this point you need to go straight to your doctor and tell them the following, "Doc, I don't know what the heck is wrong with Walgreens. They are pretty much refusing to fill Mr. Johnson's _________.  I've dealt with several different members of their staff. I've faxed in the prescription at least two different times, called it in once, and I can't seem to get them to fill it!" Then, the doctor will call and ABSOLUTELY TEAR THAT STUPID PHARMACIST A NEW ONE! Sit back and laugh. You've done a good job. You've waste almost a week of the pharmacist's time, and you've not had to do much work or call for the PA.

Final Step) Now, when the doctor returns to you,  he'll explain to you that they just need you to get a PA. They'll be so scared of the doctor, they won't say anything about your prior shenanigans. Your response should be, "Well, why didn't they just SAY THAT!?! STUPID PHARMACISTS!" He will agree and, at this point, you need to call the pharmacy again and have them fax you the information on how to get the Prior Authorization. They will probably say something about how they sent you the information -- just tell them you never got anything. Now, buckle down and actually get the PA...dag nabbit!!

And that is how you get a PA!

Here's the Abstract:

-------------------

From: leon <leonce1234@gmail.com>
Subject: too many incompetent foreign graduates
Title: Pharmacist

Message Body:
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.

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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.