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.

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

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.

A few days ago was Halloween. Another right of passage for the American childhood. The under thirteen crowd walk around with Mom and Dad to all the neighbor's houses for goodies and sweet to rot away their teeth. The over thirteen to eighteen crowd is, of course, too cool and too old to trick or treat, but they want to enjoy the atmosphere. They want to be out and about on Ghoul's Night. They do what we all did -- toilet paper and/or egg friend's houses.

This time, however, one of these little bastards went too far. I was on my way home from work. It was about 4pm on Monday 11/1/2010 (A binary day!). Cold but still a bit a daylight left. I was making my way through my little town's Memorial Park -- all towns have them these days. A quaint little square for public use. There may be a little bit of playground equipment. Trees. A sidewalk path next to a dirty pond, perhaps. But, the hallmark of the Memorial Park is the source of it's name -- the memorial. This is usually in the form of a retired fighter jet, a huge tank, or in my town's case, both. I live in a small town -- actually, I live miles outside of it. It's like Mayberry. The population is about 5-600. There's not a lot of business -- just a gas station where the old men hang out and drink coffee from 4am until they hit the fields, a hair stylist place, a daycare, and a mechanic. The closest big town (population of 13-14,000) is 15 minutes away. That's the nearest grocery store / Wal-Mart.

So, you get the picture. It's a town full of pride. Everybody knows everybody. Everyone would give their neighbor the shirt off their back. I'm new to the town as we moved here about 5-6 months ago. I'm probably still known as the "snotty pharmacist" as I haven't gone out and made a huge effort to inculcate and meet lots of people. They have a Mason temple -- maybe I'll join that and meet some friends.

Anyway, as I drove through the Memorial Park that day, I saw that the entire park had been "rolled," if you will. It was hanging from all the trees. There must have been a hundred rolls used. The town only has one cop and the sidewalks roll up after 9pm, so if these punkass kids did this after midnight, there's a good chance that no one knew/saw except them and God himself. Now, what burned my ass up was the face that they covered the park's tank in toilet paper. Secondary to that -- why was this not cleaned up by the townspeople sooner as it's now 4pm. I screeched to a stop and parked next to the tank -- I snapped a picture with my cell phone planning on sending it to the newspaper with some commentary. Parents should be ashamed if their children were responsible for this. Perhaps a rant on patriotism. And definitely a photo of the tank cleared of all disrespect (while adjacent trees still bear the evidence) -- showing that I still have a shred of passion for this country and respect for the icons that made it what it is.

As I climbed on top of the tank, I wondered how could kids do this? I only have a dog, but she knows better. I guess the fact that these kids have the privilege to walk down the street at midnight on October 31st was lost upon them as they desicrated one of our relics.

Honestly, I think I blame everyone else more than the children. I blame their parents for not showing them proper respect for our country -- probably by talking on their cell phone during the national anthem or taking their own freedoms for granted. I think I blame our school system by not instilling that fire in them. Sure, they may say the Pledge of Allegiance every morning, but did we teach them what the words mean? You can read Shakespeare all day but if you don't learn what the words mean, it's useless.

So, parents out there. Instead of raising little bastards like the people in this town. Please teach your children to be respectful off all that we enjoy.

• Environmental pollution
• Genetic manipulation
• Accumulating excessive wealth
• Inflicting poverty
• Drug trafficking and consumption
• Morally debatable experiments

Let's talk about them for a second. Environmental pollution -- new age sinning created just for those of us in the 21st century. Gideon's Bibles anyone? What about making birth control "wrong" as the church has done? Doesn't that contribute to overcrowding and pollution? Sure it does. I wonder if burning witches contributed any to the greenhouse effect? Heck, it could be the cause! Witches in the atmosphere could be what Al Gore is trying to expose here...

Genetic manipulation -- this is a load of bullshit. I wonder if monoclonal antibodies fit in here? What about the cancer that God allowed someone to get? It's a manipulation of a gene. Is someone that gets cancer a sinner - or is just the cancer going to hell? What about the delicious corn I had for dinner last night? It was manipulated to grow bigger, faster, and more delicious. Is the corn a sinner, or am I a sinner for eating it?

Accumulating excessive wealth -- wow. "Don't get money, but if you have it, go ahead and give 10% to the church and we'll absolve you." Holy shit - what if someone wins a lottery? What about a high stakes bingo game? -- that the church held? Michael Jordan is a sinner for being loaded - just because we paid him to put a ball through a hoop...What about Bill and Melinda Gates -- arguably the most generous donators of all time (Microsoft stuff withstanding). What about me? I make a healthy wage - some would call it excessive. It's obviously more than I need because others have less and do fine. Of course, we knew I was going to hell. I wonder what the GDP of Vatican City is...

Inflicting poverty -- I'm not even going to list the number of people this makes a sinner...including the church. Of course, they've helped billions...but how many fathers died in the Crusades (any of them) leaving wife and son in poverty and/or servitude? What about me - having to charge hundreds of dollars to a patient for lifesaving therapy? Or the drug company charging my wholesaler an arm an a leg for that drug? Or even the PBMs gobbling up all the profits from every direction and, in a way, making us all just a little bit poorer?

Drug trafficking and consumption -- I looked this one up for clarification. It includes consuming any drug that has a mind altering affect. You've got to be fucking kidding me? Not only is every person in America a sinner, I am the Harbringer of Death. Alcohol, caffeine, Xanax, opiates, Barbiturates -- if it breaks the blood-brain-barriers, the Vatican says, "NO!" And trafficking? Again - talk about pointing a finger directly at me...SHIT! Next point - let's make alcohol a sin, but continue to gobble it up during service, at the beer wagon during the school carnival, and any other time we see fit. It's only a sin if you drink more than the Catholics do...if you drink less than they do, you are a pussy.

Morally debatable experiments -- Whoa. Think about all the pertinent medical research that won't get done now because some zealot sitting on an IRB will read too much into this, consider risks more than benefits, or just not even listen at all (as Christians are so good at doing). Now, I'm not defending research that consists of "let's stop this heparin drip and see how long it takes a clot to develop in various patients" -- I'm defending research that I don't understand, know that's going on, or may/may not involve some part of a zygote (don't even type the fucking word fetus on my website - I'll snap. Fetus = 8 weeks+ Which is why I could care less about dispensing Plan B...) Regardless -- this is going harm medical advancement for the years to come. I wonder if this refers to private bedroom experimentation between the sexes? I mean, come on...we've all *ahem* Nevermind. Let's just say that this may be targeting certain sexual preferences...not like the church would ever do that....would they?

Overall, I feel cheated that I have more ways to sin and find my way into Hell than those born in the 19th century. Why do those horse riding fools have a better chance than me of getting into heaven? Bogus. More importantly, can I get any ex post facto leniency here? Doubtful. I've got all kinds of purgatory headed my way -- don't I?

NOTE: Before commenting, read the URL of this website.
NOTE 2: If you post one fucking word about the prescence or absence of an almighty, I will be the one doing the smiting. I'm not looking for theological discussion on this site. I just merely wanted to bitch a little about these new rules some people have to play by that don't make and damn sense, are somewhat hypocritical, and don't apply to me cause I don't give a rat's ass.

Thundercats are go...