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.

Lots of stuff to look at

Posted by The *Angriest* Pharmacist as Celebrities, Laws, Lazy People, Me being a dick, Patient Education, Robbery, Salutations, Stupid People, True Story, Work Sucks

Finally, a non bullshit assessment of generic drugs from someone without their head up their ass. They got valid opinions from people that matter and aren’t retarded.

http://www.newsmagazinenetwork.com/feature/cover-stories/090512-671/brand-name-versus-generic-drugs

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Here’s a case that is a bit odd.  Mother and son run away after MD tells them the 13 yr old’s Hodgkin’s Lymphoma  is worsening. Mother rejected chemo and western medicine and settled for tried, tested, and true homeopathic Indian Medicine.

The courts did not think this was a good idea.
http://www.cnn.com/2009/US/05/25/minnesota.forced.chemo/

Let us not forget,”Child Dies, Parents Perplexed”:
http://www.theangriestpharmacist.com/2008/03/28/child-dies-parents-perplexed/

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Here’s a handful of bullshit. The slop was posted on AOL Health.com and made it into some even bigger channels. Everone better order a bottle of Vicodin, Norco, and Soma.

http://www.aolhealth.com/health/generic-drug-safety

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Pharmacist robbed. Pharmacist gets mad, concealed weapon permit. Pharmacy robbed again. Robber killed by Pharmacist. Pharmacist chases down second robber and shoots him in cold blood. Pharmacist in deep doo-doo.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/05/30/MNKG17TI7S.DTL

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Oprah’s health advice could make you very sick. Here’s an explanation from Newsweek saying why….I’ve said since the beginning that Neti Pots were the devil.

http://www.newsweek.com/id/200025

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Hope you enjoyed today’s helter skelter rag tag post.

Drug Companies Corrupt? NO!

Posted by The *Angriest* Pharmacist as Doctors, Drug Companies, Laws, Me hating others, Money, Robbery, True Story, Update, Work Sucks, store

By NO, I mean yes…

DRUG COMPANY CORRUPT

We all know my thoughts on this, and recently Zyprexa paid out some BIG BUCKS because they pushed off label uses. It is now mega illegal for a drug rep to even utter the words off-label to a physician.

Thanks to WILL for sending this to me…

-=+=-

BONUS:

A lady bitch pissed me off today for standing at the register after I told her 15 minutes. After about 2 minutes of standing at the register I said, “Ma’am, it’s gonna be a while. If you wanna have a seat, I’ll hollar at you when we’re done.”

Her response? “I don’t have time for that. If I walk away from this counter you all will just lolligag around, and it will never get done. I have to keep my eye on you.”

In her honor, we now have this glorious shirt:

PATIENTS? WHAT PATIENCE?

Robbed at Gunpoint

Posted by The *Angriest* Pharmacist as Drug Seekers, Robbery, Technicians, True Story

No, I wasn’t robbed…today anyway.

A Notre Dame Med student and pharmacy technician emailed me recently, asking about my thoughts on robbery — as her store had been robbed, “a few times lately. So have many others.”

You might have noticed, in preparation of writing this post, I added a new poll asking if “your store had ever been robbed.” At this point, the vast majority (Close to 90%) of pharmacy employees have not been robbed — at least the ones that frequent TAestP.com haven’t!

Anyway, she also asked about dialog within the pharmacy about it. Apparently, it was a hush-hush/taboo topic in her pharmacy — and that bothered her.

—————————-

Well, in TheAngriest Pharmacy, it is not a taboo topic. While we don’t discuss it every day, it is something that every employee is made aware of at hire. Occasional updates are also provided and questions are answered. My initial training of technicians discusses what to do in case of robbery. Obviously, I tell my younger female techs to stay quiet, get/stay out of the way, not make eye contact, and do whatever you are told (except go with the person – I’ll be damned if I allow an armed robbery turn into a kidnapping). We also cover the “corporate policy” on the matter which obviously says, “no merchandise is worth your life – give it to them.”

We also discuss potential lapses in security, or areas we are deficient. Thinking like a criminal and recognizing these weak spots before the bad guys see them could prevent that easy “in” by criminals. This also goes with shoplifting.

Now, for myself, I operate under a different set of rules.

I’m a grown ass man. I’m in the best shape of my life at 6′3″ 205 pounds. I even hold a few weightlifting records at my high school AND college (squat and deadlift). Let’s put it this way, I wouldn’t fuck with me.

If someone tries to rob me, they’d better keep my eyes on me. If they turn their head, even for a second, I’m going to knock them the fuck out. I have a stationary printer right next to the station I work at each day. If I can lay my hands on it, I really don’t think the alleged robber would survive. If he did, there would definitely be some mental deficiencies to deal with.

Some of you are going to say how ignorant that cockamayme plan is. That someone could get hurt. I could get shot. I could get someone else shot. It’s not worth it. Blah Blah Blah. — Those of you that would argue against me knocking out some punkass pharmacy thief need to buy some Massengil and rinse the sand out of your vaginas. The only danger posed is upon myself. All this doesn’t even have anything to do with money — as insurance would cover a robbery. This all goes back to the principle of the issue — If I *can* stop a criminal, shouldn’t I? Am I not doing a disservice to the community in allowing this asshat to escape and get away with 30k of my inventory as well as scarring my staff?

Yup, that’s the plan………now. I was robbed once several years ago. I didn’t hit him tho — I didn’t ever really
think about it until after that happened. But, it is the reason I think the way I do now. I know I could have taken this little bitch. I feel bad I didn’t light his ass up. Anyway, I have a locked safe that is an ‘island,’ they knew that and they only wanted C-IIs. I unlocked it quickly before they could see in it. I pulled out the top shelf all the way — thereby blocking the view of everything that was under it. So, they only got half my inventory (I was proud of that little maneuver! Of course I have cameras, but I made damn sure that I knew his face like the back of my own hand, and I had a pretty good idea what the gun was. I even followed them out the door (I pretty much walked them to the door and followed them to the parking lot) and got the tag of their van and watched which way they went — so I could tell the cops. They got caught a few miles outside of my town.

I would have been a great witness. Too bad they both died. One was shot in the chest by one of the cops. Apparently, John Wayne thought he was gonna battle his way through 15 cops on his way to Opiate Heaven. The other took a little detour to Opiate Heaven. His detour was, ironically, the Opiate Highway. Get the metaphor? He died in jail a day or two later. A condom full of Oxycontin exploded in his belly. He knew he was gonna get caught and thought he’d be the king of the jailhouse!

Have you ever been robbed? How did you take it? Did you just follow orders?

Concerning my, “Knock The Fucker Out” Method — Great Plan or GREATEST Plan?