The WAR Continues

Posted by The *Angriest* Pharmacist as Blogs I like, Me being a dick, Me hating others, Rude, True Story, store

Which war you ask? Of course, the WAR BETWEEN PHARMACISTS AND CHIROPRACTORS. In honor of my chiropractor, who has been made privy to this site, I’ve made a couple funny t-shirts. We’ve had a few good conversations about beliefs, traditions, and principles of both of our professions. I’ve cited many peer-reviewed research studies. He’s cited a lot of…well…anecdotal evidence…

Pharmacist 1,  Chiropractors 0

It could be worst I could be a silly CHIROPRACTOR

Love, your local PHARMACIST

It could be worst I could be a silly pharmacist

Love, your local CHIROPRACTOR

It’s long been known there are a few IDIOT pharmacists out there, and the vast majority of pharmacists hate the fact that chiropractors are more in tune with the health and wellness of human body — finding homeostasis within holism and conservatism. I will add that a pharmacist’s misfills are responsible for the hurting and injuring of thousands each year — and who knows how many deaths. [Easter egg included with this shirt...]

TheAngriestPharmacist’s T-Shirt Heaven

Finally, A Hot Pharmacist’s Contest We Can Respect

Posted by The *Angriest* Pharmacist as --Not Pharmacy--, Facebook, GUEST CONTRIBUTOR, PHARMACY SECRETS!, Pharmacy School, Sexy Time, Technicians, True Story, store

I’m sure there are hot pharmacists out there. Why do I work with the ugmos and or dudes?

Prove to me there are pretty female pharmacists out there. I’m gonna steal a page from the now defunct hot pharmacists website out there. I’m gonna run a HOT RPH contest. I will filter through the photos and ween down to the top 5 to 10 females them run a POLL on my website to declare the hottest pharmacists. Categories are as follows:

- American RPh Female
- Abroad RPh Female
- Student Pharmacist Female
- Technician Female
- Technician Male
- Student Pharmacist Male
- RPh Male (American and Abroad)
- Cutest Pharmacist Offspring/Spawn
{My wife will judge the male categories}

Winners will get a free ANGRIEST PHARMACIST T-Shirt ( http://www.Zazzle.com/ TheAngriestPharm* ) of their choosing. [Baby's may delegate this to their parents..:-]

Rules:
Cutoff for photo submission will be March 31st. Please email photos to TAestP@TheAngriestPharmacist.com with the category above as the subject line (for easy sorting). To ensure photos are current and of yourself (or spawn), you MUST include a note where you have written “TAestP.com” on a piece of white paper. Please just send your full name, age, and category in the email message (you can forgo your address at this point in case you move before the shirt is shipped or I lose/delete it). I will contact you at *that* email address at the conclusion of the contest for your address if you are selected by myself or my ole lady as the winner.

By transferring the photo to me, you are giving me permission to publish the image, your first name (not last name), and state/country of residence in any medium forever. I will respect the privacy of your name, home/email address, and other private information. I will protect this information to the best of my ability but assume no liability in the event shit goes down outside the realm of my control.

Pharmacist’s licensure will be confirmed through the state board of pharmacy before declaration of winners — in case any of you hot, non-pharmacists are thinking about scoring a free t-shirt.

Already received FOUR legit (albeit webcam) entries via Facebook email. I really would prefer them in my email inbox at taestp@theangriestpharmacist.com as the filtering is set up already and will make judging much easier.

Additional rule — you absolutely positively MUST be 18 to enter this contest. Do NOT send me your photo unless you are 18 or older even if you are in pharmacy school or are a pharmacy technician.

Is there any truth to this rumor?

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

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

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

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

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

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

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

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

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

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

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

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

Maybe our pensioners should apply as refugees!

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

Your stupid paper card is just that…

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

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

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

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

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

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

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

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

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

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

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

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

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