I suppose that in some respects, I should be flattered. All day long, people ask me all sorts of questions. What type of cold medicine should I buy? Will Drug A interact with Drug B? Does this drug cause this side effect? People must think me knowledgeable enough to think I would have all the answers. And even though sometimes those questions become tedious, they are all directly related to what it is that I do. But then there are the questions that not only do I not have an answer to, but that if the roles were reversed, I wouldn't even bother asking the local retail pharmacist.
Of all the off the wall things people ask me, questions concerning animals are probably the biggest headache. Not because I am forced to say "I don't know", but because my answer inevitably causes a ton of butthurt which in turn leads to smirks and smart-assed comments. Let me explain this to all of you in the general public who might ever think of bothering me or one of my colleagues: Pharmacists, unless they have chosen to read up on the subject, don't know jack shit about veterinary medicine. Why you ask? Because they don't teach us that crap in school since we deal with humans 99.999999999% of the time.
What they do teach us are the laws governing DVMs' prescribing authority. But when your doggie doctor calls in an RX for tramadol, I just assume he knows what he's doing. And that's about it. So don't get pissed when I refer you to a vet. For example, a few weeks ago I had a woman tell me her dog was "bleeding out of its ears" and wanted to know what was causing it and what she should do about it. Ummm....call your vet. "Don't you have anything I could buy?" Sure, I have throw-away cell phone up front you can buy so you can call your vet.
"My cat has diarrhea, can I give her Pepto?" Beats the shit out of me. Maybe Pepto causes renal failure in cats. Maybe it causes some kind of feline Reye's Syndrome. Don't get all shitty with me about it. I had one woman who got so nasty that I finally said to her, "When you're in your doctor's office, do you ask him about your cat?" She said no. "Why not?" Because he's a people doctor. Exactly you silly twat. And I'm a people pharmacist.
Where I work, people's resistance to going to a vet is all based on one thing- money. Going to the ER for a Tylenol prescription is fine because "I got Medicaid!" But vets don't accept welfare (at least not yet; perhaps if Mr. Obama gets reelected) which means poor Rover has to bleed out of his ears because momma got drunk and kicked him off the trailer stoop. Owning a pet is a responsibility. If you are unable or unwilling to take care of one, then you should stick to a house plant. Naturally I would say the same should apply to children, but we gots the gubbermint to take care of them.
Saturday, February 18, 2012
Sunday, January 15, 2012
Just call me Kreskin
Well it's January again and in the world of pharmacy, this is the most magical time of year. The holidays are over and people are just as nasty as ever, but now the fiscal year has rolled over for 99% of insurance plans. And you know what that means? Copay changes, formulary changes and ever increasing deductibles. And as the messenger of all this wonderful news, the adoring public always accepts the news with understanding.
I have spent the last 15 days getting bitched out over things that I have absolutely no control over. "But Crestor was covered last month!!!" Yep, and now it's a new year. I don't know about the rest of these morons, but every year in October I receive a big fat booklet in the mail from my employer. Now maybe I'm more diligent than the average consumer, but I actually read what the booklet contains. When I go to get a prescription filled for a generic Z-pak, I know that the copay will be $5. There is no surprise. But with my customers, this is obviously not the case.
But at least 10 times a day I hear: Why is this so expensive!? I don't have a deductible! You need to call the insurance and figure this out! I need to? Need? Seems to me this is a big cup of not my fucking problem. Why don't YOU call you're insurance? After all, it is YOUR insurance! And you're the person who signed the contract! Things I need to do: breathe, eat, sleep, poop. Hmmm...calling United Healthcare didn't make the list, so fuck off.
For those of you out there who are ignorant of how pharmacies bill claims, here's the Cliffs' Notes. We type in the RX info and electronically send a claim to the 3rd party's computer server. The server then kicks back a response as a paid claim or as a reject (i.e. refill too soon, drug not covered, etc). The pharmacist has little to no information about the claim itself. Sometimes the plan will tell us how much was applied to a deductible or how much is left of said deductible. That's about it. We don't know what your preferred drugs are (unless a rejected claim tells us) and we sure as fuck don't know how much they will cost. So if you ever roll your eyes at me when I tell you that, I sincerely hope you trip and crack your head in a pool of AIDS.
And let me tell you guys something else, especially you stupid fucks that constantly turn your nose up when I tell you about your $2.60 co-pay. I have been working in retail pharmacy since 2000. That's 12 years. Now I realize you've been on disability and Medicaid since you were born, but that doesn't qualify you as an expert on my job. Which by the way, how is it that someone who has never held A job knows all about mine? In those 12 years, I can literally count on one hand the number of times an adjudicated price was wrong. That's right boys and girls. One hand. Tens of thousands of prescriptions. Less than 6 errors on the price. Do you know what that means? It means to shut your fucking mouth about the price and give me your money! Don't like it? Call them yourselves; it's not like you have to go to work or anything. And for what it's worth, the people who typically complain about their copays, usually have the cheapest ones. OMG, $10 for a 90 day supply of Caduet? Why do I even have insurance? And don't forget the Medicaid people- Why is this $3? It should be free. And if it's not I don't want it. But ring up these Newports and boxes of wine. And be sure to do that separately from my pork rinds and Mountain Dew 'cause I got EBT. If you're one of those people, you should be placed in a burlap sack and beaten with reeds.
Despite what a lot people think, I am not psychic. I don't know all of your copays and I don't have a copy of your policy in my file cabinet. Do I look like the Aflac duck? No? Then fuck off. I used to wonder how all of the so-called "subprime" mortgages were even put into place. Now I know- people will blindly sign a legally-binding document without having the slightest clue as to what is in it. I guess I will never understand how someone can be so dumb. That and why people look at you funny when you say selective sterilization might not be a bad idea.
I have spent the last 15 days getting bitched out over things that I have absolutely no control over. "But Crestor was covered last month!!!" Yep, and now it's a new year. I don't know about the rest of these morons, but every year in October I receive a big fat booklet in the mail from my employer. Now maybe I'm more diligent than the average consumer, but I actually read what the booklet contains. When I go to get a prescription filled for a generic Z-pak, I know that the copay will be $5. There is no surprise. But with my customers, this is obviously not the case.
But at least 10 times a day I hear: Why is this so expensive!? I don't have a deductible! You need to call the insurance and figure this out! I need to? Need? Seems to me this is a big cup of not my fucking problem. Why don't YOU call you're insurance? After all, it is YOUR insurance! And you're the person who signed the contract! Things I need to do: breathe, eat, sleep, poop. Hmmm...calling United Healthcare didn't make the list, so fuck off.
For those of you out there who are ignorant of how pharmacies bill claims, here's the Cliffs' Notes. We type in the RX info and electronically send a claim to the 3rd party's computer server. The server then kicks back a response as a paid claim or as a reject (i.e. refill too soon, drug not covered, etc). The pharmacist has little to no information about the claim itself. Sometimes the plan will tell us how much was applied to a deductible or how much is left of said deductible. That's about it. We don't know what your preferred drugs are (unless a rejected claim tells us) and we sure as fuck don't know how much they will cost. So if you ever roll your eyes at me when I tell you that, I sincerely hope you trip and crack your head in a pool of AIDS.
And let me tell you guys something else, especially you stupid fucks that constantly turn your nose up when I tell you about your $2.60 co-pay. I have been working in retail pharmacy since 2000. That's 12 years. Now I realize you've been on disability and Medicaid since you were born, but that doesn't qualify you as an expert on my job. Which by the way, how is it that someone who has never held A job knows all about mine? In those 12 years, I can literally count on one hand the number of times an adjudicated price was wrong. That's right boys and girls. One hand. Tens of thousands of prescriptions. Less than 6 errors on the price. Do you know what that means? It means to shut your fucking mouth about the price and give me your money! Don't like it? Call them yourselves; it's not like you have to go to work or anything. And for what it's worth, the people who typically complain about their copays, usually have the cheapest ones. OMG, $10 for a 90 day supply of Caduet? Why do I even have insurance? And don't forget the Medicaid people- Why is this $3? It should be free. And if it's not I don't want it. But ring up these Newports and boxes of wine. And be sure to do that separately from my pork rinds and Mountain Dew 'cause I got EBT. If you're one of those people, you should be placed in a burlap sack and beaten with reeds.
Despite what a lot people think, I am not psychic. I don't know all of your copays and I don't have a copy of your policy in my file cabinet. Do I look like the Aflac duck? No? Then fuck off. I used to wonder how all of the so-called "subprime" mortgages were even put into place. Now I know- people will blindly sign a legally-binding document without having the slightest clue as to what is in it. I guess I will never understand how someone can be so dumb. That and why people look at you funny when you say selective sterilization might not be a bad idea.
Wednesday, December 21, 2011
How I Loathe Early Refills
The subject of today's rant is the dreaded "Refill too soon" rejection that every pharmacy employee must deal with every single day. Now before I start complaining, I need to clarify. I am not talking about the people who get a 30 day supply of Lipitor on December 1 and try to stock up by calling in for a refill on December 15. Don't get me wrong, those people are stupid and they have the ability to piss me off, but they are not the topic. Nor am I talking about the people who fill a prescription for Drug X for 1 tablet per day and present a prescription for Drug X 2/day on December 20. As inconvenient as it may be to call the insurance company, even those early refills are doable.
What I am talking about are the people who have taken more of their medication than what is written on the bottle. Now a good number of these are the pillheads who every month argue with me about when their Norco is due. They throw out every excuse....I'm going out of town, I was robbed, my doctor told me I could take 17 per day, etc. They are however easy to ignore and to get rid of. But it's the other ones that are harder to get rid of than bedbugs.
Maybe you're doctor DID tell you to double upon your blood glucose testing. Maybe you needed an extra albuterol neb for 2 weeks because you had bronchitis. But for the love of God, get me a new fucking prescription. Don't expect me to just hand you another bottle of meds just because you say so. And no, your insurance will not just authorize a refill. And when I suggest you call your doctor about getting a prescription that reflect those directions, make sure you roll your eyes and tell me how you don't have time for that. So let's recap- you don't have time to call your doctor, but you do have time to fuck up my day with your incessant whining? I swear to God, people will do everything in their power to avoid doing anything at all.
Listen people, this shit costs a lot of money. Just because it doesn't cost you worthless INMED fuckers anything doesn't meant it doesn't cost me money. And forgive me for being skeptical of your excuses. It's not like anyone ever lies to their pharmacist. And while I'm sure your momma knows you're a good, honest person, I don't. I don't trust you or anyone who walks in my store for that matter. It's an occupational hazard I suppose. I trust three people in terms of my non-personal life- my accountant/attorney, my mortician and John Moses Browning. If you're not one of those 3, then fuck off.
What I am talking about are the people who have taken more of their medication than what is written on the bottle. Now a good number of these are the pillheads who every month argue with me about when their Norco is due. They throw out every excuse....I'm going out of town, I was robbed, my doctor told me I could take 17 per day, etc. They are however easy to ignore and to get rid of. But it's the other ones that are harder to get rid of than bedbugs.
Maybe you're doctor DID tell you to double upon your blood glucose testing. Maybe you needed an extra albuterol neb for 2 weeks because you had bronchitis. But for the love of God, get me a new fucking prescription. Don't expect me to just hand you another bottle of meds just because you say so. And no, your insurance will not just authorize a refill. And when I suggest you call your doctor about getting a prescription that reflect those directions, make sure you roll your eyes and tell me how you don't have time for that. So let's recap- you don't have time to call your doctor, but you do have time to fuck up my day with your incessant whining? I swear to God, people will do everything in their power to avoid doing anything at all.
Listen people, this shit costs a lot of money. Just because it doesn't cost you worthless INMED fuckers anything doesn't meant it doesn't cost me money. And forgive me for being skeptical of your excuses. It's not like anyone ever lies to their pharmacist. And while I'm sure your momma knows you're a good, honest person, I don't. I don't trust you or anyone who walks in my store for that matter. It's an occupational hazard I suppose. I trust three people in terms of my non-personal life- my accountant/attorney, my mortician and John Moses Browning. If you're not one of those 3, then fuck off.
Wednesday, December 14, 2011
Anthem's War on Pharmacy
As most of you probably know, January 1, 2012 will mark a big change in the world of pharmacy. No, I'm not talking about Obamacare, but Anthem. Starting next year, the insurance giant will be locking Walgreens out from their list of covered providers. Now some of you might be wondering "why is this a big deal?" The answer is the reasoning behind this decision, and how it will impact the pharmacy business.
Anthem is a mammoth company. It includes all of the Anthem, Wellpoint, Express Scripts and DoD/Tricare plans. This amounts to millions of Americans who use this company for their prescription insurance. As of 2012, Anthem will not be reimbursing at a rate to make it profitable for a pharmacy to fill their members' prescriptions. Here's how it works. ABC Pharmacy buys Drug X and stocks it on the shelf. When the patient presents an RX for Drug X, the insurance company pays the pharmacy a negotiated price- usually 95% AWP (Average Wholesale Price) plus a dispensing fee. The dispensing fee is usually less than $3 and is paid to cover the pharmacy's overhead cost- salaries, cost of paper, cost of amber vials, etc. So contrary to what you might believe, when you pay $50 for your Crestor, Pharmacy ABC makes an average of $0.50 to $1.00 in profit. That's right, $1.00.
What Anthem is doing, is refusing to pay pharmacies what it costs to stock prescription drugs. I believe that Walgreens did the right thing in telling Anthem to take a hike. But Walmart, CVS and others did not. And that will ultimately be bad for business and for the patients. Places like Walmart don't make their money from their pharmacies; profits come from the front store. Walmart, Kroger and Meijer are willing to take a loss on an RX in order to get you into the store because they know you will buy stuff.
Now rest assured that the rest of insurance industry is watching. And if there is not a backlash, there is a real chance these other companies will follow suit. Imagine if Humana, Medco, EnvisionRx and Caremark all follow Anthem's lead. And what will happen next? They will continually drop their reimbursement rates because they know Walmart has the capital to absorb the loss. Can you imagine Walmart as the pharmacy we will all have to use? Have you ever heard someone say how much they love their Walmart pharmacy? I know I haven't. And as for independents, you can count on them becoming extinct at an even faster rate than they are now.
It is my belief that CVS and the other chains did the profession of pharmacy a great disservice by agreeing to Anthem's terms of service. Instead they should have stood together with Walgreens and forced the insurance conglomerate to pay us for the service we provide. This decision could very well have long and far reaching consequences in the not too distant future.
Anthem is a mammoth company. It includes all of the Anthem, Wellpoint, Express Scripts and DoD/Tricare plans. This amounts to millions of Americans who use this company for their prescription insurance. As of 2012, Anthem will not be reimbursing at a rate to make it profitable for a pharmacy to fill their members' prescriptions. Here's how it works. ABC Pharmacy buys Drug X and stocks it on the shelf. When the patient presents an RX for Drug X, the insurance company pays the pharmacy a negotiated price- usually 95% AWP (Average Wholesale Price) plus a dispensing fee. The dispensing fee is usually less than $3 and is paid to cover the pharmacy's overhead cost- salaries, cost of paper, cost of amber vials, etc. So contrary to what you might believe, when you pay $50 for your Crestor, Pharmacy ABC makes an average of $0.50 to $1.00 in profit. That's right, $1.00.
What Anthem is doing, is refusing to pay pharmacies what it costs to stock prescription drugs. I believe that Walgreens did the right thing in telling Anthem to take a hike. But Walmart, CVS and others did not. And that will ultimately be bad for business and for the patients. Places like Walmart don't make their money from their pharmacies; profits come from the front store. Walmart, Kroger and Meijer are willing to take a loss on an RX in order to get you into the store because they know you will buy stuff.
Now rest assured that the rest of insurance industry is watching. And if there is not a backlash, there is a real chance these other companies will follow suit. Imagine if Humana, Medco, EnvisionRx and Caremark all follow Anthem's lead. And what will happen next? They will continually drop their reimbursement rates because they know Walmart has the capital to absorb the loss. Can you imagine Walmart as the pharmacy we will all have to use? Have you ever heard someone say how much they love their Walmart pharmacy? I know I haven't. And as for independents, you can count on them becoming extinct at an even faster rate than they are now.
It is my belief that CVS and the other chains did the profession of pharmacy a great disservice by agreeing to Anthem's terms of service. Instead they should have stood together with Walgreens and forced the insurance conglomerate to pay us for the service we provide. This decision could very well have long and far reaching consequences in the not too distant future.
Monday, December 12, 2011
Paging Dr. Stupid
So my son has been a sick kid. He has had numerous ear infections, a bout with RSV, asthma and febrile seizures. A few weeks ago, he began having diarrhea. And not just any diarrhea, but the most vile, foul smelling green squirts I have ever seen. Now I used to work inpatient, so I knew what it was - pseudomembranous colitis, better known as C. dif diarrhea. Now this would make sense, as my son has been on numerous rounds of antibiotics for all of his various infections.
So I took him in for a sick visit. The doc I saw told me to get a stool sample and take it to the lab. Fine by me. I received a call from the lab a few days later and they told me the toxin test was negative. Awesome. Plus the diarrhea had stopped by then. 10 days later the pediatrician calls and tells me the culture was positive, but no treatment was necessary if the diarrhea had stopped. Two days later, I actually bumped into the doctor while doing some shopping for my wife at Victoria's Secret. Now you want to talk about awkward? Nothing like having a handful of thongs and meeting your kid's doctor. The first words out of my mouth- "I'm not a creeper. You know my wife." Lolz
Anyhoo, I asked her about the diarrhea and the lab results. She told me that if the diarrhea started again, just to call and she would phone in a script for Flagyl. Fast forward to yesterday. I received a frantic call from my wife while at work that the diarrhea was back. I told her to call the office and explain the situation to the doc on call. She called me back in tears and said the doc wouldn't help her. Now this is where it gets good. This doctor asked her what she had tried in terms of OTC items. OTC treatments for C. dif.? Are you fucking serious? So I paged the doctor to my work phone.
First, the doctor didn't seem to remember talking to my wife. Now keep in mind this was all in the span of about 10 minutes. I explained to her 3 times about how she talked to my wife. Finally she came around. I swear to God, she sounded like she was tanked. I then explained the problem (again) and what was her response? I don't even know how to dose [Flagyl] in kids.
I was floored. You're a fucking pediatrician, for Pete's sake. But I kept my cool and told her that she was in luck; I am a pharmacist and the dose is 30 mg/kg/day divided into 4 doses for 10 days. I already had the recipe out for the compounding and would make a 20 mg/ml suspension with a dose of 5 ml four times daily. Her response? "I don't feel comfortable. There are a lot of cases of this going around and I don't know why." Maybe because you don't how to fucking treat it? Did that ever occur to you?
She continued to impress me by telling me that starting it tonight would not make a difference. This is contrary to the literature that states an improvement can be seen in 48 hours, sometimes less than 24. Now if I wait until the next day, call and make an appointment, be seen, wait for the pharmacy to compound the drug, I could easily have had 3 doses in my son if we start tonight. But my pleas fell on deaf ears. Since this was going nowhere, I hung up and told my wife to go to the urgent care. The diagnosis? C. dif. The treatment? Flagyl. The urgent care doctor didn't know the dose either, but what did she do? She called a pharmacist and asked him! It turns out we are good for something besides counting by fives! Who would have thought?
So my son started the Flagyl last night. And today he had 3 stools, all of which were normal. I guess starting the drug last night was beneficial. If anyone wants to know who this super-doctor is, shoot me an email. I wouldn't trust this woman to take care of a houseplant.
So I took him in for a sick visit. The doc I saw told me to get a stool sample and take it to the lab. Fine by me. I received a call from the lab a few days later and they told me the toxin test was negative. Awesome. Plus the diarrhea had stopped by then. 10 days later the pediatrician calls and tells me the culture was positive, but no treatment was necessary if the diarrhea had stopped. Two days later, I actually bumped into the doctor while doing some shopping for my wife at Victoria's Secret. Now you want to talk about awkward? Nothing like having a handful of thongs and meeting your kid's doctor. The first words out of my mouth- "I'm not a creeper. You know my wife." Lolz
Anyhoo, I asked her about the diarrhea and the lab results. She told me that if the diarrhea started again, just to call and she would phone in a script for Flagyl. Fast forward to yesterday. I received a frantic call from my wife while at work that the diarrhea was back. I told her to call the office and explain the situation to the doc on call. She called me back in tears and said the doc wouldn't help her. Now this is where it gets good. This doctor asked her what she had tried in terms of OTC items. OTC treatments for C. dif.? Are you fucking serious? So I paged the doctor to my work phone.
First, the doctor didn't seem to remember talking to my wife. Now keep in mind this was all in the span of about 10 minutes. I explained to her 3 times about how she talked to my wife. Finally she came around. I swear to God, she sounded like she was tanked. I then explained the problem (again) and what was her response? I don't even know how to dose [Flagyl] in kids.
I was floored. You're a fucking pediatrician, for Pete's sake. But I kept my cool and told her that she was in luck; I am a pharmacist and the dose is 30 mg/kg/day divided into 4 doses for 10 days. I already had the recipe out for the compounding and would make a 20 mg/ml suspension with a dose of 5 ml four times daily. Her response? "I don't feel comfortable. There are a lot of cases of this going around and I don't know why." Maybe because you don't how to fucking treat it? Did that ever occur to you?
She continued to impress me by telling me that starting it tonight would not make a difference. This is contrary to the literature that states an improvement can be seen in 48 hours, sometimes less than 24. Now if I wait until the next day, call and make an appointment, be seen, wait for the pharmacy to compound the drug, I could easily have had 3 doses in my son if we start tonight. But my pleas fell on deaf ears. Since this was going nowhere, I hung up and told my wife to go to the urgent care. The diagnosis? C. dif. The treatment? Flagyl. The urgent care doctor didn't know the dose either, but what did she do? She called a pharmacist and asked him! It turns out we are good for something besides counting by fives! Who would have thought?
So my son started the Flagyl last night. And today he had 3 stools, all of which were normal. I guess starting the drug last night was beneficial. If anyone wants to know who this super-doctor is, shoot me an email. I wouldn't trust this woman to take care of a houseplant.
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