Friday, September 12, 2014

I Am Nothing If Not A Man Of My Word.

I needed a favor and I mindlessly threw in a deal sweetener. It probably wasn't necessary. The Angry Pharmacist is actually much nicer than you would think, and he probably would have done it for me anyway. But I said it.

"If you do this for me I'll even write something Republican friendly on the blog"


OK, let's see here.................


Ummmmm....Oh. I think I have something. Here we go:

Neither Marco Rubio, or any other Republican, has ever cut off the head of anyone on a video broadcast on the internet throughout the world.

That I know of.

I think the fact that the bloodthirsty religious whack jobs of the GOP limit themselves to abortion clinic bombings, and the occasional doctor assassination, and that they choose not to film their acts for propaganda purposes, reflects somewhat positively on their character when compared to the bloodthirsty religious whack jobs of ISIS.

Glad I got that off my chest. I must be more careful with my promises in the future.

Monday, September 01, 2014

Area Blogger Traumatized By Threat From Anonymous Douche.

DRUGMONKEYLAND, CA-  In a development that might shake the pharmacy blogging world to its very core,  longtime publisher of the "Your Pharmacist May Hate You" blog Drugmonkey received an email today that may forever change his relationship with the completely never sarcastic blog he has been publishing since February, 2005 (Longer than The Angry Pharmacist, regardless of what he says on his Twitter feed) The potentially earth shattering message read, in whole:

Your writing style usually rides a fine line between informative and entertainment in the form of satire. Lately, your use of sarcasm has been taken to such heights that it feels like I'm reading The Onion. I don't like The Onion. 

I am a long time fan of your page and satisfied owner The Pharmacy Rip Off List, but if this is a sign of things to come then you may loose me as a an advid reader.

"It was like my world had ended" Drugmonkey said from his undisclosed location deep in The Sierra Nevada Mountains. "I mean, I realize I had taken the blog in a completely different direction with my post about Walgreens executives getting millions of dollars in severance pay after making a billion dollar error, but never in my wildest dreams did I realize an Onion rip-off article, which I had never, ever attempted before, might alienate one lone reader the way it seems to have done here."

"So after I read this I realized I had a choice. Have my writing style associated with an award winning, incredibly popular, wildly successful cutting edge comedy publication, or take a chance on "loosing" an "advid" reader.

(Look, I realize I may need a copy editor more than most people, but is anyone on the internet ever going to get this right ever again?   Loose is the opposite of tight for fuck's sake, and lose is the opposite of gain or win)

After a bout of weeping The Drugmonkey continued. "I was lost and unsure how to handle this. I prayed and cried. I went on a Native American visionquest journey and reached deep into my soul, and finally, I think I may have the answer."

"I will offer a full refund to this unsatisfied asswipe who is evidently the center of the universe. Every penny they have ever paid to access my blog shall be returned. I will also realize that anyone who claims to be a "long time fan" and never seen an Onion-like post is full of shit. "

At press time The Drugmonkey was unsure if he should change his mind and beg forgiveness from the asshole.

Sunday, August 31, 2014

An Innovative, Outside The Box Incentive Program From Industry Leader Walgreens

Deerfield, IL- Corporate executives at Walgreens, the nation's largest pharmacy chain, today announced a new employee bonus program that they promised would "shake up the retail industry, if not the entire business world" at a press conference at its Zug, Switzerland Illinois corporate headquarters.  "We're turning conventional thinking upside down" stated company CEO Greg Wasson. "How? Well hang on to your seats. By rewarding.....failure"

According to Wasson, effective immediately, all Walgreens employees will receive anywhere from 0.75 to 1.2 percent of any financial errors they are responsible for in direct payments from the company. "Now granted, to a cashier whose drawer is off by ten dollars at the end of a shift, a payment of an extra dime may not mean much, and let's face it, a store manager getting an extra ten dollars for a deposit off by $1000 certainly won't be a game changer. That's why I'm announcing the start of this program with two executives who we think will become emblematic of what we're trying to accomplish. Wade, Kermit, step on up here."  

Mr. Wasson was then joined at the podium by Company Chief Financial Officer Wade Miquelon and President of pharmacy, health, and wellness Kermit Crawford*

"Now, these two men were recently responsible for a billion dollar forecasting error when projecting our upcoming Medicare business" Mr. Wasson continued. "And there's no company where a billion dollars isn't a good sized chunk of change, so naturally, we have to let them go. But not before, and I want everyone to know this, we load them up with payments and compensation worth $8.5 million and $12 million, respectively."**

"That's right" Wasson said "Write that down for the whole world to see. Make a billion dollar fuckup at Walgreens and walk away rich!"

Asked how a plan that rewarded failure could possibly further the company's interests, Wasson replied "That's the genius of this whole thing. Like I said, this won't mean a whole lot to the vast majority of our employees. Right now that is. But what it does is let them know that if they work their way up to a position where they are responsible for a whole lot of dollars, well...then the world is their oyster. So what we're gonna have here is 250,000 employees striving every day to reach a position of greater responsibility so they too can have a $10 million screwup payday. And quite honestly, 250,000 store-level employees giving their best is worth far more than one fuckup at the top."

While executive-level business people were almost universally positive in their reaction to the new bonus program, others were more skeptical.

"I don't see how this changes current executive compensation practices at all" said Harvard business professor Camfield Rosenburg. "And to be effective, the expansion of fuckup bonuses to store level employees would have to be coupled with a policy where promotions to positions of great responsibility were based on positive performance. And I didn't see anything in today's announcement to indicate such a change has taken place."

After the press conference, Miquelon and Crawford issued a joint statement that read simply "Moneymoneymoneymoney Brrrraaaahhhhhaaaahhhaaahhhaaaaaaaa!!!!!"

*As much as I would like to say I made this up,  "Kermit Crawford" is the guy's real name. 

** I didn't make  this up either. In case you were too lazy to click on the link, these guys made a billion dollar screwup and were rewarded with millions of dollars in severance money. 

Friday, August 15, 2014

Why The Fucking Flexeril Isn't Covered Anymore.

More than a few of you have come across this situation by now I bet. In the midst of a chaotic, stressful workday you finally snag an easy one. Thirty flexeril. Yay. Two seconds and we'll have this one right out the.....

Then you see the insurance reject. Prior auth required. What. The. Fuck.

We've all come to expect this with the bullshit drugs of course. And the expensive meds  with cheap alternatives. I'm looking at you Lyrica. One of the missions of the insurance companies is to save money after all.

But Flexeril? Are you kidding me? The generic is cheap as dirt. So I repeat, what the fuck? "They must be doing this for no other reason than to get me to crack" you might be thinking. "They've decided they must make each and every prescription a herculean effort to get out the door. There is a war on my sanity. Because there can be no logical reason to slap a prior auth on a seven dollar med."

Oh but there is a reason my poor underinformed retail drone. Logical or not can be a matter for debate, but read on to find out  why that insurance company pain in your ass just got a little bigger.

I'm going to go out on a limb here and say that rejected Flexeril claim was for a Medicare Part D patient. I know this because while you, my poor pillcounter, are still stuck in that outdated world where insurance companies obsess about nothing but money 24/7, I have seen the future, that bright new paradigm where the health care powers that be now obsess But in completely new and innovative ways. Where an obsession with the dollar can lead to scrutiny of the most absurdly inexpensive of insurance claims.

It works like this. Someone got the bright idea that Medicare should do more than just sit there and pay claims sent in by the health care professional types. That since he who pays the bills can make the rules, they should use their bill-paying influence to try and influence quality of care. It was decided that Medicare would start to rate its Part D plans like AAA rates roadside motels, with a one to five star system.

So far this sounds OK, right? After all, who could argue with an effort to improve medical outcomes?

Next step involves how to go about being able to show how a large, paper-pushing, figure obsessed bureaucracy is improving things for the oldsters. How do we do that? We can't really just go around saying, " 'Ol Doc Johnson over there at Blue Cross of Lower Damnation does a pretty good job, Five stars for them!!" now can we? We need things to measure, so as we can compare like to like. Outcomes this year versus outcomes last year, Blue Cross versus Humana. In short, we need a way to generate numbers we can use in place of that unreliable human subjectivity.

I'll stop here the throw in the olive in the martini. Those star ratings are worth big bucks to the insurance companies, as Medicare pays bonuses to the highest rated plans.  It's estimated that the difference between a 3 star and 5 star rating is worth about $200 million to the plan getting rated.

That's right, the principle of using metrics to judge performance that has been such an unqualified success in making chain drugstores efficient customer service utopias has now been expanded to the realm of clinical judgement. In this case, Flexeril, the muscle relaxant that been part of the standard treatment plan for all sorts of painful conditions for longer than I have been alive, has been classified by some bureaucrat as a "high risk" medication for the oldsters. And a plan that goes over a 3% threshold of "high risk" meds is ineligible for a 5-star rating, and all the megabucks that goes with it.

So yeah, good luck getting them to approve that claim.

Except chances are, if you have a brain in your head and no desire to torture yourself, you won't even try. You'll notice that even if you moved heaven and earth and got that claim approved, the five dollar copay that would result isn't all that much less than you would normally charge a person with no insurance at all. As a matter of fact,  you could just say hell with the insurance company, charge the person five bucks,  make just a little less on the prescription than you would have anyway, and save yourself a hell of a lot of hassle.

It's a win win. And if grandpa gets a case of brain fog after popping a pill or two and falls down the stairs, it still goes down as a win for the insurance, as they don't have a claim for the "high risk" med on file, and therefore won't get dinged.

Meet the new health care order my friends. Where everyone wins, except the drugstore who made a little less on a prescription than they normally would have. And Medicare, who just paid out a big bonus that had zero impact on quality of care. And grandpa, who just fell down a flight of stairs.

Which means no one really won except the insurance companies.

Which means the new health care order looks a lot like the old health care order.

But at least you know why that pain in your ass is a little bigger now.

You're welcome.

Monday, August 11, 2014

Into The Mailbag We Go.......

Got this one as a comment to this post about the fun times people have working for CVS. Thought it deserved to be out front on its own:

Being a regular pain medication customer of CVS, I find it hilarious that not one single pharmacist will take ownership for their own fuck-ups. After getting rear ended at a stand still by a car traveling 60+ mph last year I was left with 8 bulging discs and an immense amount of pain that I will have to endure the rest of my life. My insurance won't work with Walgreen's so I got stuck with having to deal with CVS. I have a prescription for Tramadol and I don't know how many times I was supposed to have a script ready only to be told by my pharmacist that it can't be filled! You want to talk about a living hell? Try going through a Tramadol withdrawal on top of serious back pain! I am going through it again as we speak. I went back to my prescribing doctor and even pleaded to be put on anything else and he told me that there was nothing else that would help. He adjusted my prescription to where the frequency was 1 to 2 tablets every 4 hours as needed on a 120 count bottle. I have had one refill and one renewal since the adjustment and just had the online app tell me that my script was ready for a refill. I only had a few pills left so this seemed right. I put in the order online and was told it would be ready at 11:00 am. I show up at 1 pm and get told that they can't fill my script because it is too soon! They try to tell me that it was supposed to be a one month supply and I look at the label on my bottle and see "1 dose every 4 hours as needed". I talked to my prescribing doctor and he verified that he did not change the script. So some fuck head pharmacist filled out the script wrong the last time I renewed and I'm left to suffer until I can get this mess sorted out. Having just started a new job, this is the worst time to be going through this and I hope there is a special place in hell for all the fuckers at CVS who have repeatedly fucked me over. I am lodging a formal complaint with the pharmacist board. I have had enough. Meanwhile you fucktards whine about corporate pressure and how horrible it is. Then fucking quit! I can't quit my pain! Stop bitching and take ownership of your actions. Jesus Christ what a bunch of whiny fucking babies you all are . . .

Actually it was the answer I wanted to make sure everyone saw. Here goes:

Dear Whiny Douchebag:

Imagine you just got a letter from your insurance company about your tramadol coverage, and in it it said for you to get any more refills, you had to suck my dick. I bet you'd be all like "No way!! You guys can go to hell!" Right? Or at least something similar.

At least I hope so, 'cause I'm not getting any kind of hot chick vibe from your writing style.

Now, let's say I came to you and said for $15 a month, I'll tap you with a magic wand that will make sure your pain is under control and you will never have to go through tramadol withdrawal ever again. Assuming you're not a liar, (Many, many people with these type of stories are.) I bet you'd say something like "Wow! tramadol withdrawal sucks so bad, and I have this new job now with some dough coming in, and I work better when I'm not in pain, That's a bargain!! Sign me up!"

Well guess what Mr. Whineyfuck, this is your lucky day. because I am about to give you a clue as to how you should have been able to solve your problems all along.

I brought up my first point to show you that there is no law that says you have to do what your insurance company says. You wouldn't (I hope) suck my dick to get your tramadol, and you don't have to go to a pharmacy run by incompetent clowns. I'm not about to defend CVS here. The obsession with short staffing that permeates the chain drug world ensures that many people go through your type of experience.

Notice I said chain drug world, which means I wouldn't count on your Walgreen's being any better.

So what's a hurtin' tramdol dependent dude supposed to do? That's my second point. If you came into my place, I'd have you fixed up in about 5 minutes. Ten tops. And I'd charge you around $15 dollars a month without your insurance. If I happened to be in your fucky company's network, it'd be even less.

I'd also tell you the maximum dose of tramadol is 8 tablets a day, so your doctor kinda fucked you if he really did make out a prescription for 1 to 2 tablets every 4 hours. Do the math.

Which brings us to our conclusion. I'm not sure why I have to tell you this, but you don't have to be your insurance company's little bitch boy. Take some ownership of your own life, get your head out of your ass, and find yourself a real pharmacy. It'll cost you less than a Jackson. And if avoiding a life of pain and withdrawal isn't worth that much to you, then you'll get no sympathy from me.

You're welcome asswipe.

Thursday, July 31, 2014

A Random Book Excerpt, Because Not Everyone Should Pay To Experience My Wisdom.

Actually, now that I read that, very few people do. Pretty much anyone at anytime can come up to me at the store and pick my brain. Now that I think about that I'm kinda jealous of these people now. Able to ask me a question whenever they want. Lucky them.

Wait, now that I think about it even more I realize I can ask myself a question and experience my wisdom anytime I want. Whether it's 2 in the morning or during my morning shower or even in the middle of sexual intercourse.

I am the luckiest man on earth, and it would be mean of me not to share me.

Here you go:

Chapter 7: Atralin

The Med

Atralin is a brand name for the topical acne medicine tretinoin, and tretinoin was my teenage savior. Regular use, a little peeling to let me know I was using too much, a sunburn or two to teach me those warning stickers put on by the pharmacy weren’t just for show, and the volcanic mountain range that had erupted on my face eventually went into submission. The fact tretinoin can make acne worse before it makes it better was a little disconcerting, but after a few weeks, this pimply faced future professional was convinced tretinoin was a gift from heaven. I was now free to become socially awkward based only on the merits of my actions and not on the condition of my skin. It felt better somehow to know my awkwardness was now earned.

To make it even better, as I approach middle age, tretinoin has now also come into wide use in the treatment of facial wrinkles, making it easy to think of it as some sort of lifetime sex appeal in a tube. There are some people who would pay a lot for lifetime sex appeal, no questions asked I bet. Valeant Dermatology, the same company that brought us the rip-off acne med Acanya I talked about earlier, seems to have made that bet as well.

The Scam

Some of you more astute readers may have read the above description of tretinoin and wondered if I wasn’t talking about Retin-A. I was. Retin-A was the original topical tretinoin, and is now saving the complexions of the children of its first generation of users. Drugs this old have generally lost their patent protection and are available as money-saving generics, and Retin-A is no exception. Funny thing about this med though, even though it’s sold in different strengths, including 0.05%, and even though it’s available in both a cream and a gel formulation, one way you can’t get it is as a 0.05% gel. This is where Valeant saw its opportunity.  It introduced Atralin, a 0.05% gel form of tretinoin and marketed it as a new product not substitutable for a generic. The price? $250 for a 45 gram tube. Over four times the price I found for the same size 0.05% cream with a little shopping around.

Neither the cream nor the gel has been shown to be more effective by the way. Keep that in mind when you’re making your purchasing decisions.

Once again however, a little looking around will lead you to a “savings offer,” where insured patients, most insured patients that is, will pay $25. If you’re one of the lucky ones who qualifies for that $25 copay though, just remember your pharmacy has submitted a claim to your insurer for $250. Uninsured patients will pay $75 with the savings card. Which means Atralin is a product whose primary purpose it would seem, is to drain money away from your insurance company and those people not savvy enough to look for coupons, and into the coffers of Valeant Dermatology.

What To Do

Unless you’re just a really big fan of topical gels, there’s little if any reason to buy Atralin. Just stick with the generic Retin-A.

Actually, let me take that back. The box design on the generic tretinoins can be a bit boring. They have plain old boxy letters and tired plain color schemes. So if it's important to you to have stylish graphic artwork in your medicine cabinet, then by all means, go for the Atralin.

The rest of us though, can take the money we save on our lifetime sex appeal in a tube and spend it wining and dining our soon to be many suitors.

Or come stalk me at the store.

Lucky you.

Sunday, July 27, 2014

The Makers Of Dulcolax See Your Ass As A Penitentiary, And Their Mission As A Humanitarian One.

This, my friends, is an actual ad for the actual laxative Dulcolax, which ran in newspapers and bus stations in Singapore.

I am not making this up. There sit a pack of imprisoned turds, marking time around your asshole until they are, as the text in the corner says, set free by you.

"Well I should start shitting right away" you're probably thinking. My turds have done no crime, and therefore don't deserve to be doing time."

Not so fast there bubs, let me tell you what's gonna happen to those poor turds once that Dulcolax kicks in. It's a stimulant laxative, you see, and in this case, what's stimulated is the smooth muscle of the large intestine.

Which means those poor turds are gonna get crushed as the walls of their prison close in around them. Crushed until there is enough pressure to force them out of that little asshole in the floor. Look at the size of that asshole and look at the size of the turds. It ain't gonna be pretty.

I am going to go to bed now, but not before I say a little prayer for my turds. They are in for an ordeal the torturous quality of which I cannot even imagine.

Godspeed to you, innocent shit.

Friday, July 25, 2014

Once Again, Real Life Takes Away My Material. I Also Call Out Some Chicken Shit Compounding Pharmacists

Those of you who've picked up a copy of my awesome first book no doubt remember how I opened it with reminiscences of how I used to mock healthcare professionals who couldn't poison someone.  A doctor who tried to kill his mistress with strychnine for example, or a nurse who might use morphine to off a patient or two. It worked as humor because you'd assume that anyone who spent a few years studying the combination of how the body works and the chemicals the world of medicine puts into it oughta be pretty good at figuring out the poison thing. Basic stuff, right? Right in these people's wheelhouses and they screwed it up.....ha ha ha.....

Yeah....ha ha fucking ha.

The execution of a convicted murderer in Arizona lasted for nearly two hours on Wednesday, as witnesses said he gasped and snorted for much of that time before eventually dying. 
This drawn-out death of Joseph R. Wood III in Arizona prompted the governor to order a review and drew renewed criticism of lethal injection, the main method of execution in the United States, just months after a high-profile botched execution in Oklahoma.

And another one before that in Ohio. Right in the people's wheelhouses and they screw it up. Time after time. Once again I have underestimated the incompetence of others, and once again, real life robs me of comedic material.

Midazolam is the common denominator in all these fuckups, used with the narcotic hydromorphone in Ohio and Arizona and with a muscle relaxant (vecuronium) and potassium chloride (to stop the heart) in Oklahoma. So let me tell you a little bit about midazolam. It's what's known as a benzodiazepine, related to the Xanax and Valium so many people have made friends with. All in all they're a pretty good class of meds, gaining popularity in no small part because they are safer, particularly in overdose, than the class of meds they replaced, known as barbiturates.

Now, I'm gonna pause here, and place a large bet that even if you haven't had a day of any kind of medical training in your life, you can read that last paragraph and figure out the problem here, and offer a possible solution.

Some 6th grade dropout probably just said something like "um...maybe they shouldn't be using the safer one if they want to kill someone, and maybe go with that barbiturate stuff instead"...and that person... would be smarter than the Ohio, Oklahoma, and Arizona Departments of Correction.

 How many of you have had to have a pet put down? How long did it take? Seconds, not hours, yes? Guess what they use? Read that paragraph again and just take a wild-ass guess.

"Um......a barbiturate maybe?" the dumbest person on earth might say. And he would be right. Pentobarbital to be specific.

The olive in the martini here is that some states have figured this out. You won't hear about botched executions in Texas or Missouri because pentobarbital is exactly what they use.

So let's recap here. There is a successful model of a lethal drug that has a proven track record in both animals and humans. Yet some people in power think it's a good idea to go their own way and come up with a plan that uses a drug that is popular in medical practice in part because it is safer in overdose than the drug that is successfully used to kill lots and lots of living creatures.

And this is the world in which I try to satirize. Which probably says something about my intelligence.

Not that a midazolam/hydromorphone combination is completely inappropriate in theory. Pump someone full of enough of it and yeah, they should kick the bucket you would think. You know, assuming the meds were of the correct potency and actually were what they said on the label. Who knows? Maybe that was the problem here. Let's just check with the manufacturer and clear this right up....

...oh....wait. We can't do that. because no one quite knows who the manufacturer is. The prison people claim they're getting their goods from compounding pharmacies. Which means, if true, there's a colleague or two out there of mine who's a spineless, chicken-hearted, weak, cowering, thumbsucking, lily-livered, yellowbellied coward of a human.

That's right bubs. I'm calling you out. Signing a contract of death with the state is one thing, but doing so while insisting on the protection of anonymity is a whole other level of pussydom. Come out come out where ever you are deathdruggist, because if you can't stand the heat you're generating, you never should have gone into that kitchen and started cooking.

And just in case you are ready to point a finger back at me, I'll point out that I ended my awesome first book by telling the world how to get an abortion using a common anti ulcer medication, and I'll put the backlash whackadoodle anti-choice zealots are capable of generating up against anything you'll face any day of the year.

That part of the book still holds up by the way. No doubt because there I wasn't trying to mock an increasingly unmockable world.

Friday, June 20, 2014

This Is The Business Expertise I Remember From My Former Employer.

From The Motley Fool:

the biggest reason for the profit shortfall is what now appears to be overly rosy guidance for cost-saving benefits tied to Rite Aid's recent deal with generic distribution giant McKesson.

That deal transferred the company's responsibility for buying and distributing generic drugs to stores from Rite Aid to McKesson. When the deal was announced, Rite Aid argued that McKesson's bigger buying power and sophisticated distribution network (allowing for daily shipments direct to stores) would lower purchasing costs and inventory.

Unfortunately, that argument fell short this past quarter given that the company's cost of goods sold totaled 72.1%, up about a percent from a year ago.

You know, I work with McKesson myself, and I've always kinda liked them. They've always treated me fair, they have a lot of resources available for an indy out there in the big, bad, drugstore marketplace, they even gave me a free plant when I opened my account that's still alive.

I don't like McKesson anymore though. Because according to this they kinda fucked my former employer.

Which means I now LOVE them!!


I'll probably kiss my McKesson driver Monday and he'll have no idea why.

Tuesday, June 10, 2014

My Preliminary MTM Conclusion

So...working through some numbers this night, I see that my MTM revenues to date have netted me about as much revenue as....

Ten extra prescriptions.

Pushing the figures a little further, I remember that when I'm in the happy pill room by myself without technician, ten prescriptions in an hour is a pretty good pace.

And...I've probably spent more than an hour doing the MTM stuff.

Which means....the paradiem  we've been living with since Nirvana was a fresh new band, of desperately grabbing as many prescriptions as we can at any price (including now actually paying for the privilege of filling them in some cases...long story) is actually still ahead of the bright new future of pharmacy being engineered for us by the visionaries of the profession.

To recap, in case you missed it. I can probably make more money in an hour cranking out prescriptions than I can working my MTM cases.

No wonder the chains went ape shit over the flu shots with hardly a peep about making sure Grandma is taking her Lipitor.

I've gotta get that damn Medicare immunization application done.

OK, thanks for helping me work through that folks. Goodnight.

Holy crap I can't believe I'm a businessman now.