Zogenix Pharmaceuticals Meets The Country's Need For More Hydrocodone.

SAN DIEGO- In a story I am totally not making up, Zogenix Incorporated is working hard to get more hydrocodone to your customers.

The company soon hopes to market a 50 milligram tablet with no acetaminophen. I swear. That's the equivalent of 10 Vicodin in one pill without any of that pesky Tylenol to slow someone down. Early indications are that the drug, which Zogenix plans to sell under the brand name Zohydro, has the potential to be quite popular.

"If one thing has been consistent in our market research, it's that pharmacy customers are almost universally saying one thing, and that is 'we want more Vicodin'!!" said Zogenix CEO and scumbag Roger Hawley in a fictitious interview. "The demand is almost universal, reaching across all regions, social classes, ethnic groups, and even the occasional pain sufferer. So we have developed an innovative new way to get consumers what they are craving. With the dose limiting effects of acetaminophen gone, there is literally no limit to the potential use of this profit....I mean, product!!"

Early contenders for the street name of Zohydro include Supervics, Turbonorcs, Zoes, Hydros, and Yellow Death, pending final determination of the tablet color.

"I particularly like that it's a prescription product" said 63 year old Winthrop Van Drusen from his summer home in Greenwich, Connecticut. "It makes it quite convenient to obtain a safe, pure supply of narcotic to meet my needs by simply browbeating a doctor, my social inferior, into writing a prescription."

Asked about concerns Zohydro will end up simply feeding the nation's large and growing demand for narcotics, Hawley, who will never spend a goddamn day in jail, didn't say "I think the key is to build on the lessons learned with the marketing of Oxycontin, and expand on the innovative ways they have addressed these type of problems while still meeting the needs of those in chronic pain."

Deaths from narcotic overdose have more than tripled since Oxycontin came to the market in 1995, and more people now die from prescription drug misuse than in traffic accidents. A fact Hawley doesn't seem to give a fuck about.

"I wish they's hurry up and get this shit out" said drug dealer and occasional user Juan Ventimillia outside a Philadelphia housing project. "My muthafuckin customers keep riding my ass for more and more Vics, and I thought I had the problem solved when I started scoring Norco instead, but shit, it's to the point now where I gots to carry so many goddamn pills around I sound like a goddamn shorty rattle every time I move. I'm hoping the new shit will save me some space. You know what I'm sayin?"

Street level dealers such as Juan face a mandatory 5 year federal prison sentence in the United States if they sell crack, while CEO's who peddle bullshit like Zohydro generally get to retire quite wealthy. That is why most guidance counselors recommend obtaining a degree in business before embarking on a career of getting people hooked.

Asked for comment outside his Florida radio studio, Rush Limbaugh didn't seem to hear the question. Probably because he's gone deaf again.   

Think Of This As An NPR Pledge Drive. That Won't Cost You Anything.

So a friend of mine sends me a link the other day. It was from the folks at slate.com, and it was a good one. It seems they have a regular column called "The Explainer" Which takes on such topics as "How did dinosaurs have sex?" I figured this pal of mine just knew I was the type to ponder things like this for no reason. But there was more.

The explainer is having a year end poll you see. Thirty one questions have been nominated and the one that garners the most votes will be designated "question of the year" and an answer will be provided. Hang with me here.

Question 23 is "Why does it take 45 minutes for the pharmacy to get your prescription ready—even when no one else is waiting?"  You know what this means. You know this is a golden opportunity.

Because the more exposure this question gets, the more people will be searching Mr. Google and come across the real answer. We have in our hands tonight my friends, a chance to achieve an age of universal understanding, tolerance, and dare I say it,  love for our profession.

I knew when I wrote those words it was part of destiny.

So for the beleaguered technician dealing with a foaming at the mouth lunatic at the cash register, for the pharmacist at the end of his 12 hour day (14 hours at CVS. Illegal in North Carolina but not stopping them in the least) dealing with a DUR message that says "oral contraceptives should be used with caution in women of child bearing age," for the future of the profession, for all that is decent and just and good in this world. I beseech, I beg, I humbly ask, that you go here and vote for question number 23.    

Because it might help me sell some books too.

A Practical Question At This Point.

How did it work? Back in the day, when the Mormons had finally settled down in Utah after being run out of most of the rest of the country, hanging out far enough away from everyone else that they could finally just do their thing. How did they not run out of wives?

I know, I know, I know...jokes about Mormons and their wives were all run into the ground long ago. But seriously, a little math will soon show a big problem. There are slightly more baby boys born than girls, something like 51 to 49 percent, so do the numbers, and if one guy has like 10 wives, and another guy has like 8 wives, it doesn't take long before you run out of wives.

What happened? Isn't this kinda greedy? I'm pretty sure Jesus wasn't into greed. As a matter of fact, greed is one of the seven deadly sins.

It seems like there would have been a lot of fights and possibly crime among the dudes who weren't getting any wives. After all, any kind of gross inequity, whether it be economic or of access to vagina, breeds an unstable social order.

Could Donny Osmond have the DNA of a badass?

Intriguing possibility,  but back to the point.

What did they do when they ran out of wives?

A Little Knowledge Can Be Dangerous. An Illustration.

I looked up and the affluent asshole was there. This happens a lot these days. I made my move from the ghetto about five years ago and now I'm in a place where millionaires can walk right up to me as I work. One thing I've learned here is that millionaires are quiet. People in the ghetto had ways of letting you know they were coming but quite often you can be concentrating on your work in a millionaire zone, look up, and one will have appeared like a ghost. Millionaires are sneaky.

"POTASSIUM PERMANGANATE!!!!!!!" said the millionaire. Which those of you familiar with the land of affluence know was a request to purchase some.

"I don't think we carry that here sir, you might try......"

"IT'S FOR ATHLETE'S FOOT!!!!!"

"I'm pretty sure we don't have it" At this point an assistant manager offered to help the man find out for sure if the stuff was in the store.

"YOU CAN'T HELP ME!!!! Snapped the South African accented millionaire to the African-American assistant manager, in a tone that was, historically, exactly what you would expect.

Back to me now. "ARE YOU SAYING YOU DON'T HAVE IT????" and for the third time I said I was pretty sure we didn't.

"IT WAS ON GOOGLE!!!!" he said. Obviously I needed to be reminded of the strict fact checking that takes place before something is allowed on the internet.

Now, its not that I'm mean or unprofessional, but I know better than to let this man know there were several clinically proven athlete's foot remedies in the aisle right behind him. It would have been improper for me to speak out of place to the millionaire, and believe me, I've been dealing with these people for awhile now, and I know they will let their foot rot off before they will admit that their effort to consult Dr. Google might not have given them the best result. I kept to my place in the social order and the man left with fungus living high on the hog between his toes with no end in sight. I was never asked what might work besides potassium permanganate, which, by the way, Google can also tell you where to buy.

Meanwhile, in the ghetto someone just said something to the effect of "YO!! DO YOU KNOW WHAT THIS SHIT ON MY FOOT IS?" Whereupon the nice pharmacist led the man to the Lamisil, or Lotrimin, or Micatin, which cleared up the problem in a week or so.

I'd like to think of foot fungus as a fellow member of the 99 percent.

A Rerun And Shameless Book Plug All In One. What's Not To Love About This Post?

You know, I think the ideal Christmas gift would have something like this to say about the holiday:

For someone who professes to love us all, you'd think that maybe the thought our time could be worth a little something might enter Jesus' skull once or twice. That maybe Jesus could tell us, "You know, there's no need to go all out for my birthday. Really. Me and my Dad, the all knowing, omnipotent creator of universes known and unknown, the Deity that can part seas with his breath, move mountains with his pinky and knows the exact number of hairs on your head, I'm sure we'll come up with something. Don't put yourself out just on my account." 

"And there is really no need to invent The Clapper to sell in the season of my special day. You work too hard for your money." 

That's what my Uncle Harold would say. Uncle Harold always insisted we never make a big deal about his birthday, because that was just the kind of guy Harold was. Unlike this prick Jesus who pretty much ruined my whole week with this Christmas shit. 

And by whole week I mean entire month of December. And part of November as well. Traffic gets backed up because of a goddamn parade. People everywhere I want to shop. A big pile of pine trees right where I normally park my car at work. All because this savior of mankind lets it go straight to his head. 

I got news for you Jesus. I once saved the life of a mouse we found in the backroom of the store. That's right. Instead of killing it, I captured the little guy and let him loose in the woods in back of the mall. And I don't expect the mouse to buy shit every year for my birthday either. I think maybe I could teach you a thing or two about humility Mr. Son of God. 

The sad thing is it's not just me that gets screwed. The entire goddamn planet has to put their lives on hold just for Jesus every year. Fuck it makes me so mad. I got over birthdays when I was like 9, and Jesus still gets all giddy like a girl after 2000 of them? Give me a break. Buddhism looks better every day. No wonder there are so many Buddhists.

Which is why I think my book is the ideal Christmas present. Because that was an excerpt from my book.You should totally show Jesus Christmas is just about the stuff by buying a copy. And now, finally, you can put it on your Kindle which is a bit of stuff I still don't quite understand, other than to know I get a bigger royalty when someone buys a Kindle version. So um, yeah, I'm all about the Kindle. In your face Jesus. I'm gonna make some money off your birthday.

Go here to get a copy of the greatest pharmacy book ever written for your Kindle.

Or here to get me in your Nook. Which sounds kinda fun depending on your attractiveness. 

And if you're a fan of the paper, you can order a copy here. 

From the "Someone Doesn't Quite Get The Point, And That Someone Is CVS" File.

Also from the "I'm nor surprised at all" file.

 From happyplace.com. Via @DrJRod on Twitter.

Normally I'm A Thirst For Knowledge Kinda Guy, But I'm Calling This Quest Off And Remaining Blissfully Ignorant.

It started the way most great intellectual pursuits do, by aimlessly wandering through the classified ads of Craigslist. Did you know the Internet can trace its origins to a government research project into ways to keep computers in the defense department safe from enemy attack? I'm sure the people who worked night and day with a vision of keeping the world safe for democracy all those years ago take great pride in the number of men who have been able to enlarge their penis thanks to special offers spammed to them through their creation.

Not that I'm looking to enlarge my penis or anything. I was actually looking through the real estate ads, I swear, I live in a tourist town you see, and the IRS says if you rent your place for 2 weeks or less, than the income from the transaction is tax-free. I was browsing around looking to see if anyone might be interested in taking a short term possession of my condo by the sea while I am away this summer.

I didn't really find any serious prospects, but I did come across an ad from a couple who said they would be in the area and wanted to know if anyone would be up for some "knotty" fun. Something wasn't right about this, it was clear. There was a secret here that I was not a party to, and not knowing things doesn't sit well with me. My Mom tells the world that she helped me learn to read because I would get mad that there were things on a piece of paper that other people could understand and I could not. That same intellectual fire started to well up in me as I stared at this ad that was coded in a way I could not understand.

If you do not want to be shocked, appalled, and disgusted, stop reading right now.

So I set out to break the code just as surely as I cracked the code of printed English almost 40 years ago. back then the result was gaining eventual access to the poetry of Shakespeare, the wisdom of the ancient Greeks and Romans, the modern insight of writers like Philip Roth and the practical life lessons to be had in the novels of Tom Wolfe.

Tonight however, I learned that "dog knotting" is another term for fucking your canine companion. I am not making this up. Evidently.......sigh.......a dog's penis swells up at the base during intercourse, forming a "knot"  that acts as a plug so no semen can leak out. It stays like this, keeping the two.....in a perfect world......dogs....locked together for anywhere from 10 minutes to half an hour. There are, I am saddened to report, humans who evidently take advantage of this. And for two of them, getting their own dog and sharing this among themselves wasn't quite enough. They were advertising for strange people and/or dogs to share this, hobby(?) with.

I am going to take a handful of Ambien now in an effort to forget this ever happened.

If You Pay Attention, Most People Give You Subtle Little Clues As To How Their Mind Works....

......other times, it's not so subtle.

Nation Prepares For The Annual Running Of The Tools.

BETONVILLE, AR-  From the small town Sears to major shopping destinations in cities around the country, excitement filled the air today as millions readied themselves for the start of the annual shopping season that begins tonight with the Running of The Tools. This years Tool Run is expected to begin as early as midnight at retailers in all 50 states, as dullards of every stripe gather to test their mettle in competition with what passes for human beings these days in an effort to score a discounted price on electronics, clothing, toys, and other miscellaneous crap that will most likely end up in a landfill within a year. 

"We used to call it the running of the sheeple" said Wal-Mart Vice President Johnnie C. Dobbs. "but then we realized that sheep, unlike the crowds of barbarians that gather in front of our stores every year, very rarely get violent when crammed together in large herds." 

Dobbs then climbed to the top of corporate headquarters and tossed 10 vouchers good for $100 off any laptop computer to the crowd below "just to give them a little taste of blood" One person's eyes were gouged out in the resulting melee. 

While the precise origin of The Running of The Tools is unclear, archaeological research indicates it may have begun as part of a ritual of giving thanks for the sweatshop laborers whose work producing plastic disposable trinkets makes it possible for Americans to maintain a standard of living unmatched in the history of humanity. 

Actually, "living" is probably the wrong word to use there. 

In that spirit of thanks, Tool Run participants across the country this year will pause for a moment of silence to honor Jdimytai Damour, the Wal-Mart employee trampled to death under a frenzied crowd of Tools desperate to get rid of their money in 2008.

Not really. There will be absolutely no recognition of what happened to Mr. Damour tonight. Except possibly among the people who loved him. 

"Unless you come from the dark place inhabited by these people's souls, the significance of the Tool Running can be hard to understand" said Dr. Glen Nealon, author of GET YOUR HANDS OFF THAT DVD PLAYER!! Tools And The Ascension Of Consumption As The Basis Of The Modern Economy "In the absence of meaningful relationships based on caring and consideration, worthy cultural outlets, or any other type of intellectual stimulation, the life of a Tool soon devolves into a search for meaning through competition for material symbols of status, and they are willing to risk almost anything to fill the vast void of nothingness that is their existence."

"HOOOOOOOOAAAAAAAAAA!!!!!!!!!! I'M GONNA GET ME A PLAY STATION FOR SEVENTY-FIVE BUCKS!!!!!" said local Tool Jacob Hatfield, who said he had been waiting in front of a Target store for 36 hours. He also added that if we even thought about barging in line in front of him, we could expect to be cut. 

Reached in the eternal glory that is heaven, the almighty Jesus sobbed softly when asked for comment. 

My Thanksgiving Gift To You. A Passive-Aggressive Way To Strike Back A Bit At One Of The Forces Destroying The Profession.

Some of you followed my live blog of this as it happened the other day via my Twitter feed. For those of you that didn't, here's a fun game to play the next time you have to call a Medco mail-order facility for a prescription transfer:

The process will be excruciating, as you are probably well aware. It will start more times than not with a customer giving you a scrap of paper with an 800 number on it that will get you nowhere near a pharmacist. You will wade through voicemail hell to get to a human, who will begin the process of transferring you to a person who can actually help you. The ordeal will be like my penis, long and hard, but so worth the effort to get to. Because, when you finally reach that pharmacist practicing the profession from a cubicle 2,000 miles away, and you beat the information you need out of them, they will ask you a question:

"Can you repeat that back to me?"

It is their policy that you repeat the information they just gave you back to them. Their policy I said, not the law. Which means at this point you should hang up on them. Then the fun will begin. Because they will try like hell to get that repeated information. They will call you back almost immediately, and now my friends, all the power in this transaction shifts into your hands.

I've figured out they'll hold for about 10 minutes of silence before they give up. So what I'll do is around minute 7 or 8, pick up the phone and apologize for being so busy, but tell them if they can just hold on a little longer, I'll get to them as soon as I can.

Then I assure them their call is very important to me.

A couple of other tricks you may want to use: If you have a bilingual staff, you can help out the Medco cubicle rat by offering to help them in multiple languages. They'll appreciate your commitment to customer service as you let them know they can request Spanish by pressing numero seiete. In my case, I can also offer them Hindi. I bet they'll give me an extra dispensing fee for that.

Or, you may want to remind the cubicle rat that Medco's CEO seems to think that talking to retail pharmacists is vastly overrated, and that robots may be the way to go. Then maybe suggest that the cubicle rat go try to call a robot and hang up again.

The possibilities are endless really, and it makes your workday....I dare say...slightly pleasant. I now treasure an opportunity to transfer a prescription from Medco almost more than anything else I do.

Until the robot comes that is.

Highlights From A Half-Day Of Pill Counting Action.

OK, so, I have a question for you. Let's say you're out there in the world, just kinda living your life, going about your day to day business, everything going just fine, and all the sudden you get a call from a robot who says you have a prescription  ready. What would you do? Would you 1) Ignore the call because you know you're doing OK with your meds, or 2) At most, go to the medicine cabinet and check your bottles to see what you could be running low on so you could decide whether you wanted to buy another refill? Because if you would do either one of those two things, I have another question for you:

Do you really exist? Seriously. Are there people out there who would make the slightest effort to find out what the machine has told them to buy? Because I'm not seeing it. What I do see is a constant parade of people coming to the counter because they have been ordered to. They have no idea what they could be about to purchase. Not a clue as to how many prescriptions could even possibly be waiting for them. I'm not kidding you, when they get that call from the robot it's like getting some sort of surprise package for them. My already low opinion of humanity managed to sink a few more feet when I saw the other day how many more prescriptions we've been selling since the corporate mothership started their auto-fill program. The only good thing is the bonus money I'll be getting from all that extra revenue coming in.

BWWWWAAAAAHHHHAAAHHHAAHHHAAAAAA!!!!!! There's no bonus.

That does remind me of our district manager though, who I've mentioned before kinda sounds like a pirate when she talks. I know it's hard for a woman to sound like a pirate, but trust me on this, she pulls it off. An imitation of my District Manager is usually sure-fire comedy gold but my attempt this day fell flat on its face as I entered the happy pill room. I thought maybe it had something to do with the lady I saw brushing her teeth in our parking lot on the way in. How someone spitting their used toothpaste into the public sphere might put people in a bad mood. I was wrong.

The District Manager had been in earlier in the day evidently. With her boss. And her bosses boss. This was the equivalent of a visit from the Pope, or at least a high ranking Cardinal or two, thankfully without the pedophilia. Reports indicate the first thing they did was inspect the trash. There are now at our company, let me pause and make sure I'm getting them all... five different categories of trash. Each of which has it's own container. For example, a used alcohol swab, which, thanks to the characteristics of alcohol, is within a minute or two is a dry piece of cotton, is "hazardous waste," while a cotton ball used to stop someone's bleeding after an injection, which I will point out has and always will contain human blood, is just regular trash, and can be thrown out with my empty coffee cup and read newspaper. Call me a rebel, but I've always put the blood stained things in the sharps container. Fortunately no one noticed this during the trash inspection conducted by the man with a Masters in Business Administration.

The MBA man did leave word that I was unacceptably behind in my computer training modules though. So once I settled into work I stopped filling prescriptions and taking phone calls and learned that if there was a fire in the store, I should make my way to the nearest exit, and not walk up to the fire and try to make sweet love to it as I had previously thought.

Here's another question for you. Do you know if you're right handed or left handed? Because the first flu shot of the day didn't seem to. I always ask, you see, because my goal is to put it in the arm you use the least, as that arm is gonna be sore for a couple days. After a good minute of the man explaining that he did some things with his right arm but considered himself left handed, but he had an identical twin and he thought his twin was right handed, but threw a baseball with his left hand, I took a page out of the robot's playbook and just ordered him to roll up his left sleeve. While this was going on a man was insisting to my Supertech that his zero co-pay be put on his medical benefits card.

"I'm going to the bathroom" she said when the transaction was over.

"It's really gross back there." I reminded her.

"I know, but at least I'll get some peace and quiet for a few minutes."

About 10 minutes after I explained to a man that I could only print out an expense report for the year that covered his prescription drugs, and not what he paid for his extended hospital stay in another state, two fatty carts got in a wreck. Seriously. One of them just broadsided another right at an aisle intersection and neither of the fatties wanted to get up and help untangle the damage. I bet there would had been some road rage if either of the fatties had been able to muster up the effort.

The man who didn't know if he was right handed also missed his own age by 10 years when he filled out the flu shot questionnaire.

It could have been worse though. My Daddy could have toiled nights in the plastics factory, picking up overtime whenever he could in order to give me a chance to make something of myself, and I could have toiled away in one of the nation's finest universities, forgoing parties and football tailgating, in order to put into my head the knowledge both theoretical and practical that would allow me to make it in the world of commerce, and then... I could have been given the trash project, and spent my days making sure the HIPAA paper was always kept separate from the HIPAA plastic. Which is nothing like what a janitor does.

I also could have been ordered by a robot to buy the cheap scotch. Which makes me glad I didn't give them my real phone number. Cheers.

A Thanksgiving Rerun: After Roughly 400 Years, I Think The Lesson Of The Holiday Is Crystal Clear.

If strange white people come wandering into your neighborhood, kill them. That is the lesson of Thanksgiving. I seriously don't think you can make a case that the Indians wouldn't have been better off if they had just killed the Pilgrims. Or let them starve.

Same way with Louis and Clark. Indians totally should have just killed those honkies.

California's Medicaid Problem Solved.

The Drugmonkey settled into the soft glow of the nightlight as it filled the room and felt the warmth of scotch slide down his throat. It had been a rough week in the happy pill room, and he was letting it go. Decompressing. Forgetting. Beginning the process of regaining his strength for the workweek to come when the glow... became brighter. Steadily and surely, against the room's far wall a figure appeared. An overweight man it looked like. With wings. And a halo, a five 'o clock shadow, and a glowing white wife beater T-shirt. He had a lot of body hair. The Drugmonkey knew it wasn't good to mix alcohol with Wellbutrin, and as he sat his scotch glass down on the table he swore this would be the last time.

"Fear not, oh pill jockey" said the disturbing yet somehow comforting figure. "I am the Medicaid Fairy. And I bring good tidings!!"

"Oh happy joy!" said the Drugmonkey, "California Medicaid is in the most awful of ways. The state budget is a shambles, with revenue down and those in charge reducing Medicaid payments to providers, already among the lowest in the country, by another 10 percent!! Egads Medicaid Fairy, my friends who run independent pharmacies have told me they will actually lose money on any brand name prescription over $50! Imagine that, losing money by filling a prescription! Please make it better!"

"Make it better I shall, my friend, the Medicaid Fairy has a solution..."

"Yay! I can only assume this plan involves asking those that have benefited the most from living in our society to once again pay their fair share in order to make that society better for us all, as opposed to breaking the backs of small independent businesses. Perhaps we could restore the top income tax rate for millionaires to what it was under the Clinton administration, or better yet, the rate that prevailed during the reign of that stalwart of the GOP, Dwight Eisenhower."

Thirty seconds of silence enveloped the room. Punctured by the sound of a  deep belly laugh.

"Oh silly Drugmonkey, we cannot possibly risk returning the American economy to the state it was in during the 1950's or 90's. Plus, most of the drugstore owners who are about to get shafted with a barbed wire penis would not hesitate to tell you raising taxes on the affluent is not a solution to any problem."

"But.....isn't Medicaid funded by tax dollars? So if we collect more of them, then we won't have to subject doctors, hospitals, and pharmacies to these drastic cuts. Right? I mean, more money coming in means more money to spare providers these painful cuts, and maybe a pharmacy could even get paid more than a prescription costs them."

"SILENCE!!" said the Medicaid Fairy. "I have the solution to your problem, and it as follows!! No one will pay any taxes from now on!!"

"Really?"

"Yes! And as a matter of fact, everyone will get a $500 rebate from the state. And pay no more taxes. Ever!!"

"And will they get a puppy too?"

"Yes. And a blowjob from the supermodel of their choice."

"Wow. So the Medicaid Fairy just shows up, waves a magic wand, and enough money appears to keep the providers who serve the poor from getting fucked. I'm pretty sure that's what everyone was counting on happening all along. Can I ask one question though?"

"Yes."

"How does it work, this magical system where we continuously reduce the tax burden of the rich while taking a chunk out of the hide of those upper middle class people who think they belong to the elite of society?"

"It's the magic of the free market Drugmonkey. No one outside of the tea party is capable of understanding."

"Really?"

"In the world of fantasy and magic, of course. In the realm of reality though, you're doomed. I was just fucking with you."

And with those words, the Medicaid Fairy disappeared, and a retroactive invoice for 10 percent of all medicaid payments made since June was left in his place.

Wake up independent drugstore owners. Like it or not, you are most certainly part of the 99 percent.

Another Reason Your Prescription Costs So Damn Much. Medco Wants A Chunk Of Your Lipitor.

The whole idea of a Pharmacy Benefit Manager is that it will save an insurance plan's sponsor money. I mean, why the hell else would you hire a company to do something for you if it ends up costing you more than it would take to do it yourself? "Let us take care of the pharmacy end of your insurance plan" the PBM's say. "We know the ins and outs of the pharmacy business and can drive a hard bargain with drugstores." It's the whole reason they exist. To create savings and pass them along to the plan sponsor. Keep that in mind as we talk about this article from Friday's New York Times:

The biggest introduction of a generic drug in pharmaceutical history is being met with tough business strategies by Pfizer and pharmacy benefit companies, according to recent letters to pharmacists. Many drugstores are being asked to block prescriptions for a generic version of Pfizer’s Lipitor starting Dec. 1, when the company loses its patent for the blockbuster cholesterol drug and generic competition begins. Medco Health Solutions, among the nation’s largest pharmacy benefit managers, is one of the companies issuing instructions, seeking to have pharmacists keep filling prescriptions with the more expensive Lipitor for six months.

What? Has Medco lost its mind? Requiring pharmacies to use a more expensive drug? "Medco must be stupid" Some of you are probably thinking.

Pfizer has agreed to large discounts for benefit managers that block the use of generic versions of Lipitor, according to a letter from Catalyst Rx, a benefit manager for 18 million people in the United States. The letters have not previously been made public. 

"Oh my gosh! Medco isn't stupid, Medco is smart!" You're now saying. "After anal raping drugstores to the point where they have nothing left to give, Medco is going after the drugmakers and negotiating discounts! They really will be giving value to plan sponsors when they pass all those savings from Pfizer along!"

To which I will say..........BBBBBWWWAAAAAAHAHHHAAAHHHAAAHHAAAAAAA!!!!! You obviously don't know PBM's very well:

A pharmacy group and an independent expert say the tactic will benefit Pfizer and benefit managers at the expense of employers and taxpayers, who may end up paying more than they should for the drug. “I’m stunned,” said Geoffrey F. Joyce, an associate professor of pharmaceutical economics and a health policy expert at the University of Southern California, after reviewing the letters. “This is just an egregious case. Clearly there’s been some negotiation between Pfizer and the large P.B.M.’s saying we’re going to make this cost-beneficial to them, but the plan sponsors are going to eat it.” 

"Eat it" in this case, is a polite way of saying "take it up the ass"

Objections to the deal were raised publicly on Thursday in a news release from a group called Pharmacists United for Truth and Transparency, which opposes some tactics of pharmacy benefit managers. The statement called the move “a blatant attempt” by benefit managers to keep Pfizer’s discount while employers still have to pay the full price of the brand-name drug. 

Got that? Medco negotiated a discount from Pfizer alright, and evidently is planning on keeping it all to itself. Now I only had a few business electives in college, so maybe an MBA out there somewhere can explain to me how that's not a kickback.

But is Medco really planning on something so brazen? Why don't we just ask them directly:

Melissa Mackey, manager of public affairs for Medco, said its letter described “a custom plan design, which is not a new concept,” in which clients could “tailor their formulary to maximize value.”

That, my friends, is a textbook case of corporate bullshit. You ever need an example of how to talk without saying anything, you just go back to that quote. Why don't we try just asking them a simple question that requires a simple answer:

Asked in an e-mail specifically whether Medco would pocket the Pfizer discounts while employers and taxpayers paid more than the generic price for brand-name Lipitor, Ms. Mackey declined further comment.

Yup. Think we have our answer. And I'm thinking we can expect more of the same when Medco merges with Express Scripts and controls a third of the market.

Tell me again why I'm supposed to be afraid of socialized medicine?

So...Um....Yeah...Not Sure Where That Last Post Came From. Moving On....

What's the deal with water towers? Seriously. Every podonk town in the Midwest had one and I don't understand. I mean, I understand why the podonk town wants to have water, but why put it up in a tower like that? You have to expend energy to get it up there, right? So I don't see the advantage here. Other than being able to paint shit on them. That can be kinda cool.

By the way, I said get it up.......huh huh.....huh huh. Beavis and Butthead are back in case you didn't know, and that makes me very happy.

So anyway, the fact I don't see water towers all over California the way I saw them all over Ohio also leads me to believe the idea of storing your water 500 feet off the ground isn't the best one. Feel free to enlighten me.

I'm glad I'm thinking about stuff like this again. I think the Wellbutrin has finally kicked in.

Side Effects May Include The Ability To Get Through One More Mediocre Day.

It's nighttime, and soon I'll swallow the Ambien that will serve as a cut off switch to end this day. Hopefully I won't drink too much and I'll remember to lie down before it sinks into my brain, so I won't do things like have entire Facebook chats I don't remember, so I won't have to piece together what I did this night from clues that are available tomorrow morning. Hopefully, but don't count on it. There are new episodes of Beavis and Butthead on MTV.com, and those little guys remind me of the 90's, which were my decade of hope. I'll probably watch them and not remember.

Soon it will be daytime, and a jolt of Wellbutrin will make it possible for me to get out of bed and face you. I'll open the bedroom curtains and look for something. It's better with the Wellbutrin, honest it is. Before the Wellbutrin I didn't know if it was gonna be you or me, but someone was gonna get hurt. Probably me now that I think about it. I'm a lot easier to hurt. Anyway, we don't have to worry about that these days. The Wellbutrin has lifted some of the fog from my brain and let me be productive again and keep a smile on my face as you ask me about shampoo and demand to know what happened to BC headache powders. The only reason I'm able to type this now is because of the Wellbutrin. Otherwise I'd be outside on the deck staring into the night looking for something.

It's probably making some of you uncomfortable to read this. People don't like to hear about other people who take antidepressants. I'll put you at ease by instead writing about how I burned my hand on the stove tonight. The skin on my fingers is turning white and thick and it hurts like hell. I'll take a couple more pills for that.

I wonder if you know I have to wring every last bit of norepinephrine from my brain the way a man stranded in the desert would desperately squeeze out every last drop of water from a sponge just to be able to get through a workday. My mind probably stopped producing the norepinephrine on its own because it saw what it was getting me. Making me say it three times won't change the fact you should see a doctor for that wart on your genitals. No, there isn't an over the counter cream that will help. Even if you make me say it four times.

The little red light just went off so I ran to the phone. Maybe somebody left me a message on Facebook. The little flickers of light are the only moments of hope left in the day now. Like dying embers in the fire of the 90's. The other day Michael Moore sent me a direct message on Twitter. Seriously.

The giant martini I just poured will help me forget about this. It'll wipe the memory clean and let me jolt myself awake with the Wellbutrin tomorrow with a blank slate and the ability to pretend maybe something will be written on it. Or at least that the little red light will go off and it will be someone I'll want to text back.

There has to be more than this. I know there can be a lot less.

Republican Presidential Candidates. The Gift That Keeps On Giving.

I understand a lot of you aren't following the politics that much. It's a whole friggin year before the election after all, and you have other things to do. I get it.

It's just that....the people who *are* following the politics...they're about ready to give the presidential nomination of one of the two major political parties in this country to this man. I really think you should know this.

So, um, maybe you could tune in, just a little? Because they haven't yet, which means there's still time to change things. Plus the entertainment value can be very high at times.

I promise.


 

Speaking Of Debates....

A lot of you have no doubt seen this already, but for those of you who haven't, this is real, actual footage of last night's Republican presidential debate. The featured speaker here is Texas Governor Rick Perry:




I'm thinking my fellow uber-liberals and I could use this to our advantage:

 "It was Defense"

 "Wha?"

"The third agency of government you said you would eliminate Governor, it was the Defense Department"

"I said that?"

"Yes, of course, it was genius"

"Was I drunk?"

"Probably, but it doesn't matter, this is quite frankly the boldest, most decisive game changing move in the history of presidential politics. Now eliminating the entire Pentagon might be a tad extreme, but immediately ending the bailout of Iraq and Afghanistan would put you in stark contrast to President Obama, showing you have the cajones to actually do what he only dreams about."

"You mean, I'd be doing the opposite of what Obama has done?"

"Absolutely, you could be the second American president in a row to win the Nobel Peace Prize, and the first to deserve it."

"Well sign me up pardner......YEEEEEEEEEHAAAWWWWWW!!!!!"

Yup, a tough talking Governor of Texas, short on smarts, not much for details, leads with his gut and reliant on others for big picture guidance.

What could possibly go wrong?

Oh. Yeah. Um, never mind.

What Better Way To Cut Through Bullshit Than With A Good Old Fashioned Debate.

The Drugmonkey settles in behind a very statesmanlike looking podium as the buzz among the crowd settles into a low whisper. A bald, clownish-looking man enters stage left while four tired and rumpled people slowly stager in from the other side. The four are offered a seat and they immediately burst out in tears of gratitude. They sheepishly ask if there are snacks or perhaps bottled water that will be provided during this event. Not one asks about restroom facilities, as if they have no expectation of nature calling. The low whisper in the auditorium drifts into silence as the Drugmonkey takes the microphone.

"Good evening, and thank you all for coming to tonight's event. As you all know, pharmacy faces tremendous challenges as we move forward into the 21st century, and views differ as to how the profession will best meet the obstacles before us. One thing is for sure, no matter what direction pharmacy ultimately takes, CVS/Caremark will play an integral part. With over 7000 stores and control of one of the nation's major Pharmacy Benefit Managers, some will already say that as CVS goes, so will go the profession. With that in mind, we present tonight's debate, "CVS, a progressive force for the future or an embarrassment to pharmacy?"

"First let me introduce Tom Menigan, CEO of The American Pharmacists Association."

"Thank you for the opportunity to be here Drugmonkey. I gotta say our new headquarters in Washington, D.C. is much nicer than this dump though."

"And now, four pharmacists currently employed by CVS"

"May we speak now?"

Let me jump in here and let you know that while this debate took place only in my imagination, every word attributed to APhA's CEO comes from this post on his blog, while the words from the CVS pharmacists come from actual messages I have received in my e-mail box. 

"Mr. Menigan, would you like to make an opening statement?"

"Recently, Megan Sheahan, Michelle Fritts, Erika Trevino, Olivia Putman, and I visited a CVS Caremark pharmacy in the Dupont Circle neighborhood of Washington, DC, where I received my annual influenza vaccination. We had a chance to see their advances in patient care, including numerous systems upgrades to assist pharmacists in identifying, monitoring, assisting, and documenting patient care activities and outcomes."

"Interesting. I think what I'll do now, as opposed to the traditional role of debate moderator, is step back and just let the two sides engage in a little back and forth. CVS pharmacists, you're up next."

"This pharmacy keeps enacting brand new programs (more things to do). I refer to myself no longer as a pharmacist. I am now a prescription salesman. I do not counsel, I do not care about outcomes, All I am supposed to care about is getting another script filled."

"By improving patient engagement through enhanced interactions, pharmacists have created new ways to improve clinical care and provide counsel that can improve adherence. By using increased technology and maximizing the use of pharmacy technicians in the pharmacy, CVS pharmacists are improving the health of patients while lowering the overall cost of health care."

"I managed to stick out 4 years at CVS before the fateful night of January 2nd, the Monday after New Years and the busiest day of the year when I worked a 14 hour shift with one 10hr technician, filled 300 prescriptions, fell asleep driving home and ended up crashing my car into a median. As soon as I woke up, I gave my notice and went to a grocery store pharmacy, making the same money with much better hours and 10 times less stress."

"The CVS team of Papatya Tankut, Cherise Wilson, Scott Staso, and Rosaline (Rosy) El-Khoury showcased recent patient care initiatives the company has implemented to allow pharmacists greater opportunities to interact with patients and prescribers."

"This is not why I got into pharmacy, I am not a telemarketer, I am no salesman, but I am that person that will tell you, 'don't take tylenol while on that'. I would give anything just to be a pharmacist again."

"It’s clear to me that the organization is taking enhanced pharmacists’ services seriously."

"There are the traditional complaints about retail and then there are the extreme cases and CVS is one of those.... CVS takes the cake with pharmacist abuse."

"Let me just jump in here now, since the subject of pharmacist abuse has come up. Mr. Menigan, what do you have to say about published reports that CVS systemically ignores the will of the North Carolina Board of Pharmacy, which has mandated a 12 hour workday for pharmacists, by having pharmacists in North Carolina routinely work 14 hour days?"

Since APhA has never said a word about this flouting of a law it helped defend, you can insert 30 seconds of the sound of crickets chirping in the background here. 

"Very well then. Well it seems that one thing is crystal clear tonight. The views of The American Pharmacists Association differ sharply from those of actual pharmacists. Mr. Menigan, you managed to get your message out even when outnumbered 4 to 1 by people in the profession you claim to represent. That's quite a feat, but to be honest, not at all unexpected. I see the corporate special interests that actually control pharmacy have come with their pocket now, which means it must be time for you to crawl back in. Thank you for being here, and thank you you to the CVS pharmacists who have to be back at work for a 14 hour day bright and early in the morning. Try not to drive into any highway medians on the way home!

And a special thanks to our audience here at the Medco auditorium and around the world on C-SPAN and online. Be sure and tune in next time when Walgreen's Chairman and CEO Greg Wasson will discuss the topic, "How tobacco sales can drive top line pharmacy revenues" Until then, goodnight, and be sure to meet that flu shot quota!!

Walgreen's POWER Outages Continue: The Emergence Of "Deep Pill 2"

Get it? Walgreen's calls its initiative to redefine the future of retail pharmacy its POWER program. POWER outage....you with me? 'Cause people are outing it....bwwwaaahhhaahhaa...

I'm so damn funny it's a wonder I can be around myself all day without my head exploding.

At any rate, here's my original post featuring a source I've dubbed "Deep Pill" exposing what life is like in the real world of a Walgreens central-fill POWER pharmacy. Tonight we'll let "Deep Pill 2" give us the scoop on conditions at a POWER retail store. I am tired of body and weak of brain this night, so I'm pretty much just gonna run Deep Pill's story unedited. I'm sure you'll agree that story speaks for itself. And that we're all, pharmacists and customers alike, very fucked if Walgreen's gets its way:

 I worked for the WAG in AZ for just about 10 years.  I have seen many changes... but not as destructive as POWER.  Your article about POWER was spot-on.  I wanted to share with you some of the problems I experienced with POWER during my tenure at the WAG.

WAG, for those of you not in the know, is Walgreen's stock symbol. 

I was the pharmacist at the store-level.  Not sure if you were aware of this... but anyone who wanted to remain a staff pharmacist at the store-level when POWER was rolled out, had to re-apply for the job.  I kid you not.  After working for a solid 8 years, I had to re-apply for my job.  For those pharmacists who wanted to transfer to the CPO, they did not have to re-apply-- they were automatically accepted.  Then WAG spent a TON of money to hire an independent hiring company to make the determination whether or not we could remain a staff pharmacist at the store level.  This whole process was absolutely stressful on all of us.  Pharmacy managers who wanted to stay at store level were exempt from re-applying. 

I made the cut.  Great, right?  Not so much.  I had to deal with understaffing, angry customers who were misrouted by our "colleagues" at the call center, managing two lanes in the drive-thru, customers at the counter, and customers at the consultation window.  I forgot to mention flu shots.  Now POWER looks great on paper. All this "free time" to provide MTM services (which all our friends at APhA are probably orgasming to...).  This simply wasn't the case. (emphasis mine)  Because of the lack of staffing, we had zero time to perform MTM services.  Our District Supervisors told us time and time again to call upon the store manager if we needed extra help in the pharmacy.  Well, a lot of the store managers were not willing to come back to help us out.  They had their own crap to do.  I don't blame them... but I digress. 

One of the biggest problems I had to deal with was the amount of errors that I caught from our wonderful "colleagues" at the call center (CPO).  These errors were careless and made my job a lot harder.  Let me give you an example.  I was counseling a patient on her Prometh w/ Codeine.  The sig: Take one or two TABLETS every 6 hours as needed for cough.  Now I know this may not sound like a huge deal... but I have a huge problem letting a prescription leave my pharmacy that has a blatant error.  In order to fix this, I had to delete the prescription, find the hard copy, re-scan it so that our wonderful CPO can retype it.  Mind you, this patient is in the drive-thru wanting to get home because she's feeling lousy.  So the whole verification process at the CPO starts all over again... 

The District Supervisors encouraged us to fill out an error form online so they can take proper corrective measures with the people at the CPO. (Drugmonkey to malpractice lawyers; those error forms are no doubt stored somewhere, and subpoenable I bet) I have no idea if that was done or not.  I'd still get error after error.  Let me say this: I totally understand that technicians make mistakes while performing data entry.  What makes me frustrated is when pharmacists at the CPO are under pressure to "make their numbers" and when quantity takes precedence over quality.  This isn't totally the pharmacists' fault.  I'm sure the corporate 'tards stress the importance of quantity quantity quantity.  These verification pharmacists at the CPO did not have to worry about the drive-thru, phones, customers, etc.  Their ONLY job is to verify prescriptions without any distractions.  One error (which I caught) was Augmentin 500mg Take 4 tablets an hour prior to dental appointment.  Of course the prescription image said Amoxicillin.  And of course, we at the store-level looked like retards when the patient came in to pick up their medication.  We had to take the blame from the patients for the errors that were made at CPO.  What makes this so ironic is that the pharmacists at the store-level actually prevented harm to the patient.  We were not allowed to talk bad or against the people at the CPO. 

Arizona is a mandatory counseling state.  I have seen pharmacists who do not counsel.  Combine that with the errors at the CPO can lead to a disaster.

I'd be willing to bet a Benjamin that it already has.

And that we're all fucked.

Thank you APhA.

Thank you Boards of Pharmacy.

But the biggest thanks of all..... goes to the Pharmacy America Trusts.

At least they're still a decent place to buy cigarettes. 

From The "I Work At Dundler Mifflin" File.

Dunder Mifflin, for those of you not in the know, is the fictional paper company portrayed in the TV show "The Office" Until this year the manager of this company was a character named Michael Scott, who I'm betting was a little too uncomfortably close at times to what you go through in the real world. Once in the show Michael Scott didn't quite grasp the importance of a celebration of the Indian holiday of Diwali, telling his girlfriend it was a "costume party' The girlfriend showed up as a cheerleader, to much awkwardness

Today my real pharmacy manager told my supertech, who is of Indian origin, that she should wear a sari and a bindi to the store's Halloween party. Saris and bind's are generally not considered costumes, and would produce much awkwardness to be used as such, but that did not phase the Pharmacy Manager, who brought up the idea several times

The lesson I leaned this day, Michael Scott lives.

Walgreen's Bold Vision Of The Future As It Actually Works In The Real World, Including Tips On How Addicts Can Use The POWER Program To Get A Fix

Like I said in my last post that wasn't inspired by the violent crackdown on peaceful protesters that happened in Oakland yesterday, Walgreen's, the country's largest drug store chain, has decided that big changes are in order for the profession. For the last couple years their emphasis has been on what they call the POWER program, which to recap for those of you just now tuning in, is a radical transformation of how pharmacy is practiced at the community level. POWER turns the act of filling a prescription into an exercise in industrial-type efficiency management, moving as much work as possible away from the store. Routine refills are done at a central location, phone calls are taken at a remote call center, and prescriptions themselves are scanned into a computer and verified by pharmacists working at home."The goal" a Walgreen's Vice President told Drug Topics in 2009, "is to relieve in-store pharmacists of certain tasks in order to give them more time to offer medication therapy management services"

Great. What could possibly go wrong?

"Let me start off by saying that not everything that Walgreens has done with POWER is negatively impacting our profession." says the source I've developed, who for no other reason than my love of all things Watergate I'm calling "Deep Pill." "The central fill concept is actually a good idea. Having all the next day refills filled at a separate location and then shipped to the pharmacy saves the pharmacy staff in the store a lot of time to focus on the patients who are in the store."

To do lots of Medication Therapy Management I bet, and totally not to do things like ring up potato chips and Walgreen's brand beer. 

"If POWER stopped there," Deep Pill went on,  "any of the few problems with central fill could be easily mitigated, and, even if not, the benefits would far exceed the liabilities"

Well there you go, can I just stop posting now?

"However, POWER, as you are well aware, does not stop there."

Oh crap. Although you knew that was coming, didn't you?

At this point I think I'm just gonna let Deep Pill take over, as his and/or her experience speaks for itself. Read on to see where the big thinkers in the biggest player in the profession are taking us, and our patients:

I worked in what is called the Pharmacy Care Center (PCC), which is a call center. The way it works is that, when someone calls a Walgreens store in Florida or Arizona, the call goes into a call bank where it first goes through a voice recognition automated system, then to a non-pharmacist staff member (called specialists) when the automated system does not suffice. Normally, that would be fine. That is what would happen in stores where technicians answer the phones. However, the people whom Walgreens hires for these jobs almost never have any pharmacy experience whatsoever. Walgreens is literally hiring people off the street. They do not understand, and, in many cases, lack the ability to understand how a pharmacy functions. The customers and doctors' offices can quickly ascertain this incompetence. The calls that the specialists could not resolve were transferred to the pharmacists at POWER (on the other side of the room from the specialists). Usually, we were able to resolve the calls fairly easily. One example of that early on in my career there was that the specialist was unable to clarify for the customer the meaning of the phrase "1 refill remaining before 6/19/09" printed on a prescription label. For the calls we were unable to handle for whatever reason, we pharmacists transferred the calls to the store pharmacy directly. 

Now that you understand the workflow of the call center aspect of POWER, let me break down the problems that occur at each step. While the specialists are told that they are not to answer any questions the callers may have about their drugs, they frequently did anyway. If you click on the name of the drug, you can see its common uses; however, as is the case with several drugs (e.g. gabapentin, cholestyramine, amitriptyline), the FDA-approved use is in many cases not why the drug has been prescribed. Giving the callers misleading information results in panicked callers being transferred to the pharmacist queue where we had to calm them down and correctly educate them about their medications or panicked callers hanging up and calling their doctors. This problem is exacerbated by the fact Walgreens has these specialists answer the phone as follows: "Hello. This is the registered pharmacy technician (insert first name). How can I help you?" While that statement is true about their position, most people hear the word "registered" and think that the following word is always "pharmacist". Some people do not listen closely and miss the part about technician. Others cannot discern the words after "registered" because the specialists slur them together so much (a product of answering hundreds of calls per day). This problem is annoying and troublesome, but there is a more serious issue at this step.

Here is where all you addicts should start paying attention:

When the caller wants a refill and cannot figure out how to request it online or on the automated phone system, they will speak with one of these specialists. They also tend to speak with one of the specialists if they know there is going to be an issue with the prescription (e.g. want to change from insurance to cash, pick up at different store, change quantity). The following scenario played out quite frequently. The caller wants to pick up his Lortab or Xanax refill but wants to pick it up at a different store in the area. The specialist, without looking at the last time the prescription was filled, processes the refill at a different store. The patient is then able to refill whatever prescription he wants extra early without anyone noticing because he is paying cash price. I saw many examples where this problem happened. The worst one was a customer who filled the same prescription (for Lortab 10/500 quantity of 240) 5 times in 5 days at 5 different Walgreens stores. (Yes, you can transfer a controlled substance prescription more than once if all the pharmacies have a shared database.) What made that example so much worse was that the authorized refills on that prescription were authorized by a specialist, and the "original" prescription was a bogus verbal prescription (I called the doctor to check on it) taken by one of the pharmacists at the call center.

Got that? It's way easier to phone in a fake prescription when the pharmacist isn't familiar with the community, and way easier to get early refills when the person processing them isn't even a pharmacist.

It becomes really hard for the call center pharmacists to even investigate prescriptions we believe might be fraudulent because that means not taking incoming calls for a few minutes in order to call the doctors' offices and the local Walgreens pharmacy. Everytime we stopped taking calls for any reason, the non-pharmacist managers would start getting on our case. The senior group manager of our department publicly called such time shrinkage. Having worked in retail, I know the term "shrinkage" means stealing the company's resources, either by the customers or employees. These non-pharmacist managers just wanted us to take calls and get the callers off the phone within the target time of 1 minute and 55 seconds. Therefore, many pharmacists at the call center did not even investigate the validity of any prescription so as to avoid trouble.

Seriously, you addicts should go back and read those last couple paragraphs again. And thank the God of controlled substances a Walgreen's manager invented the concept of "time shrinkage"

The other problem at the call center pharmacist step came with taking new verbal prescriptions (legitimate ones). At first, we just wrote them up by hand. Then a specialist would walk around, pick up these paper prescriptions, and scan them into the patient's profile. Then the prescription would go through the Central Utility Department. This department types and verifies new prescriptions. Therefore, these new prescriptions that we had taken would be typed up by a specialist and then verified by a pharmacist in that department. About a year after I started working at POWER, they stopped having us write the prescriptions by hand, and instead we just inputted them ourselves directly into the computer. The next step after we inputted the prescription was clinical review, or, in some cases where clinical review did not apply to the prescription, it went directly to the store to be filled. This change most definitely saved time, but it removed that additional safeguard of having a couple of different people look at the prescription to prevent careless errors (e.g. it would be easy to acidentally pick Abilify 20 mg instead of Abilify 2 mg because they are right next to each other on the scroll down tab). 

As for the store pharmacy staff, the final step in the call center chain, there are a couple of major problems. The first problem is that, due to the implementation of POWER, staffing levels in the store (pharmacy and non-pharmacy) were drastically reduced.

Wait.....I'm a little confused. Walgreens said the goal was to give store pharmacists time to do medication therapy management. How can they do this with drastically reduced staff? I don't understand. Maybe because I didn't go to business school. Or because I'm not a liar.

When a call is transferred to the pharmacy, very often there is only 1 pharmacist with 1 or 0 technicians working. That pharmacist is handling all the problems of the customers in the store and cannot pick up the phone. After a specified number of rings, the call will be terminated. If someone in the pharmacy miraculously picks up the phone, typically the pharmacy staff member will ask the caller to hold. After a specified number of minutes of holding, the call is terminated. When the call becomes disconnected by one of the previously described processes, the caller becomes irate and has to actually go to the store for service.

Sweet. So basically an integral part of POWER would seem to be hanging up on customers when you can't get to the phone.

The other larger problem comes in the prescription filling process. When there is a technician working, the technician does all the filling, and the pharmacist just stands at the cash register to sell prescriptions. Supposedly, the pharmacist is to verify prescriptions by comparing the image of the dosage form printed on the leaflet to what is actually in the prescription bottle. In many cases though, that does not happen. One reason is that the prescription is for a liquid. There is no way that can be verified because there is no image and the technicians are told to never put the stock bottle next to the bag. All the pharmacist ever receives is the plastic Ziploc bag with the labeled prescription bottle and the leaflet. Another reason is that the store pharmacy staff is so rushed due to under-staffing that they do not have time for this visual verification. The store pharmacist feels that the NDC number matched up or the label would not have been printed or however he or she rationalizes not visually verifying the prescription. I know Walgreens will state that this error is on the individual pharmacist, but the company created that environment due to its own staffing levels.

But wait.....there's more.......

My understanding of pharmacy law as it pertains to the pharmacist-technician relationship is that the technicians are to be under the supervision of a pharmacist. At the call center, there are technicians (or specialists as I call them) and pharmacists working in the room. However, the pharmacists are busy with their own calls and are not supervising the technicians. There are quality analysts listening in on the calls. However, they do not listen to all the calls, and, even if they did, these quality analysts are not pharmacists. I submit that these technicians are working without pharmacist supervision, a violation of the Florida Pharmacy Act (and probably of the pharmacy laws of any other state). Walgreens has its own representative at the Florida Board of Pharmacy. That situation seems like a conflict of interest to me and enables the company to get away with such violations. However, even still, when POWER management learns that the Board is coming to inspect, they move some of the pharmacists over to where the specialists work in order to give the illusion of supervision. Even if that enabled pharmacist supervision (which it does not because we all wear headsets and have too many of our own calls to monitor anyone else's performance), that is not how POWER typically operates. With the exception of visits from the Board or from corporate, the specialists and pharmacists do not sit together.

"Well at least Walgreen's never tried to have technicians do the type of work that the law says can only be done by a pharmacist" you may be saying.

And you would be wrong:

Another legality issue that arose during my time there was the issue of transfers. Each day, management would designate 1 or 2 pharmacists to do incoming transfers. Those pharmacists would not take incoming phone calls during their shifts. They would just call competitors for prescription transfers. Even still, there were so many transfer requests that they were always behind. To remedy this situation, management came up with the idea of having technicians call to get transfers, recording the phone call, and then having a pharmacist listen to the call and compare it to what was written up for accuracy. This program was eventually scrapped because there were not many of the call center pharmacists who were willing to participate. Also, many of the pharmacists for the competitors called the Board to complain about it. Much like the other legal issue, the reason that this issue even arose was a result of non-pharmacist management's desperate attempts to save money any way possible. They did not want to pay pharmacists to be monitoring the specialists' phone calls (because then those pharmacists would not be taking incoming phone calls themselves), and they did not want to use more pharmacists to do the prescription transfers (because then that would take too many pharmacists away from answering calls). They did not care what laws they broke in their quest to save money.

I'll repeat that last line again, in case you were just skimming that last paragraph:

"They did not care what laws they broke in their quest to save money."

Except I'm sure Deep Pill really meant "In their quest to give pharmacists more time to do medication therapy management"

And finally, this is who is deciding the future of your profession:

There are some pharmacists in upper management at POWER; however, the vast majority of management are not pharmacists, and, in fact, they have never even worked in a pharmacy. For example, the senior group manager to whom I alluded earlier was a call center manager at Sprint.

So they can't even sell out the future of pharmacy to managers of GOOD businesses. I'm sure it's not news to most of you that Sprint sucks.

Generally speaking, the non-pharmacist management there treated the business as if we were selling aluminum siding rather than drugs. I have seen other companies start to emulate Walgreens' POWER model, and I would like to see POWER have its plug pulled by the Board of Pharmacy so that this disease does not infect the entire pharmacy world.

So would I Deep Pill.....so would I.

And so should you. If you give a crap about the potential poisons you put in your body.

I am not hopeful however. God help us all.

"No Excuses" Said The Pharmacy District Manager, "Tomorrow You Will Meet Your Flu Shot Quota Or There Will Be Consequences"

Walgreen's Puts One Vision Of Pharmacy's Future In The Nation's Newspaper Of Record, But Seems To Be Awful Quiet About The One It's Actually Been Working On.

Here's the shiny, happy vision of pharmacy's future, courtesy of The New York Times:

As the Walgreen Company pushes its army of pharmacists into the role of medical care provider, it is bringing them out from their decades-old post behind the pharmacy counter and onto the sales floor. 

The pharmacy chain, based in Deerfield, Ill., and the nation’s largest, has renovated 20 stores in the Chicago area and is converting more than 40 in Indianapolis to get the pharmacist closer to patients. Pharmacists in the revamped stores are being kept away from the telephone, where dealing with insurance coverage questions and other administrative tasks occupy 25 percent of their time, Walgreen says. 

“What we are seeing now is pharmacists should be using their knowledge to help consumers manage their medications appropriately,” said Nimesh Jhaveri, executive director of pharmacy and health care experience at Walgreen. “It’s not about the product but the care we give.”

Wow, that's almost enough to get me all choked up and misty eyed. Things are going to get better. Really. Walgreen's says so.

"I am a pharmacist who is under the most stress of my career trying to keep my position under this new program. We have 11 or less seconds to review an Rx for data accuracy ... and less than 8 seconds to review it clinically for interactions and dosings. They are actually riding us now to do clinical in 4 seconds [as of] our last meeting. Do you know how hard it is to look up a drug/dosing in 4 seconds? If we do not accomplish this timing, our 'metrics' are out the door ... We are put on level 1 discipline, then level 2, then we are given a 'life line' to find another position."

Huh? What? How did that get in here? Oh for the love of God, that's only an actual letter from an actual Walgreen's pharmacist that showed up in my mailbox awhile back. The "new program" he's talking about isn't the PR stunt that the Times wrote about, but a vision of Pharmacy's future Walgreen's is much further along in implementing it calls the POWER program. The idea is to move as much work away from the store level as possible, using things like off-site central fill centers to deliver refills to the store, call centers to take calls from patients, and splitting the prescription filling process into individual, repetitive tasks to be assingned to workers off site. The pharmacist above had the job of verifying the accuracy of prescription images sent to his home computer.

"The goal of the program is to relieve in-store pharmacists of certain tasks in order to give them more time to offer medication therapy management services." Walgreens told Drug Topics when POWER rolled out. Which sounds an awful lot like the bullshit they were sending the New York Times' way. Let's see how that's working out:

I just wanted to add a comment in regards to Walgreens POWER.  I received my first average (usually always above average or exceeds expectations) performance evaluation because I was going against policy and checking hardcopies (that were typed and verified by POWER) before dispensing medications to patients. I was told not to double check hard copies and to only check product. 

But.......but.......the future pf pharmacy isn't about the product. That's what Walgreens said.

By double-checking hard copies, I caught several mistakes a day.  These mistakes I documented.  At my high volume store, my near misses went from around 20 a month, to over 100 a month.  One specific prescription that I discovered was incorrect due to my double checking of hard copies was a prescription for a child for morphine sulfate written as 20mg/5ml to dispense 1 teaspoonful every 6 hours as needed.  The prescription was typed and verified as 20mg/1ml to dispense 1 teaspoonful every 6 hours as needed.  In a child, this could have been deadly.

Even more deadly than the cigarettes Walgreens sued the city of San Francisco for the right to sell. Nothing says it's all about the care you give more than fighting for the right to profit from poison.

That quote was from a different pharmacist than the first by the way. I got quite a few:

I am writing to you in response to the letter you received from the Walgreens pharmacist who worked at POWER 

I too was one of the pharmacists working in the stressful environment that he talks about... 

...My "numbers" rarely came in where they were supposed to because I actually read the prescriptions, checked for interactions, looked at refill history, etc. So on my weekly phone call from my supervisor, who was a pharmacy technician, I would be reprimanded and told to go faster.  I was verifying upwards of 1000 Rx's per 8 hour shift.  The "fast" employees were verifying about 5000. (emphasis mine)

I'll stop here and point out that's 625 prescriptions per hour. Or ten a minute. Every minute. All day long.

The Andersonville neighborhood store includes a 50-square-foot room behind sliding doors where a pharmacist, James Wu, can sit and counsel patients, who sit on a padded bench that has enough room for the patient and a family member or two. Mr. Wu’s desk is steps to the right of the private room.

Wait. I'm sorry. I've got all my notes and papers mixed up here and I keep getting Walgreen's versions of Pharmacy's future mixed up. I think that was the bullshit one.

They were also going to enroll me in a class that taught me "what to skip over when verifying prescriptions"

Well they did say it wasn't about the product anymore.

Mr. Wu said he could now spend more time talking to patients or out in the store aisles, and rarely is distracted now by the orders being placed for prescriptions. 

POWER pharmacists are stuck at a computer terminal situated between the Consultation Window and 2-3 cash registers (plus drive-thru). There's absolutely no peace or privacy; the potential distractions are incalculable, and their mere likelihood itself soon becomes a distraction in-lieu. RPh's no longer have their own personal terminal; they share the register computer with the Technicians, Interns, cross-trainers, Store Managers- basically, anyone who wanders through the pharmacy can enter data under the pretense of the RPh's initials.

Mr. Wu didn't say that second paragraph. A Walgreen's pharmacist actually working in the Walgreens of the future said that second paragraph. I could go on, but you get the picture. The reports I'm getting from the real world are nothing like the blowjob that New York Times reporter gave the nation's largest drug chain.

But wait my friends, because as they say in the advertising world, it gets better. One Walgreen's POWER pharmacist wrote me not long ago and gave me the complete scoop on what this program is like. The ups and downs, ins and outs, and all the dirty laundry of this initiative undertaken by the Pharmacy America Trusts™ to shape the profession's future.  Those of you not in pharmacy will likely be shocked. Those of you in the profession most likely will just be saddened. You'll have to wait until I get the time to get the next post up, but I'll give you a hint: it doesn't involve a 50-square-foot room behind sliding doors where a pharmacist can sit and counsel patients.

Stay tuned.

Darvocet And Dulcolax Are Interchangeable For The Right Patient.

I can't claim credit for that headline. it came from an alert reader who tipped me off to this story from the website of WSB-TV:

JOHNS CREEK, Ga. — Investigators are looking for a burglar who has hit a Johns Creek pharmacy twice in the past three months. 

Back in July someone broke into the business and got away with Adderall, Oxycodone and thousands of other pills. The store's surveillance cameras captured that crime... 

Now police believe the same man may be responsible for both crimes. 

"From the footage of the video from both of the incidents, we're pretty sure it's the same individual," 

But this time around the pharmacist outsmarted the burglar. According to a police report, the pill bottles taken were filled with candy and laxatives.

Reached in a fictional headquarters less opulent than the new building his organization can't stop bragging about, American Pharmacists Association President Marialice S. Bennett praised the "outside the box" thinking "in improving medication use and advancing patient care"

"This pharmacist obviously realized that a person ingesting a large quantity of narcotics, as this burglar or his customers were evidently doing,  is at risk of severe constipation, and took measures to address the needs of his community, extending the same quality of care provided to the law abiding to those on the other side of the law. I'd like to think of this event as the culmination of a lot of effort and hard work here at APhA, as we have been advocating various medication therapy management schemes while standing idly by as pharmacists get ripped off in business transactions for almost two decades now. Bravo Health Mart Pharmacy of John's Creek Geogia, bravo!"

Pharmaceutical Benefits Manager MedcoHealth Solutions Inc., acting on the possibility that the alleged burglar was one of its cardholders, immediately imposed a $10,000 fine against the pharmacy for not having a hard copy prescription for the candy and laxatives on file.

Why Do People Call Them Teabaggers? For No Other Reason Than To Insult Them With A Sexual Innuendo, Obviously.

From today's New York Times:

It's hard to ridicule people who do such a good job of it themselves.....

I Think This Might Be The Closest I Can Get To Being In Love Without Crossing The Gay Line.

I Suppose It Would Be Rather Horrifying To Look At Your Baby And Discover An Ass Problem.

I wouldn't know, as I don't have any. Babies that is. We'll leave any ass problems I may or may not have out of this for now.

But like I was saying, I've heard  the love between a parent and infant is unlike any bond in the human experience, which totally makes sense. Evolution would have to create a pretty damn strong bond after all to withstand the noisy, smelly, mess making, mess getting into, sleep depriving experience that is parenthood. I've worked in a retail setting for close to 25 years now, which means I now see  babies who could be the babies of the first little shits I saw wailing down the toy aisle long ago, and I am convinced. To put up with one of those things you would have to love them. A lot.

I bet the people at Stiefel Laboratories understand that as well. That a few of them are even parents, and that on occasion, they have experienced the unique horror that must come from seeing the child you love so much with its ass on fire. I'm talking about diaper rash, and I'm not trying to minimize the condition. I'm sure it's awful for a little guy or girl to have to go through. I'm also sure that the first reaction of most parents would be something along the lines of "I NEED TO DO SOMETHING!!!!!" That the sight of such suffering, along with a tinge of guilt that would come from thinking maybe they had had something to do with this, "Did I change the diapers enough? Was I not diligent enough with the baby powder?" Would spur a parent to do anything in their power to make things right again.

That's how most parents would think that is. The parents who work at Stiefel Laboratories evidently thought something along the lines of "We could make some money off of this. A literal shitload of money" Which would explain the creation of Vusion ointment. A product I am nominating this night as the biggest rip off piece of shit ever to grace a pharmacy shelf.

It's not that Vusion is ineffective. It never would have been approved unless there was evidence that it worked. The product's package insert lists three ingredients; miconazole, zinc oxide, and white petrolatum.

Miconazole is an anti-fungal agent used to treat secondary yeast infections that can take hold during an episode of diaper rash. It's good stuff to use in these situations, and Vusion contains it in a concentration of 0.25%

Thing is, you can buy an over the counter tube of miconazole , eight times as strong, in the athlete's foot aisle. It goes by the name of Micatin.

Zinc Oxide is a skin protectant that also helps to seal out moisture. Again, a great idea to use when skin is irritated and wet. You'll get it in a concentration of 15% in Vusion. Or you could get some over the counter Desitin and get it in a concentration of 40%.

The audacity to list white petrolatum as an active ingredient is my favorite. White Petrolatum is Vaseline.

So, let's recap. Vusion is a prescription product that contains a combination of ingredients in weaker strengths than you can find them over the counter. Now let's do some math:

One tube Micatin, 14grams-  $6.49 (all prices from drugstore.com)

One tube Desitin, 120 grams, $4.42

Vaseline, 75 grams $3.29

Which gives us a grand total of $14.20.

So, how much do you suppose a prescription of Vusion goes for, after you go through the process of being examined by a licensed prescriber and given the right to buy something not as strong? Guess. Seriously...before you read any farther, I want you to take a stab at how much you think the good folks at Stiefel laboratories will charge you for watered down over the counter products.

Ready?

$265.99 for a 50 gram tube. I am not making that up. It's almost enough to make me slightly sympathetic towards insurance companies.

So by all means, the next time you gasp in horror when you realize your little one's ass is in an awful way, ask your doctor if Vusion is right for you, and if your doctor says yes......

Find another doctor.

I Make A Vow To You This Night. As Surely As I See This Glass Of Absinthe Before Me, I Will Dedicate The Rest Of My Life To Work Worthy Of The Nobel Peace Prize.

An open letter to the people of South Africa,

Comrades,

It may seem odd that I, a common citizen of the United States who has set foot outside of my country only four times, would make an appeal to you, a nation halfway around the world and seemingly far more politically complex than anything I have ever witnessed. I ask only that you hear me out however, as my humble plea to you may just end up benefiting us all.

For you see, the demon seed of apartheid, planted so long ago and so far away from me, has sprouted into a flower of fire that threatens to burn out of control. Consuming my own house the way it has burned through so much of your country. I understand your problem with the white Afrikaners in a way that no one else who is not black can. They came uninvited, assumed all positions of power and went on to rule with an iron fist, tolerating no questions, much less actual opposition. First in South Africa, then with my employer. Because when you freed yourself , you chased many of your oppressors directly into the corporate suites above me, subjecting me to the very woes you once endured. By liberating yourselves,  you set up my own enslavement. I suppose it is only karmic. I was a Republican during the time Reagan was propping up the regime that held you down. I am truly, deeply, sorry.

Did they do weird shit with the trash when they were in charge of your country? The trash system they have set up in my company is truly bizarre. Did they dismiss your ideas out of hand only to implement them months later and give you no credit? Did they tell you you did not know how to do simple arithmetic when you pointed out you did 75% of a store's prescriptions?  I can only imagine what it would be like to live in a land where those people were the only ones with guns. Look into my face my African brothers, and you will see the pain of a modern Nelson Mandela.

Which is why I am writing to you this night. Because like my brother Madiba, I choose not to fight the power of  injustice with force, but with the power of peace. From this moment on, I will not rest until you have settled your differences with the Boers and they can go the fuck back to where they came fr........I mean....they can return to their homeland secure in the knowledge you no longer want revenge for the fact they used to beat your head in and make you go to the shittiest beaches. I am in a unique position here my friends, as I both know what it is like to live under their heel and am pretty sure they will never call me a kaffir. Let us sit at the table of reconciliation and let me help you work together in the common interests of humanity.

As long as that table is in your country, and not mine. Before they conscript me to do off-site flu shot clinics, please, let's see if you guys can work this out.

We Have Finally Reached A Bipartisan Consensus In Washington. Now All We Need Is A Time Machine.

So the words of yesterday's right wing whack job can get someone branded a flaming socialist today. I can only shudder at the thought of what tomorrow will bring:

A Question About A Question.

My world could not be more unlike that of the Norteños or the Sureños and their ilk. I don't have to worry that picking out what color clothes to wear in the morning might be a life or death decision. I do have to be concerned that if my peers find out I eat non-organic bananas for lunch I will lose status in my community. I think about drive-thrus far more than drive-bys, and I'm pretty sure I'll never have to shank or be shanked. I do live close enough to the gangster world, at lease physically, that news of it often appears in my local paper. The accounts usually start off sounding something like this:

 "Blue dude saw a red dude and asked him a gang related question....."

I'm not making this up, they oftentimes refer to this "gang related question"

What could it be? This question. Do they mean there's like a quiz? Really? And I thought I was under a lot of pressure what I took the pharmacy boards. At least no one was sitting there waiting to bust a cap in my ass.....

OK, seriously. What the hell is this question the gangsters ask each other. This is bugging the shit out of me.

Attention Pharmacy Students: Take A Good Look Before You Decide To Enter Retail.

It Was A Shit Sucking Day At Work Yesterday. Oddly Enough, This Made Me Feel Much Better.

It's good to know we're not in this alone, yes?


From lastrefills.com

 

Sonny Rollins And The Candy Lady

There was a time in this country when Spam was mainstream. When middle class housewives across the country popped open a can and readied it for their husbands and children and the spam made them all feel like the very epitome of modernity. Before locally grown organic bought from the farmers market vine ripened tomatoes became our status symbol, we ate Campbell's tomato soup from the can, and pitied the poor slobs who had to make soup themselves. Before we had green tea organic natural nourishing shampoo we had Prell."You can be watching TV and see Coca-Cola," Andy Warhol once said, "and you know that the President drinks Coke, Liz Taylor drinks Coke, and just think, you can drink Coke, too. A Coke is a Coke and no amount of money can get you a better Coke than the one the bum on the corner is drinking."

Except Liz Taylor wouldn't be drinking Coke today. Anyone with even a little bit of status ambition would be drinking Fiji water, at the least.

I thought about this as I wandered down the main street of the quaint little Victorian-style town a little off the beaten path and into the candy store of the sad little old lady. She wasn't sad mind you, but seeing her behind the register would break your heart a little. Most of the town had been redone to create a tourist-friendly version of the past; "authentic" saloons, old style hotels that looked like they were ready for you to ride up on your horse and ask for a place to spend the night, restaurants that made you feel all 1875 while serving you up fair trade certified sweetbreads, it was a past in which we all can pretend we'd like to spend a little time, much like a Renaissance Fair.

The sad little old lady's candy store though, represented a past that actually was. Spartan, while tiled, and spare. Serving up Snickers, Three Musketeers, Jawbreakers, and Bazooka gum. A perfectly acceptable inventory for 1975, barely tolerable for a 7-11 today. The little old lady tried to talk you up as you looked over the Mars bars, but she was slightly out of touch in that unique way that the elderly become. She wouldn't be running her candy store much longer. She found her comfort zone sometime around the year I was born and never left it. I doubt though, if the sad little old lady has any regrets.

Earlier that weekend I saw Sonny Rollins headline one of the country's premier jazz festivals. For those of you who don't know, Sonny is the last echo of that golden jazz era that gave us the likes of Miles Davis and John Coltrane, which makes him of almost the same age as the candy store lady. He's lost a step or two physically, his voice is a little frail, but he still commands the stage in a way in which he won't for much longer. He sent his tunes around the arena that night like a boomerang, the notes coming back to their source so he could hurl them back around until they made us all dizzy with delight. He played like a man on fire, a man who knew he wouldn't be doing this many more times, a man who didn't want to let it go. He played and played for a good half hour longer than would have been considered giving the audience their money's worth.

I wondered, as I sat there,  if the intensity of the performance might be because of the time he spent in prison when he was young and an artists creativity is at its peak flow, the months or years it took him to break his heron habit. The frequent years-long stretches he took away from music when he was of strong body. If, looking forward and not seeing many years there, he regretted what he did with some of those in his rear-view mirror.

I doubt Sonny Rollins ever found his comfort zone. I doubt he ever will.

I've thought about Sonny and the Candy Lady ever since, and I'm not sure which way is the best way to be old; comfortable and irrelevant, or on fire and searching, until the last moment.