Monday, October 29, 2012

My Nomination For Least Significant Study Ever.

WOONSOCKET, RI-  In research that covers ground long ago broken, drugstore operator CVS Caremark announced today that higher prescription prices result in fewer people buying prescriptions.

"A new survey of retail pharmacists revealed that cost remains a key barrier to medication adherence" says the opening line of a news story that I swear to God I am not making up.

The company commissioned IntelliQHealth to do an online survey of its retail pharmacists, which many experts say is a sign of the company's willingness to let the facts take them wherever the truth is to be found. Almost every Nobel prize in economics has been won by doing online surveys of your own employees.

More than 2,400 CVS retail pharmacists responded to the online survey, which is noteworthy not only for the earth shattering conclusion that people don't like to spend their hard-earned money, but also because it is believed to be the first time in the history of the company it has ever listened to the pharmacists it employs.

"They shouldn't get used to it" Larry Merlo, president and CEO of CVS said in an imaginary interview. "Our plan is to become known as a company that is willing to spend its time and resources to acquire a firm grasp of the obvious, which is far preferable to our current reputation as a company constantly under investigation."

Sure enough, at press time The U.S. Justice Department's civil fraud division has announced an investigation into whether instances of the company automatically enrolling customers into its readyfill refill program without their consent constitutes Medicare fraud.

"As cost continues to be a barrier to medication adherence, we need to find ways to help educate patients about their options," said Troyen A. Brennan, MD, executive vice president and chief medical officer of CVS Caremark, a company that would charge $49.59 for thirty paroxetine 20 mg tablets, a prescription that would cost $4 at a Target store.

Exactly what type of education would be required to convince a customer to plunk down $46 for the privilege of going to a friggin' CVS remains to be determined, but "we are determined to find out" Brennan didn't say. "because the alternative would be to lower our prices to the point where we are competitive with other pharmacies, which let's be honest here, is never going to happen."

"Money money money money money!!!!" concluded Brennan, before walking off mumbling something about whether round shopping cart wheels result in more purchases than square ones.

Tuesday, October 23, 2012

My Blog Saves The Country.

My friends I feel a sense of relief this night. The weight of years of frustration, of worry, of concern for the well being of our great nation has been lifted from my shoulders.

I have succeeded. The most that one man can. The burden of closing the horse gap must now be passed on, for I am weary.

My struggle started almost a decade ago, when I picked up a book at the local Borders by a Saturday Night Live comedian and then political gadfly. In it I read that modern warfare has advanced to the point that "a special forces solider, sitting on horseback" could spot a target, send the information back to commanders, and have an airstrike executed all in the matter of 19 minutes, a process that took three days during the first Gulf War.

There was one problem however, and only Al Franken seemed to notice, this is from his 2003 book, "Lies And The Lying Liars Who Tell them"






You cannot call in airstrikes from horseback if there are no horses. This country faced a crisis, and no one seemed to care. No one, that is, except me and Al.

We sprung into action. Al filed papers to run for the US Senate, and I started a relentless campaign to get him there. Regular readers of my humble blog garden will remember my two major journalistic bombshells:

- The revelation that Franken's opponent, Norm Coleman, had never denied being a member of Al-Qaeda, an organization that undoubtedly would want to keep the number of horses in the United States military at a minimum.

- The uncovering of Coleman's choice to associate himself with an organization known to have protected child molesters.

Considering Franken won the election by only 225 votes, I think the importance of my work exposing his opponent's links to terrorism and pedophiles is obvious. Had it not been for my tireless efforts the chances of the horse gap being addressed would be close to zero.

Still,  Al is but one of a hundred Senators, the Senate but one-half of the Congress, and Congress only one of three branches of the federal government. The struggle continued. The fight went on. But tonight my friends, at last, the breakthrough we've all been waiting for. From the third and final presidential debate:





Horse gap awareness has at last reached the highest levels on the land. My work is done here. I may finally rest.

Unless you guys wanna keep reading about evil shit CVS does. Then I guess I could keep going.




Monday, October 22, 2012

In The Spirit Of Friendship And Cooperation, I Continue To Help A CVS Executive With A Vexing Problem.

OK......I swear I am not trying to turn my little blog garden into a CVS attack vehicle. I am sure that the other "BIG 2" do plenty of dastardly deeds worthy of mockery and exposure. As a matter of fact, I know personally that one of them does. But, the CVS material keeps popping up in my mailbox. Like I've said before, CVS' employees really.....really....seem to hate their company.

Some of my regular readers may remember Ron Snow, Manager of Professional & College Relations at CVS Caremark. I wrote awhile back how Ron had a problem that he just couldn't seem to get a handle on. It bothered his brain enough that he wrote an article in the Indiana Pharmacist’s Alliance quarterly magazine looking for an answer. Ron you see, just couldn't understand why today's smart young men and women seemed a little less than enthused with a career with his type of company:

I am not sure when the change started, but over the past few years I have noticed an inferiority complex growing among community pharmacists. For many years the proud neighborhood pharmacist was known as the most trusted professional, but now he/she has turned into someone with self-image issues. Why has this change taken place? The way I see it, this is a complicated issue with no easy answer.

Ron, the day The Drugmonkey came across your words was a very lucky one for you indeed, because there is indeed an easy answer. Take a look:

Subject: Pharmacy Service real time update *URGENT*
Date: Fri, 25 Mar 2011 10:20:12 -0400
From: RBarna@cvs.com
To: ;

Team 4,
· We are self destructing this week on rx service!!!! 84.7; two days left let’s pick it up TODAY!! 
· 59.2 on addressed by name, 63.6 on wait time- Are we serious??? Do you think I will accept results like this? 
· Wake up and start delivering excellent service results NOW!!! You’ve worked too hard this month to throw it all away 
· If you’re not able or willing to lead your team to deliver excellent service to each patient each time please let me know so we can discuss your exit strategy- one thing I won’t accept are poor service results &; neither should you


That's an actual, real email from someone in your own company Ron. His name is Ryan Barna, a CVS District Manager from New Jersey. Maybe you've met him. If not you can certainly write to him. That's his real email address up there. Ryan sounds like the type of guy who likes to get emails. Maybe you could talk about his part in the looming federal investigation of CVS' apparent habit of enrolling customers in an automatic prescription program without their permission. 

Ryan Barna seems to be awful upset that only 59.2% of customers that responded to a company survey said someone used their name. He sounds like he's blue in the face and maybe his head's gonna explode. Kinda seems like he's totally ready to fire people for not using people's names.

Almost like to him that is the most important thing in the world.

Back to what you wrote Ron:

What prompted me to think about this image problem was a recent conversation I overheard between a couple of new grads that was centered on their career choices. The first grad talked excitedly about his choice of starting a career with a hospital where he was confident that he would eventually get the opportunity to move into a “clinical” position in the not too distant future. The second grad sheepishly commented that he was “just going to work for so-and-so pharmacy” because he did not want to give up his 3 years of service with the company. I did not hear any passion of excitement in his voice about his future career plan.

Ron, imagine you are a college student, and a pretty damn good one. Pharmacy school isn't easy to get into, you know that, and it's even harder to get out of. Years and years of fighting to fill your brain with pharmacology, biochemistry, microbiology, kinetics.....the Krebs cycle. The Krebs cycle can still give me nightmares to this day.

You remember what it's like, don't you Ron? That sense of accomplishment when you finally walk across that stage to get your degree, the gradual seeping in that you really are a drug expert, the first time you knew something a doctor didn't!! And now you can take a position where you're gonna put that knowledge to work in a clinical hospital setting making a real difference in patients health outcomes.....

OR ELSE YOU'RE GOING TO GET THREATENING EMAILS AT WORK FROM SOME NEANDERTHAL WHO SAYS THE MOST IMPORTANT THING YOU NEED TO CONCENTRATE ON IS USING A NAME!!!!! NOW!!!!! DO IT DO IT SO IT DO IT OR I'LL FIRE YOU!! I SWEAR TO GOD I WILL YOU PIECE OF SHIT!!!!!

Ron.....really....the answer is pretty easy now isn't it?

I'm glad I could help.

Once again, that address is RBarna@cvs.com

Saturday, October 20, 2012

To All My Old Friends At Rite Aid. As Ben Folds Five Once Said, "If You Really Wanna See Me Check The Papers And The TV"

Or in this case, check the cover of the magazine that just got mailed out to every one of your stores across the country. Make sure to take a look at the byline on that cover story. http://ow.ly/eA0k4



Thursday, October 11, 2012

I Will Warn You. This Post Contains The Words "Used Enemas" And "Reshelved By CVS Workers"

So....why don't we just get right to the down and dirty. Via thesmokinggun.com and brought to my attention by an alert reader:


OCTOBER 11--A Florida man has been indicted on a federal product tampering charge for allegedly returning used enemas to the shelves of the CVS pharmacy where he purchased the items. 
Ronald Eugene Robinson is accused in an indictment unsealed today in U.S. District Court in Jacksonville.

Notice the dateline. October 11th. Today.

According to prosecutors, Robinson bought several “pre-packaged CVS Pharmacy Ready-to-Use enemas” between April and June of this year. After using the enemas, he placed them back into their boxes, resealed the containers, and returned the products for refunds.

I will draw your attention to the words "bought" and "between April and June"

The used enemas, reshelved by CVS workers, were subsequently sold to unsuspecting customers...“It is believed that all customers have been notified of the tainted purchases,” Department of Justice prosecutors said in a press release issued today.

They....had to be notified? I give someone the Watson Somas instead of  Qualitest and I'll hear about it in under five minutes, but....someone gets shit on a stick...and just sits passively around until someone calls?

Just to remove any doubt:

An analysis of the used products revealed that, “fecal matter was located on some of the returned enema bottles

"Well gosh....I seem to have lost the receipt. I guess I'm just out of luck."

Or would that be "shit out of luck"....bwwwaaaahhhaahhhaaa....

But let's get back to the words "between April and June," because the indictment included with that web story clearly states that the suspect was arrested for buying and returning enemas on June 5th. The inducement also states that this was the fourth time he had done this, which aroused the suspicions of the ever alert CVS staff.

He got away with it three times. At least. I'm going to go try and wash out my eyeballs now.

Sunday, October 07, 2012

In This Season Of Debates, I Present Pharmacy Showdown Number Two. It's CVS Vs. CVS.

Good evening ladies and gentlemen, and welcome to the second in our series of pharmacy debates. You may remember last time we were here and discussed the impact of  drugstore chain/pharmacy benefits manager CVS Caremark upon the profession. Tonight, we'll go from the general to the specific as we address the topic "Does CVS enroll people in their 'readyfill' automatic prescription service without the patients consent?" We have two guests tonight, first off, CVS spokesman Mr. Mike DeAngelis.

"Rot in hell Drugmonkey. If you think a few weeks of unemployment are tough, you just wait until we're done with you"

Ha ha....he's quite a kidder that DeAngelis. Next up we have CVS Supervisor Ryan Barna. Mr. Barna oversees about 50 CVS stores in the New Jersey area.

"He's not kidding Drugmonkey, we're going to bury you"

Very well then, but first things first. Mr. DeAngelis, recent stories in the Los Angeles Times paint a picture of CVS customers systematically being enrolled in your automatic refill service without their consent. These are serious allegations, as this could, under some interpretations, be considered insurance fraud, as claims are being filed for medicines a patient never asked for. Both the New Jersey Department of Consumer Affairs and The California Board of Pharmacy have expressed concerns, and the LA Times articles imply that this might be happening as a result of pharmacists being pressured to meet a quota of program enrollment. We've flipped a coin backstage, and as a result you get to make the opening statement.

(Note, every statement below attributed to DeAngelis  and Barna come straight from the Times articles. Except for the final statement, which really happened in my imagination.) 

"It is not our policy to refill prescriptions without a patient's authorization"

Very well then. Mr. Barna, do you have a rebuttal?

"You need to go out and make this happen this week and every week going forward"

I see. You were, of course talking about a specific number, 30% of phone calls to patients that were expected to result in repeat business. It would seem that we have a clear distinction between the positions of the two of you then. Mr. Barna, if I could ask a followup question. What would happen if pharmacists did not meet this quota?

"Major personnel changes. Please understand this is not the road I wanted to go down, but action plans/phone calls/advice haven't yielded the result we're all looking for & it's time for a change in leadership in certain stores."

OK, but our topic is whether CVS ever filled prescriptions without a patient's authorization. Mr. Barna, if pharmacists called patients and could not reach them, what did you instruct them to do and say regarding those patient's prescriptions?

"We tried calling you several times this week on this past-due prescription" and that "I went ahead and filled it so it would be ready for you."


Mr. Deangelis, this seems pretty clear. Do you have a rebuttal?

the company says this is an example of an overzealous manager going too far, not a practice followed by CVS pharmacists nationwide.

Mr. Barna, you called the procedure you outlined to the pharmacists you supervised...what was the term? CVS.....

"best practices."

Yes, best practices. And I will point out here that the Times articles point out incidents of unauthorized prescriptions being filled in both New Jersey and California. Mr. DeAngelis, is it possible for one overzealous manager in New Jersey to affect your operations in stores located on the other side of the country?

"It is not our policy to refill prescriptions without a patient's authorization,"

Yes....I seem to remember hearing that somewhere before. And with that ladies and gentlemen we've reached the end of tonight's debate. Mr. Barna, since Mr. DeAngelis got to make the opening statement, we'll give you the final word.

"Thank you. As spirited, and at times heated, as tonight's debate was, I'd like to point out that my opponent and I actually have a great deal we agree on. We are both working for a strong and profitable CVS, and share a desire to make the company the best it can be. More importantly though, we share a bigger goal. Your immediate and total destruction Drugmonkey. Mr DeAngelis and I could not hate you more, and wish nothing but for you to be erased from this very planet, preferably in a painful way. Short of that, we would like to make it possible that both you and the LA Times shut the fuck up."

And on that note of agreement, we close this night's debate. Tune in next time, when our topic will be "A share or Rite Aid stock or a Diet Coke, which is the better value for your dollar and a half?" Until then, have a wonderful evening.

(Special thanks to the multiple alert readers who tipped me to this story)

Friday, October 05, 2012

Today's News, As Brought To You By Me Over A Year And A Half Ago.

From today's paper, which sadly, I will soon start receiving in digital form. I wonder what I'm supposed to start calling it then? "From today's screen?" "From today's data upload?" Sigh. I will miss you, dead trees.

WASHINGTON — Teva Pharmaceuticals has stopped shipping its generic version of a popular antidepressant after a federal analysis showed the pill does not work properly. 
The Food and Drug Administration on Wednesday said it asked Teva to withdraw Budeprion XL 300 after new testing showed the drug releases its key ingredient faster than the original drug Wellbutrin XL 300, made by GlaxoSmithKline.

Budeprion releases its ingredient faster? This sounds so......familiar. Of course it was from a long time ago I'm thinking of...let me see if I can remember....

I will say however, that when I dispense and you take a generic drug, we both expect it to be the same as its brand name equivalent, and that dumping 49% of a 24 hour dose over the course of four hours as opposed to 25% is not the same. It's almost twice as much. Which makes me wonder if maybe there's not a reason at least a few of my customers are so damn psycho .
It's also why I've started ordering Watson's version of Wellbutrin XL.

Wow. That was way back in January of 2011. Whoever wrote those words must be some sort of prophet or something. I mean.....

Wait! That was me! I remember now! I'm the prophet!! You should probably praise me and ask me to do miracles now or something.

The action contradicts the FDA's previous update on the issue in 2008, when regulators said the drugs are essentially the same.

Actually, that's being kind. According to the prophet, what happened was the FDA extrapolated results from a test of 150mg tablets to the 300mg ones. They tested one thing and assumed the results would apply to something else. As we all know, assumption is the cornerstone of science.

And by the way, even the test of the 150mg tablets didn't go so well.

"Oh prophet" some of you are no doubt saying. "Might you have any other words of wisdom for us poor lost souls who trust that authority figures are wise and just?"

Yes. Never trust anyone who calls himself a prophet. It was actually The People's Pharmacy that broke this back in 2006. Good on them.

Still, I ran the story a year and a half before the paper, which I think earns me a little praise. Is there some level between a human and a prophet? A prophan?

Maybe the paper will be faster when it's the daily data upload.  I'm not hopeful.

_______________

PS- By the way,  the guy who left this comment on that original post back in 2011?

Irrelevant! So much for pharmacists being drug experts. 
All y'all need to go back to your pharmacokinetics textbooks and brush up on steady-state. 
tsk tsk Drug Monkey.

He can suck it. Totally suck it.

Tuesday, October 02, 2012

The Column Drug Topics Rejected. Probably Wisely.

So, yeah, I don't have the best record of not provoking the wrath of the targets of my writing. And perhaps running my middle finger to Rite Aid in a national magazine wouldn't be the best idea. That's what editors are for, to make decisions like this, and I'm not the least bit upset we had to go to Plan B for this month's column. Maybe if I had an editor for this blog I'd still have a daytime gig.

Still, I think it was some quality wordsmithing, so in the spirit of "they can't fire me twice" I think the column ought to run somewhere. Here goes:

__________________________________________

Evidently I am one bad dude.

That realization came to me one day in early August, when the Fortune 500 Corporation that employed me said I was too scary of an individual to have around. I wasn’t quite sure how to handle this, as I’ve never been frightening before. I’ve prized brainpower over intimidation ever since the day in junior high when I developed a plan to charge my meals at school in order to minimize the amount of cash bullies might ask for.

Now however, I am the intimidator. I’m thinking about getting a tattoo.

This all started when my former employer, Rite Aid, found themselves with a bit of labor trouble in Southern California. The United Food and Commercial Workers union, of which I was also a member, balked at the company’s contract proposal, which among other things they claimed would lead to out of pocket costs for health care benefits of up to $10,000, the effective elimination of health care for workers spouses and children, and the virtual elimination of accumulated sick leave pay.

When I saw this I was a little angry, and I guess that much like the Incredible Hulk, you wouldn’t like me when I’m angry.

The UFCW called for a strike authorization vote, and a strike was authorized. Both sides began to prepare for a fight.

For those of you who don’t know, I’ve written a blog for the past seven years. I’ll warn you before you go looking for it though, it’s rated “R” for language and immaturity. In the wild west spirit of the internet, it is crude, rude, and incredibly opinionated. I’d also like to think it’s pretty darn funny and well written. Think “The Onion” meets “Beavis and Butthead.” It’s written “in character” as The Drugmonkey, and just as when you sit down to watch Jon Stewart or Stephen Colbert, there are parts of that blog that are meant to be taken seriously and parts that aren’t, and I’ve always trusted the reader to know which is which.

A trust that never should have been extended to Rite Aid Corporation.

People started writing to me through the blog to say they were being recruited to come to California and work as scabs if a strike went down. One person told me that when they asked if they would have to cross a picket line they were told yes, and that it would be “exciting”

That’s when The Drugmonkey said, in colorful language, that any scabs that come to California ran the risk of having their rear ends kicked. Take a look at that picture at the top of this page. You can see why someone would be frightened.

For those of you not familiar with the magazine, here's the picture that runs at the top of the page. Notice how scary looking I am: 




Within days I was told that someone who would write such mean words was someone too scary to have around, that even though I was told by Rite Aid’s media contact that the possibility of replacement workers being used to break a strike was an “unsubstantiated rumor,” a workplace violence policy had been violated. A policy, evidently, meant to protect unsubstantiated rumors from fictional characters. I am no longer employed by Rite Aid.

So this is what it’s come to in 21st century America. Use a contract to add to the misery of those who fall ill, piling on financial burdens to the burden of trying to recover your good health, and that’s perfectly acceptable. A company that purports to be part of our health care system proposing to bankrupt the sick is within the level of violence we will tolerate. But an individual using their own time and their own resources to engage in a little trash talk about the perpetrators of this violence? Well, that person has gone too far. It’s not enough that the corporations that now control community pharmacy micro-manage the way you practice the profession you worked so hard to join. They now feel entitled to every minute of your life, every action of every day, right down to the last stroke of your keyboard.

They can’t have mine. When I see injustice I will talk about it. When I see violence I will work to counter it. I may not know how to throw a punch, but I will not shut up.

My words are sharp. Fear me.