I Started This Night Intending To Write Onion-Like Satire About This, But It's Really Not Funny. CVS Is A Drug Pusher.

I mean, it would be really easy to do some tongue in cheek stuff about how the DEA protected the mom and pop drug dealers of Sanford, Florida from corporate chain competition when they pulled the controlled drug registrations of two CVS stores, and I got a couple hundred words into it, but....

I kept thinking about one of my favorites, back when I had customers. In her mid 30's, but maybe the mental capacities of a 12 year old. She was sweet and deeply troubled. Good Lord that woman had been through some shit that left her with pain both physical and mental, but you couldn't help but to see the goodness popping up through the surface of the storms that went through her mind. You have no idea how hard I rooted for her.

Now she's dead. Because another drugstore filled a prescription they had no business filling. Kinda like those two CVS stores in Sanford. Except those two CVS stores in Sanford were doing it a lot more often.

The DEA says those two stores were pumping out enough oxycodone to supply a city with eight times the population of Sanford. Which means people are almost assuredly dead now that wouldn't have been. People who lost their battle with demons that taunted them, with a little help from the friendly pharmacy that looked the other way. Mothers have no sons, lovers are alone, friends are only memories.

I'll bet you though, that every one of those tortured souls were asked at the pharmacy counter, not about the addiction that was destroying them, but if they had their annual flu shot. A few of the deceased probably met their end with a blood stream full of narcotics and antibodies against this year's  A/Victoria/361/2011 influenza strain.

If only there was great profit in getting them the help they really needed.

This is what your profession has come to. CVS is the single strongest player in the pharmacy field. On the cusp of being dominant. Walgreens just screwed themselves business wise and Rite Aid... is hardly worth mentioning. The independents have been devastated and the Wal-Marts and Safeway's that fill a few scripts do it mostly as a side business. Until an ambitious Vice-President decides he wants to make a name for himself by making the prescriptions profitable, which means he'll take a look at how CVS did it.

The accusations of bribery

The overcharging of the taxpayer.

The overcharging of their customers.

The person not a pharmacist who was perfectly able to do everything CVS expects of one.

The defiance of a body responsible for regulating the profession and protecting the public.

How the lax narcotic controls were preceded by lax controls of the materials needed to make crystal meth.

These are the people who now control your profession. Perhaps it's the onset of maturity, maybe it's the crankiness of stress, but you know, tonight, I just don't think it's funny.

CVS had the chutzpah to sue to challenge the suspension by the way, and says “We are reviewing the decision, evaluating our options and determining the best way to continue to serve our customers”

I might suggest, that if they were the slightest bit worried about the best way to serve their customers, none of this would have happened. I might suggest, that the best way to serve your customers CVS,  is not by enabling them in ways to kill themselves.

Back when we were in control of our profession, that used to be obvious.

It Takes A Village Sometimes, To Run A Pharmacy

HUNTSVILLE, AL, SEPT 10,2012, - In a devastating blow to the nation's pharmacies, Qualitest Pharmaceuticals announced today an immediate recall of one lot of the popular painkiller hydrocodone with acetaminophen tablets. According to a press release, it is possible that some tablets in the affected lot could exceed weight specifications, making them super-potent for both acetaminophen, also sold alone under the brand name Tylenol, and hydrocodone, a narcotic painkiller.

While the recall affects only one lot of one of a relatively unpopular strength of the med, pharmacists across the country worried about the impact to their bottom line.

"We sell a lot of hydrocodone stuff, I think" said some guy we've never seen before behind the counter at the Rite Aid in Monterey, California. "I mean, most stores do. I'm just here filling in for the week. What if we order some and it doesn't come in? Oh dear. If only we had an experienced staff pharmacist here. They would know what to do about this and the other million things that have come up in the last few days."

Across the country at Charmar Pharmacy in Bronx, NY, a pharmacist whose head wasn't up his ass explained "A lot of times, even though the actual recall is only for one lot of one strength, something like this can affect the whole supply chain as doctors and patients adapt to a particular product not being immediately available. Depending on how this plays out, this could have a big impact on our business."

In the United States, sales of all hydrocodone products are conservatively estimated at 45 trillion dollars a day. Actually maybe more like an hour.

However, in a surprising and apparently spontaneous display of support for their community pharmacies, customers across the nation lined up outside drugstores, clinics, hospitals and ambulance services to offer assistance.

"I heard there might be some super strength hydros this place might have to get rid of" said customer Byran Billups while waiting outside a Medicine Shoppe pharmacy in Dallas, Texas before the start of business. "I'm here to help."

Pharmacist Michael Haynard soon told the assembled crowd that while the store's hydrocodone came from a different manufacturer, and therefore was not subject to the recall, he did need some help moving some merchandise away from a broken water pipe.

"Sheeeeeeeeeeeeiiit" said Billups as he turned to walk away. It was a scene repeated across the country as customers who rushed to the aid of their local drugstore learned there were already procedures in place to dispose of recalled product.

Others meanwhile, were determined to stand by until they were the situation was under control. "Maybe they'll be a UPS strike or sumpthin, so they won't be able to ship the stuff back" said a customer outside a CVS pharmacy in Sanford, Florida. "I used to be able to count on these guys to always come through for me. I don't understand what's going on."

Meanwhile, Over At CVS......

From the mailbag...I almost hesitate to post this, as I fear it might give the other "Big 2" an idea to rip off.

But what the hell, I'm not part of that rat race anymore. Here we go:

I go into work on Wed and we have been sent CVS "thank you" cards to be HAND WRITTEN by the pharmacist and given to the preselected ESI transfer patients when they pick up their RX's. It should say some of the following things: 

-thanx for choosing CVS
-offering flu shots
-offering text messaging
-soon will have electronic signing at pickup
-CVS can have your entire profile and screening for drug interaction
-one on one patient /pharmacist counseling with expert drug info
-Blah blah blah blah blah
-Card is in an envelope and presented to patient at pickup

Bwwwaaaahhhhaaahhhaaaaaaa.....damn good thing they're not having the techs do this. Intensive pharmcotherapy such as this is exactly why I applied to pharmacy school.

By the way, I think this might be a good place for a little mash up with some words by Ron Snow, Manager, Professional & College Relations at CVS Caremark. He wrote these for the Indiana Pharmacist’s Alliance quarterly magazine and they come via the blog of Jim Plagakis. Jim gave me the break that got me into my gig at Drug Topics, which probably contributed to me getting fired from my last job. Which means I owe JP one huge-ass favor:

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.

Now back to my CVS source:

In addition we are calling every one of the ESI patients to give them the same info that is one the card and then we fax all of the calls made daily to the DM...In addition to THAT, the techs pass out 20% off coupons to each patient targeted for purchases in the front thru September. In addition to THAT, we are to delay the transfers of all ESI patients' rxs for an hour and then call the patient to find out why they are transferring...I think you already know this...

Yeah....no easy answer at all as to where those self image issues could be coming from....after 6 years of busting your ass for a doctorate...huh....yup, no idea.

Back to 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.

Why did not this recent grad not show more enthusiasm for his community pharmacy choice?

Not a clue did you make your readyfill quota. What could it be?

I believe one reason is the focus/pressure that schools are putting on grads to complete a residency...Unfortunately, I have been informed numerous times by interns that they are left to feel inferior if they choose not to pursue a residency.

Really? You know...Here's just a wacky theory....I'm just gonna....maybe I shouldn't...it's kinda crazy.....oh what the hell....maybe.....

....they are. Just a little bit ahead in their professional development than the person who got a doctorate so they could be ordered to fill out these all day.

Just a crazy idea. Back to my CVS Deep Pill:

Its all so crazy...and so demeaning to the employees and NO health care info given to patients at all...I am an old school RPh and it is killing me...

I know, but if those pharmacy schools would just let up on their pressure to put kids in residencies, everything would be fine.

.I know you feel the pain also

Felt the pain. And hoping never to feel it again. You have no idea how much I want this clinic to offer me a gig. I want. To be. A Pharmacist again.

Sigh.

So, How Was Your Day Drugmonkey?

I'll tell you how my day was. Started off with this in my mailbag:

I printed out your recommendations and sent the paper in with (boyfriend of person who wrote me for some drug advice) who, I'm sure, was utterly embarrassed to take in a note from his girlfriend. Ha! ;-D But when he mentioned about my friend, who practices pharmacy, doc asked him what you suggested... and doc agreed... and seemed impressed as well.

Hell yeah that doctor was impressed. You know why? Because I am the friggin' MASTER OF PHARMACY!!!! that's why. You got a drug question and you go anywhere else you are cheating yourself my friends.

Also did some job fishing last night and got a little nibble today. I don't wanna jinx it by saying anything, but even if you're a hater who can't handle knowing someone with the Drug Library of Congress in their head is out there, you'd probably say something like:

"I wish that Drugmonkey would burn in hell, but man....that job couldn't be a better fit for him"

OK, you know what, I can't keep a secret. It's at a clinic that serves un and underinsured patients. How much of a  fairy tale would that be if I got this gig while Rite Aid continues their slide into bankruptcy? How much of a fairy tale?

So yeah, not a bad day. Keep your fingers crossed for me.

Tales Of The Jobless Life, Part One

Tomorrow's gonna be when the fecal material hits the fan. Two deadlines to meet on Friday and tomorrow's gonna be my last chance to throw up some good work. That's what writing feels like by the way, like when you know you're gonna throw up sometime today, but aren't really sure when.

Then.....all the sudden it vomits up...messy words splattering all over the place while you struggle to get them at least near to where they should be deposited. Then all you gotta do is spend a lot of time cleaning them up and you got you some writing work done. Anyway, I gotta throw up twice by Friday.

Today though, I had a Momsitting gig. Some of you may remember my dear friend who is caring for her mother with Alzheimer's. My current joblessness is a bit of a blessing for her, seeing as how she needs occasional time to run errands and catch up on life stuff and just de-stress a little for a few hours.

She needs occasional time and I have time in abundance. Pretty much a classic win win.

So today's idea was to teach Mom a card game. In particular, "war." For those of you not familiar, I'll tell you it's the simplest card game on the face of the earth. You throw down a card, then your opponent throws down a card, and the highest card wins. If you both throw down a card of equal value, war is declared, consisting of two cards face down and one face up, and the highest one wins the whole pile. This continues until someone is out of cards.

Again, pretty much the simplest game on planet earth. And I lost. Every time.

After awhile I started to be pretty sure I was giving Mom credit for hands that I had actually won. Which would be a sweet thing to do, if I were doing it on purpose. I wasn't. Today I was outsmarted at the easiest card game imaginable by an elderly woman with severe dementia.

I'm chasing my first serious job lead since Rite Aid's asshatery. And I'm hoping, mostly for my own mental health, that it might lead somewhere.

Seriously, You Guys Just Can't Get Enough Can You?

Twenty minutes? Really? Shouldn't you guys be monitoring flu shot quotas or something? Because honestly, I don't think it's possible to fire someone twice. You don't seem to realize you have no power over me anymore.

You suck you suck you suck you suck. See? I would never say stuff like that if I was still on your payroll. Ironic isn't it? If your goal was to shut me up you were about as effective as you've been in the pursuit of profit.

I also never would give the world the scoop about your "savings card" prescription pricing if I was still your employee. The whole time I worked for you, I never once told people how I saw that depending on the med, that "savings card" turns into a "rip off the customer" card.

I still haven't. Gone into the details of how that card can screw people over compared to other discount plans that are available. But we both know I could. So maybe you shouldn't piss me off. More than you already have.

Looks like any remaining power in our relationship rests with me now, yes? I use the sweet sweet irony to flavor my coffee every morning.

It does make me happy to know, however, that based on your outclick, you're learning about the outsized influence of big money in our electoral process.

There may be hope for you yet.

Quick, Name A Drug Interaction. Any Drug Interaction.

Seriously. The first one that comes to your head. Now, I want you to remember the very first thing you thought of when asked to perform the most basic of tasks that define what it is to be a pharmacist as I dip into tonight's mailbag. OK?

"Dipping into tonight's mailbag" by the way, isn't nearly as fun as it sounds. Anyway, here we go:

I worked for (corporate soul sucking chain) about 7 years before I moved and I worked for (2nd corporate soul sucking chain) about 15 years before that. Neither had unions, but I wish they had. I developed a bit of an edge from all those years of corporate aggravation.When I got home my sweet wife would let me vent, then she'd say something like: "You're over reacting, just do your best and let it go. Hey,supper is ready..let's eat" She probably saved my life by doing that for me all those years

I like hearing someone's marriage got them through the bullshit. Probably because I fairly recently found the most awesome girlfriend in the world.

But it bothers me that the corporate folks do whatever they want without much regard for the people who work for them. A lot of it is not only silly, but just dumb.

And dangerous. Let's not forget dangerous. I'm looking at you 15 minute prescription guarantee.

Here's a little example that happened last week. Might seem little to others, but I think you'll understand: 

In the past, when we dispensed coumadin, we got a little auxillary label that said: "do not take with aspirin unless directed by physician".

How many of you named coumadin/aspirin when I asked you to come up with an interaction quickly? I'm betting most of you. It's probably the most common, most dangerous, drug interaction you'll find in any type of ranking of these things. Pretty basic stuff for anyone with a pharmacy education. Yes?

Read on.

It printed automatically on the peel off spot. One day that label dissappeared and was replaced by two others.One said do not take if pregnant without Dr advice, the other said do not drink alcohol with this med...but the no aspirin sticker was gone. I checked Facts and Comparisons to make sure the aspirin/coumadin thing was still legit. And I found out that they classify the coumadin/aspirin interaction as level 1. (Probable, prompt, and serious). The alcohol/coumadin interaction is classified as level 3 (unlikely, delayed, and not significant).

For those of you playing along at home, here's what the good folks at drugs.com have to say about aspirin and coumadin:

Aspirin, even in small doses, may increase the risk of bleeding in patients on oral anticoagulants by inhibiting platelet aggregation, prolonging bleeding time, and inducing gastrointestinal lesions. Analgesic/antipyretic doses of aspirin increase the risk of major bleeding more than low-dose aspirin; however bleeding has also occurred with low-dose aspirin.

And again, anyone who's spent more than a week in pharmacy school knows this. This is simple, basic stuff.

Back to the letter:

So I called one of the pharmacist who serves on the "advisory board" and she agreed that it might be a good idea to have that level 1 interaction put back on the label. She brought this up on the conference call and was told, "no we can't do that. Medispan would have to redesign our labels and all that and "so, no we can not do that". 

I know it's just a little green sticker on the side of the bottle, but it's my profession.

Correction. It was your profession buddy-boy. Today my friend, you are no longer even capable of judging whether the possibility that someone might bleed to death merits a warning label. Got that?

You are at 14:30 on that waiter on the counter though. better hurry up before someone gets a gift card.

I feel powerless to address this incompetence. I would like to be able to report this to the union and have them call up corporate and say: "Hey what were you thinking? Get that changed right away. Not next week, not after lunch, NOW!" 

But I don't really like unions. I would like to think that they are unnecessary for professional people. I've developed a 2 inch thick folder of gripes like the one I've outlined above, but I don't like the sharp edge that's it's developed in me. I want someone to speak for us, but I don't know who. 

You got any insight into this situation?

Yes, I do. Realize that unions are not perfect, and that as it stands today, they need a lot.....a LOT....of work before they become the type of organization that is able to advocate for our control of our profession. But right now they are the only tool we have. We need to improve the tool.

"Improving the tool" by the way, won't be nearly as much fun as it sounds.

Pharmacists can't even get an aspirin/coumadin warning on the label at one of the major chains that now control pharmacy. Imagine someone had told you that would happen back in 1995 and what you would have thought.

Now imagine what might be happening in 2030. Unless we improve the tool.

A Little Rite Aid Southern California Strike Rumor Mongering.

So....am I unemployed now or am I writer? I just spent a good 15 minutes staring out the window pondering that question. You'd be surprised how busy I've been with the writing stuff of late. Had to learn how to use the calendar function on my Blackberry I did. I've had that thing for four years and never felt the need to learn the calendar function until this month.

On the other hand, I still have a Blackberry, which would be a phone for the unemployed.

And I still start the day with an automated e-mail from CalJobs, the state website for those who aspire to better cellphones. You can set up a profile there, then have it search its database every night for the type of jobs you're looking for and report back to you first thing in the morning. Or second thing, after a cup of coffee that I can never seem to make strong enough. Wait. Third thing. Usually gotta pee right out of bed. And clean out Spooky's litterbox.

Anyway, the job listings are there when you're ready.

Yesterday's looked pretty promising for awhile, right up top there was a pharmacist position just down the coast a little ways. It wasn't a hospital, which I have my fingers crossed for if I can ever find one that doesn't require hospital experience, but maybe it was a cool indy, perhaps with a compounding practice. I think it'd be kinda cool to get some mad compounding skillz.....

Shit. It was Rite Aid. The company whose commitment to protecting scabs from hearing any mean words as they take part in the destruction of our profession is the reason I'm getting these e-mails in the first place.

On to the next one.....Rite Aid....dammit.

Next.....Rite Aid.

After that.....Rite Aid. I am not kidding you. Sixty-nine postings for Rite Aid pharmacists. Followed by another thirty-one today. This is one page of five:

 So...a company has 100 job openings for pharmacists, in one state, almost literally overnight. Let's use Mr. Brain and see if we can come up with any theories as to why.

I'll give you one clue. There are 124 colleges of pharmacy in the country today. I learned that while I was researching some writing stuff. In 2000 there were 81. Process that while you're thinking about whether the major pharmacist shortages of the 90's have returned.

You know, I'm in a good mood, so I'll give you two clues. Rite Aid is looking at the possibility of a strike in its Southern California stores.

I think we might have our answer.

A storm's coming my friends. And don't kid yourself. No matter where you work, or who you work for, this is a last stand. You know damn well what's happened to our profession in the last 20 years. If you need a reminder, next time you come home from work, I want you to look in the mirror, think about how your day went, and tell yourself you are a professional.

Seriously. Try it. Let me know how far you get.

If you ever want that professionalism back my friends, you're going to have to confront the forces that now control pharmacy. Try it yourself and you'll probably be as successful as telling that person in the mirror how valued you are for your medical skills. You need to get in the face of power and advocate for your interests, and if you go in there alone you will be chewed up and spat right back out.

Unions, however, get in the face of power and advocate for their members. That's pretty much their whole purpose. Lord knows they've done a half-ass job of it for the last generation or two, but the last scrap of infrastructure is still there, for now. With a lot of effort, it can be repaired. Once we lose this last bit though, it's gone forever.

How would you like a contract that says flu shot quotas are unethical? Only one way you're gonna get it. Repair that infrastructure and get in the face of power.

Or, you could always go to California City for $68 an hour. That has pretty much been the way of the last 20 years and you see where that's gotten us.  I always wondered how much someone's honor was worth.

I'm going to get ready for bed now. Looking myself right in the mirror as I brush my teeth, and sleeping tonight like a baby.

Blog Posts That Somehow Didn't Get Me Fired, Number 3.

Original air date, October 12th, 2008


The Discount Pricing Program From The Pharmacy That Makes It Personal.

CAMP HILL, Pa. - Rite Aid Corp., the nation's third largest drug store chain, today claimed success for its "making stock affordable for the people" program, which took the industry by surprise when it was launched 15 months ago.

"Rite Aid has always been known for low prices every day" said CEO Mary Sammons with a straight face. "But with the phenomenal success of our stock discount program, we've taken a big step towards making corporate ownership, not just shampoo and medicine, affordable for everyone."

In East Los Angeles, José Lopez is using the Rite Aid program to help him take his shot at the American Dream.

"When I first came to this country, I only hoped to find work so I could send some money home to my Mother and cousin" said Lopez, a day laborer and part time landscaper found most mornings outside the Home Depot on Wilshire Blvd. "Now, with what I earn at the end of most days I can buy part of this giant drugstore. I hope someday to own enough of it to be given a golden parachute like the businessmen I hear about on TV. "

As of Friday, Lopez held a 15% stake in the company.

Morgan Stanley analyst Barney Weismann said that unlike the products sold in its stores, shares of Rite Aid Stock really are cheap.

"They certainly were ahead of the curve in aggressively driving down the price of their stock" said Weismann. "The idea has really caught on of late, not only in the drugstore industry but across the entire business world. Rite Aid took the lead in discount stock pricing, and no one has really managed to catch up."

"Catch up and stay in business" he quickly added.

The program suffered a major setback last month when Rite Aid shares were pulled from the shelves of several major dollar store chains as being "too cheap for even us to sell," nevertheless, Ms. Sammons extolled the virtues of value stock pricing.

"I think it's an opportunity anyone who still has any money left should take advantage of" said Sammons, her voice slightly quivering. "Please....I'm begging you...take advantage.....before it's too late."

Sammons then started to weep softly.

Disclaimer- Everything in this post is made up, except for the incredibly low price of Rite Aid stock, which closed at 55 cents a share on Friday.

_____________________________


Well, four years later I certainly look foolish on this one, don't I? A new CEO, a new business strategy, and that stock price these days has more than doubled...

Yup. Closed today at $1.21 it did. While I wipe the egg off my face, let's review what we've learned so far. As we've just seen, Rite Aid was totally cool with a person mocking their business shortcomings.

They also didn't mind me openly lusting after their CEO.

Telling the world they tried to order a pharmacist to feed someone's controlled substance addiction? No problem!!

But, say scabs suck...and...you.....are....outta here. Standing up for working people who want some measure  of health security must be worse than all those things.

At least they are in some people's eyes, we now know.

Ever See A Picture Of An Unsubstantiated Rumor? Now You Can.

Because when I called the Rite Aid media relations person and asked her if the company had plans to bring in replacement workers if a Southern California strike went down, she said it was just that. An "unsubstantiated rumor"

So, if you get a picture of an unsubstantiated rumor, is it still unsubstantiated? Or have you changed it's very nature, the way you can change photons in the double slit experiment merely by measuring them? 

I may win a Nobel Prize for this. Me and the super secret spy who got the pic for me.