Highlights From Today's Pill Counting Action.

I pulled into the parking lot to start this day and I saw one of my regular customers walking into the store.

The great thing about community pharmacy is that you get a chance to know your regular customers. Because of this I went to Starbucks. Because I knew this customer all too well.

I waited in a long line without a care in the world. I decided to buy something for my keystone tech as well. "No hurry" I told the barista...... I ended up being about 5 minutes late to open the gate.

The first words out of the customers mouth when that gate opened were exactly what I knew they would be:

"HOW LONG?"

I am the king of passive-aggressiveness. Just ask my ex-wife.

Opportunities to fuck with customers will present themselves regularly to those who remain vigilant in the search for them. We had a customer this day who was named after happiness and joy. When her prescription was ready I couldn't resist:

"Are you Gay?" I said as I looked out into the waiting area. I played it perfectly straight but I have a feeling the customer knew what I was doing. There was a pained look on the customer's face. Huh Huh.....huh huh....

If you're the help desk rep from Cigna I went off on today, I'm sorry. Kind of. You started it.

At lunch I got some insight into the life of a hot chick. I mean smokin'. I mean Playboy would have been more than happy to sign her to a contract hot. There were two guys with her in line in front of me, obviously competing for her affections, and obviously not quite in her league. She got to the cash register first, stopped, stamped her foot impatiently and said:

"I don't know which one of you is paying for me but you better get up here now!"

Whereupon one of the guys did. I miss the ghetto sometimes.

Back to work and the other extreme. At least 250 pounds of fugliness spilling over hip-hugging jeans and wearing 2 or 3 faces full of makeup. "I cry after bad sex too, don't worry about it," she said into her cellphone as she walked past. I got the feeling she's cried a lot. Sometimes I don't miss the ghetto at all.

I spent a good 5 minutes trying to explain to a customer that the fact Toprol is off patent does not mean it's over the counter. I spent 5 more explaining to someone else that even though their insurance covers a 90 days supply of medicine, in the case of Amoxicillin and an ear infection, that might not be the best idea. Maybe it was karma getting me for the Starbucks incident.

That woman really was Gay though. Huh-huh.....huh huh......

Fun With HIPAA Legalese

A quote from my corpo-pharmacy's Notice of Privacy Practices:

We may disclose your health care information to the following entities and/or under the given circumstances......

.......to contact the patient for the purpose of fundraising.

So, after raping you with a price tag of over a hundred bucks for 30 generic Ambien tablets available on drugstore.com for $17.99, my employer reserves the right to contact you for fundraising purposes.

Say what you want to about my employer, but they do not lack in the chutzpah department.

My favorite entity and/or circumstance in which your healthcare information may be disclosed however, is this:

-to authorized federal officials so they may provide protection to the president, other authorized persons, or foreign heads of state.

Why the hell was it considered necessary to write this into my store's HIPAA policy? In my fantasy world it would be necessary to include this in my HIPAA policy....

Fade to dream sequence here.....

Secret Service: DRUGMONKEY! We need your help!! The well being of the president is at stake!!

Drugmonkey: Are you high? I told you no early Soma refills.

Secret Service: WE ARE NOT JOKING AROUND!! We must know if Ali Al-HusseinCheney has had a prescription for Viagra filled at this store! We have reason to believe he may be planning a sodomy attack in the oval office!

Drugmonkey: A sodomy attack on George Bush?

Secret Service: Yes!

Drugmonkey: Hmmm.....well.... if the anal integrity of the president of the United States is at stake....

The Drugmonkey then punches up Al-HusseinCheney's profile on the store's computer and sees 500 Viagra tablets have been dispensed to him over the last month.

Drugmonkey: Doesn't look like we've ever filled anything for him here.....

There has to be a reason they put that in the HIPAA policy. Hope springs eternal my friends.

A Clinton Lie Sure Isn't What It Used To Be.

Time was a Clinton wouldn't lie unless they had a good reason, like the threat of impeachment, and then only after they spent 20 minutes trying to wear you down parsing the exact meaning of the word "is"

These days though, ...seems like a Clinton will lie just for the sake of lying. Or maybe to try and make themselves look more presidential when they know they're about to lose a presidential election. Here's Hillary on March 17th:

I certainly do remember that trip to Bosnia, and as Togo said, there was a saying around the White House that if a place was too small, too poor, or too dangerous, the president couldn't go, so send the First Lady. That’s where we went.

She was talking about a trip she made in March, 1996. Except the president went 2 months earlier.

She continues:

I remember landing under sniper fire. There was supposed to be some kind of a greeting ceremony at the airport, but instead we just ran with our heads down to get into the vehicles to get to our base.

Whatever the motivation, a Clinton definitely used to be much better at lying. At least when Bill said he never had sexual relations with Monica Lewinsky, we (thankfully) didn't have video evidence to the contrary. Here's some video though of Hilary landing to start that Bosnian trip. Notice the lack of running. Notice also the greeting ceremony:



There was a large black man sent along with Hillary, but I have a feeling it wasn't for any protection he could provide:

According to Sinbad, who provided entertainment on the trip along with the singer Sheryl Crow, the "scariest" part was deciding where to eat. As he told Mary Ann Akers of The Post, "I think the only 'red-phone' moment was: 'Do we eat here or at the next place.'" Sinbad questioned the premise behind the Clinton version of events. "What kind of president would say 'Hey man, I can't go 'cause I might get shot so I'm going to send my wife. Oh, and take a guitar player and a comedian with you."

Replying to Sinbad earlier this week, Clinton dismissed him as "a comedian."

...and thereby missed the point. What Sinbad was saying was the fact that he is indeed, a comedian, and that a comedian went along on this trip would work to undermine any tales of how dangerous the trip actually was. So not only can Hillary not remember if she's ever been under sniper fire, she evidently has trouble figuring out the complex subtleties in the thoughts of Sinbad.

You know what kind of person I want answering the White House phone at 3 in the morning? Someone who can remember if they've ever been under sniper fire, and also preferably one who's smart enough to understand Sinbad. That rules out Hillary, and it will soon rule out John McCain, who's so damn old he's probably never heard of Sinbad and will be lucky to even remember what country he's in by November.

That only leaves one guy. Vote Obama. The only candidate who can remember if he's ever been under sniper fire.

Thanks to the reader who left me a tip.

This Morning Gloom Settles Over Hell's Premier After Hours Club.

"It really was the best weekend ever" Said the demon of the 4th level of hell dejectedly. "It really never has been the same since then"

"Got to feed some Christians to the lions for awhile, that was kinda fun" said 1st level Brigadier Demon Jazzelbub.

"Yeah......." The empty glass hit the bar and sounded almost as sad as the sigh that followed.

"And don't forget how we pinned the whole thing on the Jews. Talk about a successful long term plan, My God, where would we be without Hitler?"

"What did you say?"

"Oh, sorry again"

"Hitler really was a boon to us though"

"You're right, but......what I wouldn't do for just one more shot at him......"

"Who says we won't get it?"

The glasses clanked together one last time and the demons went out to face another year. Even in hell......hope springs eternal.

Happy Easter.

This Is The Kind Of Lawsuit That Drives Me Crazy.

Throwing things, cursing, other expressions of general disbelief.....those were some of my reactions when an alert reader tipped me off to this story from the Wall Street Journal.

CVS Caremark Corp. will pay $36.7 million to settle allegations that it improperly switched customers to a more-expensive form of a drug paid for by Medicaid, the government program that provides health care to low-income people. A lawsuit alleging fraud by the chain-drugstore company was brought by an Illinois pharmacist and joined by the federal government and 23 states that paid for the medication.

The complaint, filed in 2003 in U.S. District Court for Northern Illinois, alleges CVS pharmacies switched Medicaid patients taking the generic form of stomach medication Zantac to capsules from tablets. Medicaid sets maximum reimbursement prices for the tablet form of the drug but not for capsules, which are more expensive but prescribed less frequently by doctors.

The suit alleges that the switch cost taxpayers as much as 400% more than what would have been paid for tablets. The pill-switching allegedly took place from April 1, 1999, through Dec. 31, 2006.

The case was brought by Bernard Lisitza, who worked as a pharmacist processing CVS prescriptions. Mr. Lisitza previously filed a suit against pharmacy company Omnicare Inc. that settled in 2006 for $50 million. Both suits were filed under the False Claims Act, which allows people to file claims alleging fraud against the government and lets them recover a share of any payments.

Mr. Lisitza received a $6.4 million share of the Omnicare settlement, according to a U.S. Justice Department news release. His attorney, Michael Behn, said his client's share of the CVS settlement will be $4.3 million.

What had me so upset, of course, was that I had not been the one to butcher this cash cow. Almost $11 million dollars this guy gets for taking down 2 corporations,

CVS, which had profit of $2.6 billion on revenue of $76.3 billion in 2007, said the settlement wouldn't have any effect on 2008 earnings.

Make that mildly inconveniencing 2 corporations, and the best I can do is clack away on my keyboard and see that the subject is about as interesting to you as my cat. Sigh.

I admit I do wonder why you don't seem to care that the nation's largest pharmacy chain by store count was gaming the Medicaid system for tens of millions of dollars. Because I sure don't have to go very far into the pharmacy blogosphere to find all manner of vitriol directed against the Medicaid baby momma trying to get some free Tylenol or cold medicine for her child, gaming the system for less than fifty bucks. It's all about wasting the taxpayers money you'll claim. That stupid baby momma should buy her own Tylenol.

Maybe you don't realize that tens of millions is bigger than fifty. Maybe it's time for a visual aid:

$36,700,000 -amount involved in CVS lawsuit.

$50 -amount involved with baby momma.

Or maybe it's not about protecting the taxpayer's money at all. Maybe it's about kicking the people you see as beneath you because it makes you feel better about yourself. Maybe you're afraid to kick upwards because you've been trained to stay in your place. Maybe you're so focused on kicking downwards you don't feel it when your social betters land their foot across your teeth. Or maybe you do feel it, and it just makes you kick down all the harder.

Or you're just really bad at math. One of the two.

Do Suppose Satan And His Buddies Reminisce Every Year On Good Friday?

"What a day. I have never had so much fun as we did that day."

"You said it. I wish we could have broken his legs though."

"Stop with the broken legs already. Two thousand years you've been going on about the broken legs. "

"Crown of thorns? My idea...."

"Yeah we've heard about that a few times too, enough already, Jesus."

"What did you say?"

"Oh, sorry"

An awkward silence then descends over hell's premier after hours club. Everyone takes a drink.

"It was pretty fucking awesome......that weekend ruled!!!!"

"HUZZA!!!" Shout he demons in unison. And glasses come together to toast the memories....

My Ex-Wife Called It "Upselling".....At Least I Think That's What She Called It. I Don't Really Remember.

She managed a Hallmark store back in the day, and whatever it was actually called, it was one of the things they were evaluated on by the corporate mothership. It went something like this:

A customer would approach the cash register. An employee would say. "Have you seen our (insert name of gay product being promoted this month we can't sell any other way) they're just adorable!"

The ex-wife never saw the similarity between this and the pimply-faced teen behind the McDonalds counter asking "do you want fries with that?" No matter how adamantly or how many times I pointed this out. One of the reasons I have an ex-wife I suppose.

Big Pharma's got it a lot easier though. They don't bother to ask if you want your product supersized. To Sunday's New York Times:

The drug...... Cerezyme, is used to treat a rare inherited enzyme deficiency called Gaucher disease. Some experts say that for most patients, as little as one-fourth the standard top dose would work...

The standard Cerezyme dose — an infusion of 60 units of the drug per kilogram of body weight every two weeks — was set in a clinical trial involving only 12 patients.

Dr. Beutler of Scripps said that it was reasonable to use a high dose in the initial trial to prove the drug worked. But after that, he said, “the reasonable thing was to cut back and see what you really need. It didn’t fit Genzyme’s business plan, so they never cut back."

What? A drug company putting its financial interests ahead of those of patients? I've never heard of such a thing. Where would a person get an idea like this? Maybe from Genzyme itself:

Dr. David Meeker, the president of the Genzyme division that sells Cerezyme, said the company thought doctors should determine doses specific to each patient. So there was no point in doing a clinical trial comparing different doses.

“Showing that 6 out of 10 got by with a certain dose doesn’t help us,” he said.

No.....but it might help those 6 out of 10 patients. Let's go over what Dr. David Meeker said again. Dr. David Meeker thinks doctors should determine doses specific to each patient. But Dr. David Meeker thinks those doctors should have no data upon which to base these decisions.

So.....what.....should they throw darts at the package insert to determine the dose? My friends, Dr. David Meeker just provided you with a fine example of corporate bullshit.

And the stakes aren't small. Cerezyme costs $300,000 a year at the dose given in that 12 person study. That wasn't a typo. Three-hundred thousand dollars a year.

Not to mention when other companies do this type of thing with other drugs there's some evidence you can end up dead.

"Stupid drugmonkey" say the Republicans among you. "Why the hell can't you understand these drugs have to cost so much because of the incredible amount of research involved?"

Try again:

...critics say the company’s development costs were minimal, because the early work on the treatment was done by the National Institutes of Health, which gave Genzyme a contract to manufacture it.

That would be the government-run National Institutes of Health. I wrote about this type of thing before by the way. Tell me again why I'm supposed to be afraid of socialized medicine?

I think I'll pass on the fries today.

I Know I've Been Picking On CVS A Lot Here Lately, But It's So Damn Easy.

First, they show that no independent is gonna outdo them when it comes to pharmacy services, even creepy pervy pharmacy services:

Baltimore County police said yesterday that they arrested a former CVS pharmacist and charged him with trading drugs for sex.

Ramon Bautista Juta, 54, of the first block of Trumpet Court in Perry Hall was charged with two counts of possession of narcotics with the intent to distribute, possession and distribution of a controlled dangerous substance, forgery of prescriptions and prostitution, police said. Juta had worked at the CVS in the first block of Compass Road in Middle River, police said.

According to authorities, a woman told them that Juta had asked her to provide sexual favors in exchange for prescription pills she used. Police said the medications included Lortab and Xanax.

Ha ha. But I think this is more indicative of what CVS has done to the profession:

A woman has been charged with impersonating a pharmacist and police say anyone who had a prescription filled by her should have their medication checked. During a routine compliance check at the CVS pharmacy at 4405 East Riverside Drive, the State Board of Pharmacy discovered what it believes to be an unlicensed person acting as a pharmacist.

CVS released this statement Thursday:"Nancy Rose McGowan gained employment as a CVS pharmacist under false pretenses through the use of forged identification documentation and by using the identity of a pharmacist licensed to practice in Texas who is not currently living in the State. By using another pharmacist’s identity, she was able to pass CVS’ extensive pre-employment screening process"

You can stop right there CVS PR hack. You see, I'm thinking the whole point of a pre-employment screening process would to be to...um.....I dunno.....maybe keep a fake pharmacist from practicing at one of your stores?

"During (The Board's) compliance check, they asked her to produce her credentials showing she was in fact a pharmacist, she was unable to do so," said Austin Police Detective Billy Petty

Yeah.....hella extensive screening process you've got there CVS. Turns out all you had to do was actually ask to see her license. Tell me again how government can't do anything, and how we should leave things to the private sector? 'Cause it was the government that caught the fake pharmacist. Leave it up to CVS and some numbnut would be passing out Coumadin in Austin to this day.

Which says a lot about what it's like to, ahem....."practice" pharmacy at a CVS. Evidently she was performing all the professional duties CVS expects from a pharmacist just fine. Because once again, CVS didn't have a problem with her until the state board showed up.

CVS. An Everyday miracle. As long as you don't ask any questions that are too hard or otherwise want your pharmacist to do anything pharmacy-school based.

Thanks to the alert reader who tipped me off to the CVS perv.

A Direct Quote From The CVS Store Voicemail.

"Pharmacy, press 3"

Whereupon a normal person who wanted to talk to someone in the store's pharmacy would press 3, thinking it would connect them to the pharmacy.

Silly human. What you hear next is "For the pharmacy, press 1"

You see, at CVS you've gotta really want it. Because after this bit of idiotic redundancy, after you do everything the machine tells you to do, human contact will not happen anytime soon. After that weird gurgling sound, you're gonna be on hold. For a long time. You get no credit for doing what the machine wanted. You can try pressing 3 again to see if that will make the machine happy, but it's too late, all you'll hear is that oddly hypnotic piano bar music. I wonder how much CVS paid for that piano music. I wonder if they think that it's calming and therefore people who wait to talk to a human for 20 minutes will be less likely to explode in anger.

Sometimes when it's late at night I'll turn down the lights and call CVS on the speakerphone. That piano music sets just the right mood to end the day, and I know it will be playing long after I fall asleep. I think of it as just another ordinary miracle.

This Day Brought Bullshit That Was Simultaneously Familiar And Different.

"Uhhhhhhhh........yeah.......ummmmmmmm........is this the pharmacist?"

"Yes it is"

"Yeah...uhhhhh.....I'm here from out of town..."

Any phone call that starts with 10 seconds of "uuuhhhhhhhh" will not go well. Any call that starts with the words "I'm here from out of town" will not go well. This one had both. I prepared for my doom.

"......and I accidentally brought some Norco with me....."

Wow. Haven't heard this a million times before. Snore......

Wait a minute........ Extra Norco? Does not compute......

"It's my girlfriend's, and I was wondering if I could bring them to you, so she could pick some up at the corpo-pharmacy in Orange County. It doesn't have a label on it though"

I wasn't drowning in prescriptions at the time so I decided to play a little bit.

"So.....there's no way for me to know where these pills came from or where they've been, or even if they are what you say they are, but you want me to take them from you so someone 300 miles away can get some free narcotics"

He wasn't getting my drift. "Yeah" he said. There was actually a tinge of hope in his voice.

"I'll give you points for creativity. This is the first time in my career someone's ever made up a story that involved giving me some Norco"

"Huh?"

"The answer's no"

"You're a dick!!"

At least I still have all my hair.