I Obtain Exclusive Video From Secret Ongoing Negotiations To End The CVS Caremark/Walgreens Contract Dispute.

Dear Pharmacy Benefit Managers, There Is Now An Oligopoly On Both Sides of Your Contract. Prepare To Reap What You Have Sown.

I've known this day was coming for years. I wish I would have written about it earlier so you would all know how wise I am.

I did used to joke about it with District Managers though. As the years went by and the competitors became fewer, I would regularly say things like "When are we going to be be big enough that we can start telling the insurance companies what we are willing to let them pay us?"

The answer, if you're Walgreens, was yesterday:

Walgreen Co., the nation's largest drugstore chain, landed a punch on CVS Caremark Corp. when it said on Monday that it won't fill prescriptions for patients newly covered under pharmacy-drug plans administered by CVS's Caremark unit.

Walgreen said it objects to how some CVS prescription plans use discounts to prod patients with chronic conditions to use either CVS stores or its Caremark mail-order pharmacy. Walgreen also cited CVS Caremark's "unpredictable" reimbursement rates and lack of information when patients transfer to other plans. Working with CVS, it said, is "no longer in the best interests" of customers, pharmacists and shareholders.

Never before can I remember a drug chain growing a pair and standing up to an entire Pharmacy Benefits Manager like this. There have been squabbles over individual contracts from time to time, and occasional gamesmanship when it came to a state Medicaid plan now and then, but it takes way bigger cajones to take on corporation number 18 in the Fortune 500 than it does to pick on a state government these days.This is huge. This has the potential to inconvenience middle class people, and possibly a few who are affluent.

Granted, this particular PBM is owned by Walgreen's main retail rival, which gives the Pharmacy America Trusts an extra incentive to go after them, but still, this is a step up from picking on the poor people. A big fight is brewing between two of the two-and-a-half major drug chains left in this country. Who do we as a profession root for?

Injuries, mostly. One of these corporations has a pilot program that has turned pharmacists into cashiers in lab coats and the other has de-professionalized its operations to the point where they can evidently hum along just fine with someone in charge only pretending to be a pharmacist. Wasn't it Rocky II that had that cheeseball ending where both Rocky and Apollo Creed knock each other out and are simultaneously struggling to get up before the final bell? Something like that would be ideal.

But something like that will most likely not happen. Walgreens and CVS will huff and puff over the next few weeks or months. They will arch up their backs and growl like two tomcats in the alley at three o'clock in the morning, and in the end, they will reach some sort of agreement that will spare the middle class any inconvenience. After all, as far as I know even with the poor people it never got to the point where the trigger was actually pulled on them.

But, the precedent has been set. In the post Revco, Super-X, Phar-Mor, Eckerd, Duane Reade, Reliable, People's Drug, Brooks, Drug Emporium, and Longs world, Walgreen's has woken up and realized it can threaten any PBM with an immediate loss of 12% of the locations where that PBM's members can have prescriptions filled. The people at Medco must be shitting their pants right about now. And while the prospect of Medco shitting its pants is a happy one, I do hope Walgreen's takes a few head punches first. I plan to sit back and watch this one like a white guy at a California prison riot.

Highlights From Friday's Pill Counting Action.

Come someone answer me a question? I think we can all agree there are truly evil people in this world. Not just a CEO who says he wants his life back when 11 of his employees have lost theirs. No. It totally gets worse than him. There are genocidal manics on this planet. Serial killers who will slice you open just for the sheer joy of killing as opposed to in the service of the corporation's bottom line. Charles Manson. The list of truly sick, demented, twisted people without a single thing good inside of them is a long one.

So why does Karma decide to get all over my shit for making fun of a guy in a wheelchair? And only in my head? And when the guy really did look funny struggling against the uphill grade of my employer's parking lot?

I saw wheelchair guy and snickered on my way into the store and within 10 minutes had a customer try to pay for $1800 worth of medications with a check. Yes, I said $1800. A check of that amount will set off buzzers and sirens and all other sorts of alarms with my employer's point of sale software, which makes a big 'ol mess the assistant manager has to try to straighten out. He has to call some money-type place to get the check approved, which means he has to wade through the money-type place's voicemail and listen to their assurance that his call is very important to them before he ever gets a chance to find out the fate of the $1800 check. It took a good 10 minutes, seriously. Then the register crashed. Then when they rebooted the register the receipt didn't print, and the guy, kinda understandably, really wanted a receipt for his $1800 check. You can imagine how this was going over with the customers waiting in line behind check man. I looked over at the other side of the pharmacy and saw Karma staring at me, her face a reminder that when fucked with she can indeed be a bitch. I started to launch a protest but Karma reminded me I was still on probation from an earlier incident and then vanished in the blink of an eye.

We don't have to get into the details of the earlier incident, but I can assure you it had nothing to do with serial killing. Fate is unfair to me, yet I struggle on. While the manager had his hands full trying to handle the money, I tried to soothe the backlog of waiting customers by doing professional things like explaining to a little old man that there was no Vitamin D in Claritin-D, and so while, yes, I understood that his doctor told him to get some Vitamin D, there was no need for him to wait in the pharmacy line for it. I'd like to think I earned a point back with Karma for that one.

A customer asked my non-regular technician if the prescription he was dropping off was legible. The non-regular tech did what he usually does when he is asked a question, which is slowly walk over to me and repeat it, usually without losing too much in translation.

"Drugmonkey, is this legible?"

"Can you read it?"

"Yes"

"There you go"

"So, is it legible?"

It would be a long two hours until my keystone tech showed up.

There were some legibility issues with a prescription later on that day, for those of you not in the profession, I'll tell you the Latin abbreviation for "every day," QD, is precariously close to that for "four times a day," QID. It's usually not a problem, but there was a little question on this one.

"Ma'am, you usually take these just once a day, is that right?"

"NO, I JUST TAKE ONE AT BEDTIME!!!!!!!!"

Properly berated, I resisted the temptation to type the easy to mistake overdose on her label, being on the very thin ice with Karma I already evidently was.

My keystone tech came in and fielded this question from the first customer she waited on:

"This says 'flexible foam,' what does that mean?"

"Well, it's like foamy, and it's flexible"

My keystone tech has a gift to be able to say such things in a way that customers will find them to be perfectly acceptable answers. God I love my keystone tech.

She can't be everywhere at once though, and sometimes I have to slide over and man the cash  register when no one else is around.

"I THINK THIS WOULD BE LESS IF I HAD PRESCRIPTION INSURANCE!!" The fat man said in a heavy Russian accent. "WHAT IS PRESCRIPTION INSURANCE?? I AM NOT FAMILIAR WITH THIS. YOU CAN GET ME SOME, YES??"

I looked up and saw Karma standing behind the man giggling. She was just fucking with me now. The way my cat Spooky does an injured mouse.

Which is why when I saw the second wheelchair guy, who also looked very funny trying to navigate the store aisles mind you, I knew exactly what to do. I asked him if there was anything in the store he needed help finding. That may have been the only time in the four years I have spent with my current employer I have ever volunteered to help a customer find something.

Which I expect will get me off the hook with Karma. As unfairly as she treats me, I know better than to fight her. I'll find out tomorrow.

CVS Makes An Honest Mistake. And By Honest Mistake I Mean Rips Off Its Customers. Probably To The Tune Of At Least A Million Dollars.

You know how it's illegal, if you run a store, to advertise one price for a product and then charge another, higher price for that product when a customer comes in to buy it? That's why we have rain checks and stuff. Because it's totally illegal to get someone's business by promising to sell something at one price and then charging another.

Unless, evidently, you're CVS. From that bastion of the liberal media, The Wall Street Journal:

Many customers of CVS Caremark Corp.'s SilverScript Medicare prescription-drug programs have been paying higher prices than they were promised when they signed up for the plans in late 2009.

CVS blames the problem on a computer error, which it says caused prices for brand-name drugs to be listed about 4% lower than they should have been. It says the error appeared in data CVS supplied to the Medicare website that allows senior citizens to do comparison shopping between rival prescription insurance plans.

CVS says it has been charging consumers the higher prices since the beginning of 2010.

Many senior citizens use the price-comparison tools in November and December to shop for their Medicare Part D drug coverage for the following year. The tools allow Medicare recipients to plug in the drugs they take, and provide comparative costs for various plans. The inaccurate information, which appeared from Oct. 8, 2009, to Jan. 8, 2010, made the CVS plans seem more attractive than they should have been.

Holy Nader's Raiders Batman!! Surely the guardians of the consumer that toil away in the halls of Washington's bureaucracy will ensure there will be hell to pay for this. Especially with that socialist Obama in charge now, there's just no way a corporation can get away with overcharging its customers. Get ready for the wrath of righteousness CVS!!!!

CVS notified the federal regulator, the Centers for Medicare and Medicaid Services, about the problem in January. A Medicare spokesman said regulators worked with CVS to craft a response plan, under which CVS would offer a refund for the price difference, but only to consumers who specifically requested that. The Medicare spokesman said CVS also agreed to help unhappy customers switch to another plan.

That'll show 'em.

CVS sent letters of apology to affected customers starting in late March. A letter reviewed by The Wall Street Journal didn't mention the possibility of a refund, but directed a recipient with questions to call a toll-free number to discuss "your options."

"Did I pay too much for medication?" the letter said in question-and-answer format. The answer: "No." The letter said the drugs were "priced correctly at the pharmacy, but may have been higher than what the price-comparison tools estimated."

An affected consumer who recently called CVS's toll-free number said he was told he could file a "grievance" to seek a refund for brand-name drugs bought up to that date, but only if he had a printout of the original inaccurate pricing information from the Internet.

A CVS spokeswoman said that consumer's experience wasn't consistent with the company's policy, which is to provide a refund if asked.

So.....I'm gonna do a little back-of-the-envelope math here. Let's say every CVS store has 15 customers in one of these SilverScript plans, and each of these customers has two $120 brand-name prescriptions filled.

Let me know if you think these assumptions unreasonable. I don't think they are.

So, 15 customers x 240 dollars x 4% "mistake" in the advertised price = 144 extra dollars per CVS store. Ho-hum.

Until, that is, we multiply that by the 7,000 retail pharmacies that CVS operates. Do that and now we'll see that "mistake" netted CVS an extra one million dollars of pure friggin' profit. The equivalent of filling an extra 667,000 prescriptions at the standard $1.50 insurance dispensing fee. It's a lot easier to hit a few "wrong" buttons at corporate headquarters while inputting data than it is to fill 667,000 prescriptions. Especially since CVS didn't have to hire the one extra pharmacist and two technicians they would budget to fill 667,000 prescriptions.

And they're gonna get to keep most of that money. Because how many people are going to 1) Notice 2) Be pissed off enough to argue over $10 and 3) Successfully get past the help desk flunkie who's feeding them bullshit about how to get their money back?

Not many. They're totally gonna get away with it.

And just in case you still think this whole episode might really have just been a mistake, ask yourself what would have happened if some schlep would have sent the wrong data to Medicare with a result being that it cost CVS a million dollars by making them undercharge their customers.

That fictional sonuvabitch would have been fired the next day and you know it. And would most likely be working now for Rite-Aid, earning stellar performance reviews.

I'm not saying CVS deliberately ripped people off. But, yeah, it sure is a lot easier to make a "mistake" than it is to actually do more work. Or renegotiate your contract with Medco.

I report. You decide.

Thanks to JayPee, whose blog first tipped me off to this.

This One's For My Southern Baptist Friends, Who Make Up A Big Chunk Of The One-Third Of Americans Who Believe The Bible Is The Word Of God To Be Taken Literally

"And as for thy bondmen, and thy bondmaids, whom thou shalt have; of the nations that are round about you, of them shall ye buy bondmen and bondmaids." -Leviticus 25:44

My Canadian slave's name is Ian. I've owned him for about five years now.

I remember thinking when I was born again that Vancouver would be a good place to shop for slaves. I love Vancouver, and I bought a small wooden totem pole sculpture there once that is absolutely beautiful. But then I realized that that fair city probably has the mildest climate and most cosmopolitan atmosphere in any of the provinces, which would mean that any slaves from there would probably be soft and weak. I wanted a slave from a place where life was a little tougher. Where nature and nurture would throw some character-building adversity into its residents. I also wanted a major airport though, because I thought the quicker I could get my slave away from Canada and into God's chosen land the better. I decided on Edmonton.

I saw Ian standing next to the cash register at the Eddie Bauer store in the Kingsway Mall. There's an old joke that the quickest way to get a roomful of Canadians to shut up is to say something like "please be quiet," so I looked at Ian and said "please follow me," and like a good Canadian, he did. That must by why God wants you to get your slaves from neighboring countries, so you don't have to mess with nets and whips and slave ships like when we got our slaves from Africa. I left $50 next to the cash register, but then realized that the onerous tax rates that Canadians must bear in order to finance their public health system would probably push Ian's final price to something like $75. Fucking socialists. I still thought I got a pretty good bargain though. Ian seemed like a strapping young lad, and was very obedient from the start.

It wasn't long though until I had a few second thoughts. Ian didn't seem to work nearly as hard as the Mexican slaves most of my friends had. I remember thinking that those Catholics south of the border wouldn't understand the covenant between man and God that the Holy Bible represents, being members of the Papist cult that they are. But boy, was I wrong. Every morning my neighbor's Mexican slaves would be up at the crack of dawn, mowing the yard, cleaning  the house, cooking breakfast, when it was all I could do to get Ian to wake up at noon, which only gave him two hours to get the condo ready for me when I got up. He's totally useless during the Stanley Cup finals, and I suspect he reveres Queen Elizabeth more than the prophet of God George W. Bush himself. The only thing he really turned out to be good for was running over to the liquor store to get more scotch.

Which after many months of prayer I realized was the only thing I  needed a slave for anyway. I've scoured Leviticus and the rest of God's book and I don't see anything there about any specific work your bondman is supposed to do, so I guess as long as I acquired him from a nation that is around me that makes it right with the Lord.

I still might put in a bid for my neighbor's Pedro though.

Not Only Do This Country's Crazy Christian Conservatives Try To Stop Us From Learning About Sex, If It Were Up To Them I Wouldn't Have Been Able To Waste The Last Hour Of My Life Dodging Sperm. Thank God For The Canadians.

I won't ruin it for you, other than to say I only got splattered three times:


http://www.healthunit.com/article.aspx?ID=15160

I Live An Episode Of "The Office"

So I met both the district managers today. For those of you not in the pharmacy biz I'll tell you management chores in a corpro-pharmacy are usually split into two tracks. A pharmacist DM who is theoretically there to deal with things professional and another DM who is there to deal with everything else. The regular DM usually has some sort of business degree, which means the following story shouldn't surprise you much.

The pharmacy DM comes in and does her thing. Looks through paperwork, does crap on the computer, takes calls from other stores having some sort of crisis, and generally gets in the way of those of us filling prescriptions. They always ask before they leave if there's anything they can do for you, but they never mean it. I decided to test this one.

"Yes" I said. "You can give me a supervisor number." I always thought it odd I'm trusted to be alone in a room full of drugs but not to OK a $20 void sale.

I'd been asking for a supervisor number for four years, through three store managers, three district managers, and more pharmacy DM's than I can name. Five minutes later I had one. The fact I was actually able to convince someone in power to make a small, common sense change that would have a big impact on how easy it is to run the pharmacy gave me kind of an endorphin rush. These moments don't happen often. The last time I remember a Pharmacy District Manager doing something helpful was three years and three DM's ago when one of them scored us another refrigerator. I basked in the feeling of the runner's high.

Then the business major came in.

He's still fairly new from his last gig at a retailer that went bankrupt and eager to show he's in charge and ready to bring some of the magic from his last employer to his current one. He whips out some charts or something that purport to show our prescription counts are down and wants some "input from the team as to what might be causing this"

Unfortunately I'm acutely aware I'm the team member who's gotta do the talking. My keystone tech doesn't get paid nearly enough to deal with this crap.

"Well the first thing that comes to mind is the phones" I say. I've written more than once here about my store's phone problems. There have been 4-day stretches where people were unable to call the store because the technician didn't work weekends. The best phone function we had for awhile was to periodically go to the back room and reboot the system throughout the work day. Angry customers were telling me they literally spent weeks trying to get through to us.

"That's interesting" says the business major. "Because I do mystery calls to stores to ask how long it would take to have a prescription filled and they tell me not many prescriptions are phoned in"

I swear he said that.

I'm going to set aside the fact that calling a pharmacy to ask how long it will take to fill a prescription is the stupidest goddamn question I can be asked. I can tell you how long it will take if you're here now. I cannot tell you how busy I might be when you decide to come and drop off a prescription at some unknown point in the future.

I'm also going to set aside the utter implausibility that someone would tell this man not many prescriptions are phoned in. Maybe someone did. As some type of joke.

My point here is that I started out this day trying to find a way to diplomatically explain, in a way that wouldn't get me fired, that not having reliable phone service probably has a net negative impact on our business.

I found a way. Because my other choice would have been to suggest the elimination of phones altogether as a cost saving measure that would have minimal impact on sales. That probably would have gotten me promoted, and I don't feel like being on the road all day long.

I Got Nothing For You Tonight. Enjoy This Wilford Brimley Video.

My Romantic Weekend.

Friday night the Chinese lady finally gave me her phone number. She's been spooking me out for awhile now, but honestly, her English is so bad I've never been sure quite what her motivations were, or exactly how to communicate that I was not interested if they were not pure. She slipped a piece of paper across the counter and said something. After asking her to repeat it a few times, I figured out it was "when would be a convenient time for lunch or a dinner?"

Had to let the hammer down. Which was a shame. She's probably a nice lady if I could figure out what she was saying.

Got home to an e-mail letting me know my plans for Saturday had fallen through. Something about a sister being in town or something. Part of me couldn't help but wonder if "sister in town" is derived from some sort of ancient Latin phrase that means "got a better offer." The message did say I was fabulous though, and I can't help but  notice how every rejection of late usually comes tied with a compliment. Fabulous was a new one. Usually I'm nice or sweet or something. I'm going to shoot some random bastard for no other reason than I'll never have to hear how nice and sweet I am ever again.

About a quarter after midnight the phone rang. It was my last girlfriend. Having made a few calls myself this time of night to ex's, I knew it was best left unanswered.

Saturday I looked at the facebook page of the woman I would choose to spend the weekend with. I don't know why, because I don't get a choice. She did say I was nice though, and now that I think about it, I'm pretty sure the word "fabulous" was in there at some point as well.

Maybe they think I'm gay.

A wink rolled in from my match.com account from a woman who looks like a truck driver, complete with foam cap. I said thanks but no thanks. I'm sure she was very nice though.

I spent a 45-minute phone conversation trying to get 2 words out of someone. I chatted on line with an old e-friend who said she missed me. She's 3,000 miles away. I asked someone out in the real world and got shot down while being told I was a nice man.

I woke up around 2 in the afternoon on Sunday and the silence in my condo was suffocating. This is what you sign up for when you jump in the dating pool my friends. You take a leap into that thing and you will spend your time doing very little other than taking punches to the face while simultaneously hurting the feelings of people who have done you no wrong. Neither of which I find particularly enjoyable. It's brutal. There's a couple of teeth on the floor here and I have no idea if they're mine or someone's I just knocked out.

And you know what your reward is? The big payoff if you do happen to make it through that booby-trapped minefield with a fake map in your hands without somehow getting your damn legs blown off and your heart ground up in a shredder? Evenings with your significant other arguing over where the thermostat should be set. Long nights staring out the window wondering what you could have made of your life if you weren't bogged down with a spouse and a couple of kids. Eye rolls and heavy sighs and a constant struggle for power that makes the backroom deals in your state legislature look positively quaint. Don't lie to me married people. I was once one of you, and I know exactly how happy you are.

Oh, and in those few cases where it does work out? You can look forward to a devastating widowhood.

Life is a setup for failure. I'm going to go throw up now. Just to show myself I have some control over something.

Because Sometimes You Need Something More Than A Lab Rat And Less Than A Full Human With Access To A Liability Attorney

Is it possible to become too cynical?

I mean, you would think the obvious answer is yes. Intuition tells you that cynicism, like acid, has its uses,  but should be handled with great caution, as it can rot through your soul the way the HCl I once accidentally poured down the drain of my college's organic chemistry lab rotted its way through the sewer system.

Science has a way of disproving the intuitive however, and it just may be working its magic on my cynicism assumptions as well. From a piece in the April edition of In These Times, a magazine you should subscribe to right now:

“That’s a great question!” said the presenter, setting off the same sincerity alarm a salesman triggers by constantly repeating your first name.

The response came during a webinar on why “Latin America is a rich resource for pharmaceutical companies and contract research organizations (CRO) to develop new drugs at a reduced cost.”

The $175 Drug Information Association (DIA) event touted advantages of outsourcing drug trials to the developing world and of hiring CROs to manage those trials by navigating local regulations, recruiting subjects and reporting test results in a way that will facilitate FDA acceptance.

Not in a way to advance the scientific knowledge of humanity mind you. All we care about here is getting a clinical trial past the FDA while saving a few bucks.

The piece's author, Terry Allen, goes on to quote a congressional report that found in this country, GlaxoSmithKline had been “intimidating scientists, ghostwriting studies for academic researchers, (and) suppressing studies” in the name of building sales for its diabetes med Avandia, and that Avandia was associated with 83,000 excess heart attacks.

“GSK had a duty,” the report concluded, “to sufficiently warn patients and the FDA of its concerns.” But GSK failed to warn, and the FDA has failed to act—beyond advising “concerned” patients to “talk to their healthcare professional.”

Those are the standards Big Pharma evidently feels are so high they are being driven to conduct clinical studies offshore. That and the feeling the third world offers a large number of desperate suffering people eager to enroll in a clinical trial because they see them "as a viable healthcare option to gain free medication”

You always get the best science that way.

The question that was so great!, by the way, was regarding the independent ethical review panels charged with overseeing the rights of  these desperate, suffering, people. How can they be independent, it was asked, when they are paid by the very drug companies conducting the studies?

A great question that's still waiting for an acceptable answer.

Thing is, none of this phased me. I read this article the way you would read one about another killing in your city's most drug infested neighborhood. I took a sip of coffee, got ready to turn the page, and remembered, for a few seconds, what it was like to be under the spell of learning. Of a time when I thought the ultimate goal here was to expand our understanding of the processes that keep us alive.

No. The ultimate goal is to accumulate as many pennies per share as possible for the corporation. And I wonder this night how low my opinion of humanity will be driven in pursuit of it.