This Started Off As A "Highlights From Friday's Pill Counting Action" Post, But Honestly, This Is A Highlight That Deserves To Stand All On Its Own

It started as a routine reject. A quick phone call should straighten things out. 

Me: Yeah I'm calling about this reject message I'm getting, It says that only Prevacid Solutabs are covered for patients over 1. I think the rest of the message must have got cut off or something. 

Actually what I suspected was that Prevacid itself was non-formulary. Those of you in the profession know it is not unusual for an insurance reject message to bear little resemblance to the actual reason a claim is being rejected. A quick phone call and the nice lady would tell me which meds in the class were covered.  

Medco: No sir, that is correct, only the solutabs are covered for any patient over 1 year old.

Me: Ok, that can't be right. Do you know what a solutab is? It melts in your mouth, which makes them, you know, ideal for children.

Medco: Silence.

Me: Are you telling me if the patient is under 1 year old you would only cover the regular capsules?

Medco: The plan sponsor sets the parameters sir.

Me: That's not what I'm asking. If this customer was under 1 year old, I would have to give them the regular capsules. Is that how it works?

Medco: Yes.

Me: And since this person is over 1 year old, a fully grown adult actually, the only thing I can give them is the melt in your mouth version.

Medco: Silence

Me: I can only give them the solutab?

Medco: Yes.

Me: You realize.....that someone has obviously made a mistake here. A typo that should take like 2 seconds to correct. 

Medco: It's the plan sponsor that sets the parameters sir.

Me: You understand that these parameters involve asking a 1 year old baby to swallow a capsule while making an adult take the formula ideal for children

Medco: Yes.

Me: So you know this is stupid.

Medco: I understand your frustration, but I can't change the plan parameters sir.

Me: Ok, fine, but do you think that maybe you could contribute a little to the solution of this problem, like maybe telling your supervisor about this idiotic situation so they could perhaps open a line of communication to the people who set up the parameters?

Medco: Silence

Me: Can your kid swallow a capsule?

Medco: Is there anything else I can help you with?

Me: What exactly have you helped me with to this point?

Medco: Silence

Me: Is this call being recorded for training purposes? Because I think it really should be. Because this is....fu.....I stopped myself before the whole word came out because I knew that would be an automatic hang up and I wasn't done yet. I mocked the Medco lady. I ridiculed the Medco lady. I asked her if she was proud of the work she was doing. I was pretty Goddamn mean. I had to hand it to the Medco lady though. Cold. As. Ice. I was opening up on her with both barrels and there was no display of emotion, much less any budging. In the end, a 47 year old man got melt in your mouth Prevacid. 

And somewhere a baby just probably choked to death. It's a good thing we don't let the government run health care though, because if the government ran health care, then stupid bureaucratic shit would happen. 

Don't think the Canadians aren't laughing at us. 

 

Updated: A Milestone In My Life This Night. I Realize The Influence Of Larry "Bud" Melman Is Smaller Than That Of Even Ohio Northern University.

So the world is a small place my friends, and try try try as I might, the efforts I made to escape the one into which I was born will never be completely successful. This weekend I came across someone from Ada, Ohio. If you have ever heard of Ada, you know what that means. She was a college student. There are people who live in Ada who are not affiliated with Ohio Northern University, like 25 or so I think, and they are truly frightening individuals of such intellectual quality I doubt any of them could get piss out of a boot with instructions written on the heel. They make the footballs that are used by the National Football League. I'm not kidding about that. 

But anyway, this woman did not make footballs, so naturally the small talk centered around Ohio Northern University, which was the institution that was foolish enough to grant me a degree in pharmacy during an era when computers weren't advanced enough to verify a student had actually taken all required prerequisite classes. It went something like this....

Me: "Blah blah blah.....boring ONU small talk.......blah blah blah" Talk about ONU is unavoidably boring. 

She: "Well we have a McDonald's now, after David Letterman mentioned on his show that we were the college campus furthest from one"

Me: "Really? We had Larry Bud Melman on campus once when I was there"

I was starting to perk up now. It had been a long time since I had thought of Larry Bud Melman and God I missed him. 

Blank stare. Total blank stare. A blank stare that was the beginning of a shock I have yet to recover from. 

"He was a regular on Letterman's show back when he was on at 12:30"

Incomprehension. I might as well have been speaking in tongues. 

I walked back into the happy pill room slightly stunned. My keystone tech would help me out. My keystone tech always bails me out. 

"Do you remember Larry Bud Melman?"

"Who?"

"You know who David Letterman is...."

"I think so.....the one who's not Jay Leno"

"You know he used to be on at 12:30"

"What?"

"You remember Johnny Carson....."

"Not really"

I looked around the store. Desperately. I mean, I know I'm getting old, but a lot of the stuff I liked when I wasn't old is still generally recognizable by the public. I just heard someone talking about fucking Fonzie the other day and Larry Bud Melman was better on his worst day than Fonzie ever was in his wet dreams. There was a time, my friends, when I would have been constantly surrounded by people hip to Larry Bud Melman, and now, as I looked around, I didn't see a soul I had any confidence would know the name. Larry has slipped off the earth and I failed to notice. 

Or else Larry hasn't. I know I could put Larry Bud Melman into the Google, but if I do, and Larry isn't there, that means I'm not just old, but that I've gone insane. Toast on a stick. Melman Bus Lines. It might all be just in my head, and if it is, I can't take the risk of finding that out. This night I find myself quite possibly clinging to what could be the final facade of my sanity. 

By the way, that wasn't a random expletive thrown in there in front of Fonzie. The person was actually talking about having sex with the former sitcom icon. 

At least in my head they were. I think.

Update 12/29: Thank you dear readers, for assuring me that I am not insane. Maybe I should rephrase that.  For assuring me Larry Bud Melman existed somewhere outside my head. You gave me the courage to venture onto the YouTube and dig this up. You are missed Larry. 

As are you Mr. Letterman. All the more so because you're still around. 

Apparently Pharmacy Has A Code Of Ethics. Who Knew?

Not me. But there it was in black and white in the latest issue of the trade magazine Drug Topics. The code of ethics by the way, was by far the most interesting thing in that rag, Jim Plagakis being the exception that proves the rule. Why Jim continues to do the clowns that think we'd be interested to read about drugstores in the suburbs on Atlanta putting in generators and publishes statements like "Tylenol was one of the top acetaminophen products suggested" the favor of writing for them baffles me. 

Name another acetaminophen product. 

Quick. C'mon. No Googling. 

See my point? Drug Topics hurts my eyes, and if it weren't for Jim Plagakis and the curiosity aroused by seeing an alleged code of ethics that governs my profession, I might have had to try to gouge them out this Christmas Eve to stop the pain. 

Evidently The Code of Ethics for Pharmacists was adopted by the American Pharmaceutical Association in 1994. The involvement of APhA in the code of ethics goes a long way towards explaining why no one has ever heard of it. 

Name an accomplishment of APhA. 

This time you don't have to be quick, and you can use the Google all you want. See my point? But, since some geeks most likely spent the better part of a week debating what should go into this code of ethics, then another day or two deciding if the bullet points should be marked with little dots or a dash-like symbol, I figured I might as well see how I stacked up. It was Christmas Eve remember, which means there wasn't much else to do in the happy pill room. 

- A pharmacist respects the covenantal relationship between the patient and pharmacist. 

What? Covenantal? That's Jesus talk. Forget that. Unless APhA is trying to say something like my customers should worship me. I could totally respect that, and it would be the most sensible thing to come out of APhA's mouth in years. 

- A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner. 

Confidential? Check. Caring and compassionate? Mmmmm....not so much. I'll make sure your prescription gets filled correctly, and if you have questions I'll do my best to get the answers through your pointy little head, but most of the time, if you decide to walk out the front door of my store and take a flying leap off a cliff, I wouldn't give it a second thought.  Yeah, I think caring's definitely off the list. 

- A pharmacist respects the autonomy and dignity of each patient. 

Autonomy = Your right to decide to have your prescription filled somewhere else. Yeah, I totally respect that. 

Dignity? Yet to be tested on that one. As soon as I get a customer with some dignity I'll let you know how it turns out. 

- A pharmacist acts with honesty and integrity in professional relationships. 

Check. There's no need for me to rip you off or lie to you any more than Big Pharma already does. 

- A pharmacist maintains professional competence. 

Why exactly did this one make the list? We have to be told we should make an effort to know what we're doing? Sigh. Moving on....

- A pharmacist respects the values and abilities of colleagues and other health professionals. 

Nope. Because the values of Lloyd Duplantis, of Gray, Louisiana do not belong in our profession, and deserve no respect. 

As far as other health professionals,  I will respect the ability of a Physician's Assistant to be able to write a prescription that makes sense just as soon as I see a prescription from a Physician's Assistant that does. 

- A pharmacist serves individual, community, and societal needs. 

I need to get laid right now. That's my individual need. So according to APhA, there's another pharmacist out there that will serve that. Sweet. 

- A pharmacist seeks justice in the distribution of health resources. 

OK, now I feel bad. I've been mocking the APhA throughout this whole post and then they have to go and spring this one on me at the end. If only there were any justice in the distribution of health resources. If APhA magically became able to be effective at something, this is what I would pick for APhA to actually be able to do. 

Unfortunately it took them 14 years to make me aware they consider me to be a woefully ethically challenged pharmacist.  I expect they'll write in sometime in 2022 and tell me I should have used little dots to mark their bullet points. 

APhA sucks. 

Dear Employer, I Wonder If You've Noticed Something......

With all your charts and graphs, your computerized doo-dads that measure how long it takes us to get a prescription out the door (not that you're putting any pressure on us to work more quickly at the expense of patient safety you say) or how long a caller is left on hold, I wonder if you've picked up on a very simple statistic:

The more you cut our tech hours, the more often we are out of stock on something. Have you noticed that? And if you have, which I doubt, have you ever wondered why? The answer's simple really. When you cut our tech hours there are fewer people around to do the same amount of work. That part I bet you know. Which means there are times during the day when it is impossible to meet both your workload expectations and my professional responsibilities to the people who have entrusted me with their health. Guess who wins when you set up that conflict employer? Hint. Not you. Here's how it works:

All hell is breaking loose at the pharmacy counter. People as far as the eye can see, the fax machine a whirring, the five phone lines for three pharmacy employees ringing off the hook. Your wet dream. I start working the in window. The next customer in line is a mall rat with a prescription for the acne med Duac. 

"I need this as soon as possible" 

"I'm so sorry, I don't seem to have this on the shelf, the best I can do would be to order it for you tomorrow"

You just lost $200 employer. The next man in line just got out of the hospital. He's hobbling around on some sort of wacky-looking crutches. His painkiller will cost around $15 and will be out in about 20 minutes. 

He'll also leave knowing to watch out for drowsiness and to stay away from the over the counter Tylenol while he's taking that painkiller. Things I am obligated to tell him but never would have been able to had I tried to squeeze in the mall rat with the zits.

Do you get it now employer? Cut my tech hours and I start playing triage, and when I start playing triage, you won't like the results, because medical needs of humans trump financial needs of corporations.

You may say you're doing what you have to do to remain financially viable. I say that's not my problem. My suggestion to you would be to grow a pair of testicles and take it up with the insurance companies that put so little value on my professional obligations. 

Oh, and one more thing. It seems that without me saying a word to her, my keystone tech has picked up on what I'm doing. She's developed a habit, when all hell is breaking loose the way you know all hell will break loose when you cut our help, of coming over and asking me if we have something in stock when she takes a new prescription. She's a smart one that keystone tech. 

You cannot cut your way to prosperity employer. That's been an eternal truism that unsuccessful businesses have failed to learn over and over again through the decades, but you cut my tech hours again...... and I'll make damn sure that point gets driven home to you. You hired a professional when you hired me employer, not a salesman. I know you don't want it that way, but the sooner you learn that's the way it has to be, the sooner you can both make money and contribute to the health of our community. 

I'm not hopeful.

Personally, I Don't Think Jesus Is The Type Of Guy Who'd Want You Making A Big Deal About His Birthday.

Most of those hippie, live in the woods, take no shower types really aren't into birthdays and such. 

Especially since his time on Earth really didn't go all that well. It might be better not to remind Jesus of what happened to him here. I think if you really care about Jesus, you'd try to distract him on Thursday, maybe take him to a movie. Or camping. That's it. Those hippie types are totally into the camping. 

Of course, I would offer Jesus some scotch. Scotch is really good at helping you forget traumatic experiences for awhile. Those hippie types are usually more into weed though. I don't have any weed to give Jesus, and I'm not really sure where to get any. 

I do have some wine, but there's no way offering Jesus his own blood on his birthday would be cool. 

Crap. I don't know what to do for Jesus if he comes over for his birthday. I guess I'll just buy a cake. 

Please Help Me Identify My Christmas Present.

It happens every year. Some mystery customer comes in when I'm not working and drops off little presents for the pharmacy staff. I don't mean that the customer is trying to be mysterious, I mean that even after seeing the name on the tag, I wouldn't know who this customer is if they came up and bit me on the nads. I mean, I guess it's a nice gesture and all, but honestly, I've said for years the best way to show your gratitude for me doing  my job is by shutting up, taking your stuff, and getting away from the counter as soon as possible. Seriously. I will appreciate your quick exit more than anything you can do or say. 

Anyway, this year's present from the mystery customer was a manicure set. Wait. Maybe this wasn't a nice gesture at all. Maybe my hands so disgust this person that they have been moved to try to relieve themselves of beholding their grotesqueness ever again. Could it be that part of me is.......unattractive? Suddenly I am intrigued by the manicure set and the possibility of becoming even hotter. 

Except that I don't know what half the things in the manicure set are. There's like three sets of nail clippers, which is seven short of one for each of my nails, a set of tweezers, a utensil I have never owned until today, a little pair of scissors, a nail file that totally doesn't look like a nail file, and then this group of unidentifiables:



I am honest to God stumped my friends. The thing on the left has an angled edge like some sort of knife. Cuticle pusher backer? Could the fact I'm not pushing back my cuticles be the reason I'm not getting laid at the moment? 

If the thing second from the left were a little bigger, it might be the type of object you use to dig out some caviar to spread on your Ritz cracker or whatever it is you eat caviar on. Maybe with the economy being the way it is, the average caviar portion size has gone way down. Wait. This is part of a manicure set, so caviar server doesn't make any sense. I bet you might be able to use it to actually pry one of your fingernails off though. Is that some sort of new fad among the kids nowdays maybe?

My best guess for the third thing is an earwax digger. Except it kinda tickles when I gently probe my ear canal with it. Maybe it's some sort of ear dildo. 

Shit. I can't hear anything all the sudden. I should probably go to the ER when I'm done writing this. 

I'm thinking the last thing is a nose picker. See how the end of it is like a two-pronged fork? Bet you could totally spear a booger with this. Perhaps that is the civilized way to clear your nasal passageways in high society. A finger does seem sort of barbaric. 

So anyway, any help you guys could give me here would be appreciated. With your assistance, I may end this year hotter than I began it.  Or at least avoid large hospital bills.

Thanks in advance. 

I Fought The Mall And The Mall Won. She Fought The Mall And Kicked Its Ass.

So, yeah, I work at the mall. I am not proud of this. As a matter of fact, it grates my ass from the moment I pull into the mall and see that goddamn water fountain of theirs next to the street. I live in an area of chronic water shortage where an average person can fight for years to put in a second bathroom and the mall thinks it's a great thing to shoot water around for the hell of it all day long. Someday I'm gonna put so much dish soap in that water fountain it will be both ruined and squeaky clean for at least 20 years.

It's more than water waste that puts the burr up my butt though. The mall as an institution is a monument to the cheap crap made in China sell your soul to corporate control complex that rules us. Your definition of what is beautiful comes from Victoria's Secret. Your good taste from the Pottery Barn. Your culture from the cineplex down at the south end. And if your money comes from the mall, God have mercy on your soul, because you will be broken before a check is ever issued. Take a good look at the people behind the counter at your favorite store at the mall my friends. They're either high school kids or they are broken.

And if any of this starts to bother you, that's when you come down to the north end of the mall and see me.  To get the chemicals that will make you forget all about it. Unless you're me. They don't sell my brand of scotch at the mall. 

The lady at the pizza place seemed to be an exception though. I could never put my finger on it, but she definitely wasn't broken. Her smile always seemed so........real. It was evident that she lived within the mall culture but was not of it. I sensed something. I totally sensed something, but could never quite tell what it was. 

Until last week. When I read in the local alterna-weekly about the lady who used to work at the pizza place's CD release party. I went. I have no friends mind you, and I hate going to places by myself. But I went because I desperately wanted her to be good. I wanted so much for the mall to finally lose a round. 

The mall lost a round tonight my friends. I am a music snob, and as such I would be unable to tell you she was good  if she was not. She made my ears happy for a little over an hour this night, and a little bit of my soul happy for a good deal longer than that. Because the mall lost one. And I didn't have to break out the dish soap. It's not making contact with the lady who sweeps up the cigarette butts, but It'll make for an OK Christmas this year.  

In your face mall.

  

I Hate It When Other People Do Pharmacy Humor Almost As Good As I Do.

Because let's be honest, no one comes close to me when I'm on my game. Except every once in awhile. So it is with a sense of seething jealousy and the vague hope of a job offer if qfever.com ever decides to mount a comeback that I pass along a clip an alert reader forwarded my way the other day: 

Nexium® Offers Unique Advantage Over Generic Omeprazole
Only proton-pump inhibitor proven to enrich AstraZeneca

WILMINGTON, DE - Nexium® (esomeprazole), the newest proton-pump inhibitor approved by the FDA for peptic ulcer disease, offers a unique advantage over the generic form of Prilosec (omeprazole), said a panel of industry experts this Wednesday.

Namely, Nexium®, which is simply the L-isomer of omeprazole, is now the only proton-pump inhibitor definitively shown to enrich AstraZeneca, the pharmaceutical corporation that lost its U.S. patent for omeprazole in April 2001.

Nexium® is substantially better for AstraZeneca than omeprazole Experts in the healthcare community attribute the unmatched ability of Nexium® to benefit AstraZeneca to a remarkable series of scientific discoveries made at the company's research centers during the mid-to-late 1990's.

"First, they discovered that when they lost the patent for omeprazole, they wouldn't be making any money from it anymore, " says Dr. George Papadopolous, a pharmacist in Wilmington.

"Then, they realized that omeprazole, like many chemical substances, has both an L- and an R- isomer, each of which is technically [winks] a different compound, according to FDA guidelines."

"Finally, they tested and proved the hypothesis that the American public could be duped into paying far more for things available in less costly, but basically identical, formulations simply by employing colorful ad campaigns and effective direct-to-consumer marketing techniques," he concluded.

Indeed, study after study since Nexium's release has indicated that Nexium® benefits the executives and shareholders of AstraZeneca signficantly more than do generic omeprazole or, for that matter, any of the other FDA-approved proton-pump inhibitors, with a p-value of <.005.

"It's truly a miracle drug," said Patsy Goldberg, a long-time esophagitis sufferer. "Imagine that - a medication that helps my acid reflux about the same as as a cheaper generic would, and allows AstraZeneca to keep making money off me at the same time!"

Researchers at AstraZeneca are currently hard at work "discovering" the R-isomer of omeprazole, with which they plan to overcharge the general public as soon as the patent for Nexium® runs out in 2014.

It's A Short Night For Me And I Got Nothing For You Except This Picture. I Hope You Enjoy This Picture As Much As I Do

Because I really, really, enjoy this picture. I enjoy this picture more than certain types of porn.





I'll be back with more for you over the weekend. Goodnight.

God that picture never gets old.

Tonight I Answer A Question Every Pharmacist Has Probably Heard At Least Once In Their Career.

It showed up tonight in my e-mail box, which marks at least the third time since a Degree in Pharmacy touched my grubby little hands that someone has turned to me for guidance about this evidently burning issue:

Dear Drugmonkey, 

My roommate and I have read your blog regularly for almost 4 months now and we love it. Since you are The Master of Pharmacy, we want you to settle a bet we have. What is the origin of the famous "Rx" symbol that is associated with our profession? 

Thanks, 

Nikki.

Dear Nikki, 

I bet you dot the "i"s in your name with little hearts don't you? But that's getting off track....

Which one of you bet that I don't give a rat's ass where that symbol came from?  Because that's the answer. I've heard several stories purporting to explain the origin of the Rx, probably all equally full of shit. I guess I could go ahead and add one more to the pile:

The origin of the Rx symbol actually dates to ancient Egypt and the original apothecaries that served the people in the time of the Pharaohs. (Learn to use the fucking google) The business climate during the time of the Middle Kingdom was very competitive, and pharmacist Cutamohnken Venzevian Surmanses found that if he could eliminate the need to urinate during the workday, he would be able to fill an average of 2% more prescriptions each week than his competition, giving him a leg up on other drugstores and ensuring he would not go bankrupt and be drafted into pyramid construction duty. CVS, as he was known to his colleagues, then developed the ultimate penis knot to ensure that all urine would stay in his body for at least 18 hours, and posted a picture of his innovation outside his store to demonstrate his commitment to sacrificing his urea elimination and osmotic balancing needs in order to earn the AWP-40%+25 cents that most Egyptian insurers paid per prescription at the time. 

While we can only dream of reimbursement rates as high as those of ancient Egypt, the business CVS built has never forgotten the financial advantage of the penis knot, administering it to every male pharmacist in a secret ceremony on their first day of employment. How CVS has eliminated urination from its female pharmacists remains a mystery. Many suspect they are actually robots. 

I'm sorry Nikki. I made light of your serious question didn't I? I'll make it up to you. Somewhere in the story I have just written, I have embedded a clue that will guide you to the answer you seek. Good luck in your quest.