Why Do You Come Here?

Your money is your money. What you choose to do with it is entirely up to you. How you spend it, where you spend it, entirely up to you.
What is not up to you is expecting a business to conform to your rules for your convenience.
Can we special order items for you? Of course.
Will we match prices for you? Certainly.
What I will not do is waste my time calling multiple pharmacies around the area on a list of 6 medications to get you the best deal. Sometimes, if a pharmacy knows another pharmacy is calling, they will give an inflated price. (This happened regularly with me at a couple locations, including an independent.)
This makes it difficult to verify the price you are quoting me.
***This gets you mad at me for me trying to help you.***

If you want the convenience of picking up all your medications at one location, accept their prices. However, if I am the highest-priced pharmacy on all 6 medications, why do you come here? Am I the only pharmacist willing to match prices?
The other problem with matching prices is my acquisition cost may be quite different from that of the other pharmacies. If they got a kick ass deal on Mylan's version but I have Par's generic, I cannot sell it to you for less than my cost. That's bad business. Not every pharmacy uses the same manufacturer for every generic they stock.
Again, I do not mind matching prices. I encourage people to seek a better price if they have no insurance. I can and will adjust my prices where possible.
Just don't be like this guy:

Time Wasted Arguing That Prices Are Negotiable: You were supposed to match my prices.
CP: I'm sorry. When did you tell us this?
TWATPAN: Monday night. I brought in a list.
CP: It's Wednesday and we just received the prescriptions. I looked at the list but there are no prices on there.
TWATPAN: You were supposed to call them. I get Jantoven not Warfarin. That's wrong.
CP: You want Jantoven?
TWATPAN: Did I stutter?
CP: <calls competitor> Their Jantoven is more than we charge. Ours is cheaper.
TWATPAN: I said I take Warfarin.
CP: Apparently you did stutter. I specifically asked if it was Jantoven and you said "did I stutter?" Let's try this again. Here are the prices they are charging. Since your one medication is below my cost, I will charge you my cost while matching the other 5 prices.
TWATPAN: First you do away with your $4 list, now you won't match prices!
CP: We never had a $4 list and I did match your prices. Are you even paying attention? I think it's about time to knock the rust off my Klingon. Pretty sure no one would notice.

<2 hours later, TWATPAN returns>

TWATPAN: You gave me the wrong prices.
CP: Pretty sure you were standing there glaring at me while I called the other pharmacy and repeated the prices out loud and you were nodding your head in assent. Or it was someone else who looked like you and acted like a toddler who didn't get a sucker. Please tell me you don't have a twin.
TWATPAN: I called them and they gave me lower prices.
CP: Since I was not privy to that conversation, what, exactly, did they say?
TWATPAN: They said with their in-store discount card, my prices would be even lower.
CP: Of course they did. That's incentive for you to go there. I can't match special offers. The cash price is the cash price. If one tire location offers free mount and balance with purchase you have to buy the tires there. You can't bring your own tires purchased elsewhere and take advantage of the free mount and balance only.
TWATPAN: You're going to lose a lot of business.
CP: Really? So far you have monopolized nearly a solid hour of manpower today. You were here for 35 minutes earlier. You called us 3 times and now you're back for another round of arguing. I lost nearly $75.00 on your 6 medications plus an hour of payroll. If you went to the other pharmacy, I would actually come out ahead.
TWATPAN: One of these days I'm going to leave.
CP: I'd like to ask you a question that has been gnawing at me since your first visit.
TWATPAN: What?
CP: Why do you come here? It's not for the prices. It's not for the convenience. I didn't force you to do business with me. You are free to leave at any time. Please. Why. Do. You. Come. Here?
TWATPAN: <disgusted look. storms off>
CP: Must be my award-winning personality.

Pharmacist = Medication Mentor

The most common complaint people have against my posts is that normal people do not understand the inner workings of the pharmacy. Good Point. Just as I don't understand the inner workings of the restaurant business or working the line at GM or selling stocks, I don't expect everyone to have the level of knowledge I possess about my profession.

HOWEVER, I know how to learn more about the other trades. I research it. I ask questions of the people who know what they are talking about. THEN, after getting the answers I sought, I take my newfound knowledge and improve whatever I was trying to accomplish. 

In the pharmacy world, people prefer to take what I tell them, ignore it, argue with me about it, then complain about what I told them. 

Insurance information changed? I will tell you you have a deductible. 

You will argue with me because you believe you are correct. You're not. 

I understand that it is easy for people to develop preconceived ideas. I also understand it is increasingly difficult to change these preconceptions in spite of mountains of evidence to the contrary. But YOU asked ME for my professional advice. Accept it. Improve your life with it. Remember it for next time. 

A Pretty Hollow Aged Gentleman Ignoring Advice: My wife has high blood pressure. 

CP: Phrom putting up with you?
APHAGIA: What? No. She has lots of drainage and a cough. What should I get?
CP: Away phrom her.
APHAGIA: No. To treat her.
CP: Oh. I'd say chlorpheniramine. Works quicker than the 24 hour antihistamines and shouldn't make her drowsy like Benadryl.
APHAGIA: Her doctor said no antihistamines.
CP: Curious. Why would he say that?
APHAGIA: They can increase her blood pressure.
CP: That's backwards.
APHAGIA: How so?
CP: Sudafed, which is a decongestant, can increase her blood pressure. It's also not going to do anything for her cough or the fact she is leaking. Her other choices phrom the myriad possibilities out there (read: four ingredients) include Dextromethorphan, a cough suppressant that's not too good at its job and can cause nervousness, and Guaifenesin, an expectorant which she does not need if she has a dry, postnasal drip-induced cough. She has an acute condition and needs an appropriate medication.
APHAGIA: I'll just get her this Robitussin DM. It's for cough.
CP: Sure thing. Can you just sign this release phorm phor me, please?
APHAGIA: Sure. What is it?
CP: It's a standard in the pharmacy world now. It states: "I, the patient or the patient's representative who was sent to the store to ask appropriate questions and select the most appropriate therapy for my/their conditions, completely refused the expert professional's advice after a lengthy discussion and will not hold said pharmacist accountable when the medication does not work, my/their condition(s) worsen, and I am phorced to come back to the pharmacy phor the correct (original product suggested) or return to the pharmacy with prescriptions due to a worsening of initial symptoms that would have been thwarted had I listened to your expertise phrom the outset. This document serves to indemnify the pharmacist phrom all accountability due to ignorance of professional services provided here today.
APHAGIA: Wow. Seems wordy.
CP: I am witty with words and I read lots of medical studies and legal updates. It seeps in. Think of it as leaving the hospital AMA or leaving the doctor after your wife's visit for her HBP checkup and deciding not to phollow his advice on treating the HBP with medication and dietary changes. Would you do that?
APHAGIA: No.
CP: Still want this Robitussin DM?
APHAGIA: Yes.
CP: I was right and you lied to me.
APHAGIA About what?
CP: Your wife's high blood pressure. It is phrom putting up with you.

Breathe Deep

CP: Thanks phor phoning CP's Emporium. How may I help you today? 

CANDY: I need a refill. 

CP: Certainly. Do you have the Rx number? 

CANDY: No. But I know the name. 

CP: That helps too. What's your name? 

CANDY: CANDY (Cees Are Not Dees Y'know). 

CP: Okay. And what do you need refilled? 

CANDY: My diaphragm.

CP: Oh. Okay. Take a deep breath. 

CANDY: <inhales> Okay. Now what? 

CP: You refilled your diaphragm. 

CANDY: No. My medication. It's called diaphragm. 

CP: Okay. Like the little trampoline for sperm? We do phill those upon occasion but rarely refill them. Usually they're not supposed to get full. 

CANDY: No. My medication. I take it by mouth. 

CP: That's not how diaphragms work. That's called a #DentalDam. 

CANDY: No. The medication I take phor depression. 

CP: Do you have the bottle? 

CANDY: Yes. 

CP: The one with the Rx# on it? 

CANDY: Uh-huh. 

CP: Which would have helped in the phirst place but would not have resulted in this phunny encounter? 

CANDY: Yes. 

CP: Spell the name phor me. 

CANDY: C-I-T-A-L-O-P-R-A-M. 

CP: You do know that "C" and "D" are not pronounced the same, right? Not sure how you got the rest of the letter salad that resulted in CITALOPRAM becoming DIAPHRAGM but you win the award phor #PharmacyQuoteOfTheWeek. 

Pills

Pills, all I really want is pills.
And in the morning it's pills.
Cause in the evening's still pills.

I learned the way that they work
And how all them need be took
And I know what you take them for
You see me when you need some more.

Ev-er-y day
I work with pills in many ways
I have to pour them on my tray
The little lip will make them stay
This keeps them from rolling away
With spatula I get to play
Counting pills is just one way
We fill prescriptions every day

Now don't you say, "You just pour pills upon that tray
Just slap a label on it, kay?"
It doesn't work in just that way
To the insurance Gods we pray
For your prescription they will pay
If not there will be some delay
Upon me blame I know you'll lay
But you'll come back another day

Pills - to treat infections
Pills - to get erections
Pills - to make you happy
Pills - and not so flabby
Pills, that's what I really love is pills
Five at a time I count pills
Into new bottles I place pills
All day is spent counting pills, pills, pills, pills, pills!

We Take All Complaints Seriously. . . Except

Mistakes happen. Depending on your source, they either happen more frequently or less frequently than reported.
Sometimes it's a simple mistake.
Sometimes it's an error so egregious, lives are at risk.
Over-reacting helps no one.
Please do not overreact.
"Happy, smile. Sad, frown. Use the corresponding face with the corresponding emotion."

OverReacting Woman Expecting Lots of Love: I am calling to complain.
CP: <checks caller ID> What seems to be the trouble today?
ORWELL: You shorted my husband 1 tablet on his medication.
CP: My apologies.
ORWELL: What are you going to do about it?
CP: Nothing.
ORWELL: What!? This is his life-saving blood pressure medication. He needs it.
CP: And he has it.
ORWELL: I think someone down there is stealing his medication.
CP: That's quite a leap.
ORWELL: You did this to us last time. He always gets a 90-day supply and we noticed he was 1 tablet short last month. Now you owe us 2 tablets.
CP: I don't owe you anything.
ORWELL: He could die without it.
CP: He could. But he's not going to miss any of it. Perhaps, as you say, he was short 1 tablet.
ORWELL: We sat together and very carefully counted his pills and we only got 179.
CP: Must have been a phun Saturday night at the ORWELL household. Let me audit my inventory.
<checks on-hand quantity, dispensings, who counted their prescriptions>
My inventory is spot on.
ORWELL: So. What does that mean?
CP: You are the only person to have received this particular NDC of this medication in the last 6 months. Twice we filled 180 tablets for you. We had 400 tablets to start. We counted to 180 each time. I currently have exactly 40 tablets on my shelf. I am not over, nor am I short.
ORWELL: Well where is his extra tablet?
CP: How do you know we shorted him last month?
ORWELL: He takes it twice a day and he only had enough for his morning dose on the last day.
CP: I see. Thereby proving, beyond a shadow of a doubt, that we shorted you 1 tablet. Not only that, but that one of my employees is stealing it. Case closed.
ORWELL: Right.
CP: Could it not also be possible that your husband missed even 1 dose throughout the last 90 days?
ORWELL: No. He is very religious about taking these. He knows he can't miss a dose.
CP: He also could have dropped one.
ORWELL: I doubt it.
CP: As much as I doubt we are to blame. I do have a solution for you.
ORWELL: Which is?
CP: Next time you are down here, I will give you a counting tray and a spatula and have you count the medication in front of me before you leave the pharmacy. If you are short, I will give you one. If you are over, you owe me one. If your count is correct, you can go home happy and continue playing checkers on the kitchen counter with your prescriptions.



I know what everyone is going to say, "why not just give her 1 tablet and be done with it? Why continue to argue to prove a point; to prove you're an asshole?". First, my inventory would be off by 1 tablet. I hate that more than anything. Second, the patient would expect it and I'd set a precedent. (I have given a single tablet to patients in cases like these where warranted. Not in cases where patients accused my staff of stealing a single ACEI.) Third, these "kindnesses" would become expectations along with faxing prescribers for refills, automatic refills, and loaning "just a few" to get through the weekend. Fourth, I had a woman argue with me every month that I shorted her. I added an extra tablet to her bottle, thereby giving her an odd number, and waited for the phone call. When she complained about the odd number, I told her to examine her bottle where I initialed the quantity. I told her I added an extra tablet and was not putting up with her phone calls anymore. She never complained again.

Mother, Mother. . .

Student At University Studying And Getting Educated: Hi. I was wondering if my prescription was ready?
CP: Not yet. We did receive it but we have not finished it. Give me 20 minutes and we shall have it ready for you.
SAUSAGE: Many thanks. I will be there then.
 <5 minutes later>
SAUSAGE's Mom: I was calling to see if my little SAUSAGE's medication was ready.
CP: Well, I just spoke with your little SAUSAGE and explained that 20 minutes was all I needed to complete the filling process.
SAUSAGE's Mom: Okay. I'm just trying to make sure it's taken care of. My little SAUSAGE goes to university out your way.
CP: I know. I heard.
<5 minutes later>
Store Local To SAUSAGE's Mom: I'm not sure why, but I'm calling to see why you're having trouble filling a prescription for a student of ours.
CP: Let me guess. You got a call from SAUSAGE's Mom?
SLTSM: Yep.
CP: <recounts how we spoke with both SAUSAGE AND SAUSAGE's mom> So why did she call you.
SLTSM: Not sure. But this is for a student? An adult student? A university student?
CP: Yes.
SLTSM: What is going on with parents today?
CP: This has me wondering who is going to chew up the medication for SAUSAGE and spit it into SAUSAGE's mouth like a mama bird. Not sure how SAUSAGE is going to be able to manage to coordinate the drinking of water and swallowing a whole tablet at the same time.
<other line rings>
Uber-Tech: Yes, ma'am. We are speaking with the other pharmacy right now. Yes. We are filling it right now. No. I am not sure what the problem is, <whispers> other than you.
CP: Again?
UT: Yes.
CP: What now?
UT: Just making sure everything is being taken care of for her little SAUSAGE.
CP: No wonder this kid flew so far from the nest to go to school.

"Hush now, baby, baby, don't you cry.
Mama's gonna make all of your nightmares come true.
Mama's gonna put all of her fears into you.
Mama's gonna keep you right here under her wing.
She won't let you fly, but she might let you sing.
Mama's gonna keep baby cozy and warm."

#OfCourseMamasGonnaHelpBuildTheWall

Just Because You Can . . .

I do not let people bully me. That's what it is, bullying.

People believe they can get away with anything when it comes to retail transactions. Partly it's due to our disconnected society. We don't have to interact with people face-to-face to complete most of today's transactions. We order everything online from Amazon. We receive automated reminders from the pharmacy, the dentist, the doctor. We receive tonight's dinner, ready to cook, from Blue Apron or Sun Basket. We text each other. We email. We stare at our phones while sharing dinner together. 

When we are called upon to actually converse and have a tete-a-tete, we don't know how to interact and exhibit socially agreeable behaviour. 

If a patient becomes confrontational, I shall intervene. I have no problem inviting them to never return. Go sell crazy some place else. 

It sounds as if this is not going to be phunny, but I love turning things around on my boss. 

I love looking at things from a standing-on-my-head perspective. 

CP's Boss (Her Royal Highness): I see you gathered another complaint. 

CP: <Proudly Puffs Out Chest> I did. I'm on a roll. 

HRH: You're not supposed to be collecting them. 

CP: Why not? Some people collect penguins. Some collect Star Wars memorabilia. I prefer to dabble in chaos. Complaints are my phriends. 

HRH: How so? They are a negative reflection on your attitude. 

CP: <whispers> Says the boss who doesn't deal with the public. 

HRH: What's that? 

CP: Nothing. Just admiring your dedication to keeping me on the straight-and-narrow even though you couldn't do my job which is why you got promoted. 

HRH: Just because you can do, or in this case, say something, doesn't mean you should. 

CP: Why not? People are too easily offended. Your perfume offends me. Your garish hairstyle offends me. Patients who yell and scream and throw temper tantrums like 2 year olds offend me. Unfortunately, I have to deal with all of them today on top of making sure I meet your quotas and that little professional expectation of not killing people. 

HRH: Complaints are not healthy. 

CP: Wrong. You have to know how to read them. Like news and studies on the internet or in journals, you have to know HOW to read and interpret them. They are not all the same. You paint me with a broad brush and believe I am a bitch based solely on my complaints. I will not allow any patient or boss or visitor to my store to belittle me or my staff. Period. I will stand up for everyone here. I do not have to take abuse. If I wanted that, I'd sign back up for that S&M class I dropped out of right after college. 

HRH: Um. . . This is why I only visit here for short periods of time on a rather infrequent basis. 

CP: Anything else before you shake babies and kiss hands and play your exit song on the way out the door? 

HRH: Cuts in hours will be coming soon. We will also reduce your overlap by half so be prepared to do more work with less help. 

CP: I'm thinking "no" on that one. 

HRH: <head swivels around violently, cracking> What did you say? 

CP: I. Said. No. To quote a phairly self-phamous person, "Just because I CAN does not mean I should". So, no. I will not be doing extra work just because you think I can.
HRH: How do you still have a job?
CP: Because people love me. I get everything done, despite your greatest efforts to thwart me, and I still do it all with a cryptic smile on my face.
HRH: Yeah. It's creepy. I've never been able to figure out how you do that.
CP: Practice. And despite the cynical attitude I have towards the profession, I love what I do. 

Opioid Epidemic Hurts Everyone

In The War On Opioids That Amasses No Gains (WOO TANG for short) another innocent victim has been discovered. Companies are quick to promote themselves as leaders in the WOO TANG.
CVS Caremark announced how they are limiting supplies through the pharmacies.
States have limited quantities that may be prescribed.
Insurances are blocking anything more than a 7 days supply for a prior auth.

These are all great steps. 

However, as with all great strides, a few missteps must occur. 

Unfortunately, the innocent suffer. 

Uber-Tech: I need your brain.
CP: Trust me, you don't want it.
UT: I need its view of this.
CP: It will be skewed.
UT: Look at this reject for this child.
CP: "Max of 4/day". Got it. What are the directions?
UT: Take 4ml by mouth every 6 hours as needed for pain.
CP: Well, that is 4 doses per day. I'm confused why there is a limit. Let's call.
UT: On it.

CLueless Insurance Talker: How may I (not) help you today?
UT: What?
CLIT: Nothing. Go ahead and start getting phrustrated. This will not end well for you.
UT: I'm trying to figure out why this claim will not go through. I tried rounding up in case the insurance didn't like the days supply but I still get a reject.
CLIT: I see all of your valiant attempts. You probably haven't been this rejected since high school.
UT: What's the magic number I need to submit to get a paid claim?
CLIT: <drags out a long> Fooooouuuuurrrrrr.
UT: For what?
CLIT: Just 4. As in "per day".
UT: Speak English.
CLIT: The insurance allows a maximum of four(4) ml per day. Period.
UT: Units would've helped there. There is a big difference between 4 ml, 4 doses, and 4 days.
CLIT: Ahem. And now phor my prepared statement: "Due to new opioid limits, the insurance restricts this medication to a total of 4 ml per day. Should the patient require an amount to exceed the total of 4 ml per day, the patient must contact his/her insurance directly to begin the process of a prior authorisation."
UT: Wait. What?
<UT repeats phor CP>
CP: Wait. WTF? Dosing of 4 ml 4 times a day is normal. He does realise this is NOT an opioid, correct?
UT: You do realise this is not an opioid, oui?
CLIT: It is part of the insurance's ongoing battle against the evil scourge, the plague of opioid addiction blanketing communities across this great land of ours.
CP: It's phor a child.
UT: It's phor a child.
CLIT: We have to stop them early. Before they become addicted or these medications reach the hands of innocents for whom they were not intended.
CP: Can we request an override? Begin the prior auth ourselves?
CLIT: No. Only the patient can begin the process by calling her own insurance. They will then contact the prescriber for an override.
UT: This is rather complicated phor a little pediatric patient to deal with on a Phriday night at 5pm. By the time they would have completed the medication, the prior auth would not have started.
CLIT: Not my problem. These are the rules. Get used to them. I'm sure we insurance companies and PBMs will come up with even more mind numbingly phrustrating blocks to patient care under the guise of "helping" in the near phuture. <click>

UT: What now?
CP: Now that everyone is on the hook, let's tell them the medication.
UT: So they can get really pissed?
CP: So they can see the extent to which we went phor this poor little guy to get his prescription philled on his insurance. Never mind it cost less than $5.00. I just had to know why, no HOW the insurance blocked him phrom receiving his post-surgical pain medication under the "Opioid" banner.
UT: It really is ridiculous, nay ludicrous that we had to spend so much time to get an answer. It wasn't about getting reimbursed. It wasn't about the patient not being able to pay. It's the principle. This was the first time we had seen this rejection and it made absolutely no sense.
CP: Seriously. How in the world could an insurance company lump IBUPROFEN 100mg/5ml Suspension in with an Opioid rejection? It's not possible. It had to be an error. There had to be an override for a post-op prescription for a child. This is sold OTC. You don't need a prescription.
UT: We cashed it out, gave them a syringe, explained how their insurance sucked, and wished him a speedy recovery.
CP: Before you ask, this all happened well within the promised wait time, while we were accomplishing a multitude of other tasks so we didn't actually waste time on it. However, now you don't need to call on this rejection because we did it phor you.
UT: You're welcome.
CP: I hate insurances.