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Wednesday, November 26, 2014

Waiver Zone

I need a lawyer. Keeping in mind how much I love lawyers, this is a pretty big admission for me.
("If it wasn't for lawyers, we wouldn't need lawyers.")

It's not what you think, however.
I would like a lawyer to draft an exemption clause for me, for pharmacy, for those of us in the trenches. It will be an amnesty clause. Get out of jail free card.

Patients are so quick to blame the pharmacy for everything that stands between them and their medication. Building on the Disney Fast Pass Lane I want installed at my pharmacy, and adding to the $50.00 instant no-questions-asked flu shot fee, I want to add a special lane for "I'll Take My Chances".

The "I'll Take My Chances" (aka Russian Roulette) Lane will allow you to walk right over, sign a legal waiver absolving the pharmacy, pharmacist, and all its staff of any and all blame should any errors occur or fatal reactions ensue from a "Filled-Exactly-As-It-Was-Written" prescription. No questions asked. This will be more along the lines of "I Want It Right NOW" instead of "I Want It Right". Patients will accept full responsibility. I am sure we could have an attorney present at the table where these are signed to bear witness to the forfeiture of all future recriminations against anyone involved in filling these prescriptions.

Imagine the time we will save. No longer will our phone lines be tied up both ways (us calling prescribers for explanations and the patients calling us asking what is taking so long). No longer will we have to deal with the Charles Manson Stare Down as these patients will be placated in the knowledge their high-risk, high-reward prescriptions will be filled imminently. We can issue a 5 minute guarantee on this lane and have it staffed by one pharmacist and one technician at all times. There will of course be a surcharge imposed for this service but keep in mind, you are worth it!

We can even extend this to "one-and-done" on insurance billing. We will attempt to bill one, and only one, insurance for you. If it does not go through, requires prior authorization, or you are unsatisfied with the copay, your options become Take It OR Leave It. There will be no discussion, no pleas for what's behind Door #3. I am not Monty Hall. This is not a discussion. If you want fast service, know what you want and expect to pay for it. It will be like the Soup Nazi. No argument, no debate, no Rx for you. Next!

Tuesday, November 25, 2014

I'm Sorry.

Please allow me to apologise. I am sorry.
We hear this all the time. Some say it is human nature. Some will say it is conditioning. Some will say it is our parents' fault: always say "please and thank you "and apologise. I also think it is Corporate America's fault. If you say you are sorry, it will help defuse a situation. Maybe. My problem is that we offer apologies for everything today.

Your refill is too soon? I am sorry.
Your doctor didn't call in your prescriptions yet? I am sorry.
We told you to call us 2 days before you need your refill because it is a special order item and now you are out of it? I am sorry.
You think 20 minutes is too long to wait at 5pm on a Monday? I am sorry.
Your insurance changed and you left the card at home? I am sorry.
You planned a vacation and forgot to refill your medications until now…as you are en route to the airport? I am sorry.
Your prescriber wrote the prescriptions wrong and we had to call and he hasn't called back? Yep, Sorry...

Only I am NOT sorry. I am tired of that being our immediate, conditioned, pre-programmed response to people. I'm not sorry. Is that wrong? There are better ways to empathize with our patients. That's what we are trying to do-empathize with them. But it's erroneous. It's not MY fault so why am I the one who is saying I AM sorry?

Instead of "I'm sorry", let's try something else.

Mad Hatter: What do you mean he didn't send it? I was right there when he did it!
CP: Wow. That sucks dude. I feel your pain. Call them back and give them a swift kick in the ass. Next!

Mad Hatter: I am flying to London right now and need this filled ASAP!
CP: Well ASAP would be about 25 minutes. Thanks for giving me some time. I was afraid you wanted it, like yesterday.
MH: I do want it yesterday.
CP: Well, in the immortal words of Chad and Jeremy: "Yesterday's Gone". Safe travels. Next!

Mad Hatter: Why is this so expensive? Didn't you bill my insurance?
CP: Yes.
MH: That's it? Yes?!
CP: Yes, sir? Yes it is expensive. Yes we did bill your insurance. Yes they seem to suck at paying for really expensive things. It is the harsh reality of the world in which we live. Things cost money. I'd love to pay $1138 for a new Ferrari but it's not going to happen. You have the right to pay for it. You also have the right to leave it here and not pay for it. Please decide quickly as there are others behind who are waiting to make this difficult decision. Next!

Mad Hatter: I wish to register a complaint.
CP: Next!

Mad Hatter: I'm sorry that last guy was a twatscrew.
CP: No worries. And don't apologise for him or his behaviour. He's a big boy. Besides, always being right means never having to say you're sorry. (My apologies to Ali Mcgraw).

Monday, November 24, 2014

An Open Letter: Dear State Board of Pharmacy-Transfers

Dear YOUR State Board of Pharmacy,

My name is The Cynical Pharmacist and I am a licensed, practicing pharmacist in YOUR STATE. It is my mission today to ask you to outlaw prescription transfer incentives. While I understand the YOUR STATE Board is not in the business of regulating company practices, they are in the business of protecting their State's citizens.

Pharmacy is a profession. We expect to be treated as healthcare professionals. We expect to be respected as professionals. If we allow our services to be bartered for gallons of gas and free gift cards, we are nothing more than cheap hookers, a profession which does not require a license.

We pharmacists are not in the position to make these changes to our state laws. You are. You give us our licenses. You take them away. You write the laws that govern how pharmacy should be practiced in your state. We listen to you. It is time you listen to us.
There are several states that have already outlawed the incentivizing of prescription transfers. This list includes New York, New Jersey, Oregon, Alabama, Mississippi, New Hampshire, and Arkansas. Simply put, prescriptions are not commodities to be traded on the retail market. These are life-altering medications that make a huge impact on a patient's life.

My concern with continued acceptance of this practice in YOUR STATE goes deeper than transfer errors. It goes deeper than the possibility of mistakes. It goes deeper than missing interactions and therapeutic duplications. It is about perception. We are the most accessible professional in all of healthcare. We gladly give away all of our professional services for free. The problem isn't companies attempting to buy patient loyalty. Studies have shown less than a 20% retention rate on patients who use coupons and incentives. The problem is lack of respect that arrives as a side effect with these programs. If we do not respect ourselves, we simply cannot expect our patients, and even other healthcare professionals, to respect us. I am starting a campaign to take my profession back. It starts with your help.

I have broached this subject directly with my State Board in the past. I have spoken with other pharmacists who have also contacted their State Boards and had similar results. The Boards' refusals to enter this discussion often boil down to the following argument: The Board does not exist to regulate company policy. I have mentioned each of the following situations before and received the equivalent of a shoulder shrug from those with whom I spoke. According to these members, the following are simply anecdotal and they have no proof that these can happen, do happen, and even if they did, the frequency with which they actually occur.

1. The risk for errors increases each time a prescription is transferred. The more times you fill it, delete it, call it in to another pharmacy, and give a verbal order to someone else, the risk increases. (Think of the telephone game in kindergarten.)

2. Time is wasted on transfers for coupons that could be spent on any other professional task. Each time I have to step away to get a transfer or give a transfer for a patient, I am at risk of speeding through something to catch up. I may miss a drug interaction. I may dispense an incorrectly filled prescription. The risk that I may make an error increases.

3. Patients complain about not being able to shop around or "going South" for the winter. There are states that only allow single transfers. Simple. If the rules exist, patients will adjust to them. They will get two prescriptions: one for home and one for their desert oasis. (Think about how well everyone adjusted to no refills on Hydrocodone-containing products recently.) Also, with most insurance plans, the patients' copays are the same at nearly every pharmacy. They shouldn't need to shop it around.

4. Grown adults use their elderly parents' medications to make money. This is true. I have seen it firsthand. Do the parents know? Is that their right? We have people who will carry folders with their parents' prescription receipts from all the local pharmacies. Every week they will drive from pharmacy to pharmacy, transferring CVS to Target, Target to Walgreen's, Walgreen's to Rite Aid, Rite Aid to Wal-Mart. Next week, they repeat the process. This should not be allowed to happen. If an error occurs, who will get in trouble? The pharmacies. Who will pay the price? The elderly parent. Your job as State Board involves looking out for the health and wellbeing of your citizens. 

Patients will complain states are taking away their rights. I believe they are taking advantage of a system that never should have existed in the first place. We need to make our profession more professional. It starts with you. It starts with this law change. It has to start now. I want my profession back. Please.

I would be happy to attend a Board meeting to discuss my proposal further.

Thank you for your time and consideration.

I have included a link to Alabama’s law, a state that changed most recently.

“A pharmacist and a pharmacy should never offer or participate in the offering a financial award or benefit, not related to competitive retail pricing of any drug, to induce or encourage any individual to transfer a prescription from one pharmacy to another.”

Statutory Authority:
effective June 13, 2011. Amended: December 16, 2011; effective January 20, 2012.
Herb Bobo, R.Ph. Secretary
Code of Alabama 1975; §34-23-92.
Original rule filed: May 30, 1990; Effective July 30, 1991; Amended: May 9,

Here is the verbiage currently proposed in Virginia.


Thursday, November 20, 2014


If you want to sell a product, people need to know you have it available to sell.
Think about product placement. It's all marketing and psychology. 
Companies pay top dollar to have their products placed in strategic locations, whether it be end caps or eye level on store shelves. 
Remember the old department stores that had huge window displays? 
Think about car dealers. Chevy has the newest, shiniest Corvette sitting prominently in the showroom. You can see it from the street. You are invited to look at these products. You cannot help yourself. 

(CP, what the hell does this have to do with pharmacy?)

Many pharmacies have a window, glass wall, barrier, something between the pharmacy staff counter and the general population strolling around out front. Most pharmacies keep their fastest movers on this ledge...or maybe just their Amoxicillin, Percocet and Norco because they are the biggest frequent flyers. In every pharmacy I have worked, we have had a variation of this. I always find it a little amusing when the Powers That Be saunter through our department and chastise us for having these items in a prominent location. It's bullet resistant glass. It's nice to know you are more worried about an open bottle of Norco behind a window than you are about my safety behind open counters. 

To me, this is marketing at its finest. 
Remember not too long ago when the Hydrocodone products were on backorder? (Except at my store where we anticipated the shortage.) I figured proper product placement in the window was the perfect way to show people we had what they sought.

As people would walk by they would espy the pretty bottles of 512's and Norcos in the window. They'd begin to drool at the mere sight. Pavlovian response underway, they'd call all their friends and say: "Hey, guess what? We found that Norco you were looking for. It's right here in the window display under the Christmas tree with the turkey ornaments and menorahs. Come quick before they sell out!"

When corporate would ask why our numbers were up double digits in prescription sales we'd laugh and tell them about our Jolly Multi-Holiday C-II display…then they'd complain because the decorations weren't approved, we didn't suggestive sell flu shots to all of them and we only advertised low profit margin generics.

Seriously, though. What is the difference between having a bottle 8 inches in front of me, on a ledge, versus 3 feet behind me? Patients can see my entire pharmacy inventory as they walk by. Thanks to the open-concept floor plan, the only thing that doesn't flow through my pharmacy is the front end aisle. Listen to me Oh Great and Powerful Powers That Be: You cannot insist I close my door and keep select products under lock-and-key if you are going to leave 30 linear feet of waist-high counter open to the general public. You CLEARLY are not concerned about the safety and wellbeing of your employees. You are plainly telling me that the few dollars invested in a couple bottles is worth more to you than our lives. (No. It is not a safety issue. Someone doesn't just walk by, see some controls on a ledge and decide to rob the pharmacy.) For you, it is all about the inventory…which still makes no sense. It's like leaving your garage door up at night with the lights on and the door to the house ajar, but locking your bathroom door during your middle of the night micturition trip. 

Wednesday, November 19, 2014

A(nother) Debate with Myself

Me: Why are you here?
CP: Existentially, philosophically, or?
Me: Professionally.
CP: I am a pharmacist.
Me: But why retail? You so hate your job.
CP: No I don't.
Me: But all your posts are so negative and mean. You must really hate people.
CP: I don't know half of them half as well as I should like; and I like less than half of them half as well as they deserve.
Me: Okay. But is it because that's where the money is?
CP: Nope.
Me: Then what is it? And don't say "to help people".
CP: Why not?
Me: Because that is the worst interview answer ever.
CP: Okay. How about this?: To foster and promote an environment where a healthy dialogue and transaction can take place enabling patients to get a better understanding of what it means to take better care of themselves and to enable them to reach these goals on their own.
Me: Verbose. Explain. Succinctly.
CP: I still believe people are good. I still believe they come to us for their healthcare needs, now more than ever with the other services we provide. This will continue to grow. We are the face of healthcare. We are the easiest professionals to reach directly. People like us.
Me: But you always complain they hate you.
CP: They do and they don't. Hate the game. Love the player. Many people understand that. Someone once asked me in an interview what my favourite thing about my job was. I quickly answered: My patients. I love them. I love getting to know them and their families. I love knowing what they are taking so I can help them with any questions they have. I love they feel comfortable enough to ask me questions and just talk with me whenever they need it.
Me: Aw. How sweet.
CP: Then I was asked about my least favourite thing about my job.
Me: Go on.
CP: I answered: The patients. The whiny, I-need-everything-now, slap-a-label-on-it, yelling, screaming, entitled, I'm-going-to-call-corporate-on-you, hurry-up-what's-taking-so-damn-long, stare-me-down IMpatients that we all deal with every day.
Me: Nice. Did you get the job?
CP: Of course I did.
Me: Back to the question: Why ARE you here?
CP: I serve a bigger purpose than myself. I believe I can do my best work in retail. I have the knack for patient service. I'm good enough, I'm smart enough, and doggone it, people like me. It's like bedside manners for prescribers. Those who are great at it are often lacking in other areas. Those who suck at it are often brilliant practitioners. There are few who can find the happy medium. I am somewhere on that Bell Curve. Another area of practice would have fit in with my brain a little better but I am a talker and love to engage people in conversation.
Me: But you complain a lot.
CP: Sure. Look at where it's brought me. I am bringing to light many problems facing our profession today. Retail seems to be looked down upon by other professions and other professionals within the practice of pharmacy even though we represent the majority of practicing pharmacists employed today. We have a job to do. It is evolving. It has moved away from its "helping patients" credo and become "dollar grabber extraordinaire" with all its ancillary, a la carte services.
Me: What do you wish to do about it?
CP: I want my profession back.
Me: And how will you accomplish that?
CP: Stay Tuned...With this page. I have a few ideas in the works, but I need input from all my followers. Hence the Participation Polls I am conducting. Some assembly required. It's like class participation. The more you participate, the better the class does.

Wednesday, November 12, 2014

Help(less) Techs

We live and die by our technicians. Without them, we are nothing. It's like the scene in Full Metal Jacket.
This is my rifle. There are many like it, but this one is mine...Without it, I am nothing.

Great techs make great pharmacists. However, there are always those ones that annoy the crap out of you. Every job, every profession has them.

We all know the type:
1. hears all the gossip any customer or fellow employee whispers but manages to be deaf to the sounds of the phone or the drive-thru bell;
2. is ready to go on break the second it's time and arrives for work at the last possible second to be considered on-time;
3. knows how to do most things, but would rather (play dumb) delegate the "hard stuff" like looking up insurances, rebills, and adding discount cards;
4. can't make eye contact or acknowledge anyone is at the counter or if they notice, will always say "someone will be right with you" while also asking the other person to get the phone;
5. takes the refills out of the queue but ignores the lone, difficult e-script that's been looming for 2 hours now;
6. manages to turn a 15 minute break into a half-day episode of Where's Waldo?;
7. suddenly can't reach any medications that are "too high" or "too low";
8. complains about where things are placed on the shelf, but doesn't alphabetize anything after the second letter in the name;
9. has never met a full trash receptacle he/she can't completely walk past and ignore;
10. will stop counting in the middle of a prescription because it's break time;
11. strategically knows when to call off certain days of the week/month;

The problem here is it's a double-edged sword. If we pick up their slack because they don't do it, they are encouraged to continue this behaviour. If we refuse to do their work for them, we get further behind and have to work that much harder the rest of the day to make up for their ineptitude.

(Short of firing them, which in many places is not an option, what is the answer?)

Thursday, November 6, 2014

Happiness in Slavery

Today is not Valentine's Day. I will not be your bitch. But I will be happy to treat you like one.

Every once in a while there comes along an opening, an opportunity for an educational moment. A teaching moment, if you will. When the tech shouts "guy bitching about a price match and he doesn't  know the W's", I rub my hands together in anticipation. This will be good.

CP: <picks up phone> Thank you for holding. This is CP's pharmacy where you get a dose of medicine to go along with your medication if you abuse my techs, pharmacist speaking, how may I help you?
Dumb and Dumber Solo: You didn't match my price.
CP: Did you tell us to match your price?
DDS: No. That's your job.
CP: No it isn't.
DDS: Yes it is.
CP: Print me my job description and highlight that area in green for me please.
DDS: What?
CP: Okay. Here's an easy one. WHO are we matching?
DDS: I don't know.
CP: WHAT price are we matching?
DDS: I don't know.
CP: WHEN did you get this price from "them"?
DDS: I don't know. You always do it.
CP: Last one: WHERE is this mystical matching pharmacy?
DDS: I don't know. You always handle it and I'm pissed!
CP: If you do not ask me to price match, HOW am I supposed to know?
DDS: That's not my problem.
CP: Hmm. Perhaps you should not entrust us with such an important mission in the phuture. It would behoove you to have this information ready on all subsequent visits.
DDS: That's not my job.
CP: And until you bring me my job description, I am going to have to tell you it is NOT MY JOB either. YOU want me to match A price but YOU don't know WHO, WHAT, WHERE, or WHEN? That's like telling an English student to solve for the square root of purple. Throw me a frickin' bone here buddy. Prices change. Pharmacies add, but mostly remove, items from their lists all them time. My job is not to stay current on them for one crabby patient who can't be bothered to take care of his own lone prescription.  I have over 400 I am going to do today. I don't have time to worry about your price. The fact that I am going to lose money on it doesn't really make me want to exert any extra effort on my part. You obviously don't come here for our friendly staff and customer service. You come here because we will match a price. Our corporate policy dictates that you have all of the relevant info ready as we cannot match willy-nilly. I'd be willing to bet you don't wish to drive in traffic to the other side of town where this pharmacy is located, right? If you can't be bothered, then neither can I. The next time you try to pull this crap on me, I will simply transfer your prescription to them. You'll already be aware of the price.

Wednesday, November 5, 2014

It's Not Supposed to be Like This

Where do people get their irrational expectations?
Why do people believe what they have come to believe?
Why is it MY fault that what YOU believe is so damn wrong?

Why can I not go to the gas station and trade a live chicken and some eggs for a couple gallons of gas?
Why does a new Xbox 360 not cost $11.29?
Why is the Earth not flat? (Yes, some people still believe it is...)

One of my favourite words to use at work is "baffle", in its many forms.
People baffle me. I am baffled by their questions. Certain situations are baffling.
Yesterday presented another of these baffling conversations. In this case, it was with a pet owner.

(Side note: many many many medications are currently undergoing the whole go-on-backorder-for-a-month-then-return-with-a-six-hundred-percent-price-markup. Many of these used to be pretty cheap and are often prescribed by veterinarians. This is one of those cases.)

Lost Her "Marbles": Why does this cost so much?
CP: Because it's not cheap.
LHM: Last time I got this I paid like $10.00 or something.
CP: Very precise. Can you tell me when this was?
LHM: Last time. I know it was.
CP: Uh-huh. The last time we filled this, prior to today, was August, 2013. That's over one year ago. I know there was a huge spike in the cost of this over that time. Do you give this to Lady Marbles all the time.
LHM: Oh yes. Every single day. We never miss a dose. She has to have it.
CP: Ok. So where have you been filling this?
LHM: Here. Always here.
CP: And you made 90 tablets last 450 days?
LHM: She has to have it.
CP: Then today it will cost you $35.00
LHM: "It's not supposed to be this way. It's supposed to be cheap."
CP: According to whom? Who said it was cheap? Because it is for a cat? Because "that's what you've always paid"? Gas cost less than $1.00 per gallon when I was in high school. Does that mean I'm grandfathered in to that price for the rest of my life? I do not understand your complaint of "It's supposed to be cheap". Please explain.
LHM: She has to have it.
CP: Yes, Poor Pussy. You have yet to answer any of my questions so far. You dodge them as well as a seasoned politician running for reelection. Prices go up. Caring for pets is not cheap. Would it help if I explained this is a 180 day supply? It works out to less than $6.00 per month. I could charge you $10.00 if you'd like...but I will only be able to give you 6 weeks of medication.
LHM: No. I guess I'll get this. I just don't understand why it costs so much. This isn't how it's supposed to be.

(The whole time I kept picturing Switch's death in The Matrix: "Not like this. Not like this.")

Monday, November 3, 2014

Check Baby Check Baby 1, 2, 3, 4...

...okay, one is all I need.
I checked my cheque-book for cheques the other day before I went shopping. This was a trip to a retailer that accepts only cash or cheque so I wanted to make sure I was prepared. I noticed I was down to my last cheque. Briefly I considered walking out the door with my single cheque in hand. It occurred to me I might make a mistake. I could lose the cheque. I could make it out to the wrong place or for the wrong amount. A need may arise where I find myself going back into the store to purchase something I had forgotten or that I broke in the parking lot. The point is that I wanted to be prepared for any possible outcome whereby one cheque may not suffice.

...and then I thought of my pharmacy. It happens all too often, but we do have this one Vicious Twat who seeks out ways to get under our skin. She comes to the pharmacy at 8:58 with multiple refills and expects to wait when she knows we close in 2 minutes. She complains if we attempt to scold her for any of her misbehaving. Her greatest coup so far has got to be the "I only have one cheque" routine. She employs it with every visit. You all know it. It goes like this:

VT: Can you ring all my other crap here too?
CP: Nope. Too much crap. Take it up front. That's their job.
VT: But I only brought one cheque.
CP: Then you can go up front, ask them to allow you to overwrite the cheque for the exact amount of your prescriptions, which in this case is $53.00, and then you can bring that cash to me, we will call your debt settled, and you can go on your merry way.
VT: That's too much work and I'd have to go all the way up front then walk back here with my groceries.
CP: Or you could take them to your car, then come back.
VT: That's even more walking.
CP: You could get a scooter from up front and drive with malicious intent through the aisles on your way back here.
VT: But you're closing now.
CP: Correction. We already closed and thanks to you and your shenanigans, again, there are still 4 people in line waiting their turn. It would be different if you didn't do this to us every time you visit. It would be different if you hadn't filed a complaint against the nicest, quietest tech in my entire pharmacy because she politely mentioned the above scenario as an option to you and you had the nerve to get offended. It would be different if I didn't have somewhere to be at 9pm tonight. It would be different if if I could get The Powers That Be to kick your ass out of my store. As it stands, we are at quite the impasse. Here is how this will work. I will not accept your single cheque theory. In fact, I'd like to look in your cheque-book and verify there truly is only one cheque remaining. Besides, who tears out one single cheque? I will wait on every other patient behind you until my line ends. If by that time you have not come up with some other form of payment, I will close and lock my last gate for the night. At this point you will be faced with the following situation. You will be forced to take your own groceries up front, pay for them with your last, lonely cheque and go home. You must then return tomorrow with another cheque, or some other form of payment, and pick up your prescriptions which will still cost you $53.00. I shall leave it up to you but please move over so I can attend to all of the smiling faces behind you who also think you're being a rather snooty bitch.