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Friday, August 28, 2015


No one knows the value of a prescription medicine. If we want to improve healthcare, we need to revisit our approach to pricing.
Everyone knows how much a gallon of milk is worth. And a gallon of gas. The harder something is to produce, or the harder to find, the more expensive it becomes. Think lobster (outside of Maine), caviar, truffles, Kobe Beef, Lamborghinis, etc.
Thanks to insurances, no one can appreciate the true value of a prescription medication. Let's develop a chart and pricing scheme for illnesses. The more common your disease and the easier to treat, the cheaper your medication.
We could introduce tiers to each classification.
Infections: A. General, B. Complicated, C. Lethal
Heart Disease: A. Basic, B. Complicated, C: Imminent Death
Diabetes: A. Madonna (Borderline), B. Illegal Immigrant (Over the borderline)

I think we need to publish a list of costs...Acquisition Costs (AC).
American Healthcare (weigh in if your country is different) needs to use a better pricing scheme than Average Wholesaler Price (AWP) when looking at costs of medications.
Why do some companies consider Generic Zofran (Ondansetron) to be a specialty drug? Cost.
AWP is listed around $700.00 while AC (the cost the pharmacy paid for it) is closer to $4.00 for a bottle of 30 tablets.
Insurances require prior authorizations on this due to cost.
Make healthcare more affordable. Charge $20.00. That's $10.00 for the basic cost to fill a prescription with NO drug in it, plus the price you paid, plus a $6.00 dispensing fee.

Wednesday, August 19, 2015

Better to Give Than to Receive

...or so the saying goes. In the pharmacy world, this is often accurate.
Sometimes it is for insurance reasons.
Sometimes it's a relocation.
Sometimes it's because I'm an asshole.
Sometimes it's because the patient is an asshole.
Either way, the initial optimism and joy and thinking to yourself "boom! script growth, baby!" is quickly met with the harsh reality of the pain those scripts will cause you.

Just Another Cynical Pharmacist Openly Thrilled: This is the pharmacist. May I help you?
CP: CP calling for some transfers. You really busy?
JACPOT: Time is relative, my friend. Sounds like more than a few.
CP: I have 8 for you. All for one person.
JACPOT: Any chance you were given numbers?
CP: Any chance Sunderland win the EPL this season?
JACPOT: Right. Who we got?
CP: Last name Baggins. First name Douche.
JACPOT: What? Really?
CP: Um. Yes.
JACPOT: (loudly announcing to rest of staff, rather muffled) ...seriously! she's transferring. Yeah, no shit! Oh this is news most welcome. Hooray!
CP: So I take it...
JACPOT: ...Phew. Hey everyone. I'm buying tonight!
CP: Well she sounds like an old sailor, port to port. How long did it take you to get rid of her?
JACPOT: About 3 months of pure hell.
CP: Well once I have these 8 copies, you can start the clock on me.
JACPOT: Good luck! (and somewhere in the background, I could swear I heard Munchkins singing...ding dong the witch is dead.)

Tuesday, August 11, 2015


Something about the celebratory nature of an anniversary that makes one reminisce about the good ole days. There are gifts to buy, cards to send, hugs and kisses to be shared by all.
Somehow, the annual expiration of one's prescription does not qualify for this sort of fete.

Why, then, do people complain we did not call them when their prescriptions expired?
Should we have an obituary section in the local paper, or perhaps on our website mourning the passing of these refills into the land of insignificance? Should they appear on the eve of their demise?
We already know people do not pay attention to...anything really.
Silence your cell phone alerts during movies? They're talking to YOU. Yes, you on the phone right now, oh never mind.
Medication Pickup Reminders? Patients complain they never got the 7 calls we made in the last week.
Refill Reminders? Patients complain they didn't listen to the message or they weren't out when we called the first 4 times.
Text alerts? Patients ignore them.
Email Reminders? Must have been lost in their spam folders.

It's not as if we don't put an expiration date on the bottle itself. You know, the bottle the patient has to physically touch each time they wish to take a dose of said medication. (oh wait, what? we do do that? never mind.)
Remember, you can give a person an education, you just can't make him take it.

Thursday, August 6, 2015

It Matters Not

Cat, dog, beaver, monkey, rat, snake. It does not matter to me. I have filled prescriptions for these and many more animals. People love their pets. They are quite passionate about their non-human friends. This tends to make some of them a little more out of touch than one might expect, say, a normal parent to be. Bear with me.

I had this conversation multiple times my last weekend so it's not an isolated occurrence, as most of you will be able to attest. (...and I had another last night.)

Fiercely Enraged Learning It's Now Expensive: I am here to pick up the prescription for My Precious. 
CP: Peachy. That'll be $46.99
FELINE: (Incredulously) WHAT? IT'S FOR A CAT!
CP: And?
FELINE: It's for a cat!
CP: You keep saying that as if you think you are a JEDI. I am a retail pharmacist. Mind tricks don't work on me.
FELINE: (More indignantly now) But it's for a CAT!
CP: I don't care. 
FELINE: What do you mean? 
CP: Should it cost less because it's for a cat? You are at a human pharmacy picking up a human medication that will be used on a cat. Its use does not dictate its price. If that were the case, different indications for different medications would warrant a pricing flow chart. 
FELINE: So I have to pay the same? 
CP: If you were taking this medication and, like your unemployed cat had no insurance, I would charge you the same price to take it as well. The medication does not know who or what is taking it. I don't get charged less to purchase chicken wire because I'm using it to make little prisons for my mini-voodoo doll collection of pharmacy CEOs instead of making chicken coops.

Wednesday, August 5, 2015

Deal(er) With It

I wonder if people treat their Street Dealers with the same courtesies as they do their professional, legal dealers.

1. Did you make this batch of Meth in an old Mt. Dew bottle? I can't take the batches made in Coke or RC bottles.
2. What brand of baby powder did you use to cut my coke? It better not be that store-brand stuff. I want the real Johnson's.
3. My marijuana buds had little hairs on them last time. Can I get the ones without the little hairs? They creep me out. I think I'm smoking little furry spiders.
4. My crack rocks are different sizes this time. Are you sure you gave me crack and not crystal meth?
5. Can I get the Ecstasy with the pictures of leprechauns on them? The ones with Hello Kitty made me too thirsty.
6. Is this one of those bad batches of heroin that's going around? I had that the last time and it damn near killed. It must be generic. I think I'm allergic to it.
7. Where were these drugs made? I don't want any from Colombia. I heard they use drug mules and my last batch tasted like shit. I only want drugs that are made in America!
SD: Technically, they are Made in America. Colombia is in America, albeit SOUTH America. If you want to show 'Murican Pride, perhaps you should insist on "Made in the USA".

Tuesday, August 4, 2015

It's Revolutionary!

The punchline to today's joke is: ...and that's how you get a dermatologist turned on.

I was watching the telly, minding my own, when suddenly I saw balloons. 
I like balloons. But not these. 
These were no ordinary red spheres of helium. 
No. They were metaphorical orbs of latex. 
I watched with interest trying to determine into which new prescription drug advert I may have inadvertently stumbled. 
Would it be something life-altering? A real game-changer? Something revolutionary? Something to better the human race? 
Hopes quickly faded as the balloons in my mind burst like the teenager's acne they were representing onscreen. 
#Onexton was the medication; another "me-too" in the arsenal of dermatologists' acne treatments. Their cache already includes Benzaclin, Duac, and Acanya so why not one more? 

I'll tell you. Brand Names and Patents. 
Want to woo the local dermatologist? Make an appointment as a drug rep. Walk into her office with flashy discount cards and while she's listening to your sales pitch, sidle up behind her, put your lips next to her ear so they brush ever so delicately against her skin and whisper: "Brand. Name. Only." and "Discount Card".

...and that's how you get a dermatologist turned on.

Monday, August 3, 2015

Don't Leave a Message After the Beep

The whole reason for the existence of an answering machine is to accept phone calls and gather messages when you can't be there to answer them in person. The whole point of voicemail is the same. It's like mail, only a verbal version, like audio books. If the reason for their being is to provide you with a message, should you not heed it? Should you not at least listen to it?

Calling a pharmacy after receiving a voicemail without actually listening to the voicemail, is the same as calling the person who sent you an email, without having actually read the email, and asking, "What's up? I see you emailed me. What did you need?".

Apparently, the only way to get through to people, is to leave them multiple messages.
"Hi. This is CP's Pharmacy calling. Listen to the next message we are going to leave."
"Hi. Here's the message. Don't come down here! We don't have your medication in stock. Come tomorrow!"
"Hi. CP again. Make sure you listen to the other messages. Very important."
"Hi. Don't call us. Don't come down here. Wait until tomorrow. Don't waste our time."
"Hi. We've left you 5 messages now. I'd better not see you until tomorrow, or else."

Maybe we could treat them as they treat us. When patients call in, or stop by in person, we can just ignore everything they say. Maybe pretend to have an absence seizure and blink off into space before saying: "Sorry. I was too busy doing other things. I didn't listen to a single word you just said. Why are you here? Why are you calling me?"

Better yet...
CP: Hey, I see we have 36 refills in our queue this morning. They all came after we closed. Let's call each person and ask what they need refilled, when they need it, and what else they may have wanted.
UberTech: I like it. Ooh. Let's role play. You be the patient.
CP: Hello?
UT: Yes, Is this Mr. Gozinya?
CP: Call me Peter.
UT: Okay, Peter. I see you called in a refill last night.
CP: Uh-huh.
UT: Okay. What did you need refilled?
CP: I left it on the computer. I typed it on the phone.
UT: Oh. I saw your name on our list but didn't actually look at the drug or prescription number. Can you give it to me again?
CP: No. I threw away the old bottle as soon as I called it to you.
UT: I see. I see. Would your wife know what it was? Maybe one of your kids there? Or one of the dogs I hear in the background? Ooh! The parrot I hear squawking?
CP: No. Isn't that the point of me leaving it on your computer? So I don't have to worry about it anymore?
UT: You would think so, but never underestimate the power of laziness and stupidity to lower the bar on themselves.