Facebook and Twitter

and follow my blog on Twitter @pharmacynic to receive notifications on new posts.

Thursday, May 30, 2019


ME: What's got your knickers in a twist today, CP?
MYSELF: Or your diapers in a bunch?
CP: People.
ME: No shit, Sherlock. What, specifically, is chafing today?
CP: This guy. . .

CP: How may I set myself up to be bullied by you today?
Needlessly Enjoys Antagonizing, Needling, Denigrating Every Retailer That Has A Life: I need my prescription now.
CP: Swell. So do the other people just milling about out there. They're certainly not here for the atmosphere.
NEANDERTHAL: Not my problem. I'm on break and have other things to do.
CP: Most excellent. Perhaps you plan to treat the others with whom you interact as well as you have me.
NEANDERTHAL: I still need to pick up my lunch.
CP: Lucky you. I haven't peed in 9 hours.
CP: I made it 15 hours yesterday. My bladder is better than yours.
NEANDERTHAL: Not my problem. You knew what you were getting into.

MYSELF: Oh no he didn't!
CP: He did.
ME: You got pissed? lol!
CP: Well, I'd already thought about this as people like to throw this around from time to time as if it's an argument-ending trump card. That's when my mouth took over and bypassed my brain.
MYSELF: Uh-oh.

NEANDERTHAL: You knew what you were getting into.
CP: Did I?
NEANDERTHAL: Yes! It was your choice.
CP: Not really. I'm pretty sure when I was in 8th grade and watched the nice pharmacist discuss her profession, she didn't mention bladder capacity. When I researched the profession in my high school library (no internet yet, this was a real room with books!), bladder volume was not mentioned. In college, during my formative years, of all the classes in which I enrolled and attended, not one was on  the merits of urine collection. There were no tests on waiting to whizz. (Although I did practise during the Campus Party elective so I'm sure this helped.) In every job description I have ever read, there is nary a mention, nor whisper, of unusually unyielding urethral sphincters. There was no Superman description-"able to leap tall buildings, count by fives and hold it for 10-18 hours at a time"! In other words, no, I did not know what I was getting into. Are you trying to tell me pharmacists are not allowed to micturate? Anyway, what does it matter? With that being said, now that I have discussed it, I feel the need; the need to pee. Scuzati-ma.
NEANDERTHAL: But I need my prescription.
CP: Bladder over bully. BRB.
NEANDERTHAL: I need to get back to work.
CP: And I need to eat. You want to get me started on that discussion next? Or about how college ill-prepared me, and my job description mentions not the requirement that I also transmogrify into a dromedary when I come to work? How much time is left on your break?
NEANDERTHAL: You are the devil incarnate.
CP: Thanks for the compliment. Next time, just wait in line like everyone or I shall taunt you a second time!



CP: Welcome to CP's Pill Palace where we carry lots of medications. How may I help you?
Fussy Old Lady Likes Yelling: I am looking for Prevacid.
CP: <walks her out to "Aisle of Acid"> Here is our selection.
FOLLY: I do not see Prevacid.
CP: I have the Lansoprazole in our store brand. It is quite good.
FOLLY: No. I need the actual stuff.
CP: Well, unfortunately, it is unavailable.
FOLLY: But I need it.
CP: Oh, why didn't you just say that? In that case. . . it's still unavailable.
FOLLY: Why don't you have it?
CP: No one does. It was recalled last fall.
FOLLY: I've been to CVS, Rite Aid, Walmart, and a few grocery stores and no one has it!
CP: Have you asked them why? Or did you just decide to pick on me?
FOLLY: I got tired of looking so I asked you.
CP: Awesome. Anyway, no one has it because it is unavailable. There was a safety recall. It has not been on shelves since last September.
FOLLY: Well I guess I'll just keep looking.
CP: Apparently your symptoms are not that serious if you are stubborn enough to continue looking for a brand name product for near on 10 months. Perhaps give the store brand the old college try?
FOLLY: Nope. I need brand.
CP: Perhaps get a prescription from your prescriber?
FOLLY: No. This is the only one that works.
CP: Remember within the last decade when MAALOX and Mylanta were unavailable for over 3 years? The only alternative was to buy the store brands. Most people finally relented and purchased these only to discover that they were, in fact, exactly the same! Not only were they the same but they worked the same as the brand. (Some reports at the time had customers claiming they even worked better <gasp!>.)
FOLLY: I don't care. I'm going to keep looking.
CP: Good luck with that. Just please do me a favour.
FOLLY: What?
CP: Don't bother the pharmacist with this wherever you stop next.
CP: Because she is going to tell you the same thing and it isn't fair for her to have the same, circumlocutional discussion with you.
FOLLY: Thanks for wasting my time.
CP: Any time. It's what I do best. Remember, you can give someone an education, but you can't make her take it.

Wednesday, May 29, 2019

Cost vs. Cost

ME: What is today's lesson? 
MYSELF: Hippopotomonstrosesquippedaliophobia is the fear of long words. 
ME: No. I mean, yes, that's correct, but I was asking CP. 
CP: Cost differences. 
MYSELF: <zzzzzzzzz>
CP: As in expectations versus reality. Or actuality versus perception, more like.
ME: Okay. I'll bite. Do we need to follow "MYSELF's" lead and define words for everyone?
CP: No. I trust they'll follow.
MYSELF: On with the show.

CP: Thanks for calling CP, head Pill Pauper, how may I help you?
Pt: I would like to know how much my medication will cost.
CP: Got it. For today's entree, we have prepared for you a 90 days supply of the finest 5mg Eliquis available. For such an exquisite pheast, you will only be charged $135.00.
Pt: Apparently my insurance didn't cover any of it, then? That's a shame. And I pay them so much money.
CP: They actually are covering a large part of the cost.
Pt: Obviously they're not if it's that expensive.
CP: You have to be careful. Perhaps you don't understand.
Pt: Oh, I totally understand. My insurance is worthless.
CP: Not exactly. You mustn't confuse "expensive" with "not covered". To you, $135.00 for 90 days seems expensive. If we compare that with the actual, cash paying, or coupon-aided, price, I would have quoted you around $1500.00 for the same 90 days. I can take this down to a 30 days supply, which will be a third the price, or $45.00. The cost is the same, just paid more frequently. In this case, it's spread over 12 months as opposed to 4 quarterly payments.
Pt: Wow. So they didn't cover much. I guess I'll take the monthly installments as opposed to the lump sum.
CP: Again, they covered ~90% of the cost.

ME: What was the lesson you were trying to teach?
CP: With our pricing system in America, no one understands cost. People have expectations of a number. If the reality of the actual number is outside of their expectation, then something is wrong and they blame either their insurance or the pharmacy.
MYSELF: I'm guessing you're not even going to attempt to add value to this equation.
CP: No. It would be a farce for me to explain it. It's fairly simple for us to compare related products and place value on them. What differentiates the gaming consoles on the market? Blu-Ray players? Pasta? Deli Meats? Within their respective groups, you are able to compare and contrast the similarities and differences. Prices are similar or wildly different but you are able to understand and explain why and how.
ME: I'll take Capocollo and Prosciutto and Soppressata for my charcuterie, please.
MYSELF: And you'll pay for it.
CP: Many will say it's expensive. Others, a luxury.
ME: But Eliquis is not a luxury.
CP: No. But you cannot compare the price to any other, similar product. You can't compare the Prosciutto to a Playstation anymore than you can compare Eliquis to Hydrochlorothiazide.
MYSELF: Unless you compare within the class itself, provided more than once product is available.
CP: Unfortunately, that comparison has already been made, by the insurance company as part of their formulary.
ME: Which means they can either pay their formulary copay or, if the drug requires and receives prior authorisation, the higher, non-formulary copay.
CP: Right. Simply put, you cannot put a price on your health and, again, "expensive" is not the same as "not covered". It often has more to do with the plan you selected. (Think of choosing the high deductible plan for your auto protection. The more or less liability, collision, or property coverage you choose, the higher or lower your copays. Same principle.)
ME: What is your wish for all patients out there?
CP: People seem to understand their auto insurance premiums and deductibles and spend a lot of time  researching the best deals. They should read and understand the health benefits they select.
MYSELF: Especially since they will be using their health insurance much more than they will their auto or home policies.


Friday, May 24, 2019

I Have Insurance - If The Real World Worked. . .

CP: Do we have insurance?
ME: You know we do.
MYSELF: What type, specifically?
CP: Good question.
ME: Home?
ME: Auto?
MYSELF: Of course.
CP: Homeowners?
ME: Medical? Dental? Vision? Prescription?
CP: Life? Professional?
MYSELF: Yes and Yes. . . Especially in this profession.
ME: What's your point?
CP: Have you ever had to use it?
ME: Yes.
MYSELF: I hand someone a card or give them the information from the card.
CP: What happens then?
ME: Usually they tell me an amount to pay or send me a bill.
CP: Okay. Then what of you do?
MYSELF: Pay it!
CP: When you're standing at the doctor's office, or the ER, or speaking with your auto or homeowners representative, you don't question anything?
ME: No. They give me an amount and I pay it. It's a fairly straightforward, seamless transaction.
CP: Then why is pharmacy different?
MYSELF: What's the number one quote we hear from patients at the counter when they are presented  their copays?
ME: I. Have. Insurance!
CP: Right. As if that will erase everything. POOF! Copay be gone!
MYSELF: And it matters not if their copay is $0.13 or $13.13 or $1300.00. I. HAVE. INSURANCE! is waved around as if summoning the magical copay phairy to erase the balance.
ME: You know what's worse than a patient at the counter looking you dead in the eye and saying "Insurance. Insurance! I have insurance"?
CP: Standing at the counter when presented with a copay and simply, slowly, uttering 3 syllables: "Good. R. X.".
MYSELF: Yeah. Speaking of magic incantations.
CP: I think from now on, when people's response is either "Insurance" or "GoodRx", I am going to reply with "Stay Golden, Pony Boy".
MYSELF: It will be worth it for the confused looks.
CP: Sorry, I thought we were just throwing random words and quotes at each other, like a rap battle. "You say insurance, I say a quote."
ME: "Insurance"
CP: "Now is the winter of our discontent."
MYSELF: "Insurance!"
CP: "Forty-two!"
ME: "Insurance!"
CP: "All this pain is an illusion."
ME: I think you lost them all by now.
CP: Well, negotiations were short.

Tuesday, May 21, 2019

More Phun With Dick And Jane

Jane is a pharmacist.
Dick is a patient. 

Jane: Hello. May I help you? 
Dick: Yes. I am here to <phone rings> pick up my prescription. 
Jane: And the name? 
Dick: <phone rings> Dick. 
Jane: Okay. Let me find that. 
Dick: <answers phone, loudly> "sorry, yeah, just picking up my prescription at the pharmacy. yeah, sorry, hold on, the pharmacy lady is back." 
Jane: I have a few things to review with you about your new medication. 
Dick: <yeah, sorry, hang on> Which one? 
Jane: Valtrex. 
Dick: What's it for? 
Jane: The Herp. 
Dick: Can't you see I'm on the phone? That's private. 
Jane: You know that just because the phone rings, it does not mean you need to answer it, right? You revoked HIPAA when you invited a third party into the conversation. 



Jane is a pharmacist. 
Dick is a patient. 

Dick: Hello? 
Jane: This is CP Jane calling from your pharmacy. 
Dick: Okay. What do you need? 
Jane: I am calling to see if you are going to pick up your medication that has been here for 10 days.
Dick: I. AM. AT. A. FUNERAL! You picked a fine time to bother me. Have you no shame? 
Jane: Sorry, my store phone didn't come with the missile guidance system that allows me to target everyone's location. Seriously though. Who takes a phone to a phuneral? Better yet, who ANSWERS a phone at a phuneral? You do realise that just because it rings, does not require you to answer it. 



Jane is a pharmacist. 
Dick is a patient. 

Jane: I have 3 prescriptions for you. 
Dick: Okay. <answers phone in car via bluetooth>
Jane: Your total is $5.29. 
Voice In Car Talking Over Radio Is Annoying: What do you want on your pizza?
Dick: <hands over card> Here you go. 
Jane: I like green olives and bacon. 
VICTORIA: Who was that?
Dick: The pharmacist. 
Jane: I like pizza. 
Dick; She was talking to me. 
Jane: I wasn't sure. Since you felt the need to answer while we engaged in a personal transaction, I thought this was a conference call. Maybe you'll drop me a slice. 
Dick: No. 
Jane: Okay. Well with your new cholesterol medication, you need to cut down on the bacon and meats and cheeses. Perhaps a sardine and avocado pizza would befit your diagnosis. 
Dick: Don't talk about my medication while I'm on the phone. 
Jane: Unlike you, I have an obligation to discuss this. In fact, I am required to discuss it with you. Next time the phone rings, consider not answering it. Texting would have avoided this. Seriously though, avocado and sardines. Try it. 


Sunday, May 19, 2019

Dick And Jane

Jane is a pharmacist.
Dick is a patient.

<at the drive-thru>

Jane: Hello. How may I help you today?
Dick: I need to pick up my prescription.
Jane: Okay, but first I'm going to have to ask you to put out your cigarette.
Dick: Why?
Jane: Well, there are 3 No Smoking signs clearly posted on my windows and the exterior wall.
Dick: So?
Jane: Some of our staff have asthma as well as allergies to smoke. The smoke also wafts through the air on the cross breeze and directly to my counter. We have patients in the store who have asthma, allergies, emphysema, and COPD and it can affect them.
Dick: So? I have COPD too.
Jane: I wonder why.


Monday, May 13, 2019

Beat The Clock

Why pharmacy is, and should not be, like a cooking show. (Or taking an exam.)
CP: Do you enjoy watching cooking shows?
ME: You know we do.
MYSELF: Top Chef, Cutthroat Kitchen, Worst Cooks, we love them all!
CP: How are they like the current practise of pharmacy?
ME: We all yell "order up!"?
MYSELF: We take things from the pantry and assemble them into finished products?
CP: I suppose that works. Not really where I was going with this, but . . .
ME: Oooh. Oooh. I know.
CP: Yes?
ME: We have timed challenges!
MYSELF: Dorque.
CP: Closer. In the cooking shows, there is a challenge. The challenge is indeed time. There is usually a sabotage or wrinkle thrown in and the contestants, from seasoned chefs to first-time kitchen visitors,  must negotiate these as well as completing the dish.
MYSELF: Yeah. They always seem to just throw something on the plate and often forget the sauce or the mushrooms.
CP: Even though they seemingly have enough time, things don't always work out in their favour and sacrifices have to be made.
ME: Good thing we don't work under those conditions.
MYSELF: <pssst> I think that's the point of this post. These are exactly the same conditions.
CP: Quite. Whereas the judges on the show may complain their chicken is undercooked, the potatoes are hard, or the one judge didn't get the crispy kale on her plate, these conditions will only result in a bad score. These results in pharmacy can be catastrophic and life-threatening.
ME: I am appalled! These are contests that push the contestants to work under pressure to create beautiful, delicious plates of food; for a prize and for the enjoyment of the public living vicariously through them and the judges.
MYSELF: It's chaos. For entertainment. Not exactly what one wants for their healthcare.
CP: If I weren't living it every day, I'd expect a reality TV host to jump out at any moment and coach me on how to behave. In fact, I assume they are taking notes from the minds of pharmacy CEOs:
give them normal work (Rx's to fill).
now time them
now cut that time in half and promise the public that new time
add in phone calls (answering)
remove tech help to handle the phone calls
add in a drive thru
remove tech help from drive thru
add in more work (check other stores' work)
check emails
make them respond to emails about not meeting times
add in phone calls (making)
remove RPh overlap
remove tech help
add in more work (conference calls to talk about the work not getting done)
remove food and drink and sanity breaks
add in complaints
make them answer complaints
add in metrics they can't meet
add in quotas
add in vaccinations
add in sales pitches (sell stupid crap from the "as seen on TV section")
have them juggle bottles while counting
have them counsel patients while twirling a baton
add in a person to come yell at them every 12 minutes

ME: WOW! That'd make a great show. I'd watch that.
ME: You can juggle?
CP: Yes.

Friday, May 10, 2019

Kim Kardashian

CP: I have an Rx ready for a Miss Carrion.
KK: That's not how it's pronounced. 
CP: It's spelled Kar-Ian. Carrion. 
KK: The dash is not silent. 
CP: So your name is. . . 
KK: Kar DASH ian. 


Wednesday, May 8, 2019

What's In A Name?

Lots of thought.
Or no thought.
As parents, there is an obligation on you when naming your child.
Make sure he/she is not going to have to deal with a life of misfortune thanks to your decision. (Marlana backwards? Anyone?)
(And let us keep in mind the poor souls with longer-and-more-complicated-than-necessary spellings who are forced to complete bubble tests. While they are still bubbling in their names, half the class have completed the exam.)

For those of you with cute, peculiar names or with atypical spellings, keep one thing in mind: In life, there is no one who is responsible for your name except your parent(s). Especially not the pharmacy staff.
Hate your name? Change it.
Hate the spelling? Change it.
Hate having to explain to everyone with whom you interact how to spell or pronounce your name? Change it.
Or, better yet, embrace it. It's beautiful. Just like you.
We know it's not your fault, but it IS your name. It's not my name.
If you know you have a unique spelling, please accept the fact and help us.
(Yes, there are lots of photos of Starbucks cups with beautiful attempts at names but I'd rather put it in to the computer correctly and be able to find you when needed.)

If you are a Thom instead of a Tom, tell us.
Same goes for Theresa or Teresa.
Alyx and Alex and Alixx?
Allison, Alison, Alyson.
Larry or Lawrence or Laurence?
Geri or Gerri or Jeri or Jerri or any of those with a "y"?
Don't even get me started on the K v C names-
Kathy/Cathy, Katherine, Kathryn, Katharyn, et al. (Same goes for Kaitlynn)
Kris, Chris, Criss, Khris?
Cindi, Cindy, Cyndy?
Caryn, Carin? Karen?

Seriously. I could do this all day. You get it. And I know people will add some of their favourites. Or favorites.

The point is, make life easier on everyone.
When picking up at the pharmacy, or anywhere you need to give your name, just tell us "it's-Jon-with-no-H". Save us all some grief and especially that awkward moment where we have to stare at you because we can't seem to locate you in the system. I can't possibly process all the permutations of  Kaitie, or Caitie, Katey, or Caity, or . . . ad infinitum.

If you have to tell me how to spell your name, this is not the first time you have encountered this.
Be polite.
"Erik with a K" is nice.
(Also, please pick one name and stick with it. "The doctor has me as Taylor but I go by Lyn with one N here at the pharmacy but my real name is TaQLynn with 2 N's and a silent Q. It's pronounced TAY LIN.")

Again, don't get mad because we do not know how to spell or pronounce your name. Take a second, spell it, pronounce it and we may remember it.
Yes, you are unique, just like everyone else.
You live with your name and I with mine.
Our interactions are limited to minutes per month and the name exchange is but seconds of this time. It is ephemeral and quickly forgotten, as when you provide your date of birth.


Monday, May 6, 2019

Good Rx - Good Phor Patients, Bad Phor Pharmacists

I was on a Netflix or Hulu binge recently and saw a GoodRx ad. Normally my blood pressure elevates only slightly during these ads but this one made my blood boil.
Phine. GoodRx helps patients save money. Not against that.
Phine. If pharmacies want insurance contracts we have to accept GoodRx. K.
My issue with this particular ad was in the way the actualisation of the savings was portrayed. People believe what they see with their eyes, not what knowledgeable, credible, professional people tell them. This means that after watching this ad, patients will make the assumption that the scenario portrayed in the ad is a mirror of real world practises.
It's not.
Phar phrom it.

What happened in the ad to ruffle your feathers, CP?
The patient approached the pharmacy counter and was told/shown a price by the pharmacist of $67.00. As the patient's look of shock took root, she realised she had a phone which she pulled out, found a price on GoodRx, then showed it to the pharmacist. The pharmacist, at the register, waved the phone in front of the register and the price on the screen magically dropped to $8.90.

Did you see it?
It instantly changed from $67.00 to $8.90. . . AT. THE. REGISTER!
(Yes. I realise it is a 30 second commercial. This does, however, reinforce the false belief that changing a copay and getting the discount is like handing a cashier a coupon at the grocery.) #ThatsNotHowItWorks!

Why is this bad, CP?
First, it trivialises what we do.
Second, it encourages bad behaviour in patients when it doesn't work exactly as shown in the commercial.

GoodRx is NOT a credit card.
GoodRx is NOT a register coupon.
In order to use the GoodRx discount (or any other pharmacy discount card, including manufacturer coupons) we have to change how we billed the prescription. This means we must edit the prescription and either add the new coupon or reverse the claim to your insurance and bill only the GoodRx plan. This is completed in the data entry system, not the register.
Once completed, the pharmacist must then reverify all of the information, including checking the prescription and the medication dispensed. (Sometimes the GoodRx coupons are for different quantities and now we must change what we dispensed.)

How does it work in reality, CP?
Patients can expect a wait.
Can I redo the prescription in 5 minutes? Sure.
Should they expect it each time? No.
Are they the only person who needs something done right now? Definitely not.
Their prescription gets put in line along with everyone else's.

How can they expedite the process?
Call ahead.
Call for the price BEFORE coming to the pharmacy.
When you check GoodRx online, call back with the billing information BEFORE coming to my counter.
This will allow me to process it when I can and run a smoother workflow in my store.
It's also not fair to other patients waiting on prescriptions for you to expect yours to be redone ahead of theirs. Sure it was finished, but you changed the completed order. (Imagine finishing placing your order at Arby's, sliding on down to the pickup window then deciding to change your order. You can't just sidle on back to the order window, cut in front of the line, and expect the staff to redo your order ahead of those waiting to place orders. Or maybe you do expect that which is why you suck.)

Either way, please complain to GoodRx that even though they have cheapened prescriptions for patients, they don't need to cheapen our profession along with it. We can handle that quite well on our own, TYVM.