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Friday, November 14, 2008

Had a call from some lady ...

wanting to compare what she paid this year to what she's paying for insurance (Medicare Part D). She thought that since she only paid about $300 the entire year that she should toss the plan, which had higher premiums than that. I counseled forbearance: Medicare is meant as a catastrophic plan, there if you need it when undergoing expensive treatments. I told her of a woman who did decide to terminate her plan, only to suffer a heart attack the very next month. She had to endure $1000 prescriptions per month until she was again eligible to sign on with Medicare.

She wasn't convinced. I mentioned something about too bad the U.S. didn't have a single-payer system such as Canada had. She assured me that that wasn't the way the country should head in. Said that Canadians are headed here in droves to get needed medical attention. I said that I really doubted that. No, she said; she had friends in Canada and apparently they were up in arms to get out of the blasted system.

I gave her some of my own ideas, basically saying that the system that our new president-elect has drawn up has a lot of promise. We in the end agreed to disagree.

http://www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i
The above link has some of the myths regarding the Canadian health system that should be required reading for anyone having anything to do with health in the U.S. (meaning, of course, everybody).

Wednesday, November 05, 2008

So Obama won ...

not my choice (I wrote in Steve Forbes), but maybe now we'll have a chance at national healthcare.

Thursday, October 16, 2008

So we're 29th in infant mortality...

is that a big deal? Guess not, by the reaction of everybody (the media, the two presidential candidates, President Bush, Congress).

I think it was in 1960 that we ranked 12th in the world. We've dropped 17 places in 48 years. And we outspend the average industrial nation by (drum roll ...) 100 percent! Double!

Here's my take on this. The fact that we spend double and still drop back in the pack with regards to health care is not unrelated. Should we spend more? How much more?

The thing is, we should be spending less. We spend more and ipso facto we get less. The two factors are not unrelated, in fact they are inversely related. The more we spend the less we get. Why? Because the money that we inject into the system goes to fund insurance companies, stock dividends, CEO salaries, etc. The more the insurance companies proliferate, the less care we get. Insurance companies are in the business of not helping us, but instead helping their stockholders and the managers of the companies. The less care that they have to pay for the more money they get. Simple really.

If we eliminated all but one health care company (or simply converted everyone to Medicare) we'd save gazillions of dollars. Our per capita spending would be cut in half, aligning our care with the rest of the world. Unfortunately the insurance companies would be out of business and no more dollars would flow toward Capitol Hill. And what would the insurance lobbyists do?

Well, who really cares. No, really--who really cares?

Sunday, October 12, 2008

You wanna see the manager? Ha! I am the manager!

So this really nice lady (sarcasm!) comes up to the counter just about as I'm putting down the gates, ready to close up the joint. I say, "May I help you? Do you have a pick-up?" She says, "K...N...I..." So I type her nicely enunciated letters into the pick-up screen and nothing comes up.
"Do you have a prescription here?" I ask. "K...N...I..." I try it again, thinking maybe I just hit the wrong key. Nothing. "What is it you're looking for?" "K...N...I..." "Why don't you come down here," I say, directing her to one of the PCs at the other end of the counter.
I look up her profile and Lo! eleven days earlier we had put up two prescriptions of generic Prozac for her. I explained that we can hold prescriptions for seven days and that after that they are put away.
"I have to be somewhere in half an hour! I had an emergency vacation--how was I supposed to know you put prescriptions back?" Right. We just hold prescriptions for ... infinity. All that lost inventory? So what? We like to write stuff off.
Anyway, I say, getting my dander up, "My time is worth just as much as your time. I have to be somewhere too. And no one is paying me to re-do your prescriptions. It's on my time."
"So you're not going to service your customer?" she says, adding that she wants to see the manager.
I tell her that I'm the manager, but that I am going to get her her prescriptions. I say, Ma'am, I am going to stay here ten minutes after closing to get you her prescriptions, on my dime, just so I can exceed your expectations!"
Then I made her wait fifteen.

Saturday, October 04, 2008

Where everybody knows your name ...

Remember that song from "Cheers"? It came to mind recently when a customer (a long-time customer) came up to the counter to retrieve her prescription. I recognized her, but when the day gets busy as it certainly was, I find it difficult to always match a name with the face. Sometimes I can come up with the first name, sometimes the surname, and sometimes neither. I usually get around the embarrassment by asking a date of birth. That can be a problem, however, when the gender is that of a female. Women can get quite ornery when asked a DOB (date of birth), especially when over the age of thirty-ish.

I asked for her name, thinking that that would be the lesser of two evils. Actually, I apologized, then asked for her name. Something like "I'm sorry, I can't remember your name."

She then remonstrated against my failure to recall her name. "Everybody else remembers my name!" she said.

Now, that may be true, and it may be an exaggeration (probably the latter). The thing is, I'm the supervising pharmacist, the manager of the department. I'm not supposed to spend a whole lot of time at the register. We happened to be down three people at the time, including a pharmacist on maternity leave, leaving me to fill in wherever needed, which happened to be at the register at that moment, waiting on this charming lady.

I couldn't resist being persnickety. "I'm sorry, I only have to remember a thousand people, that's all. Stupid of me, isn't it?" is all I could come up with, but the tone stated that I thought she was 1) stupid, and 2) a jerk.

But I was then a jerk, too. I wish I had handled it differently. I probably should have genuflected, apologized again, and maybe explained that with the store being so busy my brain just wasn't working as fast as it should have been. Then she most likely would say something like "Oh, that's OK; I understand."

Then again, maybe she'll pack her prescriptions off and move to the pharmacy down the street. I can only hope.

Wednesday, September 24, 2008

My all-time fav lines from real, live, authenticated customers:

  1. [Answering the phone] Hello, this is ******* pharmacy, how can I help you? [Customer] Are you guys open? [Duh, if I answer the phone then I'm here and I'm open]
  2. Is my prescription ready? Then I can pick it up? [Ah, but what is the secret password?]
  3. Can I use the restroom back there? [Of course you can--we wish to exceed your expectations after all--and help yourself to some of the samples on the shelf.]
  4. [Banging on the gate, which is closed and locked, and obviously so ... closed] Hey! You guys closed?
  5. Does this come in genetic?
  6. [Plunking the prescription down on the counter, seen for the first time for maybe 2 nanoseconds] How much is this going to cost me? [Well, let me just reach into my memory banks and, oh, here it is, $117.58 minus the -- what insurance?--12.789% discount plus the $3.78 dispensing fee ... but wait, on page 29 of the contract--which I have right in front of me by some weird lucky chance--I have to further discount the price since this is a tier two drug on the formulary, so ... wait, wait ... oh, nevermind.]
  7. I'd like this filled, please. I won't be able to pick it up though for three weeks. Will it be ready? [But of course, madam. We will merely put it in the storeroom for just such purposes as this. Do not worry yourself; we have ample room for keeping prescriptions for three, four, even five weeks--months, even. We are but your most humble servants, madam.]
  8. What do you mean you don't have a year's supply of Sprintec? You mean I have to wait? How long?
  9. It's so nice and sunny outside. You should get out there. [Fantasy moment: shutting the gate in her face and running outside ... before she picks up her prescription.]
  10. Now go on and enjoy you lunch! [Mentioned after she forced me to keep the gate open for ten, fifteen minutes after lunch break so that she could pick up the presciption she should've picked up yesterday.]

Saturday, September 20, 2008

... it's entirely illegal!

What happens is this: Some fellow traveller stops in and remarks how he needs a refill on his prescription. Unfortunately the prescription is either expired or is not refillable (a clue would have been to look at the label where it says "No more refills--contact your doctor"). What to do? Well, with the price of gas going up there aren't a lot of people willing to go home and then come back later on in the day, especially if they live in a rural district where a drive to the pharmacy might be half an hour or more. Nowadays it can take several days to get a refill on a prescription, so what I do is to give the poor bloke a couple of days worth of meds and send them on their way. I then fax the doc and when I get the prescription OK I then subtract the few tablets from the new fill. Simple, right? Everybody happy, right? Sure, except ...
it's entirely illegal.
No one gave me the right to give those pills. I'm essentially writing a prescription. But I do it anyway. And what's more, we all do it. Every pharmacist I've ever worked with does it. We're all thumbing our collective noses at the establishment.
And we're quite content in doing so.
Stick it to the man! Yeah!

Saturday, September 13, 2008

NYT: McCain barbs stir cries of distortion - The New York Times- msnbc.com

Now, normally I don't add non-health care news to my blog, but as this has, at the end of the article, some information about the Obama health care proposal, I thought I'd insert it.

But first I must reveal myself as a Republican, albeit one who supports truth and the American way, and as such cannot find anyone to support among the red staters. The blatant lies told by the McCain campaigners disgust me. There are so many I cannot place them all within the space of this blog. Suffice it for interested voters to go to Senator Obama's Web site devoted to the cause: http://my.barackobama.com/page/content/fightthesmearshome.

As to the NY Times article, McCain decries the Obama health care proposal as it would “force small businesses to cut jobs and reduce wages and force families into a government-run health care system where a bureaucrat stands between you and your doctor.”

Get a clue, McCain. It's already happened. If you had the crappy health care everyone else has (except for government bureaucrats) you'd know that some bureaucrat already makes the real decisions as to what medicine to give, what tests to allow, and what everyone gets paid.

Wednesday, September 10, 2008

Top ten secrets you should know about visiting your pharmacy:

  1. The antibiotic you're about to get probably isn't right for you. As stated in the Chicago Sun-Times article (http://www.suntimes.com/lifestyles/health/1152328,CST-NWS-health09.article) half of the prescriptions written for us when we go to the doctor for colds are … worthless. If you have a cold then you have a virus. An antibiotic does not work for a virus. Simple, huh? But you sure feel better getting that prescription don't you? Otherwise you'd think you spent a couple hours in the waiting room for nothing. But that's really what you did. Shame on the doc who is writing these things, increasing resistance in the bio world so that when we get one of those superbugs we won't have anything that works.
  2. When the doctor or nurse tells you what something costs … don't listen. They don't know what they're talking about.
  3. Despite the increasing use of PDAs (Personal Digital Assistants or small handheld computers) for writing prescriptions, which could tell the prescriber if something will be covered by your insurance, doctors simply don't know if you'll be able to fill what they are writing for. It's a crapshoot. Much of the time you'll get to the pharmacy (and how often does it turn out to be 6PM on a Friday or Saturday?) only to discover that your insurance thinks the drug is too expensive and so requires a prior authorization before they'll pay. Oh well.
  4. Having a prescription written for Over-The-Counter merchandise does not mean it will be covered by your insurance. Duh. They could write a prescription for socks but do you think BlueCross would pay for it?
  5. If you abuse narcotics your pharmacist knows it. You don't lie as well as you think you do. Tip-offs include notifying us as to how much you hate taking these things, and coming in about five seconds before we close (chances are that one is a forgery). And do you really think we haven't heard the one about spilling the Vicodin into the toilet? Another one is acting like we're long lost buddies. I'm not your buddy and I doubt I want to be.
  6. HIPAA privacy guidelines really are important and your privacy rights are guarded, but … your rudeness isn't. Come in and behave like a spoiled five-year-old and believe me, everybody in town will know it.
  7. Over-The-Counter stuff is pretty much worthless, at least at the dosing allowed (and many are dangerous and worthless at more than allowed dosing). Sudafed PE? Give it up. Simethicone for gas? Nope. Hydrocortisone cream? Too weak. Saw Palmetto? A big negatory. Weight loss products? Please. Children's cold syrups? Dangerous and proven ineffective anyway. Adult cough syrups? Not really dangerous, but still ineffective: honey works better. Pretty much everything in a pharmacy that really worked could be stocked on one four-foot shelf.
  8. The six years of pharmacy school are wasted. All the studying about M of A's (Mechanism of actions … usually unknown anyway), organic chemistry, medicinal chemistry, therapeutics, and all that, boil down to chasing prior authorizations and billing insurances. And ringing out customers at the cash register.
  9. Yes, sometimes pills drop onto the floor and yes we give them to you. Shocking, yes! Well, not really. Nothing is sterile you know.
  10. Pharmacist really can be trusted. I've never met a bunch of people more willing to help others at no expense to them than pharmacists. They'll give you free advice, free medicine (meaning they only charge you for the cost of the drugs, if that), a free medicine spoons. Who could ask for anything more (other than national health insurance)?
  11. Had to put this on in: Everyone—and I mean everyone—hates insurance.

Wednesday, September 03, 2008

New record ...

464 prescriptions filled on the day after Labor Day. Few people know this but the two busiest days in pharmacies are the days after Labor Day and Memorial Day. So if you like quick and snappy service ... don't show up at the counter on those days.

I hope I didn't make any mistakes yesterday, but I'm sure I did. In a 10 hour work day, that's 1.54 prescriptions every two minutes.

Remember that episode on "I Love Lucy," when she got a job in a chocolate factory? That's what pharmacy is like now, with prescriptions coming down the belt instead of chocolate. I do seem to remember she started to eat the ones she couldn't get into the box ...

Wednesday, August 13, 2008

How about we follow some of these people to their jobs?

I do so want to go up to somebody just as they're about to leave for lunch and say something like, "But I just have to pick up a geology sample." OK, so there aren't that many geologists out there, but you get the point. If someone is leaving for lunch you don't go up to them ask for them to keep open just because you couldn't plan your errand better. Your lack of planning shouldn't ruin my day.

And another thing: If someone makes a stupid mistake and you run to the store manager or district manager and complain ... that makes you a delinquent. That's right. You don't try and ruin a person's life and career over some piddly little error. If some new person is on the job and cannot find where some product is (because they are new) then running off to complain should be seen as a character flaw. I don't even care if that person said something to offend you. Heck, everyone should be offended at least once a day. Get over it.

And stop ruining my lunch.

Friday, July 25, 2008

"Excuse me ...

but do you have shoehorns in the pharmacy?"

Well, that's a new one, I have to admit. No one has ever even mentioned the word "shoehorn" in a sentence before, that I can remember.

I may very well have identified a new disease: Pharmaceutical shopagnocis, a psychological ailment characterized by the metonymies of the department store (metonymy, you will recall from your eighth grade grammar lessons, is (from Webster's Collegiate Online)

a figure of speech consisting of the use of the name of one thing for that of another of which it is an attribute or with which it is associated (as “crown” in “lands belonging to the crown”).

What I think happens is that someone walks into the department store, happens on the pharmacy and remembering the last time they were in say, Rite Aid or Walgreens or CVS, they still think that everything in those stores is contained in our little section of a much larger store. Thus the shoehorn (which a normal, well-adjusted person might think is hanging on some shelf in a shoe department). The food section then moves within their minds into the pharmacy. So too, the Health and Beauty, the electronics, the--dare I postulate--the ladies' undergarments. ("Where are the stockings?" the unmedicated sick person asks).

This is why my little pharmacy becomes the catch-all of the store, from the service desk ("Can you tell me where the pet foods are?") to the, ahem, unmentionables.

Do we have shoehorn's in the pharmacy? Ma'am, please! What full-service drug store has not shoehorns within its confines? Do you think us backwoods? Right over by the sports cremes, and next to the brassieres.

Tuesday, July 22, 2008

I encounter quite a few personality types at work. Maybe all of 'em. How many types are there? Let's see …

There's the codger (think Walter from Jeff Dunham), the rich codger and the rich codger's wife. Middle-age guy undergoing crisis; middle-age woman undergoing peri-menopause; the young guy and cute girl; the woman with family; the guy without the family (may be married but usually shows up alone and can't remember the wife's birthday … or the kid's); the beautiful woman (by definition rare—usually found gathering in makeup aisle); the guy in the suit (also rare, as they feed in theaters and party rooms); the retired gent (who may be "the codger" or a separate class: the nice guy); the impatient lady (is it done yet? I have an appointment! My husband is out in the car! I have ice cream out in the car! My dog is out in the car!); the poor—and I mean dirt poor—lady who has a cab or bus waiting outside the store ("Can you hurry? I have a cab waiting for me.")

Kids are a separate species entirely. Some are tappers (tap-tap-tap on the counter: "Mom, why is he taking so long?"). Some are whiners, some are just cute.

Women, too, fall into different distinct sub-classes depending on dress: there is the teeny-bopper (who might be as old as twenty-five); the skank (usually has on an extremely low cut tank-top with some baseball logo tattooed on each breast, pregnant, but giving out her phone number); the beauty (elegantly dressed, curvaceous, coiffed, in heels, skirt and sweater—in summer she wears … oh who cares what she wears—she beautiful!); the older lady (your mom); the woman next door (be very careful).

And then there is my personal bĂȘte noire: The know-it-all. She tells me about the drugs I'm dispensing. She gives me medical advice. She gives me worldly advice. She postulates about my psychological state (when I have a day off, but my co-workers fill me in). And, of course, she means well. She is the one I wish would go away, transfer her scripts, and move. Anything. Just go away.

Saturday, July 12, 2008

It's so disgusting ...

when people take the wad of bills out of their pockets as they're paying for their prescriptions, and then proceed to lick their thumb, count off a few, then hand the money to me. Oh thank you, sir; thank you, madam. No, I don't mind a bit, sir, that I am handling your spittle. Glad to. It's a privilege. If only you'd given me your dirty snot rag as well, then my day would be complete.

Sunday, July 06, 2008

Today's my birthday ...

and while on the topic of birthdays, I'd like to mention one of my pet peeves. Not a day goes by when I am not faced with a man picking up a prescription for either his wife or one--or both of--his kids. Before handing over the medication we verify the date of birth of the patient, just so we know that 1) the person picking up the medicine is likely to be a representative of the patient and given instruction to do so, and 2) that we indeed have the right prescription in hand.

Simple enough, right? Wrong. You'll note I said earlier that it is a man picking up the prescription. The man does not know the date of birth of his wife. The man does not know the date of birth of this child. Many would say that this is an example of generalization, of stereotyping. Not so. While there are of course exceptions, the majority of men picking up prescriptions struggle mightily to come up with a date of birth for their loved ones.

Let me be clear: A man who does not know his child's date of birth is not a man. He is a boy. A man who does not know his wife's date of birth is no husband, but a slacker.

I don't think I've ever known a mother who did not know her child's date of birth. I know, many will be saying that that is no miracle, that it is likely that a mother undergoing birth pangs would remember it to her dying day. But that does not excuse the man. Not hardly. It is a travesty that so many men are so emotionally separated from their families that they do not know the most basic of details about them. It disgusts me.

Monday, June 30, 2008

What's it made of...

gold? Well, unless we're talking about a certain compound given for arthritis (aurothiomalate, or Myocrisin for short), then, no, not made of gold.

Oil, maybe. Heh, heh. (Actually, LCD, or coal tar, is a petroleum product but it is quite cheap--go figure.)

So, what to say to these people with such inquiring minds?

How about, "Here's the 1-800 number to Blanketyblankety Labs; why not ask them? And call me back and let me know what they say; I'm kind of curious, myself."

Drugs cost whatever the company that makes them determines they cost. Pretty simple, eh? What goes into the price? Well, research and development, certainly. That's the ol' R & D in the P & L. What else? Marketing. Marketing is actually a bigger slice of the pie than R & D. Why? Well, if you're the CEO of Company XYZ then you probably make a lot of "me-too" drugs, which is the way we pharmacy types designate drugs that really have no great advantage over all the others in that drug's class. Think of Motrin and Aleve (along with Orudis and aspirin). No great shakes either way you toss them. So what to do? You round up your creative, left-brain types and spin some ads. Along with them you round up the sales force posse and have them give some lunches and dinners to the docs. (By the way, I don't go along with the people who spell it doc's: 's is for possessives and some other rare instances for plurals. Ahem.) And then they like to show off at meetings and rent stadiums and such, which must cost a pretty penny.

Then there are the stockholders, those denizens of the financial deep (you and me, probably), demanding their piece of the brass ring.

And then there's the CEO and his minions.

The plants that house these minions, too, must be financial hogs. The equipment, as they say, ain't cheap.

Don't forget the lobbyists, those representatives of industry that serve to grease the wheels of justice and, er, ... let's call it what it is: self-serving, fat-as-hogs, re-election PACs of our heroic congressmen (and women).

So you see, this question is more complicated than it first appears. I have the feeling that many people think that the cost of the drug has a lot more to do with the ingredients (drug + lactose + talc + little bitty things) and the pharmacist's salary. Not so. Rite Aid once commissioned a study on the cost of filling a prescription minus the drug itself. That is, the cost of dispensing an empty vial. This was done in the late '90s. Even back then they found the cost about $6. Now it's probably more like $10. That's the salaries, the electricity, the computer stuff. The whole enchilada, as it were. So when you see some drug costing 128 smackeroos, it's not the pharmacy getting all greedy-like. Most drugs are sold as loss leaders, meaning the pharmacy loses money on them. The more expensive the drug, the less profit they make (it costs a lot to keep up a big pharmacy inventory). Most prescriptions are now filled with some third-party paying at least some portion of the drug cost. That puts a limit on the profit a pharmacy makes. We might fill a prescription for Drug X costing $103 and we might get $3 as a fee, but then they discount our bill by maybe 12 percent. (There are other areas that a pharmacy can make a profit, at the warehouse end, for instance.)

That's the reason why a lot of independent pharmacies are going out of business. They simply cannot make a profit. The big box stores can't either, but they can sell a lot of toothpaste to make up for it. A small independent cannot. As a matter of fact, if it tries to compete in that way, selling some of the same stuff that say, Walmart sells, or CVS, or Rite Aid then woe betide that Silly Sally. The only way to compete against the big boys is to do something they don't.

So what's the drug made of that causes it to be so expensive? Next time I'm asked that I think I'll just say, "Cat's whiskers and Billy Goat tails, sir." They'll like that just about as much as the truth.

Sunday, June 22, 2008

Thank God for Insurance...

O the humanity; O the irony. See, we shouldn't be thanking the insurance industry for anything. Nothing. Nada. Zero.

But inevitably someone comes in -- this happens on a daily basis -- thanking God for insurance. Of course, what they really mean to say is I'm so glad I don't have to pay $637.98 for my bottle of pills. (Pills, btw, are different than tablets or capsules: just a nitpick but a nitpick I just had to get out there.)

What these thankful people don't stop and realize is that the person in back of them isn't going to get their bottle of pills. No, the God-given insurance company that they have paid their money to is going to deny them because they need to take two capsules a day and they only allow one.
Doesn't matter if the doctor has already tried the one per day regimen. Doesn't matter that two per day works just fine.

Oh, and the person who was just ahead of that one who was so thankful? She left because she needed an anti-nausea tablet for her kid's chemo. Denied! No tablet for you! Next! Seems the insurance company from heaven felt the drug was too expensive for its stockholders. No soup for you!

So why did the insurance company pay for that other person, you remember, the one who was so thankful? She would have had to pay $637.98. Seems a lot for the company to pay. But what she didn't know was that they made a deal with Manufacturer XYZ, so that they only pay $98.98. Then they slap a high copay on the patient, say $50, thus getting a neat little profit, good product share in their drug class, and a thankful patient, to boot!

This used to be called payola in the music industry (a contraction of "pay" and "Victrola," btw) and bribery elsewhere, but if the government allows it it is called Good Business Practices.

Thank God for government!

Wednesday, June 18, 2008

Tea Tree oil is a great multipurpose treatment to use on a number of ailments. Whether you are looking to repel insects in your garden or if you are looking to clear up your acne, tea tree oil is a great alternative.

read more digg story

Amazing herbal remedy! Cures Acne! Kills Lice! Empties...

Pockets! (of your cash). Actually, it isn't terribly expensive, but my point is that this isn't exactly science that is being bandied about here. I am not saying tea tree oil is snake oil: there may be benefits to using tea tree oil. But where is the proof? And I'm not talking about what the neighbor said concerning her little Johnny's case of lice ("Here today, gone tomorrow! Amazing stuff. You got to get some!"). I want some double-blind study to look over.

If something is so great -- remember the early buzz on coral calcium? Cancer cure, anyone? -- then we should be able to show that it actually, undeniably, works. Show me the study.

Homeopathy is the greatest example of modern day snake oil being peddled about supposedly curing this and that, while being composed of mainly water (except the pills which are most likely lactose). I was just reading the Digg article above and the replies to same when I came across someone who cautioned (cautioned!) the use of tea tree oil. Seems that he or she was worried that such a powerful medicine might not be used properly and thereby could cause some harm by unknowing practitioners of herbal medicine (spoken with a hushed, but decidedly sinister whisper) simply unaware of how powerful a drug they have got hold of.

Well, I would hope so. I mean they might get a rash or something (from allergy). And if they put it in their hair it might, you know, smell bad.

So be careful out there, people. Please consult your homeopathic witchdoctor before using. And if pregnant or breast-feeding, well, just know it might stink a little.

Monday, June 09, 2008

"Pretty busy over there...

mind if I cash out here?" the guy says. Gee, nope. We were just sayin'--weren't we Sally (Sally over there is my technician, though heck, why would we be needin' a technician when we've got nuthin' to do I just cannot say)--that for the past two hours we done nuthin' but twiddle our thumbs. Mine's about to fall right off. Busy are they? I bet they are. Why they gots to cash out peoples like you and me and me and you and they just go on and on and on. We only have to answer the phone, call the insurance companies, call the doctors, call the hospital, fax the doctors, correct their mistakes, call back the doctors, call back the insurance companies, yell at the insurance companies, fill prescriptions (I like that part, personally)...and then we gots to ring all you fine folk out just like they do up at the front of the store.

Busy are they? Good. Son of a cabbage, that's just jimminy cricket good.

Thursday, May 29, 2008

Customer gives us a prescription to transfer into our pharmacy. Call said pharmacy. Busy signal. Busy again. Busy yet again. Customer comes back. Why isn't it done??? Um, busy signal. Customer goes away angry. Comes back five minutes later. I just called and I got through...the first time I called!
"Gee, wow. You're some really something with a phone," I think (but don't say). I call again, and get through. Transfer prescription. Tell her, "It'll be fifteen or twenty minutes." Disgusted and confused look. What?! She turns to her paramour. He said we have to wait. Why, he says. How do I know, she says. He's had my bottle for half an hour.
"I'll get it tomorrow," she says.
Whatever, I say.
Next day she comes in and when I tell her the copay is $25 she says, "What! The other pharmacy charges $3!"
I explain that I am only charging what her insurance says I need to charge, and that we don't price her prescription, her insurance does.
"So how do you explain that I only pay $3?"
"I can't." Wanted to say, "You're dreaming, lady."
Next day I get a call from the pharmacy from which I transferred the Rx originally. She needed to transfer it back. "Fine," I say. "By the way, what did she pay the last time she got this?"
"$25."
Huh. Big surprise.

Sunday, May 25, 2008

Another Memorial Day...

another whine. This will sound a tad insensitive, but I cannot stand to hear another senior citizen whine to me about how "the golden years" are anything but golden. For instance, I have this one lady who has had cancer recur several times, fighting it off each time. At each episode she can only bemoan her fragile state. Now, I agree, being sick, especially with an illness such as cancer, is no picnic. But after seeing a few of my customers--gems all--go through fatal illnesses with nary a whimper, teaching all who encounter them what it truly means to die gracefully, teaching us, really, how to die, I no longer have much patience with them. Especially on Memorial Day.

I want to ask them how many young men died not seeing their nineteenth, twentieth birthday, how many died struggling up some beach in Normandy, Sicily, Okinawa. They never saw their eightieth, seventieth, heck their thirtieth. How about a little humility, a little thankfulness, a little understanding that just having made it to the age of AARP is quite the gift, and one none of us truly deserves.

Saturday, May 24, 2008

Ah, another Memorial Day weekend...

spent working behind the counter. Do I mind? Of course not. My friends and enemies alike are spending it camping and having cookouts and such, but I feel they are missing the point. Memorial Day is a day of memories, of harking back to pay tribute to the fallen, of those who have sacrificed for our benefit. Work isn't necessarily fun, at least for most of us; we shouldn't just spend this holiday frolicking without a care, without a hint of the loss we all bear. Isn't that right. It is.

And while we're at it, I rather like to bathe in the fluorescent's gaze and the soft glow of the computer monitor. What I don't like is the constant whine and cringe inducing honk of the customer's rant:
"You should be outside; it's gorgeous!"
"If you can get out of here for an hour you're gonna love it!"
"Too bad you're stuck in here."

Actually, it wouldn't be that bad being stuck in here, except I have to listen to that crap. So shut up, people, and let me enjoy my Memorial Day.

Tuesday, May 20, 2008

Today's highlight...

A guy pays for a 27 cent --yes, $0.27-- prescription, with a check. He writes the check out (even though we print it out automatically, handing the check back to the customer) and then gives me the check which I then process. The check gets caught inside the register. I re-try. Re-try again. Finally, after describing my love for bank checks, I tell him I'll pay for his 27 cent prescription. Go. Get out of here. Buh-bye.

Thursday, May 15, 2008

I received a comment on my March 26th blog regarding the equal nature of generics to brand name drugs. The comment was as follows:

If generics and name brand prescription drugs are "identical," why do doctors overwhelming only use name brand drugs for their family?

That was an interesting question. I'm wondering if there is a factual basis to it, i.e. is it the questioner's opinion or is there some data that underlies his comment? My own experience with MD's, PA's, NP's, and dentists is that almost all get generics. Some do insist on brand, but I can reclassify these as retired, or nearing retirement age, and coming from a, shall we say, snooty neighborhood. My feeling is that they can afford the best, and so choose to shell out for the
brand, as only the top shelf is good enough for them.

Also, you have to take into account that drug companies fuel the doctor's larder with free (the magic word for doctors) brand drugs. Doctors are pretty much like everyone else: give them enough free samples and they will be yours forever. It's like doctors are walking through some great big grocery warehouse and the little old ladies handing out food samples are actually well-dressed, chatty drug salespeople. Would you like to try one of our newest Lipitors? Just out of the oven! The brand companies know this works, just like the food companies. And it's not just sampling: How many free lunches and dinners does it take to buy one's loyalty? Not many. Eventually--and it doesn't take long--doctors feel the brand stuff is superior.

There is another classification which they fall under: stupid. Anybody dumb enough to pay four times or more what the generic costs is a simpleton. I don't care if they can open your brain up and pluck a tumor out the size of a softball, they are still stupid in the arena of economics and, yes, even other areas of medicine, such as pharmaceuticals.

Most people don't know this, and most won't believe it simply because I tell them, but doctors simply don't know a lot about the drugs they prescribe. Oh, for a handful of drugs, the drugs that they rely on, yes they probably know a good deal, but outside that handful...watch out. They certainly would be surprised to know that upwards of 80% of generics are "branded" and made by the very companies that they feel are "top shelf".
Pet peeve #17...
calling the insurance company, inputting the pharmacy NPI number, the prescription number, the patient's ID number, hitting #3, hitting #1, hitting #2, holding, holding, only to hear this:
"Hello, my name is _______, may I have your NPI number? Prescription number? ID number? Thank you. I'm sorry, but this claim needs to be handled by our clinical line. I'll transfer you now. Is there anything else I may assist you with?"
Holding, holding, holding. Inputting the pharmacy NPI number, the prescription number, the patient's ID number, hitting #3, hitting #1, hitting#2, holdingholdingholding...then hearing:
"Hello, my name is_________, may I have your NPI number? Prescription number? ID number? Thank you. I'm sorry, but this claim needs prior authorization. Would you like that number? and is there anything else I can assist you with?"
No; but thank you for making our wait time for a prescription go from ten minutes to half and hour.

Wednesday, May 14, 2008

I am...
Captain Relion (as in rely on, get it?), force of good in the pharmacy universe, bringing the strong arm of Regulation and Law to the drug world. Bitten by the pharmacy bug (Arachnida apothicaricus) at the age of seventeen, Cap'n Relion has sacrificed his life and liberty in the face of unspeakable terrors...just to save a few lives. But what can only one lonely man do in the face of a hostile planet filled with egomaniac Doctor Evils and innocent, but unknowing patients (Homo idioticus)? It seems precious little, however the Good Cap'n has special powers which enable him to wipe medical incompetence off the map (or nearly so): Calligraphic vision, the ability to miraculously read any doctor's writing without need to call and verify, saving many precious seconds; Auto-insurance billing know-how, allowing our hero to simply know through his "pharmacy sense" what a person's insurance is...even when that person doesn't know him or her-self! Cap'n Relion also has the advantage of having a database brain giving him quite an advantage over his competition. He can recall at a nano-second all the interactions (how many drugs and herbs a person takes doesn't matter: he knows it all!) and adverse reactions any drug has or might have, individualized for any...individual. He's simply amazing! Why, just the other day a lady came up to his counter complaining about a bill she received from Medicare. Seems Medicare didn't know she had some other secondary coverage (because she didn't tell them?). Well, the Good Cap'n merely used his powers of Auto-insurance billing know-how and set her on her way (though she was still unhappy as she needed to pay the $135 deductible not covered by either plan and her other prescription needed prior authorization...But wait! Cap'n Relion also has Prior Authorization Powers obviating the need to call the doctor who then has to call the insurance company who transfers him to the clinical line who then puts him on hold only to say, Nein! Zis patient ees not to have zee drug!).

This world is not for the feint hearted...but fear not, for at least we have Cap'n Relion to count and stick and pour!

Saturday, April 26, 2008

When you stand...

at the counter ready to pay, fiddling around with you purse or jamming your hands in your pocket fumbling for change...we hate that! Can you possibly think that we have nothing better to do than wait patiently for you to add your change up? Just give us the bill and deal with it. I have 20 prescriptions waiting, ten people behind you waiting for their medicine, two calls on hold, and reports to do.

And while we're at it...

throw all your checks in the shredder. Checks are bogus and a waste of every one's time. Why do we still have checks? I haven't made out a check in a very long time. I pay with my debit card or my credit card. I don't need to stuff bills in my wallet and have loose change jangling in my pockets. I wish I knew how many lost hours have gone by standing there at the register waiting for someone to fill out their check. There is one good thing about checks: I can tell when someone is beginning Alzheimer's. A wonderful lady who would come in monthly for years, jotting down the information on the check, flipping it to us, then turns into someone who takes five minutes to arduously, meticulously filling it out like some exam she took sixty years ago. That tells us that something is wrong. But that is about the only good thing with checks. Throw the things out or at least leave them home.

And just give us the bills and let us get back to work.

Saturday, April 19, 2008

Ugh, the abortion question...
just wont go away. Pharmacists everywhere have been forced to make a moral decision regarding Plan B: Sell or don't sell. Which really means, sell or refer the sale to someone else thus bypassing you.

When the product came out (just an expensive high dosed birth control pill) I opted out. I felt that I just did not want to be involved in the possible aborting of some innocent kid. I know, I know--there are many of you who don't want to think of a fetus as a kid but "it" is and you'd know it if you ever cracked a biology text book--at least before they were rewritten by liberal fascists. Anyway that is how I felt: let someone else sell it and my conscience would be clear.

Well,I now sell it. It is going to be sold anyway so why put some girl through the embarrassment? I don't want to make her feel bad; she probably feels bad enough already. But the real kicker came when I thought through the entire process. What was going on in the girl's womb? Sperm meets egg (maybe), fertilization occurs (maybe), embryo attaches to lining (maybe). If the girl takes the Plan B maybe the developing baby is sloughed off like so much dead skin (which it decidedly is not: it is a miracle, plain and simply said) or it never gets the chance to become anyone at all, as the fertilization might be prevented.

A lot of maybe's and might's. I'm letting God do the deciding. The girl thinks she is in charge, but she is not. That baby will be born if God wants it to be. The decision is not hers and it certainly is not mine. God's in charge, whether we know it or not.
National Health Insurance...
is the only answer to the morass we find ourselves in. Unfortunately, none--none!--of the three major presidential candidates offer even the hope for a national program. Incredible. Even Clinton has shied away.

Why should your health insurance be tied to your job?

Why should we pay profits to some insurance company?

Why do we need ten thousand plans in this country? What waste.

The national plan could be expanded Medicare (guess what? we already have a national health insurance and it works pretty good: Medicare--so just expand it!) or some variation on the existing system, but with restrictions.

A Pharmacist friend once gave me his take on this: Why not divide the country into five or six regions. Let each region take bids from health insurance corporations to contract out benefits for a few years. That forces prices down and still gives people a measure of choice: heck, we could even vote on our plans. That way we wouldn't have ten thousand plans, but only five. Simple. Cheaper.

Only one problem: less profit for insurance companies means less money in the politicians pockets.

Back to square one, I guess.

Friday, April 18, 2008

I've read that the vast majority of seniors are satisfied with their Medicare D plans. U.S. News reports [The National Interest, April 21, 2008]:

But even the elderly, who grew up in an America where big institutions--the U.S. military, big corporations, giant labor unions--made choices for them, turned out to be satisfied with the choices they had under Medicare Part D.

Who are these people? The customers I see hate Medicare part D. Hate it. Every December they get these letters saying how they may need to switch to a different plan, or they may be switched unless they do such-and-such and call so-and-so. And then they find out their drugs are no long covered and they need to switch or get prior authorizations. Who could blame them for hating this system? I certainly hate it.

But the reports are saying that everything is all hunky-dory. Are they daft? Maybe it depends on how the questions are written. Maybe more people respond who simply aren't on that many medications and so they just don't see the worst cases.

All I know is that I hate it. I hate it good.

Thursday, April 17, 2008

No prescription for you! Back of the line!

The soup Nazi has now come to the drug store. If you make me work all the way through a prescription (or worse, several) only to tell me at the register that you are sorry but you have a prescription card and can you "just run that through"?

No, actually, I can't. We need to start over...from the stinkin' beginning. And you are now at the end of a very long line of people. I don't care if you are standing at the register like your about to set up a campsite, I don't care how pretty you are, I don't care how rude and obnoxious you are--I don't even care how nice you are about it...you're going to wait. A long time. No soup for you!

Saturday, April 12, 2008

A young woman, I'd say she was around 23 years old, recently filled a prescription for Adipex, an amphetamine derived appetite suppressor. Adipex--or rather phentermine, the generic, as nobody gets the brand anymore--is a fairly powerful suppressant of the appetite, and isn't bad for starting a diet. [An aside: phentermine was FDA approved in 1959...my birthday!!] The problem is that after several months of use it doesn't do much; there isn't any study that I know of that shows successful weight loss with the drug for longer periods of time. It used to be hugely popular in the early nineties, as part of the Fenfluramine-Phentermine combo (Phen-Fen), taken off the market because of valvular heart ailments. Even with the combination, long term weight loss was iffy. Phentermine is now somtimes used off-label with Prozac (or one of the many "me-too" Prozacs like Celexa, Effexor, Zoloft, Lexapro).

Anyway, there seems to be a resurgence in Phentermine use, as our script count for the drug is rising, at least in southwestern Vermont. Why? Well, why would it become more popular? Either it really works--which no one can prove, as the studies show--or it benefits the prescriber. One of the two has to be true, does it not? Either the one receiving the prescription benefits, the practitioner benefits, or no one does, which we can eliminate, since at the very least the prescriber gets paid.

So...since the patient doesn't benefit--studies prove that--then how does the prescriber benefit? I'd say in the following ways:
  • returning patient office visits
  • perceived caring on the part of the prescriber (if the patient doesn't get a piece of paper after a half hour office visit for which she pays dearly for...unhappy patient)
  • sometimes it is just easier to hand a prescription for a stimulant anorexiant than to counsel weight loss in a responsible manner: faster patient visits mean more $$'s for practitioner.
Now, am I being too cynical? The young woman I just gave that phentermine to, do you know what she looked like? A model. Beautiful woman, wonderful figure.

And it wasn't because of the phentermine she was taking. She just wanted a drug to assure herself that she wouldn't look fat in front of her boyfriend/husband. She didn't need any drug--heck, she didn't need to be on a diet. Period. But this doctor felt it was necessary to give her this stimulant, take her money, and book someone else for the same half hour fee. Nice.

Friday, April 04, 2008

Got the flu...
probably not the real influenza flu, but pseudoinfluenza. The aches aren't as bad, you can still get around and do stuff. Just don't feel well, is all.

So what do pharmacists take for the flu? Usually either some favorite pain reliever like tylenol or naproxen or ibuprofen. I personally like to use a nasal wash like Alkalol. It has mucus solvents that can clear the sinuses. There is an instructional video on the use of nasal saline washes (Alkolol has oils and saline, but the concept is the same: go to instructables.com).

Don't be taken in by all the marketing for cough and cold and flu meds. There really is only a few drugs out there used for these illnesses: a decongestant, an antihistamine, dextromethorphan, and some pain reliever. And all of them are weak. Some, like phenylephrine and dextromethorphan, are so weak you might as well call them useless. So don't waste your time and money on them.

Make some chicken soup instead. Maybe some vitamins too; not they actually help, but no harm no foul.

Monday, March 31, 2008

Your name is...

Customer: It's right there on the prescription: John Doe.
Pharmacist: Sorry, couldn't read it.
Customer: You can't read the prescription?
Pharmacist: It's pretty bad handwriting. I can make out the drug, though. How are you supposed to take this? What's it for?
Customer: You don't know what the drug is for? How long you been at this?
Pharmacist (now getting testy): 25 years. Drugs are used for a lot of different reasons. This one for instance. Prednisone. Used for inflammation, asthma, lupus, MS, and about a dozen others. It's also taken in different ways, and if I could read the handwriting I might be able to tell you how you are supposed to take it. Did the doctor--Oh, nurse--tell you how it's taken?
Customer: Yeah. Three the first three days, then two then one. Something like that. These doc's and their bad handwriting. They make you take a class in bad handwriting, right? [laughs]
Pharmacist: No. And I don't think it's funny anymore. Some say that about 100,000 die each year because of bad handwriting. Did you know that?
Customer: Huh.
Pharmacist: Listen, when you leave the office, look at the script before you leave. If you can't read it, ask for it to be re-written. It's your health care, right?
[An analysis by the Institute of Medicine’s Committee on Quality of healthcare [sic] America, a unit of the U.S. National Academy of Sciences, concluded that medical errors, including prescription errors caused by poor handwriting, might be partly or wholly responsible for as many as 98,000 deaths per year (L.T. Kohn et al., To Err Is Human: Building a Safer Health System, 1999).
Personal Note: The above is a fictional conversation, but I've had similar conversations with patients many times. It is no laughing matter. If you have a doctor who wont take an extra ten seconds to make the Rx legible, then either get a different doctor, or just ask him/her why they insist on putting you at risk? Some practitioners are simply obstinate and I would conclude uncaring. Case in point: A practitioner (PA I think) in Rutland Vermont who specializes in treating kids cannot write a legible Rx. The office even went so far as to make pre-printed forms. But even when using these the PA still has to put number of doses, or refills, or dosings, and these end up as unreadable. Amazing. I've let her know many times that this is dangerous for the kids, but is there any change? Nope. When I've called sometimes I get a little chuckle from the nurse who answers. I doubt there would be much chuckling when some kid dies and their practice is sued.

Saturday, March 29, 2008

All in a muddle...
is what we are. I am surprised at how little we learn day to day, at least about how to work and live more efficiently. We complain about having no time, yet we waste it like a drunk's profanity.

Case in point: How many times will a customer come to my register at the pharmacy, plop down a dozen or two items and then wait impatiently while I go through the motions of ringing them out. Some tap their toes, some their fingers. You can almost hear the most impatient of them say under their breath, come on, come on, I gots to be somewhere!

But do they bother to take the hangers off the soft lines (that's department store-ese for clothing) or put the UPC bars where I can scan them? Uh, that would be a no. Do they put the items where I can reach them? No again.

I might tell them that that might speed things up but I might as well be talking to my big toe, as one of my tech's likes to say.

Another, particularly vexing example: After waiting for fifteen, twenty minutes for their prescription--after having all their personal data loaded into the profile ("Any insurance? No?")--after waiting in line to pay, the following dialogue is customarily heard:
Customer: How much my prescription?
Pharmacist/Tech: That'll be $65.98.
Customer: Whoa! Ouch. Good thing I got insurance.
Pharmacist: What?
Customer: I said it's a good thing I got insurance.
Pharmacist: Oh, you mean an HSA? [Health Savings Accounts: you pay for these with a debit or check on an existing account meant for medical expenses]
Customer: Huh?
Pharmacist: Never mind. That'll be $65.98.
Customer: No--I got insurance. Should be 20 bucks.
Pharmacist: Do you have a card?
Customer: Sure. [proceeds to give us a card which could have saved us--and him--twenty minutes of aggravation] I wanted to see how much it was without. Wow.
Pharmacist: Wow. And thank you for the card. Thank you so very much. It's very helpful to have the card. Makes everything so much easier. For everyone. Now take a seat and we'll be with you in...twenty more minutes. Or so.
Customer: Twenty minutes? I've already waited twenty minutes. What takes so long? Don't you just run the card through and slap a label on it? [expletive deleted]
Ahh, people. We love you. Yes. Really. We do.

Wednesday, March 26, 2008

Slap a label on it...
is all I have to do, right? After all the guy was in a hurry. And he was from Manchester, snob capital of Vermont. "Can't you just do it right now? I can't run back here."

My technician explained (way too politely, to my way of thinking), that we were shorthanded, due to the flu going around, and that there were (gasp!) other people ahead of him.

Well where were they? he wondered. I wanted to tell him that not everyone plants himself down at the drop-off window like some potted shrubbery. "They're off shopping," is all I could come up with.

Later, after the guy took his prescription back, my technician said she wanted to "slap a label" on a box of ex-lax and give him that. After all, what's accuracy got to do with it when a guy's in a hurry.
Pisses me off....
when you try and save somebody a lot of money and they insist on wasting it. Case in point: A young woman comes in the the pharmacy wanting to fill her prescription for an antibiotic. How much is it? she asks. So we punch the little keys and tell her. $55.98 for the brand and $22.46 for the generic. I usually don't even tell the brand price as nobody buys them--heck, hardly anyone pays cash anymore so the insurance company gets to pick whether it is brand or generic and they rarely pick generic except when some special contract price has been negotiated--but this time I say both prices. She says she wants the brand. Huh? I say to myself. Do I even have the brand in stock? I check and we for some unknown reason actually stock it.

Well, what do you do? Just give her the stuff, I guess. If a customer wants to waste her money, then who am I to disagree. Except more than that is going on here. There is a trust issue exposed. I am trying to save her money, so I say that the generic is really the identical drug. (I like to use the word identical as it more strongly conveys the sense of being indistinguishable, of being equal to, than just saying something like "it's the same thing" which most people seem to think means "almost the same thing.")

So what underlies the conversation is this: You, the customer, do not trust my judgement, or you do not trust my character, so you are willing to spend over twice the amount of money. You, in other words, trust the drug company over me.

That's what irks me. That's what pisses me off.

So I dispense the brand and she pays. The drug company has won the battle this time, but did Don Quixote give up his fight for the Fair Dulcinea? No. And neither will I. Onward, over the next hill, the next mountain, onward to the plain of Truth and Fairness go I, and others; we shall win the war for the truth and vanquish the foes of Government and, Ack! the Drug Companies!

Monday, March 24, 2008

This from
Medical News: Campaign '08: Party Line Divides Views on Healthcare Campaign Issues - in Public Health & Policy, Campaign '08 from MedPage Today:
"For example, 40% of Republicans believe the U.S. healthcare system is better than other countries when it comes to making sure everyone can afford needed care. Only 19% of Democrats and 22% of independents share that belief.
Similarly, 72% of Republicans believe the U.S. offers better quality of care than other countries. Contrast that with the 49% of Democrats and 48% of independents who feel that way.

Huh? Now, I am a Republican, just so you know. More than 7 out of 10 Republicans think we are the top shelf in health care? 4 out of 10 think we can make sure everyone can get some kind of health care when they need it? Who are these people? Either they cannot read or they simple do not choose to read. But it isn't just the Republicans that live in fantasy land. About 5 out of 10 Dems and Independents also think we are the cat's meow.

I can only presuppose that these are the people who do not currently need health care. They are the one's who are twenty, maybe thirty years old and who think that getting sick means an occassional case of the flu or the common cold. Not needing a doctor they rarely go; not needing a prescription they do not know what a mess the current system is in. Ignorance, as they say, is bliss.

Unfortunately, nothing will be done in this country to turn our health care mess into a convenient and fair system until we all begin to look over the collective fence at our neighbors and ask the question:
How are they doing?

It isn't enough to look at your family and say, Gee, things are pretty good: my job gives me a nice income and I've got the best health care in the world.

No; you --we-- all need to look around, at our neighbors, our friends, our extended family. Heck, look at strangers: There but for the grace of God go I.

Is it right, is it fair, that 43 million people don't have any healthcare insurance at all??? 43 million people.

Is it fair that the guy coming up to my counter pays $10 for his Lipitor, but the next guy pays $50? Why? Well, the second guy had the bad luck to work at Company B instead of Company A. What has working for Company B have to do with health care? And what about the poor shlub who works for Comany Z? He doesn't get Lipitor at all because it isn't on the formulary.

Is it fair? No, obviously not. Well, then do something about it. Talk, listen, care. Then vote.

Sunday, March 23, 2008

And here's another crap-happy product: Mucinex. Technically it does work. They performed tests and it shows a minimal effectiveness over placebos. The real question is: Why shell out nearly $20 for something that works that badly? Just drinking a lot of water or juice will do nearly the same thing. They're selling snake oil again folks, and you're buying it.

Saturday, March 22, 2008

Finally! This week's Slate magazine (March 22nd) has exposed the cold remedy Airborne for the snake oil it is. The double blind study supposedly done wasn't, and the stuff will give you a good case of vitamin A overdose if taken as directed. All it is is some vitamins...but hey! it was "invented" by a school teacher, so its gotta be good...doesn't it?
Because it is basically a vitamin product the FDA doesn't have to say it is effective for what it says it is effective for (colds), but does that make any sense? If somebody comes out and says something will cure the common cold then it should give us some proof, right? (But then again, Oprah said it was great stuff so...?)
Or maybe we should all remember that if something seems too good to be true...then it isn't. True, that is. And remember, there is no cure for the common cold. Right? Right.
And one more thing: All you people out there wanting some product to get rid of your colds or the flu...THERE ISN'T ANY. RUN FOR YOUR LIVES...WE'RE JUST TRYING TO GET YOUR MONEY YOU FOOLS!
Why is everybody upset, saddened, and, yes, surprised when they are told that they have to wait--wait!--for oh, maybe an hour before their prescription is ready...when it is the day before (or after) a major holiday? How many holidays do we have to live through before we notice that it sure is crowded here after Christmas, Labor Day (doctors tend to take the holidays off, people!), Fourth of July, Thanksgiving, etc.
Wouldn't you think that after, say, ten years--twenty, thirty?--we'd start to get the drift?
But no. Here is a sixty-something woman dropping off a bag full of refills at the counter on Good Friday. Could she have called them in the day before and waltzed right up to the counter and just picked them up? Yup. But now there is a line backed up to the men's toilet and when told she might have to wait an hour she seems rather disgruntled.
Well too bad, lady. Yer waitin'.

Wednesday, March 19, 2008

The New Mafia





Kay: It made me think of what you once told me: "In five years the Corleone family will be completely legitimate." That was seven years ago.
Michael Corleone: I know. I'm trying, darling. But things aren't as easy as they seem. The government pols are giving us money hand over fist. It just wouldn't do to turn them down. What would the Godfather think?

Kay: Michael, is it true?

Michael Corleone: Is what true, Kay?

Kay: That you've never intended to get out of the insurance mafia and into a legitimate line of business? Is it true?

Michael Corleone: Don't ask me my business, Kay.

Kay: Is it true? Is it, Michael?

Michael Corleone: No. Don't worry. We'll get there.

Kay: Michael, they said that you killed that girl, Nataline Sarkisyan. When she needed a liver transplant you said no and she died. Said it cost too much.

Michael Corleone: Kay, it's a lot more complicated than that. The doctors and the hospital, they never sent the right paperwork. We were waiting and waiting. But the prior authorization never could get done. You got to send the proper paperwork, Kay.

Kay: The DA is going to prosecute you people for manslaughter.

Michael Corleone: Kay, they can't. The government has exempted us. You can't sue insurance companies anymore. We're bigger than than U.S. Steel, Kay. We have now what we have always needed, real partnership with the government.

Kay: Who are you, Michael? I don't know you anymore. My friends say you're nothing but stupid thugs. People behaving like that with authorizations and formularies, deductibles and copays. Thugs, Michael! But they're going to change things this time, Michael. Hillary and Obama, they're going to change everything so the insurance mafia will be put out of business.

Michael Corleone: Please. If anything in this life is certain, if history has taught us anything, it is that you can kill anyone.

Kay: Michael, are you saying what I think you're saying?

Michael Corleone: Yes, Kay. We're willing to with-hold authorizations on even the president of the United States. He—or she—won't be able to go to the dentist without our OK.

Kay: You wouldn't dare.

Michael Corleone: This is the business we chose.

Kay: The doctors won't go along with you. They'll put you out of business.

Michael Corleone: How Kay? Who do you think pays the doctors? Me, and my business partners. If a doctor was to, say, try to make it on his own, God bless him, then we'd just have to make him an offer he couldn't refuse.

Kay: What would that be, Michael?

Michael Corleone: We might just send—hypothetically speaking, of course,--Luca Brasi to hold an audit to the poor guy's head, and then assure him that either his signature or his college loans would be on the release. And maybe—again,hypothetically, of course—suddenly all this guy's procedure's come up “experimental.” We don't pay for “experimental,” Kay. They usually end up signing.

Kay: You know what I saw on the news, Michael? There were about 150 nurses picketing the CIGNA headquarters—CIGNA, Michael, that's one of yours isn't it?--and maybe an hour goes by and they say that they made a mistake and Nataline can have her liver transplant.

Michael Corleone: What does that tell you?

Kay: It means they could win.

Michael Corleone: Don't you know that I would use all of my power to prevent something like that from happening, Kay? There's more money potential in medicine than anything else we're looking at. Now, if we don't get into it somebody else will. Maybe the Tattaglia Family maybe all of them and with the money they earn they'll be able to buy more police and political power. Right now we have the prescription business and we have the unions and those are the best things to have. But lab costs are a thing on the future. If we don't get into it now we risk everything we have. Not now but ten years from now. I'm telling you Kay, good health is the most important thing. More than success, more than money, more than power. And good health costs, it costs big time. But someday Kay, maybe not this year, but someday things'll get better, things will be different. I'll change; I'll change. I've learned that I have the strength to change.

Kay: I hope so, darling, because this is getting too violent for me!


There was a letter in the local paper decrying the evil of "socialized medicine." Since that letter appeared there have been a few follow-up replies. Those responding seem to feel that no system could be worse than what our country currently offers. They point out that we as a nation spend 15% of our gross national product on health care, far more than any other industrialized country in the world (those bad socialist countries France and England are 10% and 8% respectively), but that our care is currently lagging behind the rest of the world (107 health disease deaths per 100,000 people versus 40 in France). One guy pointed out that the health care that our wonderful public servants currently have is actually government administered...that is, socialist. Wonder why they did that? Maybe they figured they didn't want to be hassled with prior authorization requests and formulary changes. Maybe they just figured that this terrific system of private insurance companies (the American way, after all) was getting too complicated. And then maybe they just wanted a health care system that worked.

As a dispenser of medicine there is one redeeming virtue to the current crisis: I get to yell at the insurance bureaucrats after they give me a hard time on the phone. It's so cathartic. It's probably the best thing about the situation we're in, maybe even reducing my chances of having a coronary. Hope so, because God help those of us needing treatment for something.

A manual for filling a prescription


Twenty-five years ago I graduated from a five year program for pharmacy, a veritable manual for dispensing medicine, if you will. I realize now that these times demand a manual for picking up one's prescription. Fortunately you do not need a five—now six—year degree. But there is still a need for preparation. Times have have been a'changin'.


One: Prepare to wait. (See following.)


Two: If you have a new insurance card bring it. You may think we pharmacist's copy it or run it through some swipey gizmo but we don't. It does, however, have a phone number on the back of it so we can call and find out the numbers we need for billing. The numbers on the face of the card are a trick: they are probably wrong or missing entirely. Sometimes the insurance company puts a few letters in there to try and trip us up and we need to call and find out which letters we can ignore. Anyway, we need the phone number to call the company and get the information we need (after being on hold for twenty minutes).


Three: Please let us know how to spell your name, as we cannot read the doctor's writing. Don't worry, we won't guess at the pills; we will call the office and ask what the medicine really is supposed to be. No we won't actually speak to the doctor; he is busy. And no, we won't actually talk to the nurse; she is busy too. But we can get in touch with the secretary. If she can decipher the handwriting (she can't) we'll be all set. See step one.


Four: Here is a little hint: The word is pronounced GEN-AIR-IC. Not GEN-ET-IC. That just irritates us. And yes, they are the same as the brand. Many of the GEN-AIR-IC drugs are the brand drugs put into different molds or just different bottles. If you like the fancy labels just tell us and then we can charge you more. Otherwise we are going to try and save you money, though some people don't like that.


Five: Some people like to think we only have to count some pills and stick a label on. Not so. We do really look for dangerous stuff, like interactions and allergies and doctor mistakes. Sometimes we play a little game and see how many mistakes we can catch in a day by doctors. Wrong drug. Wrong strength. Maybe wrong patient (that one's a hoot!). But most of the time is spent on the phone calling the insurance company (see step one). One caveat: if you want fast service DON'T STAND AT THE WINDOW TAPPING YOUR FINGERS AND STARING AT THE PHARMACIST. We like to put those people at the end of the line just to irritate them as much as they irritate us. One of the few little chuckles we get in the day.


Six: If you think it is funny to show up at the drop-off window thirty seconds before we close for lunch and say “I just made it!” it isn't. You're going to wait. And wait. And wait some more.


Seven: After a half hour, go to the pick up window. The prescription isn't going to be done, but we can then tell you why it isn't done. That gives us a measure of satisfaction; we can at least tell you that we are working hard to try and put the squeeze to your insurance company because they have rejected your prescription. We like to tell you how much we hate the insurance companies because, well, we really hate them a lot. We especially hate them for telling us all of this rigmarole is because they are saving everybody so much money. I know they aren't saving anybody anything—well, they do save themselves some money—and to hear that more than once a day is just the worst.


Eight: Go back to the waiting area or shop some more. We have to call your insurance company again since they rejected the claim. This is kind of funny, or would be if you weren't the person calling or the person waiting. You see, the company we call isn't really the insurance company. No. Your insurance company contracts out the billing to a second company. That is who we are now calling. That way the person “helping us” can say “I'm sorry; the insurance company does not allow for this drug, but you can call 1-800-BLA-HBLAH and they can assist you.” So we get to call someone else. So they can help us help you some more.


Nine: Go back to the counter. We can then tell you that we are very sorry (we really are) but that your insurance did not allow for the drug your doctor selected. However we can call your doctor (see step three) and tell them that (they love to hear from us). They can then call your insurance company. Not the company we call, but the real insurance company...unless that company lets the other company do that authorization thing, but it's kind of hard to tell which does that sort of thing, but after a few calls the doctor will find all that out, don't you worry. This is the iffy part. If your doctor does not yell loud enough, or, sometimes, cry, you might not get what you need. We are sorry about that. We are also sorry that when you ask us to call your insurance company and see if we can't straighten this mess out, well, forget about it. How long will it take? Um, no idea.


Ten: See step one. You see, we've just gone through the above steps for every person who was ahead of you, so we are now so backed up we're really just playing parchesi back here. Hey, it beats

talking to insurance companies.

Saturday, March 15, 2008

Hit Clear?--
That will be $19.98. Will you please sign for the prescription insurance billing? Yes, right here on the signature pad. "Cancel"? No, hit "Continue." Yes, the button at the lower left. The one that says "Continue". Thank you. Now sign...no; I'm sorry, you've hit "Accept" before you signed your name. Let me reset the pad. There, now you can sign your name. Yes, that's right. Hit "Clear"? No; "Accept." Whoops, you hit "Clear." "Clear" actually clears the pad so your signature is erased...or cleared. If you hit "Accept" then your signature will be...yes, accepted. Try it again. There you are. Now that wasn't so hard, was it?