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The price of free

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There is an inherit problem with having zero copays for our “less fortunate” friends.  Lets look at two cases.

Mary is a 35 year old single working mom.  Her ‘baby daddy’ left her high and dry when the going got tough.  By using daycare through her family, she is able to pull off a part time job and qualifies only for food stamps.  She is not eligible for full-scope welfare due to the inherit racism that goes on within the welfare system (yeah, I went there, ignoring it wont make it go away).  She forgoes the fancy cell-phone, cable-tv, and nice car to afford health insurance for her and her baby (which shes fine with, she views insurance as a necessary expense like food).  Her copays are $50/rx.

Jacob is a 45 year old male.  Due to heavy cocaine use during his youth he has congestive heart failure and as a result is unable to work (according to him and his quack doctor).  He recieves full-scope welfare complete with food-stamps and a check every month.  He spends his day harassing his pharmacy about refilling his pain-pills early and enjoys watching daytime TV.  His copay is $0/rx.

Both Mary and Jacob bring you an Rx for some Flovent.  Mary pays $50 and Jacob pays $0 for the same Rx.  Both leave your store drugs in hand.

A week later, Jacob calls you and says he lost his Flovent.  He has spend a whole 4 min’s looking for it and demands he gets a replacement at once.  Mary also calls you a week later.  She has torn her entire house apart looking for this Flovent and is reluctant to ask for a replacement Flovent at the cost of about $175.  Jacob is upset at YOU that the insurance wont pay for it early, and Mary is upset at HERSELF for losing something that cost her $50.

See where this is going?

There is a HUGE problem with giving people medications for free.  The problem is that once something is free, people see no value to it.  Sure Jacob lost a Flovent or Blood Glucose Monitor, but because to him its free, why should he spend any of his valuable time to actually look for it vs just calling and getting another one for free.  Mary has an incentive to tear her house apart (or call her insurance company) looking for the lost Flovent because it COST her $50.  Jacob is out nothing, and Mary is out something.  Jacob gets everything handed to him while Mary busts her ass.  Both are “in need”, but their reasons for being “in need” is another rant for another day.

Mary obviously places a value on her Rx’s.  Even if shes oblivious to the true cost of the medications (and how much her insurance company pays), shes quite aware to HER cost for those medications.  Jacob, on the other hand couldn’t care less how much his lost medication has cost the state because HIS cost is a whopping zero.  Who cares if he lost every medication on his profile in an act that was entirely his fault, he’s out nothing short of the inconvenience of driving to the pharmacy and picking them up again.  He wont have to choose medication or rent, and his check wont be impacted in the least.  Mary isn’t so lucky.

Lets put it this way; by getting drugs for $0, there is no negative-feedback/punishment/repercussions for losing medication.  Medication has a net-worth of $0 to them, and they don’t give two fucks what happens to their medication because their lives are not financially impacted by losing them.  If I spend $50 on something, and I misplace it, I’m sure a shit going to tear everything apart looking for it.  Is it the same if I spend $0 on something?

Think of this next time you fill that ER prescription for Tylenol and Robatussin DM.

Comments #

Comment by HospIntern on 2010-01-29 13:43:25 -0800 #

I know exactly what you mean. I work at a hospital pharmacy to where most of their prescriptions are free and if not the most they have to pay at any one visit for x amount of prescriptions is $20. They couldn’t give a rat’s ass about looking for them, they just look at me and angerilly demand a refill. Over half the time it hasn’t even been a week! One asshole has had the gumption to open his bag near the pick up window, take out his inhaler, then bitch until he got another one saying we didn’t dispense it to him to begin with. Then they bitch when we refuse to fill it early then whine to their doctor until they get it okayed. I mean come on people. Very rarely do I have that patient that actually puts value in their prescriptions and looks for them honestly. Wanna know the one major factor between the two? The one that appreciates the medication usually is one who has had to at least pay the high co-pays at some other point in their lives. Moral, make these assholes actually work or pay for their lost ‘vicodins’.

Comment by Justine Snmith on 2010-01-29 14:21:20 -0800 #

Lets not forget the person who gets the prescription for flovent or advair for free and then sells it for $20.00 to get enough money for a couple of beer at the corner bar. Or to spend time on the slot machines.

Comment by Martyn on 2010-01-29 14:46:56 -0800 #

Your ideas of free apply to not only pharmacy but the real world in general. My brother is an admissions counselor and he told me the number of Native American students who drop out of school in unbelievable. These guys get free education! They don’t pay a single penny! Yet they don’t go to class and drink all the time.

And when a white person goes to college, gets a degree, and supports hard work then people cry “OH IT’S BECAUSE YOU’RE WHITE, US UNDERPRIVILEGED MINORITIES AREN’T AS LUCKY”.


Comment by was1 on 2010-01-29 16:26:55 -0800 #

I’m having trouble getting past the obvious antisemitism of your rant. Mary, a clear reference to the Mother of Christ, is praised for being honest and hard working (like all Christians, right?) while Jacob, an old-testament name and therefore a Jew is derided as worthless and lazy.
You are clearly a heartless bastard for wanting to deny this poor soul his life-saving medicine. Why is the cost important? Would you like him better if he needed cheaper medicine? When Obama (hail the savior) makes all healthcare free for everybody will you change your opinion of Mary? Will you be upset if you lose your own free drugs? Would you agree to take citalopram or will you say you’re allergic to it and that only Lexapro will work for you? (Let me call for a prior auth).
These are the choices we are faced with today. Do I want to pay for medicine or get it free? Do I want to buy groceries or just take what I need (want) from the store? After all, look how well stocked Kroger is. Do I want to pay my rent or just have a free place to stay with free stuff and free car. After all, this is the land of freedom.
Just follow the smell of Obamanure and we will all be free together. Except for the wealthy, of course.

Comment by Martyn on 2010-01-29 16:48:17 -0800 #

Obamanure? Except for the wealthy?

Don’t be stupid, Bush got us into 2 wars and lowered taxes. Where do you think the money is going to come from, thin air?

Comment by HospIntern on 2010-01-29 18:03:19 -0800 #

That or they’re selling their percocet or lortab for cash to get the other narc they want then bragging about this in the waiting area. Then when you tell the doctor about this and they confront the patient they deny like their life depends on it then begs for more saying they ‘lost it’, ‘they were stolen’, ‘the dog chewed it up then dumped it in the toilet’, etc… The doctor in all their infinate wisedom just gives them more and they come back smug and demand we fill it for them since the doctor gave the ok. The whole cycle then starts again with them bitching about having to pay a measly 4 fucking dollars!

Comment by The Redheaded Pharmacist on 2010-01-29 19:29:11 -0800 #

It’s like when you were a kid. If your parents just bought you a lot of toys or clothes you destroyed them while playing with them or wearing them and you never really learned the value of money because they were always just replaced for you at your parent’s expense. But, if you had to work for an allowance and bought your toys or clothes or whatever with your own money somehow they were handled with care more often because you learned the value of money and you equated those items with how much work it took for you to earn the money it took to buy those items.

Setting copays at zero means there is no accountability for the patient. They can fill 12 rxs a month whether or not they really need them because why not? It is “free” right? The problem is that it isn’t free and the rest of us pay for it in the end through taxes. But hey what do they care? They are driving off in their new Escalades anyway right? If you have more gold around your neck than Mr. T then you should be able to spring for a measly copay even if it is a token amount just so there is some accountability on the part of the patient. But I realize I’m asking for a lot from the general public when I talk about accountability.


Comment by $4 slave on 2010-01-29 19:36:10 -0800 #

something I would love to see: anyone who Dr’s shops…once they are found doing it…be automatically be stripped of their card. Banned for life, no matter what state they go to. Because we pay for all those visits, only for them to use/abuse the process. Not that hard to do…if we can put a man on the moon, surely we can do this. Sometimes I dont think they want this to happen. Politicans have to give us hope for something right?

Comment by Dr. Grumpy on 2010-01-29 19:37:04 -0800 #

Damn good post, as always.

Point is well taken. It’s important to have things priced enough to make people value them, and take responsibility for them, and at the same time not have them out of reach.

And I don’t think the post is antisemitic. Anyone can read anything they want to into anything that anyone writes.

Comment by $4 slave on 2010-01-29 19:40:44 -0800 #

eventually it all comes back and bites us in the @ss. Kept saying that for years…no way you can do a war and lower taxes.

Comment by Contrary Mary on 2010-01-29 19:49:33 -0800 #

It is rants like these that make me positive you’re a UK pharmacist and not a US one.

In the part of the good ol’ US of A that I hail from, this does not happen, at least never in my experience.

I have honestly misplaced medicine before, and I have only EVER gotten it replaced with no addn’l co/pay, when I HAD A COPAY.

I am a $0/copay now, but have absolutely no other benefits, my health care is limited, I do not qualify for welfare or food stamps, nor do I want them if i did.

If I lose medicines now with my $0 copay what happens? The pharmacy says suck it the fuck up and pay full price if you want a replacement, which I had to at the tune of a hundreds of dollars which I had to borrow at great drama cost and high interest from family.

You bet like hell I know the value of my medicine and have been as careful as I can to not make such a stupid and costly mistake again.

Comment by VaTech on 2010-01-29 20:11:41 -0800 #

Thank you for this…it’s something I ask myself every day as i’m listening to people bitch about how they can’t get their lortab early.

The thing I have a problem with is when people don’t get the difference between welfare and health insurance. At our pharmacy we have a patient who likes to come in and run his mouth…loudly. The first time I ever faced him, he straight up asked me if I was on welfare like the rest of the life sucking parasite pigs (those words exactly, i promise) and was on welfare. I blinked at him and shook my head, a little overwhelmed, and mentioned that, however, I had health insurance. Oh…that was a mistake. This man believes that anyone who has any type of health insurance has basically spit on him and his family. HE paid his dues, HE paid his taxes, HE worked his whole life…so therefore, he pays full price on his meds. While I don’t get the reasoning, I believe it has something to do with the fact that he is dead-set that health insurance = welfare. If you have health insurance, you are draining the life out of everyone else who pays good honest cash for their medicines.

Sometimes it’s difficult to listen to him…Last year I had open-heart surgery and the final cost was over $140,000…if it wasn’t for insurance i sure as hell would be dead because i don’t have that money. His view on that? I should have just died. I sometimes wish that despite the money he brings into our pharmacy, that he would just go away =/ He’s rude, loud, and he visciously attacks people who have health insurance because he refuses to listen to reasoning that Health Insurance does not equal welfare. I almost wish I could direct him to your post…but it wouldn’t help.

Comment by Brittany on 2010-01-29 20:49:25 -0800 #

Or people who complain because their co-pay has gone up from $2.40/Rx to $2.50/Rx…or those who have a $1.10/Rx co-pay, but payed NOTHING from the middle of last year to the end. I WORK FOR A PHARMACY and MY co-pay for GENERIC Protonix was going to be $47.00…I think I should’ve complained A LITTLE…but all I did was rolled my eyes and put the Rx back and went to OTC Prilosec. What I think really bothers me is that Medicaid WILL pay for Zyrtec and Claritin, medications that ARE OTC but no longer pays for Rondec DM, Tussionex, Cheratussin..medications that are RX ONLY (with the exception of the Cheratussin, of course). Then you have those people who say, “I cant pay for my medication” and their co-pay is $3.00, but they are sitting in their car stuffing their face with MEAL from McDonalds…*sigh* And some are driving NICER CARS than the Pharmacists…

Comment by Georgia RPh on 2010-01-29 21:02:28 -0800 #

I would like to add that this free-mentality is not restricted to just “welfare” recipients. We had several customers once who worked for a major corporation. In its infinite wisdom, the corporation had $0 co-pays on medications. These hard-working people had just as little respect for lost medication as the stereotypical “welfare” recipients. Nobody respects anything they get for “free” and more importantly, nobody respects the people who give away things for free.

Comment by Meghan on 2010-01-29 21:43:17 -0800 #

Mary is also a traditional Jewish name. Jesus Christ founded Christianity, and was himself Jewish therefore his mother was Jewish.

Comment by Martina on 2010-01-29 22:02:51 -0800 #

  1. Many of the people in Medicaid take the meds becasue they are prescribed to them while not being needed. Just like in South Florida they have Pain Clinics that are legally allow to give up to 250 oxicodonne. Many of these people become addicits thanks to Medicaid and the doctors and pharmacists that go along .

Don;t blame the drug addicts . Lets check big pharma.

2- True fact : native American have lot of benefits, but hey, we couldn;t kill them all, so we robbed their lands.. Agh..forget thanksgiving !!

3- How much of Medicaid goes to psychotropic drugs >

Comment by Jenn, tech on 2010-01-29 22:13:30 -0800 #

I’m so glad TX medicaid limits these scumbags to 3 scripts a month. Only exceptions are kids (under 18 are unlimited) and people who qualify for special programs (i.e. adults with cystic fibrosis – also unlimited). Once they get that 3rd Rx, they have to pay cash until the next month. I wish they’d let me run the medicaid office for a day….then again I’d deny just about everyone.

And they give almost no overrides. I had a customer demand two expensive medications be filled almost a full month early because he would be out of the country for a month. …you’re on Medicaid and can afford a month long vacation out of the country? Really? I had fun telling him nope, you had your once yearly early fill override already. ARGH there aren’t enough awesome patients to make up for these jerks. I need a vacation…

Comment by LD50 placebo effect on 2010-01-29 22:48:47 -0800 #

  1. Healthcare reform is necessary.
  2. Healthcare should be accessible to all Americans.
  3. The only ONLY only way that health care will be reformed and accessible to ALL Americans is if some ‘special interest’ group is NOT dictating to their OWN special interest. The only ONLY only way that the healthcare system will be reformed is if the watchdog is the American people. (The Federal Government represents Americans all over the US and is the only entity for whom responsibility in seeing there is true reform and accessibility is available to ALL Americans); to whom the health care system answers to…that is the PEOPLE, a public option as carried out by the Federal Government–not the backroom deals brokered by drug companies with Medicare/Medicatid/health insurers/big business/hospital administrators/heart institutes, etc. anyone that has a special lobbyist representing their product to the lawmakers.

Comment by brilliant under paid tech on 2010-01-29 23:17:58 -0800 #

Angry I hope you read our comments, I do. Because I am confused. You sited rasicm of welfare but didn’t identify the race of either Mary or Jacob. Also the guy with the biblical references is off his..something. Anyway, I fill 5000 scripts a week ( although am on my sunny way to cvs/caremark because they wana PAY me for my efforts ) in those 5000 i cannot name one where I replaced a Flovent.. early… lost or not….FREE.. for a welfare recipieient. I might have replaced it for a really good customer but my chain ate the cost ( that they can afford ) so that this man or woman had his rather important breathing apparatis. Insurance in my world doesn’t give you a second chance. It’s pay full price,or commit fraud by giving it to him and billing 2 or 3 days later, but if Mary or jacob lost it say within a day or two…that’s their prob pay cost or PRAY and mean Pray big that you catch me one a rare good day.
I have my issues with all insurances not just government funded ones because our system of decided who pays what is all screwy. Maybe the only way to fix it is to let the government pay for EVERYTHING. Do you think what we spend in other countries on war and earthquakes and tsunamis would cover it? Please stop me if there was a spanish telethon on that I missed raising money for Katrina, cause those people are still fu*d. Is it only us Americans that know that? sorry if I outed us oops.
I want Obama and my leaders to pay for it all. Then again then millions of people would lose their jobs. But…they would get free Flovent.

Comment by Lagom on 2010-01-30 00:41:52 -0800 #

Years ago I worked in the only “deep discount” pharmacy in Santa Barbara, CA. This place seemed to attract a very demanding and difficult clientele. My co-worker was an elderly Jewish guy who was a fountain of wisdom, always quoting aphorisms and one-liners that he either got from the Talmud or made up on the spot. One day I asked him why so many of our clients were a pain in the azz. He answered, “when the price is cheap, the customer has no conscience”. It took me years to fully appreciate his response.

Comment by xviben on 2010-01-30 02:51:52 -0800 #

Actually What amazes me about the article is the cost!

Fluticasone – why not a cheaper generic. In Oz 120 puffs of 250mcg costs about AUD$45 (US$40 ish) so to me US$175 seems to be obscene. Tell me I am wrong.
Benedict Dr. Downunder

Comment by GE Rph on 2010-01-30 07:57:10 -0800 #

You are by far one of the few who knows the cost when you have a zero copay.

Comment by bcmigal on 2010-01-30 09:10:02 -0800 #

I must be the exception here, because I have no problem with “free”. Granted there are those who abuse the system, but there are many more who would fall through the cracks if not for “welfare” and I would be one of them. A Medicaid pt who was upset because her med was not covered said to me “What would you know? You probably have the perfect life” . Let’s see. At that time my husband had no job, one child was in rehab, the other has special needs and I was barely living paycheck to paycheck….yep….just the life I had dreamed of. So I try not to judge, we may all be one illness or accident away from from needing aid. I am thankful every day that states have programs to help.

Comment by was1 on 2010-01-30 09:29:12 -0800 #

sorry, Dr. G… I should have used the tongue-in-cheek font.

Comment by kizell on 2010-01-30 09:37:26 -0800 #

Another high-quality post TAP

This philosophy is sound and does not only apply to pharmacy. If you make something expensive, people will appreciate it, but if you make it free, people will abuse it

Welfare buttfucks who get to live in their home for free might as well live in a landfill b/c they never take care of the home. But a hard working couple that just got a loan for 200k to buy a home has real incentive to take care of their investment. The other has no incentive

Comment by Cracky McCrackhead on 2010-01-30 11:01:42 -0800 #

Pharmacist love me. I pay full price in cash and dance a little jig on my way out the door!

Comment by Wisterya on 2010-01-30 13:36:12 -0800 #

This topic chaps my ass so bad! I have been living with MS now for 10 years. I have held a full time job throughout most of those years and still do. I’m even starting college in February. My Copaxone copays are $900 before my deductible kicks in and then $200 after. Granted, I get 3 month supplies, that’s a lot of money to shell out.

I happen to work for a pharmacy help desk and I just want to strangle the freakin’ assholes who bitch over $1 copays. Yeah, I’m bitter because I work for my piss poor insurance and pay about $80 a month for it out of my paycheck.

Comment by PharmD2009 on 2010-01-30 13:42:25 -0800 #

Those on welfare are like the old saying:

“Never feed a stray dog, because it will keep coming back for more.”

Comment by theangrypharmacist on 2010-01-30 19:10:42 -0800 #

I am shocked and amazed that you looked down so far deep into this post to get some sort of religious zealot meaning out of it. I’m actually impressed.

I picked Mary and Jacob because they were racial neutral names (so the argument isn’t lost in bigotry and stereotypes).

Of course you’ll also point out that if you take the number of letters in the second paragraph, divide by the number of hours in one day on mars, multiply by the number of uses of the word “fuck” on this site, you will have exactly double the seconds that Jesus hung on the cross before he died!

Comment by pbmhater on 2010-01-30 19:48:39 -0800 #

NYC just pubished a report that 40% of all Emergency Costs/Expenses come from ILLEGAL/UNDOCUMENTED patients. And Liberal NY’ers can’t understand why NY hospitals keep closing.

California is about to go belly up. Why? Well, how can a State sustain itself if SO, SO many are illegal, who do not pay taxes, but just take, take take.

It’s all over folks!

Comment by WrongAid on 2010-01-30 20:48:42 -0800 #

I thought it was “Never feed a stray dog, because they will breed more.”

Either saying applies.

Comment by TechJess on 2010-01-30 20:54:47 -0800 #

He didn’t say that he actually replaced the Flovent, just that the customer WANTED it to be replaced.

Comment by TechJess on 2010-01-30 20:59:14 -0800 #

I actually had a guy bitching a few weeks ago because now that he has a part-time job, his welfare benefits are being cut and he has to pay a $2.00 co-pay for all prescriptions. He actually said “If they won’t get rid of these fucking co-pays, I am quitting my job”. What the hell? That made no sense whatsoever. Quitting a job just so that he won’t have to foot the miniscule bill for his medications. Lovely. Just lovely.

Comment by GE Rph on 2010-01-30 21:20:50 -0800 #

or the backroom deals with your socialist reps. wish i could get 300 million for not having a conscience like La senator

Comment by GE Rph on 2010-01-30 21:35:35 -0800 #

You are an idiot. I am sure the brilliant part is in your own mind.

For christs sake dont you realize the government is us. Do you want your taxes going up to take 90 percent of what you make. Between the Fed, local, state and other “hidden” taxes on my car, my clothes, everything you buy, I alrady pay over 50 percent of what I make to some government entity.

I will agree on one thing. Fuck the other countries. stop all foreign aid to everyone. ESPECIALLY the fucking U.N.

And those Katrina people.. GET THE FUCK OVER IT

Comment by GBG on 2010-01-30 22:42:48 -0800 #

Martyn—Hmm that’s odd. I’m Native and I PAID for my education, went to my classes and graduated. Oh darn if ONLY I had known that since I’m native I could get everything handed to me and just drink my education away. So glad you cleared that up. Contrary to what you think we DON’T get everything handed to us. Shame on you for assuming we are all a bunch of alcoholics because hey guess what? WHITE people drink at college and drop out too! Shocking isn’t it? Hell lets not discriminate here, I’m pretty sure plenty of people REGARDLESS of race drink and drop out. You need to WAKE UP.

Comment by Ray on 2010-01-31 07:30:02 -0800 #

Here is a news flash for you. EVERYTIME taxes have been cut, revenues to the US Treasury have INCREASED!!! The problem we are having is that these idiots in Washington can’t stop SPENDING.

Comment by Ray on 2010-01-31 07:35:53 -0800 #

You make me laugh.. Why do you put all of your faith in the Federal Govt. and it’s leaders. There isn’t a bigger bunch of self serving thieves in the country. By the way, healthcare IS accessible to all Americans. The problem is people want it for free, and they all feel they should get the top-notch care no matter what. Healthcare is a product/service like anything else. Some people get/can afford the Rolls Royce, and others get/can afford the Kia version. Thats life folks!!!

Comment by peon on 2010-01-31 07:47:39 -0800 #

PharmD2009, you hit the “nail on the head”. Welfare is like feeding a stray dog. After feeding a stray dog, he becomes your dog and is there at your door at meal time, then more stray dogs come to your house. Pretty soon you are keeping up all the stray dogs in your neighborhood. The same applies to welfare. Whenever a government agency is created, it has to justify its existence. It has to find more and more people to “help”. This is how the agency grows. Welfare is no different. They keep having to find more and more people “in need”. The middle class is being taxed so much, to pay for all these people that don’t work, that the middle class is in danger of disappearing. This country is moving in the direction of a third world country where there is the rich and the poor, and no middle class.

Comment by PharmD2009 on 2010-01-31 08:13:48 -0800 #

Flovent has no generic in the US. Flonase (generic: fluticasone) and Veramyst (same drug) are only available in nasal spray formulations, not inhalers like Flovent.

And yes, $175 is about the correct price for one of these bad boys.

Comment by PharmD2009 on 2010-01-31 08:20:22 -0800 #

There are certain cases where the welfare system is justified. However, the MAJORITY (I’d say upwards of 80%) of the people who are on it are scam artists.

All of their \assets\ are in other people’s names to make it look like they have nothing.

I have also heard my patientS (yes, many more than just 1) say that they can make more money on welfare than they can if they got a job. Thus, they chose to not work and live on welfare.

I think that is what this article is about; it’s not about the people the system was designed for.

Comment by John Woolman on 2010-01-31 10:56:03 -0800 #

Certainly, there is no external negative feedback for losing something that is a free good and that you can get replaced with minimal effort. What most of us with the inclination to read blogs like this have are internal negative feedback loops that inhibit us from behaving in that way. It used to be called a conscience.

Comment by brilliant under paid tech on 2010-01-31 14:24:35 -0800 #

Im an idiot? which one of us still works at GE? hmmph. Im sure your lil store on a mountain in Altoona does what 1200 a week? Im thrilled you paid 50% of your paychecks on taxes, your overpaid anyway trust me I know exactly how the bird works, The techs and interns do all the work and you scan shit…ooooooooo hard work.
And those Katrina people get over it, I really hope you go on vacation and get swept away by a hurricane.
And as for the brilliant believe me buddy ask my rph’s
I am brilliant.

Comment by Kacey on 2010-01-31 15:30:52 -0800 #

When I first started nursing school, I could never figure out how the “welfare patients” had free TV and paying customers didn’t. It is all very clear after all these years and we better watch out….when the freeloaders out number the tax paying public, we will never be able to regain the reins of government. There is power in FREE!
I do have a question….Why doesn’t Medicare allow golden oldies to have any benzodiazapines? Are they afraid the old people might get happy and stop complaining?
Hey, as a quilter….I love your avatars!

Comment by PharmIntern on 2010-01-31 16:35:51 -0800 #

I’d like to call your attention to a quote by South Carolina lieutenant governor Andre Bauer, who was to become governor if Mark Sanford had been impeached following his mistress debacle:

“My grandmother was not a highly educated woman, but she told me as a small child to quit feeding stray animals. You know why? Because they breed! You’re facilitating the problem if you give an animal or a person ample food supply. They will reproduce, especially ones that don’t think too much further than that.”

He continued the analogy to compare people on welfare to stray animals for this reason. While I realize many people use the system as intended, no one can reasonably argue that he is 100% wrong. There is a good bit of truth to his argument, poorly as his words may have been chosen.

Comment by DoneWithRetail on 2010-01-31 20:36:40 -0800 #

After 14 years I’m no longer in retail because of this very thing! People place no value on medication or our professional services. I have been advocating for years that insurance not pay anything upfront for medication. I also think the ban on advertising be put back in place (all forms) and also samples be regulated in such a way that the can only be had by prescription and at a pharmacy (not handed out to physicians, only to go home with staff and family or worse, to give an indigent 3 months of a medication they will have to be taken off of because the samples were all wasted on them). If these steps were taken, more than half of these mostly worthless drugs would go away forever and the rest would come down in price so much so that generic medication may go away as well. You get what you pay for, and people won’t be out $150 for a 30 day supply of Protonix, even if they are going to get paid back. We need to bring value back to the pharmacy and respect back to pharmacist! I’m very happy to be working in a major hospital now and getting to apply the information I learned to patients and other healthcare workers alike. I know it will never change, that is why I changed. I used to be more angry than you because of these issues and when the company I last worked retail for started giving away free antibiotics, I just could not let myself become even less valued than the $3 drugs had made me!

Comment by Longhorn Daniel on 2010-01-31 22:18:29 -0800 #

Great post. It applies to all parts of free health care. I’m an engineer for Shell. My insurance has a $1000 deductible for major medical. That means if I go to the ER I’m paying out of pocket. Meanwhile, my crackhead ass cousin’s baby’s momma can run her kids off to the ER for a damn ear ache because “it’s free”. My girlfriend’s dad fell and broke his jaw in 07 and thought about sleeping and going to the doctor the next day before settling on going to the ER and paying.

This is the primary reason I’m so a subsidized public option. People need to realize health care costs money and it isn’t something to be abused. Sadly, it’s a violation of a person’s constitutional right to make them responsible for their own health, but it isn’t a violation of mine to be forced to pay for it.

Comment by Big R. Ph on 2010-02-01 09:30:14 -0800 #

While absoulutely agreeing with the TAP, the one public policy question that needs to be asked is “Who do you want to tax?”.

Because co-pays are a way of decreasing the total cost of the payor you have to balance access to the product (at which if taken properly will give the payor a 10x bang for the buck) vs cost to the payor.

On Medicaid, if you raise the co-pays you are then taxing the poorest in society. You are also creating a hinderance to them taking their medications which in turn leads to more problems down the road (pay me now or pay me later).

Conversely if you lower the co-pays then you get an increase in utilization which leads to higher initial costs to the payor but lower longer term costs.

That being said, too early refill? Screw it your on your own!!

Comment by K-Man on 2010-02-01 10:28:32 -0800 #

Sing it, TAP. The most egregious fault of the entire welfare apparatus, and the one I hear the most complaints about, is that regular folks who pay taxes for years and then get in a bind and could use those programs get told they don’t qualify. They’re ineligible, so no benefit.

Until my mother died a few months ago, I was her (and my late stepdad’s) full-time caregiver, having left work in 2006 to do so. No income, no insurance. My copay for my doctor is $10 and I use the infamous $4 Wally’s world list for my prescriptions. You better believe I’m careful with the pills and don’t lose any. Money’s too tight.

Your comments remind me of when I was applying to get financial aid for college in the early 1980s. I was told right off the bat that my working-class parents made \too much\ money to get any money from the Pell grant program. Ultimately I dropped out after one year because the same logic was applied to federally guaranteed student loans as well. We didn’t know we were \rich! Really!

Imagine my chagrin some years later when the news came out that prison inmates had been getting Pell grants for college classes, and many of them had spent the money for personal items including cigarettes and electronic gizmos. Convicted murderers, child molesters, etc., got to take correspondence college courses—or no courses—at our expense because they had little or no income (their fault, though, right?), while I, a law-abiding taxpayer, couldn’t get squat.

Congress was incensed about this issue and stopped allowing inmates to qualify for Pell grants. But the damage had been done. And that’s more evidence that people don’t respect what they get for free.

Comment by AndyJ on 2010-02-01 13:32:39 -0800 #

As to the stray animals coming to your house and getting fed, we live out in the country and get stray dogs and cats all of the time. We do feed them and take them in, but every one of them makes a trip to the vet and is neutered or spayed. You get snipped, but in return you get a home to live in and food. Maybe that might be the answer to the human problem. I also retired as a pharmacist from a government entity who gave away free medications. I can’t tell you how many times that at noon time, I would make the rounds of the trash cans at the door and retrieve all of the prescriptions that I had just filled, because the patients only wanted the lozenges to be used for candy.

Comment by Martyn on 2010-02-01 18:24:13 -0800 #

But the majority of white people are not drunk college dropouts unlike a majority of Native Americans. It’s just a fact.

Comment by Dustytech on 2010-02-02 00:52:56 -0800 #

I agree with Ray. Look at medicare. Perfect example of what happens when you let the Federal Gov’t govern beyond it’s initially intended purpose. It’s there to PROTECT us from others encroaching on our rights, not to HAND us everything we want. And when it comes to pharmacy…dear God, I have nightmares about this new ‘reform’ and the shitstorm it’s going to bring to our profession.

Comment by Texas Pill Pusher on 2010-02-02 12:14:51 -0800 #

There is one fatal flaw in every “public option” healthcare proposal. No cost controls. Without effective cost controls, there will always be excessive inflation of healthcare costs.

The ONLY effective way to control costs is to place a large portion of the cost on the patient. Let’s say 50%. When a patient must pay 50% of the bill, they will search for the best price. If all a patient pays is $20 for a $500 medication, there is no incentive for them to get the doctor to write for a generic. The doctor will begin to care about medication costs when his patients demand he change his prescribing habits.

Comment by OldtiredRPh on 2010-02-02 13:24:07 -0800 #

Although mail-order Rx’s are not necessarily free, they are certainly offered at an enticing reduced price & for a larger quantity that we (retail) are “allowed” to fill. What a crock of bs that is. It just could be the ruination of this lil ol corner drugstore. NOT FAIR! Not only that, but your “patients” who you’ve lost to this practice, still expect you to be there for their start-up Rx’s & antibiotice & cough syrups. Not to mention, they have the balls to call you on a weekend to come in & give them the Rx they just received in the ER. What don’t they understand about this? All I can say is, thank goodness for caller id. These patients do not understand what it takes to make this pharmacy operate in the black. When they are enticed to get their Rx’s for next-to-free, they piss & moan about what we have to charge them here for those “emergency” Rx’s. We all know the perils of mail-order Rx’s & yet that seems to be the growing trend. I’m just waiting for my own group health plan to mandate mail-order for me & my employees-I won’t even be able to fill my own Rx’s!!! This is just WRONG. What do we do??

Comment by LD50 placebo effect on 2010-02-02 15:06:31 -0800 #


Scenario: public welfare fraud and waste in the Medicaid spectrum-> transgressions splashed on the front page of the newspaper (or at least one of the first pages) of Medicaid Fraud.

Scenario: backroom deals with Medicare contracts with different manufacturers and private insurers-> occasional transgressions splashed across back pages based on HIPAA violations. (When you helped your retired patients figure out which private Medicare payer plan to enroll and contribute their retirement benefits, were you in one of our 50 states in which only one or two private insurers deal with Medicare?

Where and when do we hear about the actual private insurance scammers such as AIG, Omnicare, et al denying coverage or bait-n-switching the American public? I pay my adult sons’ health insurance because his low-paying job offers no benefits. He has never needed it, but it’s there in case something catastrophic happens, because I do not want his inheritance to end up lining the pockets of Blue Cross stockholders.

AIG and other private health insurance businesses wiped out Wall Street resulting in national economy on the skids and the stock market crash. Occasionally, we hear on watchdog blogs (e.g. DrugMonkey) what we minions have seen, and how often we deal with the iniquity daily on individual bases.

Have you ever wondered why a person that calls us on the phone to ask the cost of a prescription, cannot get a straight answer unless it’s on a $4 cash list at Wal-mart. This is possible cuz it doesn’t go through an insurer kind. When was the last time you checked a Red Book price? Several years ago depending on which buying group your pharmacy buys into. Correct me if I’m wrong.

But, when the cost of drugs is set by the government as commonly seen by programs in the VA, that’s the price anyone will pay. If the company (manufacturer) doesn’t like it, too bad. As well as the example, critic arguing low administrative costs and no need to produce profit provide an unfair pricing advantage. So, as a pharmacist is our priority to the patient or to the whims of drug companies?

Nothing of any value gets accomplished when we start labeling each other as ‘socialists’ ‘communists’ ‘dilettantes’ ‘dildo’s ‘dodos’ etc., because we live in a democracy and our Constitution only allows for this system of ruler. Quit shooting out of each side of the claptrap and use the God-given brains endowed with.

When was the last time anyone brought a whistleblower suit against the fraud we see every day by private insurers? Nowhere. Because, we as individuals have no idea of all these backroom deals at the national level with widespread arrogance because, the records of private companies are closed to the public and only responsive to the stockholder nod of approval. The government deals are at least a matter of public record, to simplify matters, if we know where to look.

I don’t think anyone thinks health care should be ‘free’ if they are working. Wage-earners should ALWAYS have health care employer contributions in competitive jobs, if not only seen at the end of the year in tax deductions. The unfair thing is that wage-earners might have to pay more than others or be ineligible for insurance because of pre-existing condition or other factors, resolved or otherwise. My example is craniotomy of a benign tumor as a high school student. Not everyone has to work for a living e.g. folks living high off the hog on inheritances, and they should be investing and contributing to health care costs that are ‘artificially’ set high because health care providers themselves must provide for the coverage of the uninsured or underinsured.

If a set-point of health care costs are established at one standard rate (e.g. what the government WILL pay, not whatever deal each insurer works out with employers and manufacturers and PBMs, and politicians, etc. not every new rate at a moments’ notice every whipstitch, and at least yearly) then the costs, reimbursement, limits to drug company can be gauged from that point.

Comment by GE Rph on 2010-02-02 21:06:35 -0800 #

I doubt that if you think the government is the answer to all your worries.

Comment by JamesPharmD Intern on 2010-02-03 10:50:39 -0800 #

Overpaid!?! WHAWHAWHA! Cry a little more. If you want to get paid well, work your ass off in high school and college to get into pharmacy school, sacrifice 6 to 8 years of the prime of your life to learn the PROFESSION, and take out $80-100,000 dollars in loans, and pay them back in interest to the government! Then, get licensed, and leave your ass on the line for any mistake that is made!

You are exactly like the rest of the “have-nots” that exist. People who probably didn’t want to work as hard as the physicians, lawyers, pharmacists, entrepreneurs, and businessmen/women, but want all the rewards that are available for that hard work. Don’t like being a pharmacy tech? Think your underpaid? Quit your fucking job and go somewhere else. Or get a professional education and become more useful to society.

Oh and by the way, life isn’t fair, especially in a democracy. I worked for 6 years while getting myself through college at a retail store. I was a top salesperson and had an amazing work ethic; many of my ideas as far as logistics also contributed to the success of the store and profit/volume. Guess how much I got paid? Not much, I got paid way less than the store management, who of course played with numbers all day and barked orders. Did I get angry? Not really…..want to know why? I had no degree at the time, I had no credentials, I was just an employee. I hadn’t taken the steps that allowed one to be placed in a position of authority, of RESPONSIBILITY. This is how life works, this is how democracy works, and if you don’t like it, move to China.

Comment by ACZ on 2010-02-03 12:06:45 -0800 #

“Of course you’ll also point out that if you take the number of letters in the second paragraph, divide by the number of hours in one day on mars, multiply by the number of uses of the word “fuck” on this site, you will have exactly double the seconds that Jesus hung on the cross before he died!”

Actually, it works out to 3.5 times the number of seconds Jesus hung on the cross before he died. Just wanted to point that out.

I found the antisemitism accusation more than a little bit far-fetched. At first I thought the author was making an attempt at (failed) humor, but as there was no punchline (nor humor, for that matter), I guess they were serious. But if you look at their entire rant, their brain appears to be scrambled.

Comment by LD50 placebo effect on 2010-02-03 12:39:49 -0800 #

The mechanism for ‘cost controls’ would be the same as what happens in the VA. As far as I know, the government (us) negotiates prices for the cost benefit of beneficiaries (veterans), as well as payors (tax-payers)? I seem to recall at end of 1988, early 1989, when Congress was a bit slow on funding the VA, our workload in the mail-out pharmacy dwindled to 10%, and when enough veterans complained about delays in their yohimbe and reserpine refills, Congress scrurried around to find the necessary funding. This simple scenario seems to suggest that funding, cost caps, and responsibility lies with public sector. And, during that year as a VA resident, the concept of generics had just been implemented, and we were breaking ground in facilitating the formulary concept and I had been working with comparisons to a copy of British Formulary at the time.

Seems to me with a recent work-study experience in a major VA Medical Center, patient clout might push availability and priorities in health care altenatives. But, at least, in the VA, veterans have access to benefits whether or not they choose to use them, and practically, they’d already paid their dues. As I recall, when it came time to replace ‘lost’ inhalers, both the time it took for the refill to be mailed and other ‘penalties’ there was a real disincentive to accidentally ‘lose’ medical devices.

The intent of this statement is to say that for this segment of the population there is assurance of a basic level, a ‘public option’ with MTM, and also other health care alternatives depending on patient resources, unlike what might be available to other segments of society which did not serve in the military.

Comment by Steve on 2010-02-03 13:13:04 -0800 #

I respect you “contrary mary” in the sense that you respect the actual cost of the meds. I work in a pharmacy that is about 70% medicaid. I worked in an area for a few years that was only about 25% medicaid. I agree entirely with TAP’s posting!! I see it on a daily basis!! People on medicaid (generally speaking) seem not to understand/care about the costs to others they are causing by being purely lazy. I just had someone the other day who whined to me about there $1 copay on a med that i get filled early for them because they “lost it”. Might i also add, they whined the first time also about there copay when they picked it up the first time! I have another customer that knew how much a replacement cost was and had to decided how to afford it (patient did desperately need it). They parked there car for a month and a half and walked/rode a bike to be able to afford the medication. The patient had a heart attack not even a month prior to that and yet did what they had to do. Anyone that says there is not a difference between your average medicaid patient and a person with a major insurance (with a copay) is completely full of it and needs to open there eyes.

Comment by SDPharmer on 2010-02-03 15:27:06 -0800 #

@Kacey: Beer’s list (basically anything that will make you dizzy, fall and break your hip – HUGE increased risk in 5 year mortality after breaking hip in elderly)

Comment by Jon Boone on 2010-02-04 14:15:33 -0800 #

I am a retired pharmacist (thank God!!!!!!) of about 35 years experience. I work ONE short Saturday a month. Even on that day I experience at least one incident like the above post that SO justifies my exit from the profession.

The truth is I started hating my job(?) day one of actual practice. The end result of my entire career is that I hate doctors, nurses, lawyers, NP’s, PA’s, every pharmacy oriented corp, mid-level executives, third party payers, insurance companies and every rat-fuck welfare stooge that I have ever had the misfortune to SERVE!

Keep up the good work Mr. Angry Pharmacist. I wish you had been around at my beginning.

Comment by BTJ on 2010-02-04 15:00:56 -0800 #

Yeah, there was a study that came out when they were writing medicare that linked benzos to increased risk for the elderly falling…. so when it came to write medicare part D they didn’t want to have to edit medicare so they excluded benzos.

Comment by was1 on 2010-02-05 12:37:31 -0800 #

everybody’s a critic.

Comment by Roy on 2010-02-05 20:35:14 -0800 #

Ray – Prove it. Most of time (notice I’m not using absolutes like you do)
revenues DECREASE with tax cuts.

Comment by Doesntworkatpharmacyanymore on 2010-02-06 08:06:10 -0800 #

What was most interesting to me was that almost everyone who “lost” their meds were people who weren’t paying copays or paying like 1.10 or 3.20 which they STILL bitched about. I still can’t forget the old lady who brought her SOCIAL WORKER to try and convince us that she didn’t have to pay any copays at all. Not kidding.
I also love it when cranky old people who actually do know about insurance embarrass the shit out of ignorant people that don’t even try. Total pwnage.

Comment by BluesRPh on 2010-02-06 15:59:15 -0800 #

Except that exclusion also applies to benzodiazepines that are medically necessary (such as clonazepam for seizures). It’s not easy trying to explain to a patient that their seizure med is excluded because it belongs to a politically unpopular class of drugs.

Comment by Natika on 2010-02-07 23:01:30 -0800 #

I have a husband who on unemployment. Not because he’s LAZY but because his company can’t afford him right now and he’s laid off. I have been a stay at home mom for 10yrs. I have been looking for ANY job I can find. No interviews, nothing! Nobodies hiring.
So…I pay $150 per month for Pristiq. It’s a stupid med but after 2yrs I can’t seem to get off of it thanks to the brain zaps and ect. My husbands BP meds and other meds cost upwards of $250.

Some girl in the pharmacy the other day with her fresh french nails and her beautiful new highlights and her 3 kid’s with their matching Gap outfits…She was BITCHING because the pharmacist said she couldn’t get her 3 scripts filled early because Medicaid wouldn’t allow it. But she was taking a vacation to see her mom….FUCK ME!

Comment by Dave on 2010-02-08 12:51:49 -0800 #

This is so true. I have seen it with my in-laws. I own my store and have given one of my in-laws the “family discount” for years. He puts absolutely no value to any of his meds. When I finally cut him off of the “family discount” and informed him that I was supporting him to the turn of 200 bucks a month. He has tons of meds, a part d plan and he thinks part of the problem is that I overcharge for my drugs. He was totaly put out that he would have to look for those samples of Januvia his doctor gave him that he lost last month. I can’t wait to see his face when he gets his bill at wallys.

Comment by Brian on 2010-02-08 21:58:48 -0800 #

Martyn, where did you get such skewed views of Native Americans. I went to school at Central Michigan University for undergrad. We were the Chippewas, which is the band of Saginaw Indians of the region. I did not know one Native American student who drank him/herself out of school. Native Americans, much like many cultures within this country, end up a product of their environment. Most had it good where I went to undergrad, however, those that did not take advantage of their opportunity have only themselves to blame. But this is not the case for all Native Americans. In some parts of the country, poverty, drug/alcohol/medication abuse on reservations is a major problem. Because the Native American tribe where I went to undergrad had financial resources, deep ties with my college, and the community, resources were plentiful and many took the opportunity at higher education and excelled. My point is, you’re an idiot. All native americans do not have everything handed to them as reperations and piss it away. Many don’t have much to start with, and its these people whom I assume you derive your stereotype from. So, stop being a douche bag and read up on Native American history in this country and see how bad many of these people continue to get screwed by the system. I wonder if you’d have made as much of yourself if you were dealt the hand that many have been who live on reservations with little resources.

Comment by Brian on 2010-02-08 22:11:59 -0800 #

If all medicaid would charge, I don’t know, $3 for generic Rx’s and $5 to $10 for brand name drugs, those on medicaid sure would make better decisions on whether they really needed a drug. Bottom line, I agree with everyone that if copays are $0 or $1, there is no accountability since the service that we provide has been devalued completely. How many people here have customers who are reasonable healthy, yet see their doctor more time in a year than any of us have seen in five years? Not to mention, take their kid to be seen every time they think little johnny has a fever. Adults should have a $10 or $20 office visit/ER fee and children $5. Think of the billions it would save and the decrease in bullshit the health care industry would not have to deal with. It is a fact, when someone is conscious to the cost of a service, they will make more discretionary decisions as to whether or not to spend money on that service! Why is it so hard to get lawmakers to understand that those on medicaid don’t give a shit because they feel they’ve been fucked by the system, so they will continue to do what they do.

Comment by TechJess on 2010-02-08 23:45:47 -0800 #

Medicaid in my state has begun charging a $2 co-pay on brand-name drugs and a $3 co-pay on any drug that requires prior-auth. It has done nothing more than result in a lot of bitching by the customers and a lot of extra work for the pharamcists. Rather than pay the co-pay, almost everyone will just want the staff to take the medication out of their order and only get the scripts with a $0 co-pay.

Comment by Linda Tackett on 2010-02-09 10:05:31 -0800 #


Comment by was1 on 2010-02-09 16:27:15 -0800 #

wrong, roy, ray is right. kennedy and reagan both lowered tax RATES and both times there was increased tax REVENUE. macy’s doesnt put their stuff on sale so they can make less money. lowering taxes is like having a sale on economic activity. lower the price of moving money around and more money will move in the economy. that causes more revenue to be generated.

Comment by was1 on 2010-02-09 16:35:22 -0800 #

I always thought that meant that they couldn’t have more than 2 beers with their xanax.

Comment by OldTiredRPh on 2010-02-10 06:54:09 -0800 #

Dave, I own my own store also. My Grandfather would say, “If you count on your friends to make a living, you’ll go broke.” Guess that is true for in-laws as well. I share your pain. My Aunt & Uncle go to Wally’s for everything except for a special cough formulation no one else will bother with. They no longer receive the “family discount.” They treat that cough syrup like liquid gold!

It is true, anyone who has little or no co-pay has no idea the expensive meds they are walking/driving away with. Most drive much nicer vehicles than I do & take nice vacations-something I only dream of. Some (most?) are 3rd & 4th generation welfare recipients & know no other way to live & feel entitled!

Comment by Obviously on 2010-02-10 23:09:19 -0800 #

I think everyone is missing the big picture. Who still gets paid relatively the same whether its a medicaid/medicare/private insurer/cash paying customer? The drug companies. The same goes for medical institutions and the buying of lab equipment, medical imaging etc. The producers make the same whoever the buyer is (some contract variations). So who makes even more money if the millions of uninsured and underinsured (hate that term) people get insurance? No wonder they promised $80 million over 10 years towards health care reform – they will make 10 times that. Obama is a tool for the drug industry and he doesn’t even realize it. He’s going to take our tax paying dollars, fuck our reimbursement rates, drive thousands of independent pharmacies out of business – maybe even retail pharmacy as we know it (giant government mailorder) and where is it all going? The drugs companies are worse than big tobacco – smart though doing it with something that won’t kill you. Do you think there will be an override for a lost flovent in a system where the puppetmaster still gets paid? Do you think they care if the big chain you work for eats the cost or you corrupt fuck that posted about frauding the insurance (who is the only entity strong to fight the drug companies)? The government has to stop trying to help everyone based off a story of single mom with 3 children trying to get by. The souless giant corporations love these stories to make us pay taxes to the government for more people to be covered to pad their pockets. The government takes their share by charging capital gains etc (why do you think drug prices are higher in the US?) – seems like some sort of illegal money laundering. Maybe I am delusional and need to travel to conspiracy free Zyprexa land, but I think America’s big corporations are too corrupt for National Healthcare to work. There are not enough pharmacists, nurses, doctors, midlevels, etc for it to work. The system will be overwhelmed with the influx of people now making an ER visit for dry hands and expected Curel to be covered (I bet they have a lobbist to get it on the formulary). The only happy people will be the suppliers. The government should only exist to keep GE, Pfizer, etc from getting as big and influential as there are – and to pave my road (with plenty of smoke breaks for those state workers). Big corporations have knocked out the competition and now we are paying in our tax money. Put my damn tax money to teach an 8th grader a cough for 3 days is not an emergency visit and is not cured with antibiotics. Don’t use my money to treat their stupidity!

But, honestly do you really fault the person who figured out how to use the government to their advantage? They are the only ones that aren’t taking it up the ass. I just wish the government would give us honest people a reach around.

Comment by pill pusher on 2010-02-11 19:42:41 -0800 #

I wish I could add to what Obviously said. I can’t because he couldn’t have said it better. Hand over fist the powers that be will continue to control our profession. Honest people will never get a reach around, instead we will get a bigger fist shoved farther up our ass taking every last morsel of crap we have to give them. How long before they force us to stop? How long before we are raped of everything? It’s too late to form a common union because the chains control our direction. How could we have been so short sighted to allow this to happen? At least our colleagues in North Dakota still have something left to fight for which in and of itself is an amazing and honorable achievement. The rest of us sold out and now we have allowed companies like CVS/Caremark. I guess we didn’t realize that the Sherman Anti-trust act would be forgotten. Well I haven’t forgotten it;
A Section 1 violation has three elements:[16]

  1. An agreement
  2. which unreasonably restrains competition
  3. and which affects interstate commerce.

A Section 2 violation has 2 elements:[17]

(1) the possession of monopoly power in the relevant market and
(2) the willful acquisition or maintenance of that power as distinguished from growth or development as a consequence of a superior product, business acumen, or historic accident.

Um,,, does any one of us need to be a lawyer to see how CVS/Caremark clearly violates every element? I think even Forrest Gump could appreciate this.

I wish I had the answer

Comment by KDUBZ on 2010-02-12 12:51:53 -0800 #

I would imagine you are one of those “brilliant techs” who thinks that they are able to counsel patients about their medications. I am also guessing your Pharmacists simply tell you that you are brilliant to pawn all the bitch work (ie taking out the trash) onto you. Finally, the attitude that all pharmacists do is “Scan shit” really shows that a better title might be “ignorant overpaid tech”

Comment by welfare-man on 2010-02-12 22:36:15 -0800 #

tap are you a anti-semite? as a republican you are supposed to love and respect the jews (including me). think like a republican

Comment by LD50 placebo effect on 2010-02-13 21:31:05 -0800 #

More of the problem is like that analogy I heard on PBS Radio this morning about trying to contain a filled water balloon in a big net; poke it one way and squeezes out another place. Seems as if the net is getting weaker and weaker because the holes are getting wider. It’s not the drug companies only taking advantage of the situation. They rip off the government (government programs like Medicaid, Medicare, pharmacies, FDA, cash-paying customers, PBMs, and insurers) to the maximum amount they’re allowed because they can get away with it. In turn, the actual providers like pharmacies, medical practices, other health professionals, etc. try to eke out what can get under the clamped down reimbursement rates because they have to cover for both the actual costs of goods and products and recover for low reimbursements from all kinds of insurers (selected by the Medicare companies in the state) which dictate reimbursement rates to the providers. Government programs do the backroom deals with the drug companies, PBMs, and insurers to jack up prices and keep them artificially high. Not only are there drug company monopolies, but the insurance business as a whole switches its tail with all the bravado of a bullying monopoly, too. Some chain drugstores and hospitals and clinics negotiate their own price deals, as well, so act as bargainer in price-fixing schemes. Plus, healthcare facilities get big government subsidies from their Medicare patients (when we tax-payers pay up) to start freestanding clinics and health care institutes. (I don’t begrudge the Insitutes because they’re usually heavily involved in research and training to provide top care in a specific locale but why does one town need two major heart surgery centers, or why, in my town does there need to be two overlapping medical care centers? Because, the hospitals put money up front to build them, then rip off Medicare outrageously $5.00 for a tablet of Tylenol in the hospital?

From my point of view, if the government is not corrupt in and of itself, the overseer of equal access would be the government–no matter what is said about bureaucracy, there is a way to make government facilities and care accessible to those enrolled in the program. That’s why establishment of a public option on the face of it seems pretty fair and the most equitable way to carry out a National Healthcare program.

Comment by pharmacyphil on 2010-02-14 06:14:40 -0800 #

Every workday, I sit in my car in the parking lot for 2 min to psych myself up. I turn off all senstivity,reason, self worth & common sense. “Good work Ethic” and “professional practice” translate into “= Just “shut up” and ” suck up” whatever bullshit the customer slings at you for 12 working hours. To make matters worse, I work for a company that treats you like something they just scraped off the bottom of their shoe. With new corporate initiative, roll outs, and upgraded(??) computers, I don’t know how much longer I can hold out. I just scratch my head and think, HOLY S**T!!

Comment by Kim on 2010-02-14 14:10:02 -0800 #

I think the original commentator was commenting on the reservations located in the midwest. Unfortunately it is true that the most common treated condition is alcoholism at these reservations. A number of pharmacists I know work with the Indian Health Service.

Additionally, I applaud all these passionate native american commentators who either through hard work or a privileged life were able to make themselves a success. However, unless they actually live on the reservation, or volunteer time there, or find a solution to the transparent high drop out rate- they cannot be indignant. I think of immigrants, or children who come from difficult families and were able to find it within themselves to do more than their circumstances dictated. Don’t tell me children living in the ghetto have less resources than those living on the reservation. There’s always someone who is less unfortunate than you out there. The difference is what you do with the circumstances handed to you.

Comment by Kim on 2010-02-14 14:16:51 -0800 #

How does the angry pharmacist using “mary” in his make up scenario become an attack on your religion? No offense meant, but your logic does not completely follow through.. It’s just the principal, but I agree that everyone that we realistically can medically cover- we should. Unfortunately the reality (unless this new healthcare plan succeeds) we can’t. So, do you want to pay taxes to help the drug addict? Or the single mother paying for health insurance?

You can be indignant and recite a universal truth- “no one should be denied their medicine!” But what if, given our economic state, we have to choose to cover one over the other? Who would you choose?

Comment by Annoyed on 2010-02-14 14:46:30 -0800 #

Earlier this afternoon, my tech had a patient come to the pharmacy counter and ask to see our $4.00 MENU…typical patient. At least I work in a pharmacy that has no $4.00 MENU.

Comment by rph3664 on 2010-02-14 19:15:57 -0800 #

That’s really racist, like it or not.

Comment by pill pusher on 2010-02-15 21:41:19 -0800 #

Even if the pharmacy you work at doesn’t have a $4 menu you will still be forced to ask if they want a regular or diet coke from the drive-thru window. What’s the difference if you charge $4 or $30 when you are getting paid $55 to $65/hour? Your work will suffer at the expense of selling a diet coke! How long can this last? Hey, I will be very happy to sell groceries out a drive through window and get paid a 6 figure salary, but certainly not while I am filling prescriptions. How does that make us look? if we are more concerned about selling someone toilet paper instead of taking the time to tell them that they have to stop taking Maalox while taking their Cipro and that they should use famotidine or omeprazole instead. Come on now, let’s add fries too, why don’t we sell fries yet? Really, who gives a shit about the prescription? It true value is meaningless and it’s treated just like another commodity. Give me a Coke and make sure it’s ice cold. While you’re at it, grab me some q-tips and a dozen eggs. Oh, and put a rush on it, I am in a hurry to go home and watch TV.

What the fuck has happened to pharmacy?! I still can’t understand what kind of manipulation took place that expanded ownership of a pharmacy to anyone with money. Why bother going to pharmacy school? Just put everything over the counter, isn’t that what these huge corporations want? They don’t want to pay us a 6 figure salary, after wall we’re only selling coca-cola and q-tips.

I would love to see the day when a BTC class is enacted as law. I would also cream my pants if the law also prohibited us to ring up anything but BTC or Rx drugs. While we’re on that subject, the law should also mandate that pharmacies must be designed in such a fashion that would prohibit unnecessary interruptions. This way someone would never have the opportunity to interrupt the pharmacist while he/she is working, to stop everything and lick a stamp for them because they ran out of spit.

Are we slicing balogna behind that counter? What happens when you go to the deli at a supermarket and jump in the front of the line? I don’t know because I have never seen that happen. It can’t happen, because the person slicing the balogna won’t even acknowledge you until your number is called! Next time you go to the supermarket on the weekend, I challenge any one of you to jump in front of the line and ask where the hair spray is or what aisle the toilet paper is in and also order your lunch meat out of turn. Just tell everyone that you have to catch a plane. Come back here and tell me about your experience.

Why have we come to such a pass? Is it because too many of us are cynical? Would we rather take the money and run? If we keep this up, our profession will die and we will be slicing balonga, at least we will have some respect and allowed to slice one balogna order at a time, and since you don’t need to go to 6 years of schooling to learn how to slice balogna, (it’s very simple, ya know, not much to it, put the meat on the slicer and watch your fingers) you won’t need to pay off the 6 figure loans needed for pharmacy school and can use that money to buy a decent house instead. Wait, there is more you will also have a coffee break, a lunch break and get overtime after 8 hours a day. So, why go to pharmacy school, medical school, nursing school, etc… a bean counter will be put in charge of your operation anyway and your knowledge will be worthless to anyone and lost.

I am not a religious man at all, but God bless all of us for the job we do on behalf of the ill.

Thanks for letting me vent.


My lawyer told me to take out the part about cutting in line at the deli because he is afraid that if you get injured, you may turn around and sue me for suggesting such action,,, so don’t do it. I didn’t want to put you in harm’s way, unless of course you are the CEO of CVS/Caremark, Express Scripts, Medco, Bernie Madoff Inc, EXXON, or any other fuckhead that sucks away my hard earned cash faster than the government can say Gotcha!

Comment by RX1601 on 2010-02-16 15:44:16 -0800 #

Pill Pusher, I completely agree with you. What happened to the profession of Pharmacy. It feels like I am a McDonald’s. My raise & my bonus depends entirely on how quickly I can flip the burgers (fill rxs) & my tech hours get taken away if we don’t sell enough flavor for rxs. I hope things change soon, because I am having serious doubts about America’s most trusted profession.

Comment by ssstevem on 2010-02-17 14:37:00 -0800 #

Nothing will change until enough pharmacists decide to stop working under these conditions. Easier said than done I realize, but true none the less as the current retail business model needs a massive overhaul. I am afraid that the profession is far too weak and/or complacent and that any overhaul will only benefit large companies (ie, Walgreens and POWER). I can’t see retail pharmacists maintaining six figure salaries in this environment.

Comment by Phar-mom-acist on 2010-02-18 22:21:49 -0800 #

Angry, you never fail to surprise me, some days I almost think you’ve gone all liberal Obama-care on me, and then you redeem yourself with a lovely rant such as this. Why is hard working folks like me have NEVER been to the ER for anything requiring pain meds, but people with no significant copay seen to be in there every week or so?!

Comment by Phar-mom-acist on 2010-02-18 22:29:51 -0800 #

Had a good one last week, bonehead on disability gets new script for very pricey specialty med ( you know, once a week injectable $2000 per month type) leaves it out of fridge all week, then blames us for not telling him to put it in fridge, we get override for early refill from insurance then loser refuses to pay $3 copay!! Classic!!

Comment by pill pusher on 2010-02-19 01:28:48 -0800 #

I agree who is going to pay you 6 figures to sell groceries out of the drive thru window? Tell me who and I will go work there. I will have a smile on my face, the same smile I that have after I eat a piece of of chocolate cake…. but wait… who will give out the drugs? Who will know enough not to let the female techs not to touch the finasteride, who will know enough to know what is dangerous to some but life saving to others? I am busy selling q-tips, who will do my job?

Comment by pill pusher on 2010-02-19 01:39:27 -0800 #

Wait a second, I have the answer, the computer will know all of this, Now we’re fucked, we will be digging ditches along side the physicians. You are all laughing aren’t you? My best advice is buy options and go long on CVS or WAG.

Comment by John Thomson on 2010-02-19 01:51:28 -0800 #

Have you USA pharmacists ever looked at ANY other country’s pharmaceutical distribution systems (aka retail/community/(gasp) government) before offering such bogan opinions that appear in this blog. Angry Pharmacist – there are people in this country (New Zealand) who would like to foment the self righteous/deserving poor opinions that you seem to want to promote. I’m proud to be a pharmacist who likes to think that every customer/client/patient is someone who needs my professional support – if you think/believe/suspect that your customers/clients/patrients are using medicines inappropriately – are you more concerned about crowing about that and parading your obvious prejudices about the non deserving poor/ethnic minorities – or doing something to assist your customers that you are quite happy to take the revenue from “co-payment” or not. – Doesn’t a great country like the US of A not have the facilities to deal with a problem that has been induced by your medical system ? It’s called iatrogenic disease- Ivan Illich has a bit to say about it – combine that with your self righteous comments about sections of society that you probably, in all honesty neither you or I would want to know about, makes sad reading. Humility, I would imagine, does not sit well with anger . Yours sincerely – John Thomson – a (sometimes angry) another NZ pharmacist

Comment by Mario Rana on 2010-02-19 07:01:03 -0800 #

Every man is equal in front of the disease

I would like to add a little comment at this post. My point is that there is a big difference between a principle and their applications on the real world, as good and honest a principle can be it will always have, in everyday life, some fault.
The principle is: everybody regardless to the social/moral/economic/religious/.. condition have the right to have medical assistance. And you will get because you need it .
The principle is based on the fact that everybody is equal in front of pain/disease, everybody needing medical aid will get it.

We are going deep on the real essence of man, you have medical assistance because you are a human being I am not interested if you are rich and can pay for you medicament, if you are a criminal convicted of a crime, a terrorist, you just left you wife and children, you don’t pay the taxes or whatever, in front of me you are a patient, you have a disease and you need to have assistance.
This is, I think, the reason why we see the most beautiful and altruistic acts in the world: doctors go in prison free-willing to heal innate (why they should they were convicted of crimes!?), cure enemy’s soldiers (why they should they just killed your friends and brothers!?) you still are a human being, your sufferance is just as mine, your pain is just as mine you had a mother/wife/children waiting for you to come home just as I have… everyone, in front of the pain is equal. This is the principle full stop.
This principle declined in the everyday life is something else; you, me, humanity in general are not perfect: doctors prescribe to many medicaments, pharmaceuticals firma want to make profits, we resell drugs on eBay, we take to many pills, we are assholes, we are stupid.. whatever…
Whatever imperfection, flaw you describe (all true I am sure) it does not simply match the greatness of the principle.
The medic aid or any other kind of health assistance offered to everyone is simply one of the best advancement of humanity – ever.

Comment by FoulVulgarBastardPharmacist on 2010-02-19 16:18:26 -0800 #

Yes government should be more involved. Like monitoring the fucks that go to different ERs every week with their free treatment card to get an injection for “back pain.” The shitheads that go doctor shopping for the Soma and Oxy prescribers. Sterilize them. Doctors and patients. Kill them all. Call me a Hitler, but that hillbilly/gangster drug seeker trailer park fucker population sucks an inordinate amount out of the system that could be used by those who really need it like the cancer patient faced with bills for thousands each month because they are dicked over by their insurance or another arm of the government charged with making it as difficult as possible to get payment. Many just just give up. Fuck all those shitheads. Death sentences mandated by govt. Death to Cracky McCrackhead. die die die Cracky

Comment by Ed Pollick on 2010-02-20 15:50:17 -0800 #

Keep the faith Angry. There are some of us in law enforcement who take drug diversion seriously. Now if the DA would look at prescription drugs in the same way as all other drugs, us angry cops could make a difference. I wish all pharmacists would not only get angry when they see someone gameing the system but call the police every time. Crime is not protected by HIPAA. A lot of people, some famous most not, would be alive today if someone had just picked up a phone.


Comment by pbmhater on 2010-02-21 09:51:13 -0800 #

Why don’t you blog about what the Left Wing media like the Huffington Post has to say about us GREEDY, SUPER RICH, DISGUSTING Independent Pharmacy owners, or do you just ignore these things on purpose?

Have you seen this piece?

Comment by DizzyedUpGirl on 2010-02-21 14:15:45 -0800 #

Yeah, I misplaced a half a pack of birth control once. Luckily it was only $32.99, because they would not have replaced it that early. The only scripts I can get for free are those that are for reproductive organs. But I still watch those like a hawk from now on.

Comment by RxDawg on 2010-02-21 18:50:11 -0800 #

Did the TAP get sick or something? Very few posts these days. I need my fix man!!! 😉

Comment by PharmD90210 on 2010-02-21 19:18:30 -0800 #

as a newly minted pharmacist fresh from a school where they have engrained in our minds that Healthcare is a right ™, thisis an interesting pov to me. I guess I never thought of it that way….

i know we need to do something, though… The status quo isn’t fair.

as long as drug companies and pharmacies chains especially) care more about reimbursement losses yhan actual patient care (that is usually not a metric when hiring pharmacists and retaining them at walgrreens) the field will continue in a path where we exist just to make money for da man. (not you, tap, but many of us)

Comment by angry P2 on 2010-02-22 16:34:24 -0800 #

I get that some people struggle to pay for things. I’m a P2, I struggle to get sleep, God knows I would love help but I don’t qualify…for ANYTHING. I’m too old for daddy dearests insurance and fuck me if I could only afford my own BCBS, but instead I have shitty ass school insurance. Anyways, not really my point. I try my best when I see some one struggling to tell them to check with their doctor or the manufacturer for discount card or vouchers if its possible….but really people….if you have them….drop the fucking things at the same place you would an insurance card….DROP OFF 1 or DROP OFF 2… not fucking wait for me to leave production and come ring your damn ass up and wait for me to finish everything and THEN tell me you have compny Xs voucher card…..motherfucker. If I’m 7 people deep at the register and a tech short on the shift, do I look like I have time to go get the PICs card so I can void out what I just rang up and then go back and rebill the rx because you didn’t have the presence of mind to cough it up when you dropped off. KISS MY ASS. You can sit your ass in chairs and wait while I ring out all the poor smucks behind you..negative 20 IQ points for YOU..THEN I’ll go fix what you were to stupid to bring up when you talked to the other girl at drop off….I’m not going to fuck over the 7 people behind you that have a brain because you are a fucktard. And PS….if the voucher is not for a drug you are getting today… will not work for the drugs that you are……for Christ’s sake someone invent a pill for common sense and stupidity drug intervention…..your discount for Androgel does not apply to your Singulair…duh jackass. And don’t bitch at me again when it doesn’t work because you have a Part D of some form or another….if I tell you that and then try it and it …uh…REJECTS….don’t blame me…..I damn well told you that when you made me redo it and I read the card that you so kindly withheld until after you were rung out.

Comment by Murray on 2010-02-24 02:06:46 -0800 #

John I cannot believe a man that has been on the register as long as you can still talk this kind of shit. I have been a New Zealand registered pharmacist for 25 years and thank God Almighty this is the year I quit. You may think your customers, patients or what ever else you want to call them appreciate you, it’s bullshit, they just want you lick arse and run around after them. In New Zealand we are nothing but the DHB and Pharmac lackies taking the abuse and blame for things totally beyond our control.

Comment by ARS on 2010-02-24 16:49:15 -0800 #

You know the key thing her is that I am tired of the bitching and whining….You either be happy with the assistance given to you, or pay for your damn meds yourself.
So, 5 minutes ago this guy (late 20’s) shows up with 8 scripts on subsidized medicare D (bullshit disability) says he needs them in 30 minutes because he is going on vacation and he is holding some casino brochures, etc..(I work 50 hour weeks and can’t afford to take a decent vacation, but him…that’s besides the point) SO initially I say no, because the counter is full, but then I think its good business, etc…. so I agree, bust my ass, get them done just in time. So here I have about $900 retail of rx’s, his co-pay total about $29… Here starts the bitchin’: ” I dont know if I have enough money, do I really need all of them..maybe I can skip a few to save 6 dollars, and the greatest…can I pick it up and pay when I come back from my trip?” My question: “Why the hell did you have me hurry and fill all of your scripts if you didnt have the cash?”

Comment by Jess on 2010-02-24 21:20:46 -0800 #


You need to come to the USA and witness the mayhem that is a major retail chain pharmacy. It is thoroughly removed from the mom-and-pop days of yore. Imagine a pharmacy running like a McDonald’s. The flow is nonstop, and they get mercilessly harassed by the customers/clients/junkies. It is frustrating to witness.

Comment by FloorBlue Rph on 2010-02-25 22:56:40 -0800 #

I have a problem with people coming to the counter and asking “is it free?”. Nooooo… It’s not “free”. It comes at no cost to you. That’s what gets under my skin the most.

Comment by Luke on 2010-03-02 12:12:30 -0800 #

As a recipient of SSI benefits, including Medicaid, I find it insulting that a PHARMACIST would judge me like this. I have an extreme case of panic disorder, and I have been on benzodiazepines and many antidepressants and other psych meds trying to find something that works for me for nearly 5 years now. My illness began when I was 17, and I’m now 22. I can’t even put into words how grateful I am for my Medicaid, and I can’t stand the fact that you lump everyone who has Medicaid into a group of ungrateful bastards. If I didn’t have Medicaid, I’d probably have killed myself by now due to the unrelenting panic attacks that I deal with whenever I find myself in a crowded place.

My illness rules my life right now, and I’m currently getting Rxs for Klonopin 2mg 3x daily, Ambien 10mg at bedtime, and Effexor XR 150mg at bedtime. I have been in therapy as well for a long time, and I’m so glad that I’m able to have Medicaid take care of the cost of that for me, as well as the cost of my monthly psychiatrist visits. Being as unwell as I am is quite expensive, and I don’t know what I would do if I didn’t have the state’s help.

Now it’s time for me to judge you. My take on you, “the angry pharmacist,” is that you’re just a cynical, judgmental, son of a bitch who thinks anybody on welfare is a scumbag. If you were my pharmacist I’d switch pharmacies, because judging sick people the way that you do is completely ridiculous. You get paid very highly for what you do, yet you have nothing better to do than rant about your job on the internet. Get a life Mr. Pharmacist. Not everyone is as financially secure as you are. Deal with it and stop making an ass out of yourself by bitching about those who you are supposed to be helping on your stupid little website.


Comment by karmasmami on 2010-03-02 19:18:00 -0800 #

only God can pass judgement on anyone! i am a recipient of the PA ACCES card (medicaid) I don’t lose my rx’s or sell them and i do take them as directed. There are ppl on welfare who do, lots of them. but there are some honest people who are on it simply because life dealt them a hard time and they are trying to work through it. My Husband lost his job and we have no money to live on and still don’t get a welfare check. Only medical which is very helpful since the two rx’s i’m on total about $800 a month. I have a condition called DDD (degenerative disk disease) Which means by the time i am 30 in 5 years i could be paralyzed or in a wheelchair. I also have a 2 year old to take care of. It is called ASSISTANCE for a reason. not to live off of it as a free ride but to help ppl get through the tough times in life. Don’t judge ppl on medicaid unless you know for sure their personal situation. Thanks

Comment by karmasmami on 2010-03-02 19:43:15 -0800 #

I keep reading about the CVS and WALGREENS they suck. I filled a rx there that was for a 3 wk supply and they put on the bottle 62 pills but there were only 42 like there was suppose to be. I didnt think to check b4 i left the counter. (who thinks to stand there and count ever pill when that is the pharmacy’s job) now my insurance won’t pay until i have already been out for a week. This isn’t a medication you can just not take. Serious problems can occur. So now i have to shell out $156 for a weeks worth of meds. Thanks CVS. I’m never going to a place like that again. Any does anyone know how i can fight this. My dr. can vouch for the amount the RX was for. Will it help? Where should i start?

Comment by The Redheaded Pharmacist on 2010-03-02 22:30:20 -0800 #

The real problem with all of the waste and abuse in the system is that it draws attention away from the fact that there are lots of people who really are in need and who would take their medications correctly and aren’t out to just take advantage of the system. And with our economy in the crapper for an extended time I venture to guess that the number of people that really find themselves in need are gorwing in ranks everyday. I have seen, talked to, and helped many people at work that just find themselves in a difficult situation or have come on hard times. As easy as it is to focus on the shitheads that just take advantage of the system and use it as a lifestyle I can’t ignore all those that really do need a helping hand.

I’m reminded constantly how lucky I am to have an education that has allowed me to keep a steady relatively well paying job during these tough times. Am I rich? Not hardly. Is my life perfect? Not even close! But I am lucky enough to provide for myself by having a job. And I see a lot of my fellow Americans struggling right now because they aren’t as lucky.

So yeah, it pisses me off that there are jackasses that not only feel the need to live off of the system but they also feel the need to be a prick to everyone and complain about a token co-pay. Heck, I probably get more upset than most. But at the end of the day I know that I’ve seen many people in my career that truely needed help and were grateful for it. That is what gets me through the day when I have to deal with one of those people that is simply using the system. I had to find something to keep me going and help me keep my sanity!

Comment by Murray on 2010-03-03 00:51:17 -0800 #

Luke I’m betting you would last about 15 minutes as a retail pharmacist. Money does not compensate for the crap the majority of customers inflict on us. We go home at night not wanting to talk to another human including loved ones. It takes a hell of a toll on yourself and your family so if we want to let off steam on a blog for pharmacists then so be it. You people who have never done the job, and in your case have probably never had a job, can go and get fucked. You have no right to comment. In the pharmacy we may have to bow and scrape to you even though we can’t stand the sight of you, but on this blog we don’t.

Comment by IT on 2010-03-03 12:22:56 -0800 #

Another Native here and I pay for friggin everything. My husband and I struggle so much to put me though school and I work my ass off! Which I had Martyn to tell me I could just get everything for free. 🙁

Comment by bcmigal on 2010-03-04 11:57:22 -0800 #

I don’t have time to take an extra breath, let alone “judge” you. Go find another stupid little website on which to kvetch.

Comment by BummedRPh on 2010-03-04 14:36:25 -0800 #

pharmacyphil, You are not alone. As I walk into the store where I work, I have to convince myself that the 10 hours of my life that I am about to sacrifice are worth it. That and the fact that there are no open phamacist positions in this area are an incentive to get my burned-out ass to work. You are fair game for abuse by customers, doctors, and nurses. The pharmacy manager makes a shitload of mistakes that leave the pharmacy and she hardly ever gets written up for them. When she does get written up, somehow, the report never makes it to headquarters. But if one of the pharmacists, who is not one of her BFFs, makes a mistake they are fucked. They will get written up, dragged into a meeting that is held in a dingy room that is similar to of those old detective movies. All the space needs is a bare lightbulb hanging over the head of the accused. Then,the pharamcist who screwed up is coached by two idiots:the store manager and the district manager who are not even pharmacists and Dr.Dragonlady the pharmacy manager. The Three Stooges will submit whomever is in the hot seat to a rant about productivity, the quality of service,and company best practices
. Yup…two dingbats who probably could not open a pill bottle with a childproof cap, and a PM has me always wondering who in hell in their right mind handed this harpie a degree in pharmacy.

Comment by Bryan Jackson on 2010-03-05 13:55:50 -0800 #

I enjoy your post. I agree with your conclusions. I referenced your post in a similar post of mine.

Thanks for the insight and common sense.

Comment by venting it out on 2010-03-06 19:25:39 -0800 #

just had to vent…had a pt on ntg patches and dammit we were out. they used their last one…on a saturday…what should i do??? NO rx in our town had it, but a town 25 miles away did. tech drove there to get it and left me alone for about an hour…and the best part is-last filled 12/09!!!

Comment by everyone’s favorite floater on 2010-03-06 22:39:38 -0800 #

My favorite are the people who ask you to refill “all of their medications” regardless if they’re taking them or not. A few weeks ago I had a patient do that to me but I refused and asked her for the names of the mediations she needed instead. When she asked for Singulair (well over $100) her husband/boyfriend/whoever said “but you don’t take that anymore”. She actually said to him “who cares, it’s free anyway”. She actually said that… out loud… in a pharmacy full of people.

Comment by commonsense rph on 2010-03-09 22:36:25 -0800 #

I bet the medication you claim short are NARCOTICS!!!

Comment by pill pusher on 2010-03-10 01:38:17 -0800 #

The price of free. That really burns my ass. Who pays for the price of free? Time is money to you and me and certainly to the corporate world! If our time is taken up by someone that doesn’t give us cent for it, then how can we be expected measure our worth to the corporate world who owns us and uses our license on their behalf? How many times has someone interrupted you to ring out their groceries, or to acknowledge them while you were on the phone taking down a prescription? People are rude, and ignorant. They may not realize that you are on the phone clarifying someone’s warfarin dose or even understand the implications of it. That is the entire reason that YOU are there in the first place, because you are qualified to know what that means so that your patient doesn’t suffer a heart attack/stoke or bleed to death. Should the person who wants to know where the Q-Tips are be able to unwittingly interrupt you, while you are doing the job that you trained so hard to do? The physicians calling you are under the same amount of pressure and pulled from 1000 directions as well. They don’t need to be delayed getting patient information from or to you because you have to ask them to hold while someone demands that you ring up their diet coke or cigarettes at your register.

Pharmacists have been way too kind in the past and now people are starting to take advantage because we have previously given free advice, from shoe polish to toilet paper.

A friend of mine wrote that she was confronted with 2 people that wanted to buy Plan B. She went on to say that the (boyfriend?) started quoting prices from other places that were cheaper than the price her store offered. Who knows how long they tied her up for, 10 seconds was too long. Yes, I understand that everyone wants to have a good time. Boys and girls like to have sex. It is part of nature. We’re human. You can’t blame anyone for that. However, the consequences of sex are pretty serious. There is a possibility that you can bring a new life into the world. It’s a beautiful thing especially when it’s done responsibly. Even when an “accident” happens life is a beautiful thing, but the problem we face is who’s going to pay for life? How long can life survive if it’s not cherished and nurtured? How long can we last if our society cynically learns that one person’s life is not as precious as their own?

This guy could have easily used a condom or the girl could have used a more reliable form of birth control. But the lack of respect for life was over looked. Maybe we can contribute much of this to innocence and ignorance but go ahead and try to explain that to a 20 year old college student… good luck. So enough about doing what’s wrong or right at a human let’s talk about doing what’s wrong or right as a pharmacist.

The first problem I see here is that this “Couple” needs your time to sell them what they want, the second is that they are arguing with your about the price. Whether they buy what they are asking you for or not, they are still taking up your time.

The most equitable solution I see here is to charge a flat fee (say $15 for the first 5 minutes) payable in advance before they approach you whether they decide to use your service or not. If they sit and argue with you about the price being $2.00 cheaper at a pharmacy else where you can bill them $3.00 for each additional minute that they argue with you. Your time is money, and they are holding you up from helping others that are relying on you why should others pay for these 2 irresponsible knuckleheads lack of foresight.

The other day I had to have an electrician come to my house, up front I understood that I was going to have to pay a fee for his time whether he was going to do the work or not. I didn’t have time to shop around and see if someone would give me a free estimate, I had a major problem that needed to be addressed asap just like these 2 knuckleheads did. The difference here is I was happy to pay for their time because I knew that if I didn’t address the problem now, it would cost me much more down the road, possibly my life if a fire broke out.

These 2 would argue with you to save a couple of dollars when in the end a child would cost them much more, not to mention the rest of us. This happens because this country has no respect for the job that we do and corporate America doesn’t know how to justify paying 6 figure salaries to glorified cashiers.

If this guy knew that it was cheaper at “Planned Parenthood”, why did he come to you? Apparently, planning ahead was not in his nature.

I do not like what we have become. We busted our asses to get licensed to help people and now we are slaves to the laws governing us to work for free.

Comment by KatLurker on 2010-03-10 16:09:20 -0800 #

Man I just came up with an awesome plan if I’m ever unfortunate enough to end of on Medicaid.

I’ll borrow a nice car from a friend, get something that looks like an iPhone, and get some designer knock off stuff to wear. I’ll pull up to the pharmacy drive thru, chatting on the fake iPhone about how I have a fabulous European vacation planned. When I leave I’ll have the satisfaction of knowing that your panties will be so unbelievably twisted and that you’ll obsess and stew about me the rest of the day. It’ll ruin your day to imagine me as some mythical welfare queen who’s living the high life on food stamps.

Good luck with wasting your time and energy obsessing over medicaid patients. It’s no wonder so many of you are miserable in your careers.

Comment by wagbeeyotch on 2010-03-11 09:36:09 -0800 #

Trust me….you are the minority and MOST on Medicaid do abuse the system and DON’T have real medical problems. You have the right to come on here and “whine” about your anxiety issues, just as TAP has the right to bitch about our awful profession, if you don’t like it—DON’T COME TO HIS SITE!!! And IF you can find a pharmacist who doesn’t feel this way–good for you because more than likely you are being scammed—we PRETEND to care because it’s our job, I fill thousands of dollars a month for a family on welfare, she is a bitch and her kids are on multiple meds that don’t even make sense, but the doctors write them, we fill them, she’s always trying to get them early and she is obnoxious and ungrateful and has NO IDEA that I wouldn’t piss on her if she was on fire… oh and FUCK YOU!

Comment by wagbeeyotch on 2010-03-11 09:40:48 -0800 #

Just a side note–you don’t have “insurance” you are on welfare….

Comment by wagbeeyotch on 2010-03-11 10:11:27 -0800 #

You aren’t on welfare Katlurker? Then you should be angry too, it’s YOUR taxes paying for their stuff. My husband recently found out one of his employees(full time with benefits) gets food stamps. Her and her boyfriend both work, are expecting her FOURTH child that was PLANNED and they both have new cars and a cell phone bill that is $300, they each have an iphone. So why do my taxes go to pay for her food? I don’t own an iphone, our cell bill is only $100, because we don’t get all the bells and whistles. Why do I have to make choices to budget my money so THEY can choose to have another child when they can’t afford the 3 she already has (“But I want one with HIM!!”)?? i am saving money for my future, what kind of future do they have, they don’t care the government will be there to pay for whatever they need why should they forego their iphones??
So WHY aren’t your panties twisted? Is this kind of behavior ok with you? Because what I see everyday in the pharmacy pales in comparison and THIS itself irks me. And no I don’t obsess over it but it still angers me!

Comment by MASTER OF CYNICISM on 2010-03-12 23:58:09 -0800 #

Ok I have the answers to all your problems.
For those who are angry:
Get some control over your situation. Think quality and not quantity. If anyone interrupts or hurries you, tell them you are taking extra time to make sure everything is done accurately, for their own benefit. Don’t let people steam roll over you; tell them you don’t feel comfortable with whatever their request is and you need their MD/insurance authorization etc. If they are druggies, well you don’t have to fill it. Its called professional judgment. Don’t do it and if anyone calls the “manager” or “office” or whatever, stand your ground; do NOT apologize to them unless its actually you at fault. I guarantee, they will not fire you but will respect you instead.
As for the junkies, you have the right to ask for photo ID and report fakes to police.
Just the threat of the police makes them run- I had one dressed like a Rabbi with fake Percocet Rx stand there till I merely told him the Police are on the way and he actually jumped up and RAN.
For the Medicaid/Zero Copay Crowd:
The government is running out of money. But you have been paying at least 25k in taxes yearly; that is 250k over 10 years. You will never see that money again…Unless YOU get medicaid. Then you pimp the system till you get 250k in benefits back. Make sure to get food stamps, expensive psychotropics to sell, and drop you pills down the toilet for early refills. For extra entertainment, act real retarded unless someone says “copay” then turn into a fast talking SOB and proudly tell them you are too smart to work; you just get money from the government for free. Don’t forget to cheat on your taxes- its your money to begin with- its the American way.
Don’t you realize that in your past lives you were these same patients and in this life, your punishment is serving them. LOL

Comment by rph chicago on 2010-03-13 16:21:37 -0800 #

I have a simple solution to welfare abuses. I had to sign paperwork from my company to work indicating that they can take a randomized drug test from me. Do the same with welfare receipients. If you fail a drug test, you get kicked out of the system. Your childrens are still allowed to have medicaid coverage but you lose yours and have to go to county hospital or pay the doctors or pharmacist to see them.

Comment by Feeduppharmacist on 2010-03-16 04:21:12 -0700 #

You know, I wonder if this is unique to pharmacists. I have the same thing. When I get off work I don’t want to talk to anyone for a minimum of 2 hours. I have talked to no less then 4 other pharmacists who have express similar feelings without me mentioning that I feel that way. I have now read several different people on pharmacy blogs mention the “I don’t want to talk to anyone after work” problem.

Comment by pharmacyphil on 2010-03-19 06:55:53 -0700 #

Count me in!
When I leave work at 10pm, I do not listen to the radio in the car, nor watch TV when I get home. I want COMLETE SILENCE. This phenomenon is called Stupidity overload syndrome (lol). It is a response to 12 hours of confronting B.S. from all angles. At home, I just sit in silence, get somthing to eat finally(11pm), glass of wine and go to bed. As a result I am 30 pounds overweight., I used to be in good shape!!

Comment by AF on 2010-03-19 17:46:06 -0700 #

I too believe that medicaid, doctors and rph’s force people to put PAIN pills in their mouths when they have no pain. I am a seasoned cpht, and my greatest relief is when my stores finally got that table with straps so the patient can’t flail around anymore. It makes administering meds SO much easier.

Comment by AF on 2010-03-19 17:49:06 -0700 #

It is NOT going to be free for ANYBODY. What the low-income people get for cheap, the mid income people will have to pay up to 10% of their income for….and our taxes are going to hit the fan, I mean you can’t just spend money you don’t have. Wait i guess Obama is already doing that so he can keep doing it, never mind my post then.

Comment by AF on 2010-03-19 18:06:16 -0700 #

Wow, I should get a medal. I achieved the same result with only 5 years as a tech. LOL, congrats on the retirement! You’ve earned it!! 🙂

Comment by steve on 2010-03-24 16:46:27 -0700 #

  1. Healthcare reform is necessary.
  2. Healthcare IS accessible to all Americans.
  3. Obamacare surely involves all kinds of special interests.
  4. The best reform we can employ is a return to catastrophic coverage. This will make insurance premiums affordable for the middle class and will return physician services back to the free market (after all, who would pay $200 for a “routine physical”?)

Comment by RMpD on 2010-03-24 20:47:44 -0700 #

Are you jewish by any chance?

Whatever you are, it doesn’t really matter, what does matter is you make me sick; people like you that CAUSE rasicm and hatred by looking for it and creating or building it in their own minds. It is hypocrits like you that make the world a more hostile place, and that are the true racists… biggots… descriminators.

“You are clearly a heartless bastard for wanting to deny this poor soul his life-saving medicine. ” – are you kidding me?? Yea he might just kill this person from denying this acute-reaction-saving medication, that if you even read the post would have realized this is the type of patient isnt likely to use it right anyway. Are you even a pharmacist or in the health care profession? I mean it just plain isnt the point to the post anyway. Maybe you shouldn’t come on this site.

Comment by sherrold on 2010-04-06 16:07:17 -0700 #

You do know that Reagan raised taxes 6 years of his eight, right? One year after his massive tax cut, Reagan agreed to a tax increase to reduce the deficit that restored fully one-third of the previous year’s reduction. Faced with looming deficits, Reagan raised taxes again in 1983 with a gasoline tax and once more in 1984, this time by $50 billion over three years, mainly through closing tax loopholes for business. His historic Tax Reform Act of 1986 raised corporate taxes by $120 billion over five years and closed corporate tax loopholes worth about $300 billion over that same period. Neither did Reagan reduce the size of government — the number of federal workers rose 61,000 under Reagan (and dropped under Clinton), and the deficit tripled from the time he took office until the time he left.

Let me repeat that last sentence: deficit *tripled* from the time Reagan took office until the time he left.

Comment by Keri P on 2010-04-12 10:51:16 -0700 #

LOL, just use Shanniqua and LaZakary next time and leave no doubt who you are referring to. Haven’t you figured out yet that no matter what you do the crybabies will have something to cry about?

Comment by Keri P on 2010-04-12 11:08:16 -0700 #

I think I love you. Are you married? LMAO All the things I think in my head but could never say outloud for fear of the ground opening up and swallowing me straight to hell. Thank you. 😉

Comment by ILOVETHISBLOG on 2010-04-23 14:02:00 -0700 #

The majority of white people are still eating good off the free labor of my ancestors.

Comment by Alaska PharmD on 2010-05-08 17:46:09 -0700 #

Oh whatever– my ancestors ran a safehouse for your ancestors. STOP THE RACIAL STEREOTYPING!!!!

Comment by 3of4generationrxer on 2010-05-30 16:23:55 -0700 #

Hit 2 new lows today. Hispanic mom with welfare child and rx from E.R. When I tried to discern address for the file she handed me a Mexican drivers license…with a South Carolina address on it.
Second welfare client has been to E.R. at least 20 (no kidding) visits this year has her 20th + rx for 10 vicodin/percoet/dilaudid/etc not covered this time so she leaves, shoplifts an item in the store and tries to return it at front checkout to cover the $10 rx. Your tax dollars at work.

Comment by Solid_Snake on 2010-06-12 14:25:15 -0700 #

Nice, sherrold, facepalmed those conservative asswhipes. I don’t know why everyone says cutting taxes increases revenue…are they stupid or something.

Comment by Molecules ‘r Me on 2010-06-15 16:20:17 -0700 #

Move over Iron Man, take a hike Batman, Superman you’re a hasbeen – the Angry Pharmacist is my new public hero. He is right on – tell’s it like it is. Yeah,great customer service is a nice concept but via such strategies too many Big Box Retailers have successfully convinced a generation of people that it’s okay to be a whining, hypocritical, Toad, because your’re the customer and you’re always right. WRONG! All we have done is trained the consumer to be spineless, constantly complaining and (here’s the real big one) irresponsible. Responsibility is like a four letter word.

So, next time you go to open your pain meds, don’t do it over the sink or the toilet. Who in their right mind does this kind of thing – then spills half of them down the drain and expects the Pharm’ist to make things all better.

What a crock!!

Molecules ‘r Me

Comment by Ms. C.R. on 2010-09-22 22:34:46 -0700 #

You will have to ignore Martyn…He is a complete racist. Hate is sooooo Heavy on his heart that’s why he’s miserable. Maybe a native American got a position he really wanted. Martyn couldn’t stand the fact a non-white individual is MORE QUALIFIED THAN HE.
Martyn-you have proved to everyone that not only are you a racist, but you are an idiot.
Drink all the time? You need to stop listening to fictional books on cassette. Surely you don’t think Natives driink all the time. That is a complete sterotype. Here’s some truth for ya…no sterotype, honestly! WHITE MEN MAKE UP 70% OF SEX OFFENDER REGISTRY. SEE FOR YOURSELF AT THE FOLLOWING LINK. YEAH THOSE EDUCATED WHITE MEN GO STRAIGHT HOME AND SLIP RIGHT INTO LITTLE HALEY’S BED…. STINKIN PERVERT.So Does that mean ALL WHITE MEN ARE RAPIST?
Read about it here:

Comment by pill pusher on 2010-10-14 22:52:08 -0700 #

The answer to welfare. If you need welfare no problem, before you can receive your 1st check you have to have an orchiectomy if you are man or an oopherectomy if you are woman of childbearing age. It would also be a good idea to extend this to everyone who commits a felony as well. Pretty soon we will find ourselves helping only people that matter, and have a better world for our children.

Comment by egoist on 2010-10-17 04:04:45 -0700 #

This concept is universally applicable, not just Rx, not just welfare, but to everything that is given – given b/c it’s “easier” than the alternative of making people carry their own water. I know – otherwise smart – adults that do their kid’s homework for them. What value must a kid put on that free answer, and the centuries of thinkers that developed the solutions (and the drive to even inquire)?

Stop creating / enabling moochers!

Comment by Or on 2010-10-17 05:39:13 -0700 #

Way to go.. the deadbeat man vs the hard working woman (deserted by a deadbeat man)… no stereotyping at all..
Well done, daf! We don’t have enough male bashing in the media, thanks for throwing some more.

Comment by Zeek on 2010-10-17 05:59:55 -0700 #


Did you mean “inherent”?

Comment by Fyndy on 2010-11-18 22:47:54 -0800 #

Um…I’ve actually lost a medication that costs me $3 copay. Maybe because I’m a nurse, and I actually do realize what those pills cost because I’ve looked them up, but I tore my apt apart looking for those damn pills. Some of do care about our health, our bodies even when we have free medical care thanks. I don’t expect everything handed to me on a silver platter just b/c I live in a country where healthcare is free.

I had to take my script to a place that couldn’t do the copay b/c of a problem between my insurance company and the pharmacy where I normally get my pills filled. And guess what. It came down to deciding between eating that week, or my much needed hypothyroidism pills. Guess which one won for 1 month. That’s right. Just because I only pay $3 copay doesn’t mean every medication I take (and I take a few, thanks to my heart condition that I WAS BORN WITH) comes free, and I understand that.

Not everyone whose copay is 0 or just $3 is a douchebag.

Just saying.

Comment by Vincent Oconnell on 2011-03-16 13:10:20 -0700 #

Like I said, you cant beleive everybody is like that though, you can do the same thing to Dave and Bill. Watch

Dave is a retired military vet that served his country for 14 years. He refused to go to medicl about anything even though his knees would always kill him. He gets out of the military and starts a family late because he didnt want to miss out on any of there lives. He gets married to a woman that he has been dating for 5 years. He works hard doing what he can to support him and his family. He just had a baby last week and plans on doing whatever he can for his son,but unfortinutely his company gets shut down. He goes out and looks for jobs applying everywhere but nobody needs any employees at the time. He even travels out of his way extending to 60 miles but his money is starting to run slim. He decides he has to swallow his pride and get medicare.

Bill is a highschool drop out that sells cocaine, meth, and weeb for a living. He has gone to the state requesting medicare because he is unemployed and has been for 6 years straight. He gets full benifits because according to the state he is making no money.

Both now have $0 for a copay. Who really deserves it? Now lets go on with this

Dave’s still looking around for a job and is now looking for even hard labor when he knows there has got to be something wrong with his knee. He explains it as pain with pressure on it. It feels like it is going to go out on him or it is unstable and it pops. One day he is talking to a friend and his friend is a doctor. The doctor tells him that he needs to get some medication for the swelling after he saw it. Dave doesnt want to because he feels that he needs to work for everything he gets. Yet when the doctor tells him that he has torn his miniscus and it can cause greater damage to his legiments and his joints. He goes to the hospital to get it checked out and they tell him he needs surgery and they put him in for vicoden and naperson (I am not a pharmasist so dont expect me to spell them right, lol). He calls in to the RX and requests for the prescriptions. He is told show up in 1 hour to fill them. He shows up 15 minutes early because he is trained to no matter what and waits patiantly. He thanks the pharmasist for there help and appologizes for the inconveiniance of paying no copay. He wishes you guys a great and blessed day.

Bill gets the shit kicked out of him because a drug deal goes bad. The doctor sets him up with the same meds to reduce the swelling and to help with the pain. Bill shows up at the same RX without calling in. He demands the prescription be filled at once. He smells of ass, weed and still has some coke on the inside of his nose and has shown up high as a kite and acting as a moron.

Later Dave invites a friend into his house that just went homeless. He cant see a former military member live on the streets like that so he gives him a place to stay until he can stablize himself. Well, unfortionatly his friend has turned into a peice of shit and when he is out of the house with his family his friend steals his tv., his laptop, and his meds. Dave comes home in pain from going for a walk in the park with his wife and son. He notices what has happened and calls the police. After the police leave he goes to his medicine cabnet to take his meds because he is now in extreame pain. He now notices that his medication is gone. The next day Dave calls the RX and tells them what has happened and appologizes for the inconviniance. He is now begging for help because even with the welfare the bills are racking up on him and he cant afford the meds. He understands the severity of the situation and he appreciates what he had even though he doesnt understand how expensive the medication is.

Bill is having massive parties and this last one he broke his arm. He goes to the hospital and the keep him on the same meds after the surgery. His refill isnt for another 2 weeks and he is now missing his meds. He calls up the pharmacy bitching that he lost his pills and demands that he needs more. He is now furious because he has to pay for his medication and threatens to bring you to court.

Who is right here??? Neither because they both are getting no copay??

Comment by Celia Hoover on 2011-05-16 20:17:30 -0700 #

It is in the instances of catching pain pill doctor shoppers on medicaid one can consider the situation of the uninsured worker being hounded by debt collectors, and being faced with bankruptcy as a result of the unexpected e.r visit, but does not qualify for public help. Has a new sort of class warfare begun to rear its head?

Comment by Robin McCarthy on 2015-01-10 20:38:41 -0800 #

The only case you can make against $0 copays is if “Jacob” loses his medication he wont care because he didn’t pay for them?

You are suppose to be professionals. Why are you taking the behavior of people personally? You can’t control what other people say or do. You can control doing your job professionally and accurately. I think that’s more important than worrying about “Jacob” not caring about how much he is getting for free,

Comment by John Faso on 2015-02-15 10:28:10 -0800 #

Robin, the reason we get so angry about customers like “Jacob” is because they abuse the welfare system. You can’t control other peoples actions, but that doesn’t mean we should enable people to be careless. When you work in pharmacy, you see the full extent of suffering. We, as pharmacists, are for the most part at the mercy of insurance companies. I can’t tell you how many times I’ve had to tell patients, “I’m sorry, there’s nothing I can really do.” because I work for a chain, so if I give away $400 medication for $10, I’ve just lost the company money and potentially my job. Most of us get into this field to care for people and to help people. We’ve since become cogs in the corporate machine, and it’s no longer a career, it’s a job. The reason you see so many embittered pharmacists is because we simply ask that patients have just a smidgen of responsibility, to which many fail to do that. Patients like “Jacob” are all too common. They feel the world owes them something, and don’t respect the healthcare industry. They treat their medication like it’s nothing, and if they lose it, “Oh well the pharmacy will provide me with another!”

Welfare is supposed to be assistance. You should NOT be living on welfare. If you have such a debilitating disease and feel the need to live on Welfare, you need to apply for disability. My tax dollars should go to people who actually need help, not entitled and irresponsible people. We’ve become a culture of people who think that everything should be free. I had a woman throw a fit last week because her insulin, 3 boxes of Novolog pens, had a $3.00 copay under Medicaid. That’s EASILY $800 worth of medication, and she’s throwing a fit over the copay. She asks us to waive it (certain Medicaid plans offer the ability to waive the copay, one time, but of course people treat this like a coupon).

The system is broken. Pharmacists are miserable, and it’s because the people we help treat us like garbage and a great deal of patients act like spoiled children. It’s amazing how many people believe in the American, “you are responsible for you, you make your own way” attitude, yet act like they’re entitled to free medication because they pay their premiums.