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Antitrust, Chain/PBM’s, Independents and You

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Think of this senerio:

The owners of 3 independant pharmacies go out for dinner.  During the dinner they talk about how (for a very accurate yet hypothetical example) low MedImpacts MAC’s are compared to other insurance companies.  During the discussions they rabble on about how they cannot do business at COST + $0.75 and jointly decide to fax their contract termination letters into MedImpact.  That, right there, violates the Anti-Trust laws.

Now think of this:

CVS/Caremark (a pharmacy/PBM merger) decides that MedImpact doesnt cut the mustard.  They threaten to terminate their contract which will effect a couple hundred stores.  MedImpact tries to play the hero and refuses to negotiate, and now 300+ stores are off of MedImpacts provider list.

Three independent pharmacies get dinged for Anti-Trust behavior, while CVS/Walgreens/Rite-Aid(?) can nix hundreds of their stores without violating anything.  Tell me if that was the intent or spirit of that law.

Since we’re talking about the exploitation of the Anti-Trust laws that were made to protect citizens from such behavior; lets take CVS/Caremark.  Now a while ago we (meaning every independent in town) underwent a Caremark audit.  Now considering those auditors are paid by the infraction, and they will cancel out any prescription that was written for tablets but filled will caps (even if the medication did not come in cap dosage form) among other totally bullshit non-fraudulent-act (like the MD instead of the NP checked off), do you really think CVS gets held to the same exact standards by Caremark as us non-CVS stores?  Have you ever thought about how shady and corrupt a PBM looks taking money away from the direct competitors of their affiliated pharmacy (probably in a futile hope of putting them so far under they will sell out to *their* affiliated Pharmacy chain)?   CVS Pharmacists: Do the Caremark auditors come into your store and audit your records?  Since you’re affiliated, aren’t they just taking away from themselves? Or do you guys write off the store losses by filling ‘fraudulent prescriptions’ thereby making your store less profitable and thereby pay less taxes?  Marvel at my TinFoil hat and how its shiny!

I wonder if Medco audits its mail order pharmacy, god knows they love to audit us independants.  I wonder if all of the big PBM/Retail anti-trusters have some sort of unspoken fraternity-boy truce going around leaving the independants/grocery-outlets/walmarts on the audit chopping block.

Naaaaah, that would be in violation of the anti-trust laws that prevented 3 small pharmacies from speaking out against a dont-give-a-shit-about-you PBM.

Comments #

Comment by Durham on 2010-02-27 22:11:48 -0800 #

As an attorney, I can tell you have no idea what you are talking about. Good thing you aren’t one!

Comment by Zippy on 2010-02-27 23:54:04 -0800 #

As a drone at one of these retail distributers mentioned, I do see where TAP is coming from. I do assure you that our store has been the target of such bullshit audits. You see, even though the merger has makes one company, they are still very separate entities. We at the local level have NO access to the mail order systems and I constantly barraged by angry customers promised one thing only to run their script and find that they are not eligible for what was promised to them. the big corporate wheel knows what it is doing, and while I labor away to calm customers screaming at me of why this didn’t work the way some asshole in god knows where promised them it would, i am the one faced with the angry customer. No gift card bullshit, which TAP has already addressed, consoles people that are unhappy waiting for 15 minutes because the person who is picking up the 20 meds for their just released from the ER family member in great need of their medication will prevent some crack head from ripping off mine to get their pain pills faster. Everyone is affected by the great PBM machines. I spent time working at both the independents and the corporations, the independents had 6 pharmacists, 9 techs and phone answerers and all the luxuries of saying “get the hell out of my store”, where if I turn a patient away, I get a phone call saying I was wrong and “WE” had to give the patient a 25$ giftcard to keep them as a loyal customer. Screw them! I Threw them out of my store because I didn’t want them in it, why bring them back to piss me and them off more. The big companies find a way to keep the business by what ever means necessary, and pharmacists get caught in the crossfire. i loved my job 5 years ago, though I was making a difference, and now I am just trying to keep it amongst all the corporate bullshit. Chain/PBMs are not the answer they are the reason our profession is so screwed up. the people calling the shots HAVE NO CLUE what it is like to be behind the counter. We get audited from our own company, and the “aren’t we playing for the same side?” argument never seems to sink in. I’d take the pay cut just to have what left of my sanity back, any independents there is a gun for hire… and we know all the corporate bullshit that goes on and how to play the game. The front line knows the weaknesses and how to provide the best services… not make more paperwork and nonsense that has dick to do with pharmacy and more to do with tracking revenue. “Do what makes you happy, and the money will follow” goes the same for customers as it does for businesses. the independents can provide better services at lower costs because they don’t care about stock prices. As long as you can support that, the independent will win every time. screw the audits, screw the paperwork, screw the corporations, give me drink!

Comment by s is for supertech!! on 2010-02-28 01:28:17 -0800 #

I work for cvs and we get audited all the time by caremark!! We get ramdom walk in audits 1-2 times a year, and fax audits about every 2 months. I hate the fax audits they seem to go back a year or more and I LOVE to sift through all the boxes of rxs up in the rafters for 1 box with 1 rx hardcopy in it!!!

Comment by Dr Jeff on 2010-02-28 07:06:54 -0800 #

As a physician, I can smell you from here, Mr Attorney. These anti trust laws are out dated and antiquated. (similar to most of the laws in this country). Please tell me why the “big” businesses, the ones that contribute heavily to Uncle, are “exempt” from the anti trust rules??? How did the great insurance companies of our land manage to become exempt? One word…lobbying. Its a joke that when I’m at a conference and a group of maybe 5 or 6 docs are sitting around yet “scared” to talk about their fee schedules cause someone may be listening and we would all go to jail. Cut me a fuckin break. Its time to say “screw the antitrust bullshit” and lets get together and fix this ongoing healthcare problem/crisis. Oh wait, we cant….the lawyers wont let us.

Comment by RxDawg on 2010-02-28 07:12:19 -0800 #

Eric that you?

(sorry if this is a duplicate)

Comment by Mary Augstine on 2010-02-28 07:21:24 -0800 #

From what we learn in pharmacy law classes, the spirit and intent of the law, and good faith impact our individual behavior. Maybe the good lawyer is saying that ‘corporations’ like the ones that have been granted rights similar to individuals under the Constitution recently, have special extra rights, and are not required to have honest spirit or intentions?

Along the lines of what is so disturbing about the presented scenarios is the extra layer of intrigue afforded health insurers under government-sponsored programs like Medicare and Medicaid. PBMs are merely the handmaidens of the health insurance companies. (It seems all health care hinge on decisions of the payors—and we Americans enrollees evidently have abdicated our rights as beneficiaries to be handed over to designated private health insurance payors.)

Medicare reimbursement is profoundly affected by what private health insurance companies will pay, and driving the market to impact what Medicaid, and other state-funded programs can pay. I wonder the effect of Medicare on the servces that the VA provides.

Comment by RxDawg on 2010-02-28 07:34:33 -0800 #

Oh, and to TAP yeh your right. That’s all total BS. I can’t believe any company has the right to come into your business an take away claims for stupid crap like that. That should be illegal because it’s down right theft. I say it every time, if I ran my own store I swear it be cash only, you file your own damned insurance.

Comment by Jen on 2010-02-28 09:19:24 -0800 #

yes, the “grocery-outlets/walmart” get audited pretty regularly! Everyone likes to stick it to those guys.

Comment by Dr. Grumpy on 2010-02-28 09:21:21 -0800 #

I think the original writers of the Sherman antitrust act, and Teddy “the trust-buster” Roosevelt would be pissed off at the way this is being perverted now.

Audits should be done by impartial auditing companies, with no baseline ties to the industry they’re auditing.

Comment by Dee on 2010-02-28 09:40:35 -0800 #

Durham, you may be an attorney but I can tell you have never been an independent pharmacy owner or even any pharmacist audited by a third-party payer. These audits are more about intimidation and gathering information before future contract negotiations. I even paid the expense of having my attorney sit in on all audits to try to protect my rights and to ensure boundaries set in the audit letter were not encroached. Just another d**n expense that hurt my bottom line and drove me out of business.

Comment by PharmD90210 on 2010-02-28 09:56:38 -0800 #

this may have been said already.. But since we are pharmacists… It’s spelled “independent”.

and I agree w you.. I wonder what happens at cvs audits by caremark??

Comment by Crusty Rph on 2010-02-28 14:57:04 -0800 #

Fill us in —

Comment by kizell on 2010-02-28 18:56:36 -0800 #

I remember one time we had a medicaid audit at the pharmacy I was working at as a student. One of the audits was on some Detrol LA. We were told we would not receive reimbursement for this claim b/c the doctor we put on the Rx wrote it at a hospital, but when we put his name in, we used his office address. We have been recently told that you can no longer put apply to affected area for topicals. You have to specify the exact area of application.

It is pathetic what is happening to a genuine profession that truly seeks to help others. We have allowed our lives to be taken over by the insurance industry and governments. There is no such thing as owning your own pharmacy anymore (that is unless you are cash only). The minute you accept insurance claims, you have put yourself at the mercy of others. Low reimbursement rates from PBM’s and audits are only the beginning. It will get much worse from here.

Comment by toddq138 on 2010-02-28 19:26:09 -0800 #

Another Antitrust issue I have is with Giant Eagle and kroger giving out FREE antibiotics and $4 generics. How are smaller pharmacies going to compete with that.

Selling something at a loss to drive out the competitors is antitrust violation no? I remember reading Rockefeller Oil would sell their oil at a loss whenever a new gas station opened up in town. They would continue to sell at a loss until the new gas station had to close shop. then they would hike the prices and business as usual. They could use the profits from their other cities to help subsidize this practice of driving competitors under.

I am surprised Giant Eagle/Kroger have not been busted for selling prescriptions at a loss to drive the independents out of business and subsidizing this practice by selling groceries.

Comment by pill pusher on 2010-02-28 19:44:51 -0800 #

I hate to say it but I guess we’re fucked!

We are entirely responsible for accuracy of every prescription that we fill. It doesn’t matter that you were interrupted 3 times by a customer’s nonsense while you are on the phone taking down an order from a physician. Why do we put up with these interruptions? Because Corporate America would rather have you sell a diet coke out the drive thru or stop what you are doing to lick a stamp for an old lady who ran out of spit in the name of customer service since they make money from her as well as the patients whom you have an exclusive duty to serve. While you are being interrupted by the lady with xerostomia, you still must make sure you hear the doctor correctly and that what is being said makes sense. We also can’t forget to mention the time needed to question any unusual dosing requirements and document them accordingly on the Rx so that you don’t get your reimbursement that was already only pennies over cost taken away by the auditor for a $5000 prescription of Lovenox. Don’t forget your spit the old lady is still waiting and by now she is pissed so you might have to give her a gift card. Might as well stick a broom up your ass so you can sweep the floor as you move around the lab, that serves a good purpose, in the name of production you won’t have to worry about stopping to take a shit and you’ll be cleaning the floor because your help might be on break or not scheduled for that matter.

Oh, but wait I almost forgot, if the PBM and the pharmacy report to the same shareholders does anyone think they don’t care if the company’s own internal audits result in a bigger tax break leading to bigger profits because the pharmacy division can write off the loss while the PBM part smiles and writes a tax free check to itself.

Forget the issue of patient safety and proper compliance. That is not important there is no money in that. So the company (not to single out any one of them out because they would all have us suck green donkey dicks to earn an extra buck) justifies cutting costs due to the decreased revenue in the pharmacy division from the audits by cutting labor costs which leads to less people to do more work and to more audits and more tax breaks.

What a wonderful world we live in. Corporate America has found a foolproof way to squeeze more money out of every nook and cranny of our health care system. It really isn’t necessary to illustrate this point much further and it’s fairly obvious their unscrupulous gains result in losses for everyone. We can’t afford to have the resources needed to do our job safely and professionally. None of us want to do any harm to our patients, even if they are the most annoying or most disruptive person we would never even think of intentionally defrauding them or giving them a bottle full of piss and water and labeling it as cough syrup. Yet the 3rd party payers take 30% right off the top shamelessly, to fund their vacations, company outings, and much worse. They force us to work with minimal help and encourage us to work under extraordinarily difficult circumstances instead of developing fail safe systems that safeguard the health of the people that they insure. At least Bernie Madoff didn’t kill anyone (that we know of) but he hurt the rich and now his is in jail. The rich hurt the common man and put him in jail adding insult to injury. The people with the money have the power. So I will say it again… “We’re Fucked!”

Does anyone remember what happened to the pharmacist that was responsible for the terrible tragedy that resulted in Emily’s Law in Ohio? He was just released from this month (February 2010) after being convicted for involuntary manslaughter because he failed to verify a prescription incorrectly prepared by his technician for a young toddler, because he was inundated with an extraordinary amount of other orders each one just as important as the next, due to the failure of the hospital pharmacy to provide adequate back up measures he overlooked a fatal error. Time is money, and is also life. I am sure he wasn’t kicking back, reading a magazine while smoking a cigar as his technician prepared the order. Circumstances revealed that his head was spinning from the orders coming at him from every direction. And additional pressure was given for that order from the floor by a nurse to get it up quickly. Sadly, now that precedent is set for us. How is sending him to jail going to prevent this from happening again. The entire reason that happened was because we let it happen. It’s bound to happen again. We’re not slicing bologna behind that counter, yet the people responsible for paying for and administering our operation don’t know the difference. The administrators, or the ones with the money even if they are aware are so far removed from little Emily it doesn’t affect them. Even though it was the huge corporate monster was to blame for her death it was all for the sake of their money. Can anyone tell me how much influence one pharmacist has to fix this while under fire? Yet Emily remains a statistic to the people counting the extra money they saved by not investing the proper resources to prevent such a tragedy, while an overworked and stressed ex-pharmacist has to learn to live with himself after being responsible for the death of an innocent child.

It’s only going to get worse if Corporate America is allowed to make more money by bullying us to believe that anti-trust laws are useless because they are immune. Was I kicking back reading a magazine smoking my stogie when the anti-trust vaccine was developed? I missed it, someone fill me in please.

So step aside and take a look back at your work. Before you boast that you can fill 300 prescriptions in one day by yourself in the name of production and a buck as you compare yourself to someone else that is unable to handle that same volume, remember, your complacency is someone else’s life.

To conclude, I will praise the pharmacists in North Dakota for still controlling pharmacy and not letting the corporate world from taking over. Maybe the people in ND are not fucked but the rest of us are.

Comment by RxDawg on 2010-02-28 20:49:26 -0800 #

Fucking amen pill pusher. That crap that happened to the pharmacist in Ohio was beyond fucked up. The tragedy that fell upon him was almost as bad as the tragedy that killed that little girl. But that’s a different rant…one I’d like TAP to tackle sometime actually.

Anyways, drove by one of our local independents tonight. Their billboard out front said “We fix $4 prescriptions”. Ha, I about pissed myself.

Comment by Cracky McCrackhead on 2010-03-01 10:44:31 -0800 #

Ya’ll never have to worry about me. I pay cash for all my scripts, none of that insurance bullshit or medicaid. Time to write some more prescriptions for Soma and Vic’s.

Comment by UGARx on 2010-03-01 12:58:04 -0800 #

Another interesting CVS/Caremark issue I’ve noticed for many of our customers. They are being forced to go Mail-order for there medication, they can’t get it at my store, but they could “technically” get it at the CVS store down the road!! WTF??

Comment by pill pusher on 2010-03-02 03:13:27 -0800 #


I think it belongs in this rant more than anything else, because ultimately, our ability to do our job correctly hinges on how we are exploited as health care providers by these enormous powers that are constantly stifling the care that we are able provide for the sake of their profit. It doesn’t matter if it’s a hospital administrator, our government, or retail chains like CVS/Caremark and Walgreens. In the end the patient pays, and unfortunately, sometimes with their life. What is worse is that now there is a precedent set with a pharmacist jailed because of mistake. The hospital administrators who dictate what resources are available to the pharmacist just cowered behind the dignity of this pharmacist who woke up that innocent day just to go to work and earn an honest living. God forbid any one of us would be part of that terrible tragedy, do you think that we would want to practice pharmacy again?

Even though we are talking about monopolies in this blog, the most important thing to realize is the bottom line has changed from focusing on the patient to making more money for the people paying us. Doing our job as serious as it is in the most stress free environment possible is paramount because we know exactly (better than anyone else) how serious our work is and needs to be our main focus. No one is better qualified than a pharmacist to understand that. Would any of you take a job even paying a 7,8 or 9 figure salary knowing that the possibility that you might kill an innocent person greatly increases with your salary? If you say yes then you are no better than entities that we are working against here. If you can live with yourself knowing that you did this for the money then go get a job as an exec for CVS/Caremark or Walgreens because you would be prefect!

We need to move, and move now before the powers that be get the best of us and destroy what we have left of our precious profession. All of us were smart enough to make through pharmacy school. We are not dummies 🙂 If we lose our ability to practice pharmacy we won’t have to go on welfare. The question I must ask is do we care enough about what we do to make a difference? Do we leave our customers/friends/patients behind do we let them down and let the powers that be determine their fate? The chains would love it if a law was passed not requiring a pharmacist to be present. In Pennsylvania, we are getting closer to that. A law was just passed saying that the pharmacist was allowed to leave the pharmacy for lunch if a someone was present as long as the pharmacist was accessible to counsel, verify, receive verbal orders etc… CLOSE THE DAMN PHARMACY FOR 30 MIN! Here is the law:
(1) The pharmacist shall remain in the pharmacy, or in the case of a pharmacy located within a retail establishment or institution, in the immediate building containing the pharmacy, and shall be accessible for emergencies or for counseling, if requested. For purposes of this paragraph, the term ”immediate building” means the physical structure that contains the pharmacy. A pharmacy located at a complex consisting of multiple retail and other business establishments, such as a mall, is not considered to be ”located within a retail establishment.” In that case, the entire store containing the pharmacy is licensed, and the pharmacist shall remain in the store during a break.

 (2) The pharmacy may remain open during the pharmacist’s break for patient-related services, including:

 (i) The receipt of new written prescriptions.

 (ii) The preparation of prescriptions for final verification by the pharmacist.

 (iii) The delivery of prescription medications that have been verified by the pharmacist.

Ok, um first off let’s consider what a break is? How is this a break? The only thing this does is it allows your clerk or technician (if you are lucky enough to have one) to dispense medicine while you are not there. More over the patient may have a question but is in a terrible hurry and doesn’t want to wait 30 seconds while you swallow your burrito to ask a question. Then they call you back 7 hours later. Yes you are still there, with burrito sauce stain on your tie. The stain got there in the 1st place because you were in a hurry to catch that patient b4 they left and forgot that the burrito’s salsa that you were just enjoying just oozed on the shelf you were eating it off of and your tie managed to find it as you were putting on your lab jacket to go out and talk to your patient who was too impatient and left. During the phone call you discover that your patient has just taken a month’s worth of Maxalt in the span of 6 hours. She wants to know why she is uneasy, has bloodshot eyes, and still has a headache. I didn’t know how to respond, I asked her if she read the directions that I wrote on the label, she tells me no, and didn’t know that she was supposed to she was supposed to read the directions. She said that she saw an advertisement somewhere and this was supposed to cure her headaches. I send her to the ER and kicked myself for not getting to her before she left. She is actually a very nice lady, and her family comes to us all the time. I felt terrible and that I left them down. In the mean time I am bombarded with several other prescriptions, resolving insurance rejections, people with no refills that tell me that I am supposed to know better than to keep them from their medicine. OYE!

5 min before I am ready to close over 13 hours after I opened the store I look at the mess on the shelf of a 1/2 eaten burrito with salsa dried up as it dripped off the side of your shelf. That is my shelf, the one I earned after many years of pharmacy school and experience. I have to stay and clean it of course otherwise tomorrow I will have dirty shelf, and if the state inspector comes in, my ass will be fined. Next time I will get a turkey club. So even when I am still in the lab trying to relax and eat lunch, I can’t because I never know when you need to drop what you are doing to talk to someone that needs my help. What makes the state think that a tech would be able to recognize when a specific patient may need my advice? Don’t get me wrong I love my techs some of them are like my right arm and I couldn’t do my job without them. Sometimes, all that school I went to, the conviction that I have for my job is worth it, when I can help someone. Most of the time people don’t give a shit and then try to sue you because you didn’t get involved when you should have.

So my rant comes down to this. If the state wants you to be available at all times during a break, how can they call it a break if they don’t give the pharmacist the authority to close the pharmacy to take a shit or eat lunch? The answer is because these huge chains do not want to deter production in any way shape or form and want nothing else but to have your register ringing in their money at all times. Who has the most representation in this state, the pharmacy associations or the pharmacy chains? This is why this rant belongs here, this is what CVS/Caremark or Walgreens or any of the other chains are all about. The monopoly has to do with the money that your license is making them, the license that you earned and they control.

Oh and you non-pharmacist people reading this. It’s not a lie that we work 12 – 14 hours without a break and are completely responsible for you and your family’s medication. I would say a thank you is in order for getting it right so many times. You try and do the same at your job. Good luck if you are a meteorologist, you’d be in jail after your 1st week.

Comment by The Redheaded Pharmacist on 2010-03-02 15:40:35 -0800 #

It is all about greed and power. Who has the power over the healthcare system and who makes the money. I think PBMs have put a strangle on retail pharmacy as a whole but especially for the independents. And yes, big corporations have reduced retail pharmacy to near sweat shop conditions in many cases to simply crank out more prescriptions and now more flu shots as well. A large retail chain won’t fight the PBMs and their insulting reimbursement rates or their borerline criminal activity with their audit system but they have no qualms about cutting tech hours yet again or inventory to try and make up the difference. The problem is, like Walgreens is learning right now, you can only cut hours so much or in their case you can only keep you phramcies open so long before you run out of hours in the day (24 hr pharmacy anyone?). At that point you still have the PBMs controlling the entire industry and taking a handsome profit for their efforts. And on top of it all your customer service has gone to shit and people will remember that more than anything else the next time they need a prescription filled!
And no, pressing criminal charges on a pharmacist for a misfill albeit it a terrible one is not how to solve problems or prevent future errors. It is all about blame. That case is extreme but it represents all that is wrong with being a healthcare professional in the United States in this day and age.
The real question becomes this: what do we do with the mess we as a profession of pharmacy have gotten ourselves into? How do we reverse the trend? Why is it such a battle to get a simple request such as a real lunch break or a decent amount of help while we work? A single pharmacist can feel pretty helpless to do anything meaningful resulting in real change other than losing their own job by trying to fight the system. Chains will simply find someone else, even from overseas, to do it with the added bonus of possibly paying them less. Forget the fact that they might not speak Engish or have the customer service skills of a piece of tape. We as professionals are expendable to the mighty retail chain giants.
The frustrations that are being felt by so many in the profession can be plainly read here and on many other sites across the internet. I share in many of those frustrations myself. We as pharmacists simply feel like over educated puppets that are being manipulated by some unseen group of executives that have real power and authority over our operations but no real common sense or reasoning skills. The average corporate executive knows about as much about customer service and retail pharmacy operations as I do about ice fishing living here in the southeastern US.
I would love to work for an independent pharmacy or even open one myself if the business model of retail pharmacy wasn’t so completely broken. There is no money or even survival potential in this current environment and things could get worse real soon depending on what those idiots in Congress decide to do when they aren’t campaigning for re-election. Someone asked me once why I wasn’t willing to open an independent pharmacy myself. My response “That would be financial suicide!” Am I wrong?
Chains have been overtaken by a diesase of greed. Big companies think you can run a retail pharmacy like you can a fast food chain, department store, or gas station. It doesn’t work that way and it never will. Retail pharmacy is a uniquely difficult and challenging business that directly impacts public safety and health in ways a fast food chain will never compare. When the guys at the top of these companies take a few moments away from counting their bonuses or collecting their golden parachutes they might realize that but I doubt it will ever happen. And so things go on, and even get worse and what is there really that can be done? I don’t know, I really don’t!

Comment by RxDawg on 2010-03-02 18:23:26 -0800 #

I agree Pill Pusher. I worked as a tech in a CVS right before getting into pharmacy school. It just about turned me away from the proffesion. I’ve had people from CVS try to recruit me before and I just always say “no thanks, you wont give me the help I need”. Now I work in Hospital work. It’s a very different animal, but I think about Eric from Ohio often. What’s that, the phones ringing? Oh well, it’s just going to keep ringing until I’m done focusing on dosing this poison (drugs) that could kill someone’s grandmother if I F up. Of course, that’s easier said than done. Sometimes the people pleaser side of me kicks in and I find myself doing too much, and that’s when the screw ups happen. I really do try my best to not get too hurried about things though and just think about Eric if someone starts bitchin. But I digress, I feel like my working environment is much much better than the chain pharmacies.

UGARx, go dawgs! 😀

Comment by PharmD90210 on 2010-03-03 02:09:47 -0800 #

the Florida walgreens case ($33mil for a warfarin 1mg vs 10mg error) just hit ABCnews… Just as wags is chopping heads and basically putting no limit on the number of rxs a pharmacist should get out, while cutting tech hours and other staff. I’m not sure when pharmacists are going to get a backbone and voice the facts of the matter (pressure to increase just rx output as major reason to retain “good rphs”) this trend will continue.

I haven’t seen the abc clip yet but the nuance seems to be “dispensed by a 19 year old pharmacy tech” wtf for bleep’s sak, when will the public take pharamcy as a career seriously?

Comment by Gern on 2010-03-03 08:56:16 -0800 #

This dude writes a pretty good argument for docs vs.the insurance industry in regard to antitrust.

Comment by 2BAPharmD on 2010-03-03 09:43:44 -0800 #

And I am endlessly grateful I chose to do a PGY residency and avoid all of this retail garbage.

This entire problem is further proof that the marriage of money and medicine is destructive. Businesspeople are only concerned with the bottom line because in the end, the only reason they’re in business is to make money and please the shareholders.

Compound the problem like this: Take someone in, say, CVS/Caremark, who might actually ne able to fix something if s/he wanted to. However to do so would imperil his/her career, because it’d be easier to fire/annex/subjugate or otherwise silence this person than to actually enact change of any lasting variety. And like Islamic extremists, if you take two out of te equation, two more are ready to take their place.

For as long as the RP. himself/herself is ultimately responsible, like Eric, people like him and Emily will continue dying / losing their licenses. All in all, accidents are rare. During my residency at a bay area hospital, we caught far more renal dosing, wrong patient, not on formulary errors made by MD/DOs than the pharmacists themselves made,

Screw malpractice insurance. We need LICENSE insurance. Lest we succumb to the ever-sounding tones of the telephone we must answer, the statin we must fill, and the cracky mccrackhead we must supply Hydro for and we make an error once, (or not catch someone elses) and POOF! 8 years of undergrad in tough material and professional school plus residency if applicable and then the CPJE/NAPLEX andall the BS in between, not to mention the student loans that still want their money even if you can’t practice, all comes crumbling down.

Hold corporate executives responsible for deaths like Emily’s, or nothing will EVER change.

Comment by RxRoo on 2010-03-03 19:04:33 -0800 #

As a pharmacist in ND, thanks for that! Just know that we are getting inundated by big pharma pushing to repeal that law as OBVIOUSLY it’s hurting ND residents as they can’t get $4 medications. There’s been commercials/mailers/etc. all sponsored by big pharma telling everyone how bad independent pharmacy is and how much we’re ripping off our customers. It’s absolutely peachy.

Comment by Mr Knows A Lot on 2010-03-03 19:23:30 -0800 #

CVS/Caremark is going to get theirs. There is nothing they can do now. All the evidence is already collected. The CVS/Caremark timebomb is ticking. Almost at zero. Give it just a little time.

I loved the post from the CVS pharmacist saying they get audited by Caremark. Too funny. That would be like taking money out of one pocket and putting it in your other pocket.

Comment by bcmigal on 2010-03-04 11:47:55 -0800 #

This Walgreens case has been ongoing since 2003. So we can see that nothing has changed in retail practice for 7 years, and is, in fact, getting worse. The public has not viewed pharmacy as a profession for quite some time. I know that I do not have to list our complaints because they are universal. What leaves me speechless ( and that is a real feat) is that our DM actually had the cajones to ask me why morale was low! (Huh?) We have one store in our chain where every technician and ancillary quit and the PIC is on stress leave! Do you think the suits got the message? I am sure we all know the answer to that!
So, now, I am off to work my 7th day in a row on a “no overlap” day. Hopefully, I will give the right drug in the right dose to the right patient in 15 minutes or less.

Comment by pill pusher on 2010-03-04 21:04:23 -0800 #

Mr Cracky McCrackhead, it doesn’t matter it you pay cash or have medicaid, you are not my only patient. I have a zillion other patients and concerns to deal with in the midst of dealing with you. So just because you are paying cash it doesn’t mean that everything stops to accommodate your wallet because your one wallet alone won’t keep me in business. You are just as susceptible to receiving a miss-filled prescription as the next guy who is on welfare. I only have so many resources to draw from and those resources do not change just for you because you are paying cash when 95% of everyone else on a 3rd party plan. If I am being pulled from a thousand direction while I am working to fill your Soma and Vicodins you still need to watch out, it is conceivable that I make make a mistake and inadvertently put Senna and Visicol in your bottles in my haste to get the work done. Then you will appreciate what it means to have a really shitty experience at the pharmacy.

Comment by KiKi on 2010-03-06 10:23:27 -0800 #

And if you work at Walgreens in Arizona or Florida it’s 9 minutes or less. 🙁

Comment by everyone’s favorite floater on 2010-03-06 23:17:44 -0800 #

I work for CVS too and last time we got audited by Caremark they cancelled DOZENS of prescriptions (and refills) and took back thousands of dollars for creams and ointments. The reason was that the “affected area” wasn’t cutting it as directions and we needed to write out exactly where the cream was being applied. Do I really need to write “apply to the butt” on a tube of nystatin for a 6 month old?
And while the money just got moved around within the same company I’m out of luck because my store took a significant loss.

Comment by bcmigal on 2010-03-07 21:47:16 -0800 #

Does that come with fries and a drink?

Comment by pharmacyphil on 2010-03-10 05:44:51 -0800 #

Customers have a very personal relationship with “their” hydrocodone.
Their refill order is as such: I need simvastatin,amlodipine and “my” Vicodin, when will the doctor call in for that and when will it be ready. Because I cant be without it!!(vicodin). Sorry, I left my crystal ball at home…

Comment by OldTiredRPh on 2010-03-12 07:08:28 -0800 #

Yea, pharmacyphil. I want to tell them “your” vicodin will be ready whenever we hear from the Dr. to ok it. That is, if it’s not too early, which it probably is. Then you will just have to wait. No, I won’t give you “just a few” to get by til that date, no, I don’t care if you are leaving town on vacation (when was my last vacation?!) no, I won’t call him, no, I won’t call your other dr., no, don’t call the vet to prescribe it for your dog. You are so pathetic!

Comment by AngryTech on 2010-03-13 13:50:41 -0800 #

Man, what the hell do you guys expect from the average person? Of course they identify more with their *pain pill*. Nobody is fond of their cholesterol medication, or their blood pressure medication, because it’s something they have to pay for and be on to control a problem for which they don’t often have symptoms.

However, they have this pain pill over here, the one that takes away their pain, helps them ignore their symptoms, and removes their problem from their brain rather than reminds them of their problem, and generally makes them feel good.

Also, people that are not quite familiar with pharmacy.. try to get in their head, wondering when their doctor will call something in. We deal with the offices of these doctors every day, it’s not unreasonable to think people would be under the impression we know the turnaround time from these offices on refill requests. For every person asking when their MD will call in a vicodin refill, you have fifty old ladies asking when they’ll call in their boniva. Most of them don’t know the laws behind controlled substances, and it never hurts to ask for a few. Most stop asking after we tell them we can’t.

It’s sad, but these people can develop terrible habits from the drugs as well.. but you didn’t go into pharmacy to judge people. You either went into it to help people, or for money. Either way, throw a fax to the doctor’s office, you’re either helping them or you’re making some damn money. If it’s early to fill, ask the patient about their dose, tack on a nice note that lets the office know they might be taking more.. it’s more effective to let the doctor know than to judge the shit out of their ass.

Comment by PharmIntern on 2010-03-14 08:29:12 -0700 #

“no, don’t call the vet to prescribe it for your dog.” –> LOL 😀

Comment by Derek on 2010-03-15 07:14:13 -0700 #

I think you won some sort of award from the Health and Life blog/site: something like ‘top pharma blogger’ =)

Comment by Stiggs on 2010-03-15 13:59:34 -0700 #

The profession of Pharmacy makes me very sad. We had a state medicaid audit recently and they took back almost $15K because I didn’t put a diagnosis code on RX’s for Revatio. Last time I checked there was only one indication for Revatio. Whats the point of a diagnosis code if there’s only one diagnosis you could have? FML

Comment by OldTiredRPh on 2010-03-17 06:31:07 -0700 #

My Dear Angry Tech,

I am not referring to the patient that has pain that is not being controlled by their vicodin for a legit. pain. I have no problem ‘tacking on a nice note’ for these people. I am talking about the revolving patient who I deal with week after week, month after month who takes increasingly more & more pain meds. They obviously are either taking a literal handful each time they pop “their” pain med, or are making a tidy little sum on the street sharing with their friends. That, my friend, it a terrible habit. I don’t know about you, but I like to sleep at night & will continue to attempt to make an honest effort to keep these people from killing themselves &/or their friends.

Yes, I went into Pharmacy to help people & hopefully, make some damn money. It is impossible not to judge idiots like the above. Of course the average person doesn’t know about refill authorization turn-around. But when it’s been explained & explained & they STILL have those lame excuses, the begging sickens me

By the way, the vet & dog story–true.

Get a clue, Tech. I’m not as terrible as you think.

Comment by bcmigal on 2010-03-17 11:47:08 -0700 #

I have a personal relationship with “my Actonel” since I do not look forward to having a broken hip. No judgement here, but yesterday I was presented with a script for 150 Norco 10 and when I searched for the patient, I saw another RX for the same patient at another store in our chain. The 2 hard copies differed by one serial number, the dob and the address were similar but not the same. What a coincidence! Called the other store, paged the md and faxed it to him. This whole episode took about 20 minutes away from filling rxs for some sick kids. This is why we get po’d, Angry tech. At least the MD did not ask me to call the cops. That would have flushed away the whole night.

Comment by AngryTech on 2010-03-20 21:44:06 -0700 #

Why is “their” in quotations? Is the implication of ownership somehow incorrect?

If you like to sleep at night, why do you merely deal with these people? If they’re in so often, why not take a more proactive approach? Suspend judgment, take note of when, and how early they come in each time, bring them to the consultation area and ask them what’s up, in a more sympathetic manner than neutral/judgmental?

Call the office until you can speak directly to their MD, and instead of all of these “this prescription is early” “ok whatever” with the nurses, bring attention to “he came in x days after x was filled on this date, then x days early on this date, and x days early on this date…”

From my experience, this is ridiculously effective compared to the usual.. say no to refill, ignore it, maybe call the office once in a while about it.. while these people slowly eat at your soul.. approach, that most pharmacies I’ve been in apply.

Hell, most people only come up with such ridiculous excuses because nobody calls them out on it, and instead is just all happy-sunshine and gives a candy-coated “no.” Getting very proactive makes people considerably less brave trying to con early controls, and in only about two months after adopting this approach, it rarely happens at my store. I don’t have to get frustrated having to deal with early control refills more than maybe once every couple of days, now, or the same people are otherwise understanding about it. It used to happen every hour or two like clockwork, always getting screamed at while trying to be way, way too polite.


Comment by pharm76 on 2010-03-24 12:03:43 -0700 #

I work for CVS and I agree to every point you mentioned. I get my rxs from an independent and I dont shop cvs or any drug chain. Hell with their employee discount. I can get better service at smaller phamacies. Fuck off their PCI it is a piece of shit. It is not to the benefit of patients to go to a chain and over pay for their rxs.

Oh we have a target of 40% in ready fill for rxs. Guess what, if your doc writes a refill on one of your rx, be prepared to pay for it for your life at CVS.

The best way to combat corporate greed is to boycott the greedy corporates.

Comment by Independent Minded on 2010-04-04 06:09:41 -0700 #

I transferred a prescription from a CVS last week for two Xoponex MDI. The CVS gave the RX a 30 days supply. It actually was greater than a 30 day supply. I had the pleasure of discovering this when the patient made a scene in my pharmacy accusing me of price gouging. When I called the CVS back to confirm the incorrect day supply at the CVS, the pharmacist said, “We gave it a 30 day supply. That is OK because it is a Caremark patient. The “independent auditor” would probably overlook something like that.” I let the patient listen on speaker phone as I talked to the pharmacist. I explained the relationship her insurance company has with CVS. She said, ” I thought that kind of stuff was not legal.” The patient agreed to the higher copay and apologized for making the scene. She told my staff of the terrible service etc and that it was worth the extra copay knowing she would see the same pharmacist whenever she came in.

How many other CVS/Caremark prescriptions get filled like that? I know they would take money back from me for that prescription.

Comment by Homer Simpson on 2010-04-13 20:32:56 -0700 #

Independant Minded; As a soon to be ex-CVS pharmacist (Osco for 27 years then CVS the last 4 after a buy out) the information you were given by the CVS pharmacist was BS. Osco hammered compliance into us pretty good & we have never had a significant problem with any audit, whoever/whenever they have occurred. We have a local grocery chain we run into this problem with constantly: 3 or 4 bottles of insulin for a months supply for a patient who’s not on an insulin pump/multiple inhalers/15 cc bottles of eye drops 1 drop OS qd:30 days supply & I’ve dealt with my share of angry customers because we won’t do likewise. I’ll admit it’s just CVS taking money out of one pocket & putting in into another but in my experience we are held to the same standards as everyone else. CVS does a LOT of stupid, venal & even criminal things but holding their own store to different PBM auditing standards ain’t one of ’em.

Comment by bcmigal on 2010-04-17 00:46:17 -0700 #

Homer is correct. CRK auditors are just as strict with CVS as any other provider. If an MD writes for 30 with 2 refills, we cannot decide to give a 90 day supply. We must receive an entirely new RX for #90. Even “as directed ” for insulin doesn’t cut it. Nor can we turn a 45 day supply of an inhaler into 30. I think the CVS pharmacy just goofed and did not want to say so.

Comment by Dustytech on 2010-05-01 21:26:13 -0700 #

POWER to the people! I work at WAG in Arizona, and POWER is terrible. I tell them the inherent problems (the big wigs) and they act like they care. I voiced my complaints almost a half year ago. No positive changes, only more staff cuts. Joy.

Comment by woodside pharmacist on 2010-05-31 18:20:48 -0700 #


I currently just took over a retail pharmacy located within a clinical building. The problem is that i have no clue on how to prepare my self for medicaid inspections. I know that they are always giving out fines and outrageous penalties for the smallest mistakes. Does anyone know or can help me prepare of these inspections/audits? i need to know how it is organized in the pharmacy you are in now?

Thank You

Comment by techie on 2010-11-11 07:27:54 -0800 #

That is hysterical! These patient’s do not care if we care! The doctor’s do not care either! We have doctor’s in our area that will give them scripts & scripts & scripts(and after 13 years only one has list their dea license!), not to mention the local Er’s! The people who ask for their pain pills 2 weeks early are the junkies, wake up. It always cracks me up when we have a floater pharmacist that tries to counsel one of our “regulars”, you know the ones from the ER that only have enough money for the pain pills, because you know that antibiotic wouldn’t sell on the street!

Comment by Laura on 2010-11-26 20:22:27 -0800 #

Angry Tech…how long have you been doing this work? Sometimes the only thing ‘revolving patients’, Dr. shoppers, dope heads understand is the word NO! The pharmacists I work with are very proactive with our customers – the dope heads and the ones who are truly in need. Maybe you should find a new store. I’m still learning – the job, the people, etc. but it’s easy to know from the beginning whether or not someone someone is a recreational user. You need a reality check.

Comment by Mike on 2012-02-09 04:18:12 -0800 #

Is there a preaudit kinda software that can catch the errors every night after business hours. so that next morning , u can correct them and go on with the regular work ?

The Angry Pharmacist
The Angry Pharmacist
Started this site in 2005 out of frustration that pharmacy school does not prepare you for dealing with the ungrateful unwashed public. Was hugely popular until life called and I had to take a break. Now I try to provide low brow potty humor that applies to the pharmacy population at large. Except you clinical fucks, go play doctor with your white coats and snobby attitude.