Skip to main content
  1. Posts/

Paying the PBM’s to service them.

·10564 words·50 mins
Table of Contents

So I had this nice 2014 post queued up that involved:

  • Me shutting down the site and hanging it up.
  • Me meeting this awesome hospital pharmy named Michelle who has (of all else) a totally awesome cooking website that (used to) throw down f-bombs worse than yours truly AND wrote a kick-ass cook-book (plus she was all “OMFG FAMOUS PHARMACIST” when she met me).  Every fucking pharmacist is published but me.  At least hers involves food porn and fucking tons of delicious bacon.  Uh.. Fucking as in the adjective, not the verb of her having sex with bacon.  Sorry NomNom, didn’t mean to imply that you have sex with bacon.  Fucking bacon is delicious though.. ARG FUCKING AS AN ADJECTIVE GOD DAMMIT.  You get the picture.  Her website is and go buy her book, its awesome.  Her little cartoon of herself has no nose, which sorta bugs me, but I will certify, under penalty of perjury, that in real life she DOES have a nose.
  • Me getting pissed off at this derpy douchebag patient and reviving the smoldering blaze of TAP that lives in my soul.  No, really.  I almost brained this fucker with the cash register I was so fucking pissed off at his utter waste of a life, and a resulting waste of my time.  Then his mother got all involved.  He is 40 by the way, that should speak enough right there.
  • How in the past few years, I have taken into consideration not offending anyone (ie: Crackheads) with my ranting, and by doing so I am doing you all a grave injustice.
  • How gasoline cans in California fucking suck with the safety valve (instead of a direct spout) and as a result you spill more gas on the ground (and all over yourself) then you get in the tank, thereby making the “save the world” mentality that California wants to impose on people a fucking waste of effort, not to mention a huge safety hazard.  Plus you smell like fucking gasoline for a few days and must resist the urge to light yourself on fire to end it all.
  • Other shit that Im too lazy to type because Im fucking livid about the topic below.

However, this topic came up and is far more important (and involves far more swear words).

We all know that drugs are like stocks, the price goes up and down (mostly up).  However recently, a ton of shit has just skyrocketed in price.  Take various creams.  They used to cost 10 bucks a few months ago, and now they are just shy of 100.  Digoxin ranges from 900-1000 dollars for a bottle of 1000 where a few months ago it was 50 bucks for 1000.  Morphine ER has jumped from pennies to fucking hundreds and Endocet is almost 100 bucks a bottle.  Nobody knows why the price is going through the roof, and nobody has any answers other than the generic drug manufacturers must enjoy raping the American public so they can sell their shit in Mexico for reasonable prices.

Now usually this isn’t a problem, because as the price of the drugs go up, the PBMs (The companies that YOUR insurance companies hire to do the processing/computer shit and pay US, the pharmacies) adjust their prices and pay us more.  Its done on a contract basis like Cost + shit + a crap fee.  Its not the greatest, but it keeps the doors open and paychecks from bouncing.

HOWEVER, due to some fuckery or just plain greed, as the price of medications go up, they PBM’s are paying based upon the OLD price.  That means that little ms crackhead who gets Morphine ER that now costs me $200 the store is getting a fat check for $40, the price of the drug from 5 months ago.  In other words; under cost.  Thats right, I’m expected to dispense medications and take a $160 dollar loss.  Then the fucking twat has the balls to bitch about her $3 copay and take up 20 mins of my time as she bitches about what she can take (for FREE) because her turds resemble a fucking piece of plaster-of-paris.

So whats a pharmacy to do?  Take care of the patient so they don’t die and take a $100+ loss? Or tell her to take her shit elsewhere? The choice is easy, give her back the Rx, tell her it pays under cost, and you dont know where she can go to get it filled.  Per your contract with her insurance company she can’t pay cash (HAHAH PAY CASH!! AS IF!!).  Only rich fuckers and chumps pay for their medications now days.  Its not called Freemacy for nothing.

There are two huge points to be made about this:

  • Unless I can pay my fucking house payment and put food on the table using “Good Deeds” as a currency, Im not going to take a loss filling a prescription.  That little lady, when push comes to shove, doesn’t really give two dicks about you, your kids, your store, or the good deeds you do for her.  She wants her fucking dope, plain and simple, and she doesn’t want to pay for it.  By you taking that loss, you have just shown her that your time/profession/skills are worth nothing to her.  In fact, you’re just a fucking whore to her and her insurance who takes a fucking and then gives $100 for the privilege of getting your asshole reamed out.  Its reverse prostitution, and we as a profession are better than that.  Well, I used to think better than that, until the chains started handing out gift cards to PITA patients instead of backing up their abused staff and showing these fucks the door.  Grow a fucking pair chains!
  • By refusing to fill the Rx based on losing money, you are putting the ball in her court.  The insurance companies dont give a fuck about the pharmacies, but they give a fuck when she gets on the phone and cries that nobody will fill her medication.  SHE pays their paychecks, not us.  A problem with HER insurance reimbursing is not OUR problem, its HERS.  Does the grocery store give a fuck that your credit card was stolen by hackers who got into the Target systems and thereby wont work? No, because its YOUR credit card through YOUR bank so its YOUR responsibility to take care of that shit.  If enough patients complain and whine then maybe they will do something about it.  Yeah, and I can pull gold out of my asshole.

Now this all sounds fine and good, however the chain stores (and the pharmacists who staff them) really don’t give a shit if they lose money on an Rx.  They hand out gift cards to whiny fucks who complain that their prescriptions weren’t fill in 2 seconds or less.  The chains are so afraid of losing business they will gladly take that loss with a smile on their face.  The chain stores are killing the profession of pharmacy.  By having the chains put up with this bullshit, they are just showing the PBM’s that we are nothing but fucking whores who’s time and education are worth absolutely nothing (because we will fill the Rx even if we lose money on it AND reward patients for abusive behavior).

I’ll just make another point, that the PBMs, the insurance companies that hire them, and the pharmacists who work for these companies are nothing but fucking idiots.  They are so blind to the big picture, that they have NO CLUE that independent pharmacies are the counterweight to a huge big deep dicking thats on the horizon.  Let me elaborate:

You cut your reimbursement so much that it drives all the other pharmacies out of business.  Sure you make a zillion dollars and your CEO can afford that beach-house.  Sure you traitors to the profession get that fat bonus for saving “all this money” and the CEO strokes your cock a bit for being a “good little insurance-company pharmacist” for saving their plan a ton of cash with your bullshit cost-analysis and P&T handjobs.  However now all there is left are Walgreens, CVS, and Rite-Aid.  Three huge companies that will gladly pay that million dollar anti-trust lawsuit fine for the sole ability to COMPLETELY FUCK OVER YOUR INSURANCE PLAN AND RUIN YOUR PBM.  How?  Easy.  The men in suits from Walgreens come to your insurance company and want to talk about their contract:

“So, since there are no independents left, we want to renegotiate our contract.  We want cost + 25% + $15 for EVERYTHING.  Oh? You don’t like that? Well then I guess you’re going to lose a few hundred stores in your network.  Oh, and see CVS and Rite-Aid? They want the same deal that we want.  Man, its going to suck for you when the members who use your plan cant go ANYWHERE ELSE to fill their prescriptions because your shit reimbursement rates put the independents all out of business.  Why don’t you think about that for a few hours while we go to lunch with the CVS and Rite-Aid execs and discuss if your plan fits within our business model.  Oh, and we don’t care if you sue us for anti-trust, because we’ll make up that fine in a month from this revised contract.  Im sure that your members will understand.  Chao!”

You have painted yourself in a corner with only a few HUGE chains left.  Huge chains with a TON of stores that your members are forced to go to because there are nobody left.  Your penny pinching now cost you your anal-hymen.  It fucking kills me how people shop at Walmart because they have done the exact same thing to the manufacturers of household items because there are no little mom and pop shops around anymore to offer any competition.  They can name their own price, and that price is a few steps up from FREE.

So when you fill that Rx and see the fat negative reimbursement and your pharmacy system blows up with warnings that you’re losing your ass; think of me.  Think of where you are going to work when the toilet of pharmacy finally flushes and we’re all out of a job.  I’ll see you fuckers in the unemployment line with a huge smile on my face and a huge bowl of “I FUCKING TOLD YOU SO” for you to eat.

Comments #

Comment by Phathead on 2014-01-08 21:59:46 -0800 #

Case in point, at my store our volume is up roughly 8% over last year, and is increasing as our neighborhood is suddenly expanding. We are both visibly,and qualitatively, busier.

However,on Jan 1st our budget hours were cut 10% in “prospective” of lost Rx numbers due to “narrowing of pharmacy networks.”

Naturally we have held our numbers, but are now crippled in terms of staff. What makes it worse is our very seasoned excellent techs have all left and I am training two new, very green techs who will inherit the store in about three weeks time.

And we were threatened that more budget cuts are in the future.

But hey, at least we made all that extra money pushing Oxy in Florida, right?

Comment by Jesse Thunder on 2014-01-08 22:59:37 -0800 #

Confused. This pharmacist are angry that we need our medications? I don’t see how its our fault. Blame our parents for fucking and letting us born into this world.

Comment by Melissa on 2014-01-08 23:56:03 -0800 #

That’s funny, because when I worked for the insurance company, and a pharmacy had an issue with the reimbursement…they just sent us a fax with their reciept of the cost, and we adjusted the price based on it and the AWP. Made several pharmacies very happy about the cost changes. Yes, prices do change a lot…and PBM’s aren’t perfect. It takes a lot to adjust payment every day. That’s why you need to stay on top of it. If you have an issue with a reimbursement. TELL THEM. Sheesh. It takes 5 minutes of your time.

Comment by Richard on 2014-01-09 04:19:26 -0800 #

Dont be scared of the insurance companies; Like i said in previous comments, I charge cash for all oxycodone and endocet10/325 rx’s . Fuck the insurance companies. why are you afraid of them? so what if they call you up and ask you why you arent filling the endocet?

Comment by Gettingreadytofarm on 2014-01-09 05:18:17 -0800 #

You must work for cvs too. We do about 3000 a week on 290 tech hours plus 20 hours for delivery. Come first of the year they told us 273 a week total. So we had to tell all of our delivery pts, sorry.
I asked the sup how can we get more hours, she said no more hours to he had. I then said let me rephrase, what do we need to hit numbers wise to be able to flex up. She replied with no flexing, the hours are what they are.
Then I said, how about you cut my hourly rate so we can up the tech hours. She said that’s impossible, it’s not about the money. If it’s not about the money, then what just fucking us for fun!

Comment by Deb on 2014-01-09 06:20:53 -0800 #

Angry, I don’t know if you’re really in CA or not, but I am… I’m a veterinarian who owns a small practice here. We are facing the same issues (on slightly different levels, but still the same) and oh how I wish we could all find a way to stop this bus from sliding down this hill. No one gets that most veterinarians are small business owners, too. Cheaper, more for less and discounts – that’s the whole name of the game nowadays and it’s making it harder and harder for professionals who own small businesses to simply earn a fucking living. I love what you have to say and your honesty. Please keep it up. And when you get a chance please drop me a line – we have so much in common and I’d love to correspond. Keep up the great work.

Comment by Susan Hayes on 2014-01-09 08:18:28 -0800 #

I am a big fan and I loved your post today. The problem is that for the same transaction that the PBM screwed you out of, they charged the plan sponsor AWP * 200% and kept the spread, screwing the same prople that hired them. If you are ever interested in speaking at our Pharmacy Benefits Academy, let me know.

Comment by Kurt W, on 2014-01-09 08:53:03 -0800 #

Last week when I lost over a 100 bucks on a morphine ER rx, I did call, and fax them the paperwork. Yesterday, I received a fax back, said basically we paid you what the reimbursement rate should be, sorry you aren’t buying it cheap enough, but the $45.00 reimbursement, was correct.

So yes, we do take 5 min out of our day and try.. but what happens now?

Comment by GRUMPYRPH on 2014-01-09 12:36:27 -0800 #

Not so funny.
The major PBM’s use a 3rd party to handle the ingredient costs. There are very few left that will take a simple fax notification with and an invoice. When I do spend the time to send them the info needed, I am met with a response 3 weeks later saying that they have reviewed the medication and found that the price they have is correct, even tho most of the other PBMs have the correct price. And remember 5 minutes of the pharmacist’s time costs the business $1.65 per minute.

Comment by Burnedoutrph on 2014-01-09 13:36:30 -0800 #

I hope the Angry Pharmacist keeps the website and his posting going. I have been an owner for over 30 years and “I’m mad as hell and I won’t/can’t/might take it anymore!!”. The pharmacy profession is a bunch of pussies cowering down to the PBM’s since day one. We are firkin doomed unless we raise hell now, not wait for the chains to be the only players left and they will have the leverage to be profitable again. I would like to work 5 more years…..if I can make it!! Apha…Pussies! NCPA….Pussies! state associations….Pussies! ugh

Comment by rxist on 2014-01-10 00:16:14 -0800 #

This is exactly why I got out of retail, long term care is where it’s at. I never deal with insurance companies or drug seeking crackheads anymore. Best of luck to those still in retail, I’ll never go back.

Comment by Deb on 2014-01-10 09:52:51 -0800 #

Oh Burnedoutrph, believe me, we have SO much in common – veterinarians and pharmacists – all of us getting screwed…

Comment by GRUMPY RPH on 2014-01-10 16:03:24 -0800 #

I feel your pain Kurt. I have stopped giving out medication under cost. I had to tell a long time patient that Wellcare was paying $35 under cost on his digoxin and I wouldn’t bill it to the insurance company. I offered to transfer it to Walgreens with my apology. Hell Wellcare hasn’t even raised their MAC on generic Mycolog yet and it has been a year. Fortune magazine listed Taro as a company whose profits have risen the much faster than most. The reason given for the increased profits — NYSTATIN/TRIAMCINOLONE cream and ointment.

Comment by Ghent on 2014-01-10 20:01:43 -0800 #

Kudos… it’s already happening, too. Walgreens and Express Scripts had their little kindergarten playground sand-kicking about 2 years ago or so, and after the Medco merger they had to eat crow and come crawling back to Walgreens and put them back in-network because Medco & their insureds were all unhappy and not willing to accept the smaller network.

Comment by Lee B on 2014-01-12 12:55:55 -0800 #

I’m the 63 year old son of and the nephew of three more independent pharmacists and I just discovered this blog in December.

Before he died my dad saw a lot of this coming and he would be an “Angry Pharmacist” if he were still around.

I worked in his store until college but “escaped” into another line of work but my sister still works in the business and wrestles with the insurance companies and big pharma on a daily basis.

I’d be saddened if you hung it up because someone, a lot of someones, need to keep saying these things loud and often.

Comment by Ruth on 2014-01-12 13:02:09 -0800 #

Melissa, things have changed! It takes a lot longer than 5 minutes to appeal these too low reimbursements, and the reply we receive after several phone calls over several weeks, is that they believe they are paying a “fair price”. They are basing their costs on what mail order pays for drugs, NOT what retail pharmacies pay for drugs. On top of all this, the PBMs are not offering contracts to independent pharmacies as they are to the chains. If you think this is easy, you live in a dream world. Yes, it should be easy, but it is a nightmare. The law requires that PBMs update their pricing daily to keep up with cost increases. They are not doing this across the board, with certain payers much worse than others. Go work in an independent pharmacy and see for yourself. I’m sure someone will take you step by step through the procedure of trying to get paid. If it were only once every now and then, it wouldn’t be so bad, but it is several times a day, every day!

Comment by Ruth on 2014-01-12 13:04:20 -0800 #

Wouldn’t be so bad if it weren’t for that little thing called a contract.

Comment by Ruth on 2014-01-12 13:45:21 -0800 #

Susan, I have read much of your website, and you offer a great service. What is the solution to eliminated the cheating among the PBMs? The independent pharmacists are suffering across the country, and this is OUR profession! We are the ones who provide the services, care for our patients, spend time with them and ensure they receive quality pharmaceutical care, all on top of just dispensing a product to them. We get paid cents in many cases on the very inexpensive drugs, and it is getting worse. We run businesses that, in order to stay open, we have to pay overhead, purchase drugs in volume sizes greater than what is dispensed monthly creating slower turnovers, and it takes money to pay employees, pay the bills, and make a profit to justify being in business. We cannot do this with profits of $1.00 on generic drugs. To do greater volume, it requires more employees, because only so many prescriptions an hour can be filled safely. The machines that fill mail order prescriptions, do not care about the patients, do not counsel them, are not available to answer questions, do not come out in the middle of the night to fill a child’s prescription or an emergency room order, and they do not do anything to help patients get by. We are constantly begged and pleaded with to provide temporary supplies of drugs that have not yet arrived from mail order, answer questions about mail order prescriptions, etc. and it just isn’t right that we should be so underpaid when the pharmacy profession belongs to us, yet the PBMs and their spread pricing are accumulating the bulk of profits. And if we question a PBM about reimbursement, we are told to contact our PSAO. The PBMs are the greed behind so much of the problems, and should be ordered to stop cheating, provide transparency, stop the back room deals and the kickbacks (aka rebates), pass along any savings to the patient, pay a fair and reasonable price to the pharmacies for filling a prescription and all the requirements that go along with that, and if they are not willing to do this, then we should find a way to eliminate the PBMs from the middle and deal directly with the plan sponsors. Too many conflicts of interests are out there, and the PBMs and pharmacies working for the same company or owned by each other, are just one of the big ones. If there is a way for pharmacists to make a difference as a group, other than our own associations, please advise.

Comment by your mom on 2014-01-13 10:37:52 -0800 #

  1. You arent allowed to tell patients that their insurance underpaid. It is a violation of your contract with them.

  2. Prices are going up because of Obamacare, according to multiple sources, including Bloomberg. Generic companies are setting new minimum prices because they are worried that Obamacare will set a minimum price under the established (previous) minimum price. This is the reason!

THANKS AGAIN OBAMA!!!!!! Double-thanks to the unemployed welfare scabs that elected OBAMA for a second glorious term of incompetence.

Comment by Kirsten on 2014-01-13 13:59:51 -0800 #

Thank you for posting this. I deal with negative adjudication and harrass the PBM’s about it all day long! It’s absurd how little money is recouped for these damn drugs.
Next time I see my screen lit up with red negative marks, I’ll think of you!

Comment by Kirsten on 2014-01-13 14:04:20 -0800 #

Must agree with GRUMPY. I have disputed payment less than cost more times than I’d like to think about and I almost NEVER get the reimbursement corrected. They MAC the price based on the “market” and thats the end of the story. I wish my boses would man-up and choose not to fill scripts that are paid at less than cost.

Comment by GRUMPY RPH on 2014-01-14 06:32:40 -0800 #

I have recently joined PUTT – PHARMACIST’S UNITED FOR TRUTH AND TRANSPARANCY. This group is dedicated to making the PBM’s transparent and honest. I have spent time with our CITY OF STOCKTON (who filed for bankruptcy) human resources dept and council members trying to show them their PBM’s prescriptions wore overpriced. Their solution was to go to the PBM’s mail order saving the patient’s 1 month copay on a 3 month supply – not realizing that the city is paying the extra copay. I even caught them charging the city over $400 for 90 Losartan 100mg while paying the pharmacy $20. I was told that they receive bigger discounts when going to the mail order pharmacy. It better be a big fucking discount. Another problem I discovered was the consultant. These consultants are either incompetent or comply with the PMBs. Now the PMB have grown too large for control. The PMBs are a cancer to health care. How can they have the nerve to say they are aiding in providing affordable health. Tell me how a company like MEDCO could be caught so many times for fraud and sold to EXPRESS SCRIPT for 28 Billion dollars just for processing claims. When Medicare Part D began Wellcare got caught hiding there already obscene profits. But the authorities have been unable to reign in the abuses. Unfortunately, GW Bush (who I voted for) trusted them like he trusted ENRON.

Comment by GRUMPY RPH on 2014-01-14 06:35:13 -0800 #

Where the fuck are our Pharmacy Associations because all this shit affects all of pharmacy.

Comment by Susan Hayes on 2014-01-14 11:47:19 -0800 #


The biggest was to combat the PBM fraud of reimbursing more than they are paying to pharmacist(ies) is to educate plan sponsors (health plans and employers) that is is going on. NCPA has an excellent program whereby the local pharmacist takes a local company to lunch (sounds corny but it works). That one on one grass roots education is the only way to stop this practice. It’s not like the PBM is going to tell a client that they reimbursed the pharmacy $20 and charged the client $200 because who would go along with that idea. You also hit the nail on the head – why do you let your PSAO become lazy and not contract on your behalf. I can tell you outright that Walgreens and CVS doesn’t take this crap…they have aggressive contracts with PBMs. But you are left to pay for their aggresiveness with your PSAO that is supposed to be working for you.

Comment by Jeff on 2014-01-14 15:48:50 -0800 #

Contract or not, most states have laws which make it illegal to sell an item or service for less than it costs the seller of said item or service (with certain notable exceptions like inventory close-outs or damaged items). In California “loss leaders” are illegal according to the B&P code. A loss leader is an item or service that is sold below cost in order to maintain existing business or gain new business. If I sell an Rx at a loss so that I can continue to sell profitable Rx’s to the insurance company, that is the very definition of a loss leader. Even if I have a contract with a company, that company can not legally even suggest that I sell the item or service below cost.

Comment by Jeff on 2014-01-14 16:08:12 -0800 #

your mom, I don’t recall you looking over my shoulder while I reviewed and signed any of the contracts that I currently have with any PBMs or insurance companies, so, with all do respect, don’t tell me what I can and can’t do per my contract because you have no fucking idea what my contract says I can and can’t do.

There is nothing in any third party contract that I have ever signed which would prohibit me from telling a member that their insurance underpaid. In fact I am looking a contract that just came across my desk today that says under the heading of “Confidential and Proprietary Information” that “Nothing in this Section shall prohibit either party (the PBM or the Pharmacy) from discussing reimbursement or payment issues with a Member.”

Comment by Ruth on 2014-01-15 20:38:31 -0800 #

Exactly! And, a loss leader would be OUR decision to do in order to gain new business, NOT the PBMs or the insurance company’s decision to cut our throats. This business of MACs being applied is FUBAR. What model are they using to get these MACs under cost? Are they using mail order costs?

Comment by Ruth on 2014-01-15 21:02:04 -0800 #

On Dec. 4th, 2013, I had a prescription for Oxycodone 10/325, and as we all know by now, the price on this has been jacked up by the suppliers now. My cost on the prescription was about $88, and the PBM, a Worker’s Comp processor, sent back a paid claim of $47. I told the patient and his wife that the company had not updated their pricing since the drug cost had gone up, and that they only wanted to pay the old price. The customer who has had 2 back surgeries in the last 4 years, is not abusing this medication, takes steroids and other non controlled meds for his problem, and he cannot afford to pay full price for this one prescription every 5 weeks. So, I called the PBM, and talked to a young woman, that sounded VERY young, and lacking in knowledge, with responses she was surely reading off a card, when I asked what I need to do to appeal the cost. We contract directly with this particular PBM, so I assumed I would need to fax over recent invoices as proof of cost we paid. She told me to contact my PSAO. Well, in the mean time, I couldn’t just loan out a CII like we would on Lisinopril to get some by until we can get the issue resolved. I asked her if I could speak with a pharmacist or someone in PA. Nope, I had to contact my PSAO. So, I did, and we went through all the proper channels of the appeal process. Eight days later, I checked the update from our PSAO, and it stated that the Rx was under review still. The patient was getting antsy and out of pills. I told him the problem was in limbo. He contacted his adjuster, with the insurance company. We immediately received a phone call from the adjuster, who not very politely told the pharmacist that we “have a contract with them and are required to accept what they pay”. Our pharmacist told the adjuster that we do not have a contract with the insurance company, but have a contract with the PBM, who is also contracted to pay us cost plus a fee, and we are not going to fill prescriptions losing $50 on one prescription. Who would? We won’t be in business long at that rate. The individual told us to tell the patient to go to another pharmacy. Our pharmacist proceeded to tell the adjuster that we are the only pharmacy in town! We are the only pharmacy within 25 miles, and are in the mountains, which makes it difficult to get to a chain, and why would I send a patient elsewhere to use the worker’s comp that he has only had for 1 year, when he has been our patient for over 20 years? So, after several of these calls back and forth, our PSAO posted on the website that the investigation/appeal had been closed, because the PBM stated that “they BELIEVE that they are paying a ‘fair price’ for the prescription in question”. And get this… was signed by an R.Ph. Unbelievable! Since then, the patient went back to the adjuster, and a different person contacted us, and we asked to send over invoices with an explanation so they can see for themselves what we are paying. We did so, and they increased payment to pay us the cost of the drug (no profit, which really tells how sorry these people are, because they couldn’t pay even a couple of dollars to make it even worth our while after all we went through. The girl who said, why can’t we take just 5 minutes, is clueless.

Comment by theangrypharmacist on 2014-01-15 22:30:24 -0800 #

Where are they? They are flogging the dead horse of MTM while giving themselves awards and throwing mutual masterbation parties. APhA is short for PBM now days because they don’t have the balls to stand up to them.

You have to remember that most APhA members are students (who dont know any fucking better because pharmacy schools are so out of touch with retail its sickening) and chain pukes who really don’t give a fuck about anything because their corp paychecks will always cash. I have more followers (15k) on twitter than APhA does (7k), what does that tell you about how much people respect APhA.

Comment by bdogg on 2014-01-16 04:02:56 -0800 #

Feel your pain.

I work in Ireland and we’re getting the same shit over here.

The UK is the worst – chain stores dominate and the Independents have no leverage. Plus, there is no private market over there – so everything is done on a flat dispensing fee.

For example here, the government run a socialised scheme (if your income qualifies you for it), and you get paid back: cost of drugs + (-9% clawback of wholesale discount) + €5 dispensing fee. So, I had to give out 2 x Abilify 10mg (28’s) on loan to a patient. I’ll probably loose on it when I wrangle the script out of the physician. Also, we’ve to deal with dispensing Insulin with that -9% wholesale clawback when in fact the most we can wrangle is 2% discount on insulin (and as it’s a fridge line it’s non-returnable). The problem is that you’re caught over a barrel, because if you don’t dispense it – some chain will take the hit.

Indeed, pharmacy is the only profession where you’re asked to behave professionally and ethically and are re-imbursed like a total bitch.

Comment by Lee B on 2014-01-16 22:01:04 -0800 #

“while giving themselves awards and throwing mutual masterbation parties. APhA is short for PBM now days because they don’t have the balls to stand up to them.”

One of my colleagues in the business I got into, sound system setup and operation, is working one of those “masturbation parties” right now.

Can’t tell you which group of jackoffs because a “non disclosure” agreement had to be signed.

Comment by GRUMPY RPH on 2014-01-17 14:37:44 -0800 #

Unfortunately the PASO services are generally provided by our wholesaler, who in turn sign everything. We do not use a PASO but apparently in the past we had one and are unable to talk to some of the PMBs and can not change our status. Because of that some of the PBM will not talk to us, so just do not fill the RX if there is a problem. It is funny we have patients who get 90% of their Rx’s from us and fill those without profit across the street at Walgreens. I have talked to Walgreen pharmacist and they are getting the same payment we are. I thought that eventually the PBM would listen to them, but no such luck. Wellcare is still reimbursing $15 on $70 rx of generic Mycolog.

Comment by BandAid4RiteAid on 2014-01-17 21:32:14 -0800 #

APhA is a fucking joke. That organization isn’t worth a squirt of piss. Any cheesedick pharmacist that belongs to that shithole outfit couldn’t find his ass with both hands, let alone run a pharmacy. Let us all face it. This profession is just one big joke and I treat it as such. The pharmacy organizations – JOKE. State Boards of Pharmancy – JOKE. District Managers – Dick in hand JOKERS. The way I survive in this “profession” is I just don’t care. I work for a company that hands out gift card to brainless, complaining assholes who are totally in the wrong , but are always right. How do you fight that? When I cared I was angry and frustrated. Not caring is so liberating. I still take time and fill accurately, but when in doubt I give it out – for free if necessary. I have been ass fucked in the past for caring and doing the right thing and enough was enough. Am I proud of this? NO!! But I am done being the worlds punching bag. Hopefully I will be out of this “profession” in 2 years. As bad as I have it, working for CVS from what I hear totally sucks. I have one question for CVS pharmacists: Why do you work for such a bunch of idiots that constantly roll you over ans do you dry?

Comment by miranda on 2014-01-18 10:34:55 -0800 #

For me, this is an interesting blog; thank you for writing it. I’ve never understood why it’s a herculean task for me to fill my prescriptions at the end of every month, why most pharmacists are inexplicably hostile, why it takes me hours, days out of my life, the degradation and anxiety.

When I write things like “I’m a cancer patient, bone marrow transplant survivor, have had years of chemo, high dose radiation, 20 surgeries, a hip replacement, neuropathy, myalgia, I’m treated by the best doctors in the world and am lucky to be alive,” I’m not making anything up, or complaining. I just require modern medication to live; otherwise I would be dead.

So whereas the sociopathy endemic to your profession is still utterly incomprehensible, at least your blog provides evidence of it.

If you hate your job so much, why don’t you get a different one? That might be nicer for everyone. You must see people every day who are suffering from serious illnesses; wouldn’t that create a sense of gratitude for your health?

Also, if you spend so much time writing, why is your writing so poor, and why is your language so obscene? I guess I feel bad you’re so unhappy; retail can be dismal; but can’t you find music you like, or books or movies, to cheer up a little? I’m listening to Mozart right now, because I can’t get out of bed; it’s extremely good music, have you tried things like that? I don’t get it.

Yours, a real patient

Comment by Geno on 2014-01-19 16:30:26 -0800 #

The Fortune 500 companies all have the same board members, same tools and same methods of breaking down small companies to maximize profits. Printing was one of the first to go and no one cared because they were not printers. Then retail stores and no one cared because they could save fifty cents by shopping at the big box. Little by little EVERY small private business will be eaten by the Big Box 500. We are starting to notice that real pay has stayed the same for the US but the most money is being held at the upper end. What will people say when there are only minimum wage jobs and corporate CEO jobs? Then when your son or daughter graduates and gets a job at Taco Bell and has no future, then, will you care? Growing up I was told to look for a job with retirement, that is all gone. I was told to look for a job with health care and that is all gone. Is anyone paying attention? No the lemmings are all saying, well it is not happening to me (yet). Good luck future generations.

Comment by laurac68 on 2014-01-19 22:14:21 -0800 #

This has absofuckinglutely nothing to do with your post, nevertheless, I wanted to jump in here for a sec and just say THANK YOU for all that you people do in your profession. This thank-you is 2 years late but, your website literally save my mother’s life a few years ago. LITERALLY. At age 82, (very young, spry 82..)she was diagnosed with C.Diff. after the local hosp had botched the original tests for C.Diff, told her she was neg. for it ( and I knew she had it…little else looks and smells like C. Diff laden stool…nuff said). Anyway, 30 days later, after she’d gone from 132lbs to 112, they finally got it right and started her on Flagyl, which did nothing. She ended up in the hospital where they put her on Vanco caps. The sent her home a few days later (after some improvement thanks to Vanco) with a prescription for it. The pharmacy told me it would cost around $1600.00. I (we) didnt’ have it at that time or anyplace to borrow it. I left the store in tears and frantic because I now believed her life was on the line at this point. Vanco was the only thing that had helped her. I came home and Googled the hell out of Vanco and somehow ended up on your website where I learned about oral use of Vanco IV, and the fact that it was affordable. Within 2 days, I coordinated her primary care Dr., her Gastro, 2 hospitalists and a compounding pharma 10 mi away (oh, and Humana MA)and managed to get her the Vanco for $345.00, ultimately Medicare reimbursed almost $300.00, not that I gave a shit about $300 at that point. I could afford that. Hell, I was thrilled with $300.00. I was so overjoyed that I went back to her gastroenterologists office and told them the good news…that Vanco IV taken orally will accomplish the same thing as the outrageously expensive caps and to make sure their patients (specially the ones that are broke…) knew they had that option. The dimwit at the desk looked at me like, “whaaa??” I grabbed a post-it pad off her desk and wrote down ‘Vanco IV for C.Diff can be used orally – much cheaper than caps” and told her to stick it by her phone, someone’s life may depend on it. A gastro office with 9 Dr.s and NO ONE said anything about Vanco IV orally. I don’t take anything prescribed by my Dr. until I consult my pharmacist. She’s about the only one I trust these days. Wonder why….
Anyway, that’s my story. I know you get a lot of shit from people during your workday. Granted, many of us on the other side of the counter truly suck. But some of us realize that we wouldn’t be standing (upright, above ground, greenside up) on the other side of the counter if it wasn’t for you guys (and gals). Yeah, we owe you money, and a pantload of respect but, above all, we owe you our lives. From the “contingent” that tries hard not to suck….THANK YOU!! We are eternally grateful to you and appreciate you more than you’ll ever know. 🙂

Comment by bcmigal on 2014-01-20 12:24:00 -0800 #

to Getting ready….we had our workweek cut to 32-34 hrs. This works out to about a $20/hr pay cut. The workload is the same for 6 hours as it is for 8 and there was no increase in tech hours. If we want to work a 40 hour week , we must “loan” ourselves to another store for a 6th day. Be careful what you wish for. The company will gladly cut your hours (and/or pay) and give you kick in the behind in return.

Comment by Ruth on 2014-01-21 23:52:43 -0800 #

In response to Miranda…firstly, I am very sorry that you are ill. Most all pharmacists are in this profession to help people just like you. We care about the sick, we want to know our patients, and we want to help them and educate them to use and take medication properly so that they will feel better or be cured of whatever ails. Most pharmacists went into pharmacy because of a mentor who encouraged them to do so, or a parent, or some influence in their lives that caused them to want to be in this profession, that once was well respected, fair paying, and rewarding for the pharmacist. The Angry Pharmacists and others on this blog that “rant”, are ranting because the profession that we love, has been taken over by NON-pharmacists, or pharmacist who do not practice pharmacy but have found a way to make a living working for the “enemy”, the insurance industry, or worse the PBMs, who admininster insurance plans. Many of these third parties who are paying portions of our patients’ medications, are cheating the system, stealing reimbursements from pharmacists who provide medication and pharmaceutical care, forcing our patients to use mail order services rather than their local pharmacy, violating laws and rules to gain unfair advantage in luring patients away to the big chain pharmacies for lower copays yet refusing to offer the same contracts to the independent pharmacies who make up nearly 50% of all pharmacies in our country. These third parties have somewhere along the way, decided that they want the profits of the pharmacy profession, although the licensed pharmacists are the ones who spend 5-8 years in college learning the profession, learning drug chemistry, learning pharmacy management, and becoming the “drug experts”. Unfortunately, there have not been enough pharmacists available to fight the battle legally or to go to Washington to educate our representatives because for years there has been a shortage of pharmacists and most pharmacists are tied to jobs that do not allow extensive absence. Pharmacists work weekends, nights, and holidays, and must be on duty for their shifts, which means they cannot just take off to go to Capitol Hill, because someone must fill their shoes. On top of all the issues of third party payers, and independent pharmacists barely able to make a living because of this, the pharmacists are required to be the “drug police” and the “Sudafed police” all because of people who abuse drugs, and abuse the system. In addition to this, lives are in danger because of the addicts desperation. In the US last year, several pharmacists were murdered in their pharmacies, just because of being on duty at the wrong time. So hypervigilance, security systems, safety training is another issue in today’s pharmacy because we also deal with the lowest of the low. Many independent pharmacists are now carrying guns, just to protect themselves from being murdered on the job. You wonder why the blogger doesn’t just quit, or why he is angry, or why he doesn’t do something about his situation? Why should he have to do something about a situation when what he is angry about was done TO him and his colleagues? It occurs every day! Why should someone who wants to help the public, goes to college for 6-7 years to earn an advanced degree just to help others, and has to deal with nothing but problems all day long on the job…why should this individual have to leave their profession when everything wrong with it, is out of their control? Running away from the problem doesn’t solve the problem. Ignoring the problem doesn’t solve the problem either. The only way pharmacists can reclaim their profession is to get involved, get the word out that there is malfeasance throughout the third party industry, get together to come up with ways to beat this monster called PBMs, share stories and situations, and get angry about the fact that our profession is being ruined by those who aren’t even in the profession. When it comes to cancer, illnesses both acute and chronic, pain, and terminal illnesses, nothing else every seems important really because life and death are the most important issues, but for the working pharmacist, we know our roll in the healthcare system, and it is valuable and significant, and necessary that we exist for the public welfare. Without a pharmacist, you would not have access to needed medication. You would not have an accessible and knowledgable person to call to ask questions at anytime of the day. Please do not ask a pharmacist to leave a profession that he is trying to protect and defend from the enemy. Until you have done this job and walked in these shoes, you cannot possibly understand.

Comment by Jesse on 2014-02-12 05:35:08 -0800 #

Sounds like CA independents need to put together a campaign to have everyone go after the CA AG at the same time to make their office pay attention to the laws being broken by PBM’s. Sure, independents are technically breaking the law, but unfair competition (afforded by big chains being able to eat the losses) is the root of the problem is bigger than them.

Comment by Jesse on 2014-02-12 05:37:46 -0800 #

I love the people too dense to realize that these large multi-national corporations are using ObamaCare as an excuse to price gouge. Open your eyes, would ya?

Comment by CharAUpharm on 2014-02-19 13:35:37 -0800 #

Greetings from Australia. I will be following this blog as Australia is hitting the shithole from the government, but not as badly as America it seems. The goverment are slashing our reimbursement costs but not below cost thankfully. Sounds like you guys need a mediator of all the insurance companies – Medicare/PBS normally handles price disclosure.
On another note it still cuts our bottom line dollars and the fucking big chains are slaughtering each other (pharmacists killing our own profession) for a few extra $$. With CPI and every fucking expense going up, rent + staff wages + overheads and especially electricity (almost doubled now due to greenhouse government signing bs), my wage hasn’t increased at all in the past 5 years and if anything will go down just to keep the staff employed.
I wonder how much longer until the old lady down the street has to travel 5km via public transport on her rollator to go to a chain store when we close down one day. I fucking hope that day never comes for her sake and all the locals like her.

Comment by Aly on 2014-02-22 09:14:37 -0800 #

With all due respect, you have no fucking clue what you’re talking about.

Comment by Juliet on 2014-02-27 01:51:35 -0800 #

I am a patient. A nurse as well. I have mutiple sclerosis. The pharmacists looked so stressed the other day. I’m talking….lost weight kinda stressed. I do empathize with you guys, and I love love love your gruff rants. Love them! I get why alot of your customers make you want too smash their faces in…..don’t you get angry at the physicians for prescribing some of these crack heads the meds? I think I would be more perplexed by the rx’ing meds, and sick of the crack heads the way a waitress gets sick of an unhappy, my burger is overcooked. ..wait, it’s undercooked…kinda way?

Comment by Juliet on 2014-02-27 01:53:17 -0800 #

How are you able to do that?

Comment by Juliet on 2014-02-27 01:56:35 -0800 #

Right! Obama. What a joke. What an insult to the average intelligence this aca has caused. Disgusting.

Comment by Corporate Cog on 2014-02-27 05:17:17 -0800 #

Melissa, definitely not true. I work at the headquarters of a large chain pharmacy and my whole JOB is MAC reimbursement. If it was as easy as you say, I’d be out of a job.

Comment by Beth on 2014-03-01 19:44:55 -0800 #

I’ve not worked retail in 3 years, but even then we were seeing this happen all too often – including with Medicaid – who you could call and they’d get it fixed right away. But the PBMs were reluctant. For them I’d dial the number and give the phone to the customer and let them explain that the pharmacy doesn’t have the drug at the price the PBM is paying for – so they can’t get their meds. MUCH better results!

Comment by Beth on 2014-03-02 07:29:06 -0800 #

Juliet, I totally agree about it ultimately being the prescriber that is to blame. The odd thing is, that at every turn throughout the system, they aren’t the ones held accountable. The DEA requires the wholesalers to question why a given pharmacy buys more narcotics than the DEA thinks they should need. It should be the DEA who looks at who is writing the inordinate number of scripts and going after them!

In my state we are required to report every controlled substance filled at a retail pharmacy (have been for years) – but it’s obvious that nobody from the state or the federal government uses that data to go after the doctors who over-prescribe.

So they just keep suing wholesalers (like they did Cardinal Health in Florida) and threatening retail pharmacists or heaving more and more work or reporting requirements on them – rather than investigating the source. It’s nuts.

Comment by Ruth on 2014-03-09 17:41:15 -0700 #

We seem to have pretty good success with state Medicaid, but you are correct. The PBMs do not want to update their drug files/costs. This was mandated a few years ago, that they update promptly, and even with appeals and invoice proof, we get replies that they “believe they are paying a fair price”. A fair price would be a fee for service or a fee on top of cost, as that is the only part of a price that should be flexible or contract based. The actual cost of the drug should be paid for certain, and proof of cost should be adequate. If the PBMs that are refusing to pay properly were above board, they would have no problems doing what is right. For some reason, they imply that pharmacists, most especially the independent pharmacists, are billing inappropriately, when we all know that basically everything that transmits through a PBM is MAC’d. So, if they would update their drug files, to reflect increased acquisitions, they would get this right. We have had a couple of instances in which the actually plan was contacted by the patient, then the plan contacted our store. We were able to tell the plan that the PBM they use is not living up to their contract. We explained that until the plan, i.e. the insurance company, does something about this, they are going to have unhappy clients and will ultimately lose clients. Guess what? Both of these patient’s prescriptions went through the next month with correct payment. Maybe going back to the plan and reporting PBM breach of contract is the way to make this practice well known, and force these monsters to do what they are supposed to do.

Comment by scb on 2014-03-13 10:50:26 -0700 #

your mom…..your should really thank all the conservatives that stayed home for electing Obama…Romney got 9 million LESS votes than McCain did…so when is your base not your base? I would have thought these purists would have learned after the first time.

Comment by your mom on 2014-03-31 09:08:39 -0700 #

right…It would matter if presidents were elected using the popular vote and not the electoral college, but thanks for playing, obama-lover

Comment by PharmDGator on 2014-04-07 04:31:41 -0700 #

They don’t allow this anymore. You can’t just send a fax in and get them to change their reimbursement on an NDC. Don’t you think if it was that easy, we would do it?
It’s too hard for them to check pricing everyday, but when a drug price drops, they are all over that shit. When a drug price increases it takes them months to adjust.
You’re in he wrong place if you want to defend PBMs and insurance companies.

Comment by Will iam on 2014-04-09 12:00:16 -0700 #

TAP must get every crackhead in his county. You either have great customer service or a couple of Techs who just give your inventory away.

I have been a Chronic Pain Pt. for 12 years and had the same doctors and same Mom and Pop pharmacy.

How did you guys get hosed by the big guys? Family in Germany tells me that each pharmacy must be owned by a pharmacist and they can only own 1 store.

So sad how everything is getting taken away by Walmart type stores.

Comment by Missouri Pharmacist on 2014-04-12 11:51:18 -0700 #


Where in the hell do you work, that pays 99 bucks/hour?? I must be getting f’in hosed here in the Midwest making 62/hour !!!!!!

Comment by Ruth on 2014-04-13 11:41:58 -0700 #

It IS about the money, but the supervisors are not privy to that. They are only given budget in terms of hours. Hourly employees are the first expense to cut when the money isn’t coming in and budget isn’t being met. Payroll is the easiest expense to manipulate to make budget. Unfortunately, pharmacy is difficult to budget prospectively, and everything is based on trends and last quarters figures. Very frustrating for the pharmacist who is responsible for the smooth operation of the pharmacy, accurate filling and checking, counseling and patient safety. There is a point where the company does not want higher volume, because that means increasing payroll, which defeats the increases.

Comment by grumpy rph on 2014-04-18 12:45:26 -0700 #

You’re not getting hosed, you just have no idea how much you cost the business/owner. Along with the $62 – the owner must match the amount paid for Social Sec and Medicare (7.65%), Unemployment (6-7%), Work Comp (3-5%), vacation pay (2% for 2 weeks), sick pay, 401k or profit sharing plan (10%), bonuses (5%). Next add health insurance (%300-1200/month depending on age. So think about that next time you are wasting time talking on the phone, texting, shooting the bull with other employees, or even jerking off in the bathroom.

Comment by Ruth on 2014-04-18 18:30:49 -0700 #

It is going to boil down to employee pharmacists getting paid what they are worth to the business. If they are not doing their jobs well and taking care of business, they will not be employed. If they do a good job and take care of the customers and provide good service and quality pharmaceutical care, they will be appreciated by their employers. Doubtful that the chains will keep increasing pay though. Sad for new graduates who are trying to create their own jobs these days.

Comment by reddead on 2014-04-24 11:55:48 -0700 #

I am not sure how much of the price increases are due to the profit margins of the drug industry or the Red states anti Affordable Care Act, but has anyone factored in the legalization of pain medication/mental health with marijuana?
I see marijuana advertised almost daily on Yahoo and TV promotions.

I use Novixus for my mail order and wish I could figure out a way to shop around to pay for my medications, when I pay $20 for a $37.00 medication. Novixus phone support respond like I am a drug addict calling to refill my prescription.

Hey, consumers can rant too.

Comment by GRUMPY RPH on 2014-04-25 05:05:59 -0700 #

Legalization of pain medication would double its price because it wouldn’t be covered by your health plan.

If it is worth $17 to you to be treated like a piece of shit that is up to you, but blame it on Novixus not the drug industry or Red States. Good, prompt service comes at a price. Real pharmacies are required be properly staffed and can’t work at a warehouse in the sticks. I have yet to see a mail order pharmacy be a savings to the consumer. If they save you a dollar on one prescription, they will get it back on another. There is an asterisk at the bottom of there ads that says if there is a generic for the drug listed then the price shown is for that generic. That generic price is twice the price of a retail pharmacies generic. It is simple bait and switch. When you talk to the Novixus $12 an hour caring technician rather than a licensed pharmacist are you really getting a savings on your medicine.

Comment by C on 2014-06-19 07:13:39 -0700 #

THAT would explain why Target’s gotten into the pharmacy business, for several years now. They’re big enough to take on Walgreens, CVS, and Rite-Aid, the store management has a reputation (at least in this area) for backing up its workers when the customers not right, and Target’s big enough (even if smaller than Walmart) to grab the insurance guys by the collars and make them listen -but they’d really rather be polite.

(And everyone is vulnerable to hackers, Target’s just had the most noise made by the media because they were trying to warn them. I had only used cash at Target’s store before and during the requisite time, to limit how much I spent per transaction, but they still sent my email a warning, with information to contact them if there were problems.)

Comment by XL on 2014-07-23 20:30:13 -0700 #

Not to mention CVS owns both pharmacy chains and PBM at the same time.

Comment by Will on 2014-08-19 20:22:55 -0700 #

Remember, these PBMs also own huge mail order pharmacies. They make thousand bottle purchase orders directly from the manufacturers and turn around and use that pricing to determine their MAC.

Comment by texanfootballmom on 2014-10-29 13:02:34 -0700 #

I am guessing not many people would pay 75% of their salary to their boss just to work at their company. I would post a big fat sign explaining that unless they are paying cash for that medication, it will not be filled by your store…if that is possible.

Comment by Mike Wilson on 2015-03-02 13:51:20 -0800 #

Wow, I’m starting to think that I somehow go on a bender and black out, fly to California, and write TAP posts and then proceed to forget the whole endeavor. Especially after this part:

How gasoline cans in California fucking suck with the safety valve (instead of a direct spout) and as a result you spill more gas on the ground (and all over yourself) then you get in the tank, thereby making the “save the world” mentality that California wants to impose on people a fucking waste of effort, not to mention a huge safety hazard. Plus you smell like fucking gasoline for a few days and must resist the urge to light yourself on fire to end it all.

Is it possible that I am TAP? Well, I guess not, but I agree with 99% of your posts and they are hilarious! Keep up the good work!

Comment by Apothecarist Arthur on 2015-03-11 12:11:56 -0700 #

I have always been of the school of thought that pharmacists are an unneeded spoke in the wheel of the health care system. Id prefer to stick my rx in a machine, have it do its voodoo and spit my barbituate of choice for pain out and then go on my merry way. Hey, we dont need druggists… we have the Internet to do your job. All them drug web sites from Canada and Mexico are tripping over their pill bottles to serve my every pharmaceutical needs and wants. The trouble with the system is to be blamed on the niggers in the country today.

Comment by h8retail on 2015-03-13 11:07:48 -0700 #

Thank you Tap. My thoughts exactly.

“flogging the dead horse of MTM while giving themselves awards and
throwing mutual masturbation parties”

I get nauseous when I catch a glimpse of a
freaking newsletter. Same old grinning idiots doing just what u said.