Letters of Warning for me (K**** H*****), (Three Pee Ex), and my former district pharmacy supervisor.
These letters are not disciplinary, and do not impact pharmacy licenses in any way. Effectively, a slap on the wrist.
I am relieved that this is the extent of the Board’s punishment for me – and now that it is over, I am exhausted.

There is a reason why I chose a feminine puppet.  The majority of new pharmacists are women.  Women have a horse in this race, but I don’t get the feeling that many of the pharmacist who comment here are women.  I have been a feminist since the Equal Rights Amendment days of the early 1970s.  This amendment was first introduced by Alice Paul in 1921.  It did not pass Congress until 1972.  IT HAS NEVER BEEN RATIFIED BY THE NECESSARY 38 states.  Equal Rights is NOT the law of the land.  Except in Washington State.  They did it themselves.

What am I missing?  Are women satisfied with the way it is?  If so, the men might as well give up.

Since the mid-1970s, the puppeteers have been the guys who have taken our profession to the brink.  The non-pharmacist MBA bean-counting Masters of the Universe.  They have NO standing in pharmacy.  They have never acted as a cashier.  They have never accepted a new prescription.  They have no clue how to enter a new patient, new insurance and then type the prescription.   The idea that they would have any sense of what the pharmacist does is laughable.  I’d love to see one of these Masters of the Universe at the drive-through.  How would he handle a guy smoking cigarettes and demanding his Norcos now.  His 20 year old Cadillac is spewing fumes through the drive-through drawer and he refuses to turn his engine off.  His obese girlfriend with a tattoo of a Big Mac on her neck is eating “healthy” food.  A deep-fried chicken sandwich.

“Sir, your prescription is not ready yet,” says the Master of the Universe.

“Get it now or I’ll see you in the parking lot when you get off work.”

Just a little fun.  You get the point.  Non-pharmacists with power and authority have taken our retail pharmacy industry to the point of failure.  What we do is not sustainable.  I won’t discuss the professional failure today.

About 40 years ago, some non-pharmacist Bozo said to the Executive Committee, “We do not need 40% profit.  (We were a 40% profit industry until the 1970s)  Let’s lower our prices on the top 50 prescription drugs.  Let’s go to 25%.  We will still make a ton of money and get a competitive advantage.

You know what happened.  In order to not be in a position of competitive disadvantage, every chain company lowered their prices.  It finally got to the point of ridiculousness.  Nobody had a competitive advantage.  The industry threw money at every problem with no return.  If our industry manages to squeeze out 18% gross profit in 2012, I would be surprised.

Non-Pharmacists MBA bean-counting Masters of the Universe need to be assigned to the variety store where they belong.  Feet-on-the-floor pharmacists (good drug store merchants) need to be brought into the decision-making loop.

Our industry is on the brink of failure.  We have been trying to maintain a 50 year old model without the profit.  The model is not sustainable.

When our industry is unable to deliver the prescriptions that our culture demands, turn out the lights.  They are watching us.  Who are “They”?  The interests that want dispensaries and not pharmacies.  A lot more mail order.  Central filling.  This is a horror to think about.

10,000 Americans turn 65 every single day.  Our population is 330,000,000+.  Our culture expects prescriptions when they go to the doctor.  What can you give me, Doctor? is the question.  Big Pharma will answer that question.

The Masters of the Universe have an answer for diminishing returns.  Well, Larry and the rest of you executives enjoying this catered lunch of Rhode Island clams, I know what we can do.  I am an MBA and I know that the answer is to cut overhead.  Turning off half the lights is so 1970s.  How about we cut the budget for ancillary help.  They don’t need a cashier after 7:00PM.  (One again, the fucker has never come within a football field of the working side of a drive-through).  They don’t need to have technician overlap on Tuesday, Wednesday and Thursday.  This would save us about $400.00 a week.  That is pure profit.  (I like calling the Masters of the Universe FUCKERS because they have been sticking it to us for four decades) Larry hands out big cigars and the MBA Master of the Universe thinks What a good boy am I.

By the way, you are not going to find MBAs who were “A” students at The Wharton School working for CVS.  You will probably find “C” students from a public school at best.  Night school at worst.  The brightest MBAs from Stanford are on Wall Street getting huge bonuses from moves that lost billions.  Go figure.

Having non-pharmacists design the pharmacy business plan is like having an MBA running a medical office.  Doctors are not stupid.  The people who have been running drug store companies make you wonder.

Okay, Plagakis, get to the point.  If our industry was still a 40% business, we would have no problem delivering the crush of prescriptions to come.  We could have extra cashiers, extra technicians.  The technicians beyond the RPh:Tech ratio could be doing maintenance work.  We could run streamlined operations and still make a terrific profit.  We could counsel.

The non-pharmacist bean-counting MBA Masters of the Universe have simply fucked us up.  This is PHARMACY, not a variety store.

One more word.  We get chicken-shit reimbursements from the PBMs because we lowered our prices to rock bottom.  The PBMs say, “We are not paying you more than the industry standard.”  How much better would it be if the starting point was 40%?

Received an e-mail from K*****. It read: “The hearing is at 4pm on Monday the 14th. I do not believe it is open to the public”‘

MONDAY, MAY 14, 2012.  North Carolina Board of Pharmacy offices.

6015 Farrington Road, Suite 201, Chapel Hill, North Carolina.

A preliminary hearing will be conducted.  K***** H**** will be charged with violating the Pharmacy Practice Act.  He was the pharmacy manager at the Three Pee Ex store.  He was working with a marginal technician.  His best tech was out sick.  At hour seven of a 14 hour shift, he had been reviewing, verifying and completing prescriptions at the rate of one every 80 seconds.  He had neglected important counseling and was behind.  For the health, safety and welfare of his patients, he chose to close the drive-through.  He did this so he could focus on running Three Pee Ex’s Prescription Mill and to funnel the sale of all prescriptions to the front register.  A terrific idea.  He had the legal right and the professional responsibility to do this.

The non-pharmacist store manager went ape-shit.  He marched into the pharmacy, usurped the pharmacist’s authority, and opened the drive-through.  K***** H**** closed the pharmacy and went home.  Three Pee Ex, with an army of attorneys (3 P X is huge), apparently filed a complaint with the board and charged K***** H**** with violating the pharmacy practice act.

K**** H**** filed his complaint with the board.  He charged that 3 P X violated the pharmacy practice act.  He alleged that the non-pharmacist store manager has no authority in the pharmacy whatsoever.  (alleged?).  This is backed up by the law.  The store manager barging into the pharmacy is no different than the Vicodin-seeker storming into the pharmacy.  No shit.  That is not hyperbole.  Non-pharmacists have NO authority. Pharmacists who are not licensed in North Carolina have no authority in a North Carolina pharmacy.  That is the law.  The NC BOP either recognizes the law and cites 3  P X or they are a joke.

There is a North Carolina law that restricts a pharmacist’s shift to a maximum of 12 hours.  Every single 3 P X pharmacist in North Carolina works 14 hours shifts.  3 P X will claim that that is the pharmacist’s choice.  Tough shit, 3 P X.  The law is the law.  There is no fudge factor.

There is a law restricting the number of prescriptions a pharmacist can “fill” in a shift.  I know.  You get a hiatal hernia from trying to stifle your laughter as you fill 400 Rx at the local 3 P X.   It is so bad that you pee your pants.  K**** H**** was filling one every 80 seconds.  That is 315 prescriptions in the first 7 hours.

The North Carolina board is interesting.  Google it and take a look.  There are no chain drug store executives on the board.  The board is elected.  I believe elected by North Carolina pharmacists.  There is a good chance that 3 P X will be cited.  Of course, the 3 P X army of attorneys will be brutal.  They will try to paint K***** H**** as a rogue pharmacist who endangered the public.

K**** H***** has an attorney.  One attorney.  That is all I know.

My only reason for writing this is to urge you to attend this meeting.  If Monday is a day off and you live fairly close to Chapel Hill, please invest the hours in pharmacy’s and your personal future.  3 P X may have a cadre of high priced attorneys in $3,000.00 suits with an arrogance that makes you want to slap them silly, but you are pharmacists.  The presence of just 20 or 30 pharmacists would make a huge impact on the board.  You do not have to do a thing, but sign in: Jill Jones, North Carolina Pharmacist # 654321.

This case is HUGE!  Think about it.  If 3 P X is cited, it would be precedent-setting.  If 3 P X is ordered to cease and desist on the 14 hour shifts, it would have nationwide reverberations.  If the NC BOP says, Yes, we mean it.  The law of the state is XXX prescriptions in a XX hour shift. That would cause a tsunami in California.

This is no little preliminary hearing.  This is no insignificant meeting.  The members of the NC BOP just want it to go away, but it won’t.  K**** H***** has them boxed in and they have to do something.  The board knows that pharmacists all over the USA are watching.  K***** did not do this out of meanness.  He had no choice.  He was fired.

3 P X would have been very smart to say, “K*****, this was an unfortunate incident.  How about we give you a year’s wage with 12 month of benefits and you just withdraw your complaint.”  But, 3 P X is a bully.  This thing could have gone away.   They could have quietly painted K***** as a loose cannon to their other pharmacists and could have gotten away with it.  But, hell no.  No pharmacist can be allowed to close the drive through and then close the pharmacy.  3 P X wants to make an example of K*****, but they are in a very dangerous position.  3 P X’s big ass is squarely balanced on the line.  You can help push them off.

My call is that K*****’s hand will eventually be slapped.  If the NC BOP actually punishes him and suspends him, they absolutely MUST suspend the pharmacy license of that particular 3 P X for the same number of days.

This is your frikkin’ Super Bowl whether you can see it or not.  Bigger than the Super Bowl.  Your very life may not depend on it, but your professional life is at stake.  Not just if you work in North Carolina.  This case will affect you in Salt Lake City, Seattle, Birmingham, Tucson or Honolulu.

Attend the meeting.

Be respectful.  Dress in business casual.  If they give you a chance to comment, be careful.  K***** has an attorney.  However, you are a pharmacist with standing.  What you have to say could make a huge difference.  Remember, the BOP is mandated to protect the public from excesses like the 3 P X 14 hours shifts.

Then whine and complain and cost your CVS pharmacist in a store in the deep south $5.00 from his/her pocket.

This has been passed from RPh cell phone to RPh cell phone all over the deep south.  It finally made it to Jay Pee a couple days ago.  It originates from the Tupelo, Mississippi “District” of CVS.

IF, We do not address you by name

If, We are not courteous and professional

If, Your script was not ready when promised

If, You are waiting and it took longer than 15 minutes

We consider this unacceptable service and we will give you $5.00

Jimmy Eddleman, Pharmacy Supervisor CVS

I have been told that the $5.00 comes out of the employee’s pocket.  Big Evil at it’s best.  They will never let us down.

Here are some thoughts I have.  GREED.  Bullying, Nasty, Brutish in a hidden corner of the black ages of pharmacy.  All of a sudden, Jimmy boy, we are all watching you.  The damage done by ignorance is glaring.  Fight the brute with self-control, empathy, morality and reason.  I would never suggest that you undermine and sabotage.   You could, but well that is not who you are, is it?  Sadism, revenge, dominance.  Fear = Obedience.  There are animals in the jungle you need to watch.  There are animals that you can walk right by.  I have learned to carefully watch the animals that can kill me (metaphorically).  Watch the animals that can kill you and kill them first (metaphorically).

Self-control.  Don’t be stupid and righteous.  Protect your good thing.  Be the HUNTER, not the HUNTED. Underneath all of Jimmy’s bull shit, he is afraid of you.  All it would take is for five of you to turn on him in a dark alley (metaphorically) and Jimmy is done for. Where is his head?   Certainly not in the game.  Has he forgotten that you are pharmacists?  Most of you are well-experienced.  Most of you MAKE MONEY FOR CVS.

Centralization of authority & ineffective bullies as” leaders” has caused a mess.  What is this?  The 6th grade?

Death by a thousand cuts.  This is just one cut.  Every pharmacist has multiple scars.  How long are we, as a group of professionals, going to put up with this kind of humiliation?  The disrespect of the last 25 years has been crushing.

Is Jay Pee an anarchist as the CEO of Price Less Corporation charged?  (Drug Topics is banned from Price Less because the pharmacists were reading “JP at Large” and getting uppity)  I am far from an anarchist.  You can call me the Dean of “The College of Change”.

That is what Jay Pee thinks and I have this advice:  Find the Power and Identify the Weakness.  That is all I will advise.  If and when you take Jimmy Boy down, I did not tell you what to do.  I simply advised that you examine your situation carefully.

Take baby steps.  Anger can be your friend.  For crissake, do not go off half-cocked.  Righteous, knee-jerk anger can kill you.  You have a family to take care of.  Let your anger work for you and not against you.  (Read “The Prisoners of Comfort”).  Smile a lot.  Nod and say “Okay” even if you are thinking “No fucking way, asshole”.

Take it easy.  You are a bad ass if you play it right.

My last word is, “Good bye, Jimmy, it was nice knowing you.”

Please take the time to comment.  Get some righteous screaming in the comments.  Adult language is encouraged.  I am not adding my offerings at my usual pace.   Your comments will help keep my unique visits between 350 & 400 a day.  My ego, you see.  I will take the MPJE on May 14th and the NAPLEX on June 14th.  I am am reading a lot.  Thanks, JP

Pfizer is the BP of Drug Companies

The DRUG PRICE COMPETITION AND PATENT TERM RESTORATION ACT of 1984

This act made it easier for generics to enter the market.  It allows for manufacturers to extend the patents on brand name products.  The act was also designed to promote and influence the development of drugs that are really new.

What the……?   Where are they?

The new drugs are profit-makers that cost over $1,000.00 a month, are IVs and the guy talking really fast in the television commercials reminds you that the patient can suffer instant death at any time.

Esomeprazole, escitalopram and desvenlafaxine ARE NOT NEW DRUGS.  But, they got a new patent.

When the guardians of the public come up with a new law that benefits a business a company does have some responsibility, don’t you think?  Where are the new $100.00 a month PO drugs that your average American can get at the pharmacy?

They improved on lovastatin.  They ran the course from hydralazine to the Angiotensin II receptor blockers and no American needs to sit and wait for a stroke.

You would expect that they would double down on Type II diabetes because it is estimated that one in every three Americans will be “afflicted” because of all of the french fry gobbling, burger chomping fatsos.  But, they really haven’t.  Can you imagine that it might be more profitable to simply manage diabetes than working toward curing it? Not enough profit in curing anything.

I am cynical and you know Jay Pee, I am an optimistic idiot.  But, I have no faith in Pharma, big or small.  In the 21st Century, it is all about GREED.  I firmly believe that curing illness is not a priority.  If the people are cured, they will not need that $1,000.00 a month drug.

So, Big Pharma got patent extension in return from allowing the generic manufacturers to use (basically) their package inserts.  It’s a no brainer.  The proof is in the pudding because in 1984, Big Pharma made promises about innovation.  Big Pharma has not kept faith with the American people.

You know that I have been around for awhile and I clearly remember when there were NEW drugs every year.  Not anymore.

Pharmacists have gone from being the drivers of the profession to being prescription-drug pimps.  Period.  How did this happen?  My contention is that it happened as the industry became became more invested in profit and less invested in healing, curing or ameliorating disease.  To the contrary.  More disease.  More profit.  Period.

What do we do?  What can we do?  Take the enormous profits for drugs like esomeprazole off the table, that’s what.  Make innovative drugs where the money can be made.   Force them to come up with molecules that are actually NEW.

I get a hernia, I laugh so hard.  The Jay Pee, Patient, Pharmacist lobby has no power.

Before you read this, relax.  Rita Hayworth.  From the golden age.  I read the Frank Langella piece in Newsweek last month.  Rita had Alzheimer’s near the end.

What an idiot.  I have been the naive turtle.  I actually believed that the pharmacy boards had the welfare of the public as their sole mandate.  Then, I heard that the Texas Board has stated, “We don’t interfere with in how a company does business”.

The preliminary hearing conducted by the North Carolina Board of Pharmacy in May will tell us a lot.  The NCBOP members are all working pharmacists (+public).  No chain store executives.  We’ll be watching.

Perhaps, we should just give up and go directly to the legislatures and the media.  Find a young state legislator (certainly moderate, liberal or progressive) who wants to make his/her bones and give him this.  It could prove to be a “hot button” issue.  What do you think.  I gotta go.  Duties with the wife call.  I’ll be back.

Five Weeks?

There will be “Tech Check Tech” and I think it will be sooner than later.  We cannot continue to define our jobs as what we do to run “The Prescription Mill” and still call pharmacy a profession. A this stage, we are presiding over a professional failure.

I testified at a meeting of The California Board of Pharmacy in August of 1972.  The California board rotated the cities where they held the meetings.  This one was in San Francisco.  The number one issue that had gathered a list of maybe 15 people who wanted to testify was: Shall a new designation of pharmacy ancillary help called “Pharmacy Technician” be allowed.

People went ape-shit.  The unions were there.  The Guild was there.  The associations were there.  All of these people defined pharmacists as “Prescription Mill” minders and that was what we did in 1972. They warned that pharmacists would be out of jobs if technicians were allowed to type prescription labels.  They screamed that patients would be put in danger.  They all were smug and self important and then Jay Pee stepped up to the microphone.  If the union chiefs had tomatoes, they would have been flinging them.  The head of The Guild shook his fist at me.

My message to the board was simple, “We do this or we are dead as a profession”.  You know how that turned out.  Without technicians, we would be dead in the water.  We would not be able to provide essential medicines to all patients in an effective, efficient and timely manner.  We would be a failed profession.

We cannot afford that.  When there is “Tech check Tech”, you can go do what pharmacists at mandated by law to do.  I do not have to remind you of what that is because you break the law 100 times a day.

“But, Jay Pee, how can you trust technicians to deal with interactions, dosage irregularities and those types of incidences?”  You don’t.  That would be idiotic.  When the pharmacy software stops the process and warns:  Look at this.  Only a pharmacist can look at it and sign off.  I think you do that with a secret password.  In Washington state, my password was:  JPOK.

For “Tech Check Tech” to work, we need a new designation.  I suggest “Advanced Pharmacy Technician”.  They must be trained by the industry and not by the companies. I do not believe that all drug store/ big box/ grocery companies can be trusted.  Rite-Aid will do anything to try to get a profit.   CVS has a reputation of cheating.  Just Google CVS in trouble. The list is huge.   The APhA loves this kind of shit.  Let them do it.  I have no doubt that an Advanced Pharmacy Technician designation earned by working through an APhA program would produce the real deal.

Celebrate.  What do you do?

You counsel.  You explain to the young mother with a 4 year old asthmatic child how to use the Xopenex MDI with a spacer.  In the process, you discover that the young mother is illiterate and she cannot read the dosage instructions on the tapered dose of prednisolone liquid.  You go and be a professional.

I do not expect that this process will be slick and easy.  It will be new.  I can attest to the value of counseling, on Rx, on OTC drugs, on wound care.  People like it.

There are pharmacists who will not want to do this.  Go into real estate.

There are pharmacists who will not be competent.  Now, that is scary.  Should the pharmacists who give inaccurate counseling advice or incomplete counseling advice continue to get a six figure salary?

This is coming, you guys.  Better get ready now because we want to run this ship.  We do not need non-pharmacist MBA Masters of the Universe anywhere in the process.

And that Problem Is:

The Merger Has Been Approved.

I am taking a five day vacation.  Be back the 11th.  If it rains, I might write something here.  In the meantime, what are your thoughts?

Every day, I hear from pharmacists who have been working in conditions that put the public in danger.  From everywhere, almost.  I have never heard from an Oklahoma pharmacist.  Does that mean that it is different there?

You are not getting enough help because your company is not making enough money.  It is not your fault, but the result is that your department is a hard slog every single day.  You violate the law.  You give no shit about patient care.  Wait times rule your kingdom.  This is not practicing pharmacy.  This is a rodent on a hamster wheel.  The “Prescription Mill” needs Advanced Technicians, but we need strong advocacy from You Know Who.  It starts with an  ”A”, ends with an “A” and had “Ph” in the middle.  That gripping you feel in your stomach is not good for your health.

Here are my thoughts.  The big companies that run pharmacies aren’t making adequate profits and it is their own damn fault.

Forty years ago, 90% of all prescriptions were cash.  There were no on-line plans.  Paid and PCS were paper billing. The union members brought in cards that the “Pharmacy Clerk” (There were no techs yet) filled and the RPh signed.  The patient paid cash and was reimbursed by the union’s welfare/medical fund.

Some bright idiot Master of the Universe (probably a 1970s version of a graduate of a night school MBA program) said, “Hey, you guys, we can get a competitive advantage by lowering our price on the top 50 prescription drugs.”

“Awright,” the CEO chortled, “Let’s do it.  We don’t need that 40% profit.  We can get by with less.  Light up the big cigars and pop the corks, Motherfuckers, let’s do it.”

Down the street, the Masters of the Universe at Drug Chain Lemmings responded, “We’ll show them. Let’s do the top 75 drugs and go lower.”

After every drug store chain lowered their prices, NOBODY had a competitive advantage.

But that paradigm has driven the algorithm of our industry since the 1970s.  What really pisses me off is that non-pharmacists (I love to call them Masters of the Universe) have ruined our industry and nobody seems to notice.  I would have fired their asses with the first utterance of “Gift Cards”.  Let them go ruin a big box store or a grocery chain.

MBA Mastesr of the Universe have traditionally been viewed as shady characters unless they graduated from schools like The Wharton School and, trust me, MBAs from U Penn, Stanford or Yale are not working for Rite-Aid or CVS.

Doesn’t it piss you off that your industry has been ruined by kids who HAVE NO STANDING?  None of them have ever answered a pharmacy phone.  None of them have ever ran the POS.   None of them have ever gone to the drive-through and had to breath exhaust from a 1978 Pontiac.  And those are just essential tech jobs.  You could not even start to explain to them what a pharmacist does (and is supposed to do).

“I know Mr. Master, that I should be doing all of those “Waiters” on the counter, but this young woman is bleeding all over your new waiting area furniture and I am going to put her Methergine prescription first.

“What about Mister Tantarino?  You want me to do his Norco, Soma and Xanax first?”

“I am going to ignore that mouthy bastard who keeps whining that he ‘Needs his meds now’.”

“What’s that?  I need to follow company policy?”

“You need to kiss my ass.  I think I will call the state board of pharmacy on your ass.” (You and I know what a joke that would be even if I officially complained of non-pharmacist interference.) But the MBA does not know that.

Silence.

“Hey. Mister Master of the Universe, what’s your home address?”

“What?  Why do I need your home address?  Because I am going to send my tech “Bruno” over to kick your fuckin’ ass after he breaks your kneecaps.”

Sorry about the adult language, but, my friends, I need that kind of release once in awhile.  The language does not diminish the message.   The only mistake we made was to allow this to happen…. for a paycheck.

In the mid-1960s, an outfit called Revco started the deep-discount madness in Ohio.  The big question being asked at the University of Toledo was, “Would you work for Revco?”  Most of us said “No”, but some of us did go to work for Revco.  We could have killed off the discount craziness fifty years ago.

I have talked about the coming avalanche of prescriptions.  One statistic.  10,000 Americans turn 65 every single day.  That’s a lot of prescriptions.  If you are youngish, look into an SBA loan and open your own store.  If you like rural areas, you cannot miss.