JP is Back. Rock ‘n Roll

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My friends, This is stream of consciousness, Unedited and rough. As slick as sand in Vaseline. I apologize. Forgice me. I have been gone a long time and just wanted to get it done. The LATE EFFECTS OF POLIO is not an achy boutique condition. It is the real deal and a wheelchair is probably in my future, sooner than later.
Can you imagine that 55 years on my feet behind a pharmacy counter could have anything to do with his? How about no breaks? Back to back 14 hour shifts? Five days straight? Cheap mats on the floor. Even without the polio, what will happen to you? Your best bet would be to avoid CVS, the garbage dump of pharmacists.
Paul Trusten. You eat generic themes up like this was homemade vanilla ice cream at an outdoor Bar Mitzvah party at Uncle Saul’s back yard during the dog days of summer. What the fuck was Uncle Saul thinking? 90 degrees. 85% humidity. The ice cream is exotic and sparkling in your mouth. Does it make it better? Do your old legs stop hurting when you balance your check book? What do you say, Pauly? Give us your best. Stretch it out. Make the readers wipe the dust off the dictionary. Do you have to put up with this shit in hospital?
I am so sick of whine, whine, whine that I want to slap you silly. There is a way out, my friends. And there is support. What you do to get control is legal. THEY CANNOT RETALIATE. You will finally practice pharmacy legally and your THEM can do nothing.
How? Find the answers when you join The Pharmacy Alliance, We will send a special premium. “Thrive as a Retail Pharmacist”. Click the JOIN button.

A quick anecdote of how bad it can get. A Pharmacy Manager had her license suspended for one month because she had to use the rest room and could not wait. She worked for a METRICS-CENTRIC chain that works its pharmacists like indentured servants.
This pharmacist left the pharmacy to go to the bathroom. A prescription was sold while she was gone. It was for a hydrocodone/APAP product. The patient was an elderly woman who was engrossed with her bowel movements. Not uncommon among the older among us. Anyway, she wanted to know if this product caused constipation. The cashier tried to answer the question. She had used this product herself and had not suffered constipation.
Of course, the old lady became constipated. She complained to the company that she did not take precautions because of the answer to her question. They sent her a $50.00 gift card with not a hint of an apology and a promise to not allow cashiers to counsel. The patient sent an official complaint to the state board. In the end, both the company & the Pharmacy Manager were punished. The company got a CHICKEN-SHIT FINE. The Pharmacy Manager ended up on the float team.
I want to write more, but I am in a lot of pain from sitting in an expensive net desk chair. Look for JP tomorrow. For your benefit: GET BACK IN THE GAME. It is NEVER over. Pharmacy is yours/Not theirs.
JP The Founder of The Pharmacy Alliance.
The above-mentioned PAUL TRUSTEN was there at the beginning. He is an originator of The Pharmacy Alliance.


A Quick Report on the evolution of THE GUERRILLA PHARMACIST

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#1. Protocols for The Guerrilla Pharmacist. This could be entirely stand-alone magazine or a major section of a magazine. I cannot create this on my own. Just too much. I will need you to help us out. An example (short version)
The protocol to follow when a pharmacist is WRITTEN UP or otherwise disciplined.
WHEN PRESSED SAY, “I have been advised to not say anything.”
“Who advised you?”
“That is not your concern.”

That is a start. Need Help? Contact Jim Plagakis, Goose or Steve Ariens.

Another Main Focus will be WARNINGS. Guerrillas will direct their advice at STUDENTS AND/OR NEW PHARMACISTS.

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Jay Pee is back and they’re gonna be in trouble
Some of you have noticed that I have not been available for a couple months. This site, the TPA site and The Guerrilla Pharmacist have been neglected. I will be 75 years old on the 29th. I had been healthy until the “Small Stroke” two years ago. I am not going to list everything I went through. I have written about it here. If you want to know, you can find it.
I have been living a health nightmare for 2 years. 12 months ago, my cardiologist and a whole panel OF MDs, INCLUDUING THE SURGEOON WHO DID THE triple CABG gather to discuss Jay Pee’s codition0. They impressed my wife with an icy message. “Mrs. Plagakis, You should start talking to funeral directors. He is not coming back”. I WAS COMATOSE. THE PROBLEM WAS A REACTION TO AMIODARONE. A young pharmacist started the amiodarone investigation. A doctor from RUSSIA closed the circle. I came back 4 hours after the amiodarone was DCed. What happened next was actually funny. My brother had arrived for the death watch. Victoria came into my room first AND I SAID QUIETLY “HELLO, MRS. PLAGAKIS.” Her eyes got big. Her smile was sort of crooked. Then my brother walked in. I said, “Hello, Mr. Plagakis.” His eyes got really big. He walked to my bed and whispered, “Vegas.”

I had believed that I missed the crushing polio hammer. I was wrong. 60 years after the active polio infection, I am experiencing the late effects of polio. Pain is the symptom that stops my productive life. I can’t even write notes.
I can see the light at the end of the tunnel. I should be back to the cane in a matter of weeks. I can put the walker away..
I am back and plan on doing my work on the revolution. I will write here and put it on the TPA site also. Guerrilla Pharmacists will get it in their inboxes.

Crank it up you guys. It is time.
I have been quietly working a new Guerrilla publication in my sleep.
I will invite Goose, Fred, Pharmacy Gal, Kim and others to participate.

Think about this. Put it on the back burner and let it simmer.

Protocol: The rules of correct or appropriate behavior of a group, organization, or profession.

The Guerrilla Pharmacist Protocols. Even the title gets me excited.


You have let this bullshit fly for decades. Call their BLUFF. A quintessential GUERRILLA Action

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The Biggest Lies The Chains Use in Advertising.

Live up to what they sat about you. This will increase wait times. When they come back at you, show them the advertising. Send the requisite letter to the Corporate Compliance Officer. The Manager is ignoring company policy. Document Document Document.

Our Pharmacists Are Our Most Valued And Honored Employees

We Respect Our Pharmacists As Highly Trained Medical Professionals

Our Pharmacists Are Encouraged And Empowered To Always Put The Patient’s Needs First

Our Pharmacists Are Given All The Tools Needed To Practice Pharmacy In A Legal And Ethical Manner

Our Pharmacists Enjoy The Most Supportive Professional Environment In The Industry

How about those cowboys?

The five statements above are common pharmacist fodder among upper management. They spout and publish statements like that everywhere you look. The CEO, the President and the board room people who light-up-the-big-cigars and pop-the –corks would never tell the truth.

They may even be sincere, but there is a disconnect between upper management and the middle managers.

The middle managers are institutionalized, just like you and me. Their job is to produce numbers. They couldn’t care less about the single mother who can’t read. You are wasting your time when you spend twenty minutes counseling her

on her baby’s dose of Prednisolone.

Here is how the middle managers hold you as a valuable employee.

“Listen, Buster, we pay you enough . So just do your goddam job. Nobody waits more than five minutes and you take coupons and give away antibiotics with a big smile.”

“What? You want a meal break in a 14 hours day? You have a nice roof over your children’s heads. They eat good food. They go to good schools. You can afford Disneyland every year. You have friends who think you are hot shit because you drive a Lexus.Bitch, bitch, bitch. What more do you want?”

“You make me laugh, asshole. Self respect? You think every RPh goes home at night and feels proud of herself? You think the job is dignified? You gotta produce numbers and you gotta cooperate so you get those numbers or your ass is grass.”

“You run the worst pharmacy in the district. You have the longest wait time. I don’t care that that heart transplant patient wrote to The New York Times about how you saved her life. You either get acceptable wait times or I’ll find somebody else to do the job.”

“You want self-actualization? Where did you get that term? In Psych 101 at your Junior College? You are a pharmacist, Judy. We give you money and that should make you happy.”

Is that enough about the Big Lies?

There has been talk on this site for 10 years about how to enhance the pharmacist’s image with the public.

I think you should start acting like the pharmacist that the upper management aims at with the five talking points. Start acting like you are what the CEO says you are. Then watch the shit fly.

You are an idiot if you want to enhance your image and still refuse to counsel according to legal requirements.

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“Good Job, Plagakis” Said the Spider to the Fly. “Really Great Job”. “Fuck You,” Said the Fly to the Spider. I KNOW that I do a Good Job.” I do NOT Need anything from you.”

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Sorry about this. I had a minor emergency and had to leave in a hurry.

My POINT is that Metrics should mean nothing to you. Metrics are a tool used to spy on you, to collect evidence that you can’t do the job. Or, To find a reason to acknowledge you for a good job.

I have bought into the Metrics Game more than once during my career. Pay ‘n Save offered a good bonus in California. I qualified for the standard bonus or much better every quarter. My Gross Profit was huge, around 44%, the best in the company. In California, I discovered that I could access the

    Pricing File

. That made it very easy to get the Pricing structure that I wanted. The beauty is that we gave nothing away. I never had to handle a

Two Bean Counting, uninformed, pharmacy-naïve, MASTER OF BUSINESS ADMINISTRATION degree earned at the local Community College came busting in one day. They wanted to know how I did it. 44+% GP for prescriptions was unheard of, Impossible.
So, I told them. They said, “Let us take you to lunch. Is that Mexican place across the street any good?”
“Let’s do it,” I said, knowing it was not possible, “but I will have to lock the pharmacy.”
“What? Blabber Blabber Huh?”
They were gone for an hour and a half. Red faces. They laughed too much. They could not remember their questions so they had me answer the questions on a Pay ‘n Save questionnaire. Questions like ARE OUR PRICES REALISTIC? They believed that the California stores were being strangled by the Seattle Pricing Structure.

Wait Time, Pharmacy Assistant hours (They were not called Techs yet), Inventory (No computer generated ordering in 1986). Pharmacy Assistant hours was the one we fought over.

In the end, the only thing that mattered to them was the 44%. What mattered to me was the 15 minute commute, weekends off, the fun I had serving the patients/customers and the nice bonus. They sent me the Metrics Evaluations and I could not give a shit. I knew that I did a good job. No one had to tell me. The Metrics system was a huge waste of money. The Return on Investment was a black hole that sucked up the money to never be seen again. I forgot about Metrics until years later. In 1997. I was managing a Rite-Aid Pharmacy in the same location where I did the Pay ‘n Save. Metrics was no longer an effete little watchman. Now, the SOB is a killer. Muscular and Mean, slicked back greasy hair, a sour cigarette smell, a switch blade in the front pocket.

I left when the District Rx Manager came in, shook my hand and said, “You are doing a good job, Jeff.”
“How do you know that when you don’t even know my name?” I turned my back on him and said hello to a good customer. I was in love with her and she was single and had told me that
she loved me. That is okay, you guys, as long as you do not do anything about it. I went to her wedding at a small church in Coupeville, overlooking the water. I shook the bridegroom’s hand and wished him luck. I kissed the bride when I danced with her at the reception. It was held at a very nice club at Whidbey Island Naval Air Station. yes, her new husband was a naval aviator, the back seat (Navigator, Bombardier) of an EA6B.
When I kissed his wife the second time, I could feel her pulling away softly. I looked at her face. There were tears in her eyes, Softly, she said, “Ooohh, Jim”. Better than Metrics. In the beginning, perhaps, I was impressed by me when they showed me the paper and raved about how good I was. I did not need that while I finished up with Rite-Aid. I knew that I did a terrific job.

I ended my 50 year retail career with 7 years at Walgreens. (March 2005 to April 2012) Tuesday morning early shift and Friday late shift at an interesting Walgreens on the Seawall. I learned quickly what they wanted and I learned how to cheat. Wait Times were rarely a problem. The Metrics were a cinch.
Right before I left, Jason the Rx District Manager came to me. “Will you work with Mid-shift
PHARMACIST about the Metrics? I taught her how to cheat and all was well after that. That is what they get when their demands are unreasonable.

I could go on, but you get it, I believe. You do not need an artificial grading system to tell you when you do a good job.

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Rock ‘n Roll. Call Target Pharmacy in Brooklyn, NY and get some coaching. Nobody does UNION better than New York City

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Ah Right
News from Rex. Thank you, Man. Looking forward to your unimpeachable story. I am getting old. Have an active case of post polio syndrome. Today is a good day. Fred, I will have the promo magazine “The Best of the Best from the first 5 Editions” ready to print by Sunday. I will collate and staple. You must find some strong hands to fold. Mark Hill taught me how to do it quickly. It does take strong hands.

Who else wants to promote the revolution? C’mon, you can’t stand by and expect the other guy to do it . Look how that has turned out. Contact me at or cell 941-281-9096 NEVER after 9″00 PM Eastern time.
The Guerrilla Pharmacist is making a difference. Slow but sure. Remember, This is a guerrilla warfare. WE are not trying to set off an atomic frikkin’ Target bomb. Smaller skirmishes won by us are, to Target in this case) the companies, huge losses. They know that all it will take is a quantum degree of guerrilla victories and they are fucked. Trust me, if only 10% of a company’s pharmacists in one city mail the guerrilla letter as outlined in Edition One of the magazine, we win. It will be all but love. The same with organizing as a union. This is not difficult. Once you start, the company cannot retaliate. The Fed will be your personal body guard. Talk to me. Talk to Steve , Talk to Goose
Talk to Peon Talk to Pharmacy Gal You can do this. Repeat YOU CAN DO THIS!

    By: Nandita Bose (Reuters USA)

CHICAGO (Reuters) – A group of pharmacy workers within Target Corp’s store in Brooklyn, New York, have won a vote to form a microunion, making it the first unionized store at the retailer since its inception in 1902.
Earlier on Wednesday, Reuters was first to report that a group of pharmacists and pharmacy technicians won an initial ballot, 7-2, to form the union, according to a filing on the National Labor Relations Board website and union officials.
Target said it was “disappointed” by the vote within its store and will appeal the NLRB’s decision to allow the vote to proceed.
Target is in the process of selling its pharmacy business to CVS Health Corp.


Will Counseling Be The Sharp Edge of our WEDGE?

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It's The LAW

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” Margaret Mead

People are always blaming their circumstances for what they are. I don’t believe in circumstances. The people who get on in this world are the people who get up and look for the circumstances they want, and, if they can’t find them, make them.
George Bernard Shaw

PPSI Takes The Lead Again. Think about it. Wake the fuck up. The Operative words are LEGAL REQUIREMENT. You Do Not Counsel. You are ILLEGAL most of your work day. If they ever start citing about failure to counsel, it will be YOU that the government will fuck up. NOT CVS, WAG or RAD. The Wal-Mart RPh will be fired. You know how Wal-Mart works. Zero loyalty to good workers. What can you do? Start counseling, document everything. Invest in a high tech “SPY” device.

Spy Device

Dear Ginny,

Thanks for allowing our PPSI group to testify before the California Board of Pharmacy at the enforcement committee hearing, Wednesday, September 9th from 1:00-2:30pm in Sacramento.

I have a few questions after going over the notes that were taken at the meeting.

1. There was reference made to a December meeting where consultation and some of the issues discussed by the board members will be heard.
a. CAN YOU TELL ME WHAT TIME, PLACE, DATE that will be? The website does not indicate that information.
b. Will there be an agenda, and more time available for speakers?
2. When we told you that we could only find 3 Failure to consult, you mentioned that there were much more. Can you please send them to PPSI? PPSI believes that 83% of errors can be caught at consultation, and that 150,000 Californians are harmed each year from “uninformed and improper use of prescription drugs” at a cost of $1.7 billion of economic loss.
3. How many inspectors do you currently have, and how often are they inspecting pharmacies? Is it still every 2-3 years?
a. Do the inspectors in the C&F ever point out why the Rx errors are being made, other than the fact that the wrong pill was in the wrong bottle?

b. In the Walgreens case reported by Aglaia Panos, where the wrong directions were put on the label. Is it ever written up in the reports that there were 8-12 patients waiting, that it was 8pm on Sunday night, that there was one ancillary personnel on duty, that there was a drive up window, in addition to the waiting patients, and that there was only 1 hour from 8pm to 9pm until closing time, and that the pharmacist was stressed out?

i. We have not seen cause and effect in the Cites and Fines. We were wondering what is the CBoP procedure for these kind of Walgreens incidents. And how are they corrected?
4. Are there any standards for counseling as mentioned by a public comment? Can that be sent along?
a. What states require documentation of what was communicated during consultation? Can you please send along any information you have on that?
5. In Iowa, there is some kind of metrics on numbers of prescriptions that can be filled safely by a pharmacist. Do you have any information on that standard of practice, and can we get a copy of it?
6. You mentioned promoting the importance of counseling. Can the board release press releases? How can consumers be informed that 150,000 Californians are harmed each year, and that counseling can help? Are there funds for an awareness campaign?


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Here Is How the Nurses WON. Why not Pharmacists?

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Union Power
“You can take a perfect, careful, and very accurate pharmacist, who isn’t error prone, and place him in a dysfunctional, error prone pharmacy system, and the system will win every time” (from a C.E. on pharmacy errors that I took to maintain my Florida license) (Tony M, a member at PPSI)

From FRED AT PPSI 8-30-2015

As you can see nursing had lots of support from the ANA for studying nursing outcomes. The data from the studies were used by nursing management, who went to bat for the nurses with hospital administrators.

If pharmacy outcomes are to be documented then pharmacists need support from APhA and ASHP. Only then will pharmacist managers, store owners and hospital pharmacy directors push for caps on number of scripts filled and better staffing in pharmacies.

From what was said at the CE program by a Kaiser pharmacist, Kaiser was only interested in speed and number of scripts filled as their benchmarks for advancement and job retention. You may also remember that Kaiser pharmacists are represented by the Guild for Professional Pharmacists, a pharmacist union. So much for a union solving the problem.

As long as pharmacists are willing to work under bad conditions the conditions will continue. If the BOP continues to cite and fine individual pharmacists rather than going after the corporate management the conditions will continue.

John Buffum, PharmD, BCPP
Clinical Professor of Pharmacy, UCSF
Vice President, Marin County Pharmacists Association

Subject: How the nurses won the patient to staff ratio battle
Marti wanted to correct your assumption that all the nurses had to do was form a union and strike to get a reduced patient to staff ratio. By the way, the staffing in the ICU is 2:1 or 1:1 depending on acuity, not the 4:1 or 5:1 you mentioned last night. It is the floor nurses who have the 4:1 or 5:1 staffing ratio, again acuity based. These ratios were arrived at by research that is still ongoing.
About 20 years ago CALNOC was formed to gather data on nursing outcomes.
Originally named the California Nursing Outcomes Coalition. The name has since been changed to the Collaborative Alliance for Nursing Outcomes.

“CALNOC was launched in 1996 and has since grown to become the premier nursing sensitive benchmarking provider.
CALNOC began as one of six ANA pilot sites that ultimately contributed to development of the ANA NDNQI. Today, CALNOC is a self-sustaining, non-profit corporation that provides the premier nursing sensitive benchmarking registry. Our offerings deliver seamless interactive access to facility-specific and group benchmark data on nursing sensitive outcomes.
CALNOC contributed to the development of the National Quality Forum nurse sensitive metrics and is the measure developer for the NQF Pressure Ulcer and Restraint Use prevalence measures for acute care.
CALNOC’s success, in the midst of healthcare system turbulence can be attributed to its innovative, customer focused, high value products and services.
With hundreds of hospitals across 9 states, CALNOC has garnered and maintained a high level of customer satisfaction.”
Marti was on the CALNOC Board shortly after its formation and remained even after the Veterans Administration formed their own nursing outcomes group, VANOD.
VANOD or the Veterans Administration Nursing Outcomes Database was formed to collect nursing outcomes data that was computerized and retrievable for decision making by VA nursing management. Marti was the Assoc. Chief Nurse for Nursing Research at the San Francisco VA Medical Center and head of the VANOD group responsible for spreading VANOD throughout the whole VA system. The military formed their own version of VANOD, called MILNOD.

The American Nurses Association (ANA) formed the NDNQI or National Database of Nursing Quality Indicators. Marti was also involved with that group. All of the groups collaborated (CALNOC, NDNQI, VANOD & MILNOD).
I mentioned all this because nurse to patient staffing ratios were data driven by documentation of nursing outcomes, first in California and then nationally in private and federal hospitals. This process of documenting nursing outcomes has spread worldwide. CALNOC is now in many different countries.

Marti has presented at conferences on nursing outcomes all over the US. She even gave a talk on nursing outcomes at Swansee University, Wales, in May 2009.
In summary, when the overwhelming amount of data showed that high patient to staff ratios resulted in bad nursing outcomes, nursing administrators were able to go to legislators and hospital administrators and negotiate staffing ratios.

So there you have it. Good project for one of your students.

John Buffum, PharmD, BCPP
Clinical Professor of Pharmacy, UCSF
Vice President, Marin County Pharmacists Association


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Knowledge is POWER. PPSI consistently provides INFORMATION that you can act on.

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A CVS Pharmacist

Fred Mayer, CEO of Pharmacist Planning Service (PPSI) consistently shares very important information about our industry. What Fred says is often of great consequence and the kind of stuff that the Non-Pharmacist, Bean-Counting Night School MBA Masters of the Universe could use when making decisions. But, they won’t. They are too ego-driven and important to listen to an old Berkeley Hippie from the 1960s. That is very good for us. When the idiots in the executive suites figure this out, it will be too late.
After The Pharmacy Alliance, you may want to consider joining PPSI.
Here is the Email I received from Fred. Read it over, consider the implications and then we will discuss it more. Fred, by the way, has been a huge player in the Guerrilla Revolution.
From: Ppsi Ppsi ( Fred Mayer, CEO
Sent: Thu 8/27/15 9:18 PM

Yesterday, PPSI put on a CME for 25 pharmacists on HIV/HCV.

The speaker, James Scott, Pharm.D., Associate Dean, Western University, School of Pharmacy, Pomona, California told me the following after I mentioned no jobs:

1) the ratio of pharmacy students to applicants nationwide has dropped from 5 applicants for
each single position in the SoP, to now 1.3 applicant per position, which means a 300% drop in pharmacy school applicants.

2) if this continues, the quality of pharmacy applicants will take a nosedive and schools will be closing, as you predict.

3) did you say 20 schools will close by 2020?

4) Dr. Scott told me that there is a group of Deans in California associations and folks who get together every 3 months to decide policy for California pharmacy. Do you or the gang know about this group and what they are called and how to take our case of too many schools and too many pharmacists to this consortium ?

5) We also had a discussion at our meeting, led by Aglaia Panos, about RX errors and stressed out pharmacists and the most recent $505K fine against Walgreens, CVS and Rite Aid, for failure to counsel in 3 different California counties, by San Diego DA’s.

6) We had a 15 minute discussion by our newly hired attorney, Natallia Mazina, Esq. on RX errors and the proposal to appear before the California BoP, to present the case on behalf of patients and consumers.

7) Did you or any of the gang see the $9 million settlement on failure to pay and have dinner breaks, settled in the LA superior Courts ?

8) WE HAVE A NEW SCHOOL OF PHARMACY IN CALIFORNIA-UC Merced-I will write Lucinda and Peter and see how many more schools are opening up. I think this is 13-15.
Now, think about the Masters of the Universe who have been scratching their self-important balls as CVS fires older, experienced pharmacists and hire much younger robo-dispensers at 20% less per hour. Emotions will flare at the intensity that is felt when a spouse is found in bed with a much younger man. Chances are you are done with that spouse. Same for CVS. The surplus of pharmacists will end in less than 5 years. CVS will never keep you when WAG is offering 20% more in wage, a full 40 hour week, all benefits. You can see some dignity & self-respect with WAG. WAG suggests that you practice by the laws that CVS has been ignoring for decades.

There will be pressure put on the retailers from every corner. And it will be too late for them. Pharmacists will be in the driver’s seat once again. The industry will never again be in a position where pharmacists will take any job at any wage just to have a job.

Now, you tell us your view of the coming shortage. This is a direct result of the greed and hubris of the companies. Idiots! Nothing lasts forever. Especially when they have been trying to fuck smart people.

Put your thoughts in the COMMENTS. I will copy and paste them right here.
Comment from PEON:
Yes, nothing lasts forever and the over supply of pharmacists will come to an end. Pharmacists need to focus on the future. Best of all, we need a strong pharmacy organization, with some insight, to help guide us into the future. A big problem for pharmacy is a lack of an organization and strong leadership. In the 70′s, retail pharmacies made the mistake of accepting insurance contracts and the insurance companies got control of pricing in pharmacy. And, about 20 years ago, when pharmacists were in short supply and big demand, pharmacists failed to unionize. We have been behind the curve. It is time we did not just catch up with the curve but got ahead of it. Unless we do, pharmacy will be just an educated job and not a profession. I think I could make a good case today that we are no longer professionals…just employees. The Guerrilla Pharmacist is the right approach to pharmacy. I am tired of seeing complacency and hearing the constant whining by pharmacists. It is time for a radical approach. It is either a radical approach or we are doomed to be slaves. We need the fortitude to stand up and fight. We need to step out of the working and complacent environment in which we live. At stake, is the profession of pharmacy. At the rate we are going, there will not be a profession. Not only will we need to stand up against the chains and make demands, but we will also need to do this in the political arena. We must get hold of the PBM’s and wrestle the money and power from them. At the same time, we must watch government to make sure it does not siphon all the money from pharmacy. Many of you will remember retail pharmacies that had home health equipment. The government took all the money from it. If we are not vigilant, they will do the same with prescriptions. We are at a point that we must demand what we want. No more of this abut ‘proving our worth’. No more just sitting around waiting for a government handout.

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THE GUERRILLA PHARMACIST Takes On Metrics. Know the Enemy.

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Edition One.  Premier!
“THE GUERRILLA PHARMACIST” is the official magazine of THE PHARMACY ALLIANCE. GUERRILLA is not your grandpa’s Pharmacy Times. Guerrilla extends a workable and viable strategy for poking CVS right in the eye. You want to feel free and able to control your situation. Give The Guerrilla Pharmacist a go. Visit the PayPal JOIN page at A subscription to THE GUERRILLA PHARMACIST is included with your new membership in The Pharmacy Alliance. Or subscriptions are available.
“The Saga of Rex Guevara” is next . A full magazine that will inspire some of you to
take a stand and recover your standing as a professional.

Click at the top of this page. You will be taken to the Subscribe essay. Click on the red Click Here will take you to the TPA
PayPal page at

For the next edition after “Rex”……..essays on METRICS! We will include
your thoughts on Technicians.

An open call for:
Anecdotal evidence?
What are the metrics?
How or why do the metrics adversely affect patient care?
How or why do the metrics adversely affect patient safety?

Doctor visits?
E.R. Visits?
Hospital admissions?
Hospital readmissions?
Permanent damage? Death? Patients are dying.
Your ass.
Your heart rate?
Your blood pressure?
Blame The Metrics for the inattentive pharmacist who tries to be quick & fast rather than live up to her Duty To Warn. I am telling you, man, that it is the rare animal who actually counsels.

There are doomsayers who smugly hang crepe and insist that pharmacists will never be able to get rid of the metrics. You think?

BUT, with ORGNIZATION and REPRESENTATION, A PHARMACIST Union could negotIate changes in policies and procedures and implementation of those METRICS! A Union CONTRACT agreement between Pharmacists/Rite-Aid can include provisions for obeying all pharmacy LAWS.


FRED MAYER, CEO of Pharmacist Planning Service, asked to have this put up front & center

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Looks Like Candy To Me

The National Take-Back Initiative on getting rid of outdated medicines has announced its tenth annual program, scheduled for Saturday, Sept.26, from 10 a.m. to 2 p.m.
Unused medications in homes create a public health and safety concern because they are highly susceptible to accidental ingestion, theft, misuse and abuse. Almost twice as many Americans – 6.8 million – currently abuse pharmaceutical-controlled substances than the number of those using cocaine, hallucinogens, heroin and inhalants combined, according to the 2012 National Survey on Drug Use and Health.

Nearly 110 Americans die every day from drug-related overdoses, and about half of those overdoses are related to opioids, a class of drug that includes prescription painkillers and heroin. More than two-thirds of people who misuse prescription painkillers for the first time report obtaining the drugs from friends or relatives, including from the home medicine cabinet.

More than 14 years have passed since the U.S. Geological Survey concluded that 80 percent of tested water contains trace amounts of pharmaceutical compounds, including prescription and over-the-counter drugs and dietary supplements. Yet, Marin and the state of California have not mandated a solution to the improper disposal of pharmaceutical waste, which is often flushed down the drain or tossed into the trash.

Senate Bill 1014, by Senator Hannah-Beth Jackson of Santa Barbara, was introduced 2 years ago to have the Pharmaceutical Manufacturers Research Association (PhRMA) pay one cent per prescription sold to the consumers in California, similar to what has been done by PhRMA in Canada, UK and the Euro countries. The bill was heavily lobbied and defeated last year in Sacramento, by Big PhRMA.

“Every day, I hear from another parent who has tragically lost a son or daughter to an opioid overdose,” said Mark Dale, from Marin County, cALIFORNIA, RX Safe Drug abuse coalition.. “No words can lessen their pain. But we can take decisive action, like the one [the Drug Enforcement Administration](DEA) announced, to prevent more lives from being cut short far too soon.

In September, the DEA will hold its next Take-Back Day. To find an authorized collection site in your community, call the DEA Office of Diversion Control’s Registration Call Center at 1-800-882-9539 or visit At this time, DEA has no plans to sponsor more nationwide Take-Back Days in order to give authorized collectors the opportunity to provide this valuable service to their communities. Marin county is the fifth county in the United States to vote for a new regulation for its own takeback program, funded by PhRMA, in July of this year.

The Marin County Board of Supervisors, along with Marin’s Environmental Health Services, led by Former Supervisor Susan Adams, Ph.D., RN, initiated one of the first pilot programs targeting the taking back of pharmaceuticals in 2004. This program is one of the simplest in the country: Pharmacies are provided with secure containers into which patients and consumers simply empty their unused, outdated and unwanted medications. Pharmacies contract with the County of Marin and licensed medical-waste haulers pick up, incinerate and destroy the unwanted medications.

“We know that if we remove unused painkillers from the home, we can prevent misuse and dependence from ever taking hold,” Dale said. “These regulations will create critical new avenues for addictive prescription drugs to leave the home and be disposed of in a safe, environmentally friendly way.”

In addition to hospitals, police stations and independent pharmacies, there will be other collection sites, according to the DEA website.

In Marin county, California, if you miss Take Back Day, consumers can bring their unwanted, drugs in a plain Ziploc baggie with no names attached to the Marin Senior Information Fair on Wednesday, Oct. 21., from 9-3. The Marin County Pharmacists Association will have a booth and the pharmacists will give them to the county for disposal and incineration.

Fred Mayer, RPh and MPH, resides in Smith Ranch Homes in San Rafael. He has been a pharmacist for more than 50 years, previously owning Sausalito Pharmacy. Mayer is the president of Pharmacists Planning Service Inc., a nonprofit, consumer, public health, pharmacy education organization. Contact Mayer at and visit our website at


CAN WE GET PHARMACISTS TO TELL THEIR PATIENTS AND CONSUMERS WHAT WE DO, BESIDES COUNTING, POURING, TYPING and being good little lemmings salivating as they work themselves to distraction making the bean-counting, night-school MBA Masters of the Universe smug and fat by being a robo-dispenser Prescription Mill worker that puts metrics before patient care? Now THAT is a stupid question.


Too Big For Their Britches. Is WALGREENS Headed for a Huge Fall in Indiana? Will money or favor pass under the table?

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Check out this major example of investigative journalism in Indianapolis. With an “Inside Man” on the Indiana Board of Pharmacy, WAG remodeled a whole slew of pharmacies to put the Pharmacist OUT FRONT and leave filling up to Techs OUT BACK. Those of you in Indiana can help this initiative by outing the Indiana Board anywhere you can. The governor. The legislature. Television.

Too bad, I can’t get the link to work, but you can find it here: JP’s Facebook Page

Okay, Doc

    Steve Ariens Steve is a long-time Indiana resident. His eye is amazing. His ability to engage in analytical assessment of what is happening in our world helps us see clearly. Keep it up, man.
    August 10 at 6:11pm

    Here is what Steve has to say. In Indiana all the Pharmacists on the BOP ..except one.. is a corporate employee… we have some BOP members that are or have been on the BOP for 4 to 5 – four year terms. IMO.. the fact that they made two separate trips to WAGS’ HQ to avoid Indiana’s open meeting law… so that they would not have a quorum in place. speaks volumes about how things work with the BOP in Indiana


Paula Zorek “Mrs. Whistleblower” Sends Us Eddie Morales. He Is A GUERRILLA PHARMACIST Who Just May Not Know It Yet

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Eddie? Maybe, from Google Images

This May or May Not be the Same Eddie Morales, but I like the image.

Paula, can you get me in contact with Eddie? He needs to write for Guerrilla. JP

Hi Paula Zorek,
Rogue Pharmacist-Eddie Morales said:


In your opinion, does the profession of pharmacy exist anymore within the chain store pharmacy environment?

Remember, just because you act in a professional manner doesn’t necessarily mean you’re in a profession.

Is the “profession” of pharmacy now the “job” of pharmacy?

Managers are quick to point out, “Be thankful you at least have a job,” whenever a pharmacist speaks up for himself or herself.

Should what’s happening at CVS and other chain pharmacies be brought to the TV media and or newspapers?

How many of you would like to be involved in a nationwide campaign to bring what’s happening at CVS and other chains to the TV media and or newspapers?

There are plans to do this if we can get enough support across the nation.

More to follow.

Rogue Pharmacist Eddie Morales


Too Many Pharmacy Schools? Too Many Pharmacists? Not Enough Jobs!

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Glut of Pharmacists

JP.. How about a crusade to legally mandate Pharmacy schools to teach PHARMACY. The new for-profit schools are basically very expensive NAPLEX preparation courses. How about making training in compounding mandatory? Including laboratories. Pharmacognosy? Still a valid discipline. Taxol from the bark of the Yew trees that grow in the temperate rain forest below Mt. Saint Helens. Who figured that one out? Did a Salish-speaking Indian Shaman shake a hunk of Yew bark, walk up to a white man camping on the edges of the mountain and say, “Heap good cancer medicine in this bark.” I’d like to know the answer to that. I believe that the number of students diminishes proportionally with the expansion of the curriculum. The closer they get to what the University of Michigan or UCSF require the higher the quality of students. Case in point. First day at Toledo. September, 1959. 119 Freshman Pharmacy students. Of that group, only 20 something graduated with pharmacy degrees. 80 or so became teachers. Why? Pharmacy was hard, damned hard.

Too many pharmacists? Pharmacy school glut? The debate rages on !

March 18, 2015
By Julianne Stein, Content Channel Manager Drug Topics

From a pharmacy industry CEO
In the matter of too many pharmacy schools/too many pharmacists, the question is, how can the problem be alleviated?

According to some estimates, if nothing changes between now and 2018, there could be a 25% oversupply of pharmacists in the marketplace. The only solution would be to create more jobs for pharmacists, jobs outside the normal dispensing function of most pharmacists today. Where would these jobs come from?
I can offer only one possible solution.

Legislative and regulatory

First, pharmacists must achieve “healthcare provider” status. Getting H.R. 592 and S 314 passed in Congress is the first step.

Second, CMS must make an adjustment under Medication Therapy Management Program (MTMP) Requirement 423.153(d) and eliminate “target procedures,” as well as eliminate “targeted beneficiaries,” as described in Section 30.2.

I am suggesting that all beneficiaries under Medicare and Medicaid should be required to have an annual comprehensive medication review (CMR). The CMR should be administered by either a pharmacist or some other qualified healthcare professional.

Reimbursement overhaul

Third, reimbursement must be made to the pharmacist, or to the pharmacist’s employer, for the time involved in performing the CMR with the patient and submitting the proper documentation to CMS for payment.

 This reimbursement to the employer would have to cover all the employer’s expenses, including the hourly wage rate, plus all mandatory taxes and insurance, and the fringe benefits package, as well as any other hidden payroll expenses.

The result would be benefit across the board. I have seen studies that describe an annual savings to CMS of approximately $13 billion dollars, per year, every year. It would be a win-win for all parties involved — especially the patients. CMS wins, the patients win, and the problem of pharmacist oversupply would be alleviated.

The time to act is now. We should not wait until 2018.
Ronald G. Cameron, CEO
Cameron and Co. Inc.
“The Pharmacists’ Registry”


BroncoFan NAILS IT. The Vampire Squid is the ENEMY.

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PBMs are just Big Banks
This is from Bronco’s recent comments. He is right. The Big Banks (PBMs) are using our profession as a money cow Piggy Bank. Can we (individual pharmacists) do anything? Of course, we can. Follow all pharmacy laws. Your employer will quickly have a spittle of desperation dripping from her mouth. The PBMs will be in very deep crap. When huge employers find out that their employees cannot get their Rxs filled because pharmacists cannot legally fill Big PBM prescriptions, the PBM will not be in compliance with the provisions of the contract that guarantee prompt dispensing of Rxs. Am I close, Steve? JP

From Bronco Fan
This brings me to my main point. Mr. P’s blog does a GREAT job in capturing the ills of Chain Pharmacy practice. What it doesn’t consistently do, is focus on the TRUE boogeyman and the biggest threat to our profession,the insurance companies (PBMs) who are profiteering by each and every RX that we dispense for their insured patient lives. I cannot state this strongly enough, we are truly at the point where it’s an “US versus THEM” proposition.

So while Chain Pharmacies do in large part employ a stressful, understaffed business model, their counter to these increasing complaints and decreasing gross margins are going to be a decrease in every Pharmacists salary (to the $40-$50/hour range by 2020). And the main driver of this isn’t simply chain Pharmacy executive greed, but instead those working from the shadows, the PBM. We need to get refocused folks.


Your Debt is Killing You. The Interest You Pay on your Student Loans Is Dragging You Down. Refinance NOW

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Pay Off NOW
Inspired By: “The Prisoners of Comfort” by Jim Plagakis, R.Ph.

When you are thirty years old and earn ten thousand dollars a month, you realize that your family does not have to wait for the good life. You can have it now. You have two nice cars, your children go to a private Montessori school, you can afford the best dance classes for your daughter and your son is already a black belt in Taekwondo. Your house is a dream that you and your spouse believed would come some day. Why wait? You told your spouse that you could have it now. The mortgage is hefty, but you can make the payments and your sisters are envious that you got that place on the lake when they may always be stuck in town. You have a life of comfort.
You and your spouse scrimped during the college days and you have vowed to never do it again. You may not know it, but you are a Prisoner of Comfort.

Making payments on your student loan at a thousand dollars or more a month is not a problem as long as you are making the good money. Your family cars are an Acura and a Mazda Miata. Nice cars but a Honda Civic and a Toyota Corolla will get you where you need to go just as fast. Student Loans are in a class all by themselves. Student loan debt is how you got where you are. Borrowing to get your PharmD was necessary. Student loans are not luxuries. You have to pay them back. Be smart about it.

Can you see that your choices on how to spend that bloated income are what are causing the stress? Your life of comfort is going to kill you; at least your marriage is liable to go. Change your life right now. Downsizing and eliminating or consolidating your debts is a great place to start.
CLICK HERE: CommonBond

The Following was written by a professional employed by Common Bond.

    Student loan is a crisis in America right now. I agree that private student lenders can only do so much. There’s going to have to be some serious forgiveness if we’re not going to ruin millions of young Americans’ lives. It’ll be okay for the top students and those making some money, and that’s where we think private lenders can help, but for those students whose debts will never be repaid, I think the government is going to need to take some action.

    CommonBond also believes that debt management doesn’t have to be such a tiring experience. One of our favorite statistics is that 71% of millennials would rather go to their dentist than visit their banks (maybe a good one to throw in a post!). Our focus isn’t just on lower rates, but actually changing the face of finance from something we dread to something that we could get excited about. For example, every one of our borrowers receives a handwritten note and a gift chosen especially for them when they join. Sure it’s not as important as saving them money, but we think this kind of stuff is important in building a relationship of trust (especially after 2008


1 Comment

Paula (Mrs. Whistleblower) picked this up at Facebook. Danny Miller is a stud. Let’s get him for Guerrilla.

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We are Awash with Cortisol
Danny Miller THIS IS TERRIFIC. Danny Miller hit a home run with bases loaded. BTW. I filched this from Facebook.
7-22-15 JP

A little pharmacy rant: Staffing Hell!
Many pharmacy companies staff according to the script count model; more scripts filled on average = more tech hours. The problem with this model is that it fails to address the modern realities of pharmacy operations and it is incompatible with contemporary pharmacy design! What good are 40 foot counters and half a dozen computer/cash register terminals, and a two lane drive through if there is no one to run them?!
A pharmacy is bit like a baseball diamond; many positions that need to be covered: drop off, pick up, drive through (frequently with two lanes), data entry/billing, dispensing (counting), and final verification (the pharmacist). Add to that list phones that never quit ringing, scripts left on voicemail, scripts faxed in, electronic prescriptions, various health screening, MTM, and vaccinations and your pharmacy is being slammed from every angle!
But corporate is convinced that these things don’t happen simultaneously and a few people should do just fine! And if you just follow the handy flow chart on the wall that tells you where to be, everything will be OK! And they even time how long it takes for you to fill a prescription, do final verification on a prescription, answer the phone, open the drive through window, etc. but these timing metrics are good they say! So we or management can look at the numbers and find gaps in “efficiencies!”
Well I’m here to tell you that most days the phones and drive through alone could each take a staff member just by themselves! And so could data entry, filling, and verification, and pick up! Only drop off can be squeezed a little but some stores need that position covered as well!
So even a slow to moderately busy pharmacy could EASILY use 5 to 7 staff members to run properly! And that’s on a good day!
But what do we get often?….two or three techs, a pharmacy on fire, and stress on top of stress! Half of your techs will also be barely trained new-hires because pharmacy techs are under appreciated and WAY, WAY underpaid causing them to leave frequently and the hiring/training process to start over again!
But never fear, management is here…..remember those pesky metrics? They revealed that YOU are the problem and that YOU aren’t working “efficiently!” That piss you took caused a prescription to be filled in 10 minutes not the expected 8! Your inability to split yourself in two like Superman (part 3 – underrated) caused you to not be able to counsel that old lady about her health concerns, while simultaneously counting the six Percocet scripts that just got dropped off! And that time you sat on a stool for a few minutes (while still working) shows a lack of stamina and something needs to be done! And don’t you worry, that stool won’t be there to tempt you next time!!!
It’s refreshing to know that we are the problem!


A FaceBook Comment focuses on Technicians. I believe the writer is a Tech. I would hire her in a minute.

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Technician Wage
Here you find Wendy’s comments. Then, we need to discuss the group of pharmacy WORKERS that is most responsible for filing prescriptions. Most responsible for accuracy out of the pot. Most responsible for a steady work flow. THE TECHNICIANS.


Wendy Dorfman Kerth commented on your post.

Ummmm. Forget crappy techs, I’ve worked with some really crappy pharmacists. State maximums are a good idea but some pharmacists still won’t survive. The tech ratio sucks. That should go away. One horrible PHARMACIST and 4 techs is not a recipe for a safe pharmacy. Some stores need more help typing and filling. My store sometimes needs 2 fillers and 2 typers. And you need a tech in the drive thru, not a cashier. Hell, cashiers are not a solution. U need someone who could help with insurance etc, at the counter. Not a warm body.

From JP: I have worked as a licensed pharmacist in 6 states (Ohio, California, Washington, Idaho, Vermont & Texas). Washington State had the most stringent pharmacy technician rules of all of those states. In Washington, a tech had to be licensed by the state first. National certification was a minor license. No state license, no workee in Washington. Think about that. Texas is the scond largest state by population and their technician requirements are pure Hook ‘em Horns cow shit. Here is how it works for an independent in East Piney Woods Texas. \
“Hey, this is Billy Bob Baxta out east here, 80 miles north of Beaumont. I am hankerin’ to hire me a technician girl. Whad I Hafta do?”
“Is she qualified, Mister Baxter?”
She is my daughter-in-law’s mother’s brother-in-law’s sister. She done worked for That Car Wash Place that fills prescriptions.”
“How about I send you the paperwork.”

WAG, in Texas, requires national certification.


That is about how easy it is. Is Ohio still the nightmare state where the UNLICENSED brother-in-laW can screw up a compound, kill a CHILD & walk free while the pharmacist is prosecuted for a felony and ends up doing 10 years hard time for the technician’s error? About that error. Was the pharmacist overwhelmed with work and gave no more than cursory attention to compounds?

Technicians are the most important member of the pharmacy team. WE would be dead in the water without them. It is more likely that a TECHNICIAN will catch your mistake before you do. Nine times out of Ten. This is a very valuable employee. If you agree, why do we let these big companies pay the technicians no more than what they pay an experienced cashier? Talk to me. WAGE is how we determine an employee’s worth. What does your best single mother (with 3 kids) tech get paid? Does she have to rely on Food Stamps to feed her family. PATHETIC How we have failed so badly. The bean-counting night school MBA Masters of the Universe will not one day announce that all techs are going to get a substantial raise. NEVER unless you, the PHARMMCISTS, help out by making a horrible noise.
To paraphrase FREDERICK DOUGLAS: “POWER gives nothing unless there are DEMANDS.”

I AM SURE THAT I MISSED A LOT . I PROMISED PAULA, Whistleblower’s wife, that I would address the subject of the technician. This is a start and I will count on you to fill the cracks.”

How in the world can a Pharmacist make a difference? I filled scripts today while having a full bladder for 5 hours and two untied shoes for almost 2 hours. We don’t get a second of relief for an entire 12 hour shift and cannot make a peep for fear of being fired or relocated. I agree the techs are important but that is because it has been so long since I have worked with another Pharmacist that I can’t remember it. Filling 500 prescriptions in a single shift with 3 or 4 techs if you are lucky is insane. Nothing will change until innocent patients start being harmed at a high enough rate to cause change. The compound industry was unchanged until a pharmacy killed 18 patients. Things changed quickly. We need to take pharmacy back to a healthcare facility and away from the fast food model. Drive thru’s, 10 minute guarantee’s, immunizations on demand, instant relentless access by the general non patient public and a complete lack of a break are a recipe for failure. If every tech failed to show up for their shift tomorrow the stores would open up that same day without fail. And corporate would write the pharmacist up for not getting to the drive-thru in a timely manner. The corporate machine model is the problem and it is being fed by the APhA and state boards of pharmacy.


From: Dennis Miller, RPh to Fred Mayer, PPSI

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Errors are expected
I absolutely agree that state boards of pharmacy need to become more involved in the prevention of pharmacy mistakes. From my perspective, the primary cause of the epidemic of pharmacy mistakes at the big chains is dangerously understaffed pharmacies.
Understaffing seems to be the business model that the big chains have embraced. Understaffing increases productivity but it also increases pharmacy mistakes.
From what I’ve seen, the state boards of pharmacy claim that staffing levels are an employer-employee issue that the boards can’t regulate. The state boards claim they can’t intervene in the private sector in employer-employee issues.
In my opinion, understaffing is a public safety issue that, in fact, screams for state board of pharmacy involvement.
I wish you would consult some of your legal experts to see whether they agree that state boards of pharmacy are prevented from addressing staffing issues because that would be interfering with employer-employee issues. If state boards of pharmacy are mandated to protect the public safety, they need stop trotting out their pathetic excuse that staffing levels are an employer-employee issue.
One day a state fire marshal cited the chain store I worked in because boxes in our stockroom were stacked too close to the ceiling sprinklers. The fire marshal did not say, “Well, it’s up to the chain to determine how high to stack boxes in their stockrooms.” The fire marshal evidently determined that protecting the public from fires is more important than giving the store the prerogative to fill the stockroom shelves however high they like.
I wish you would contact a pharmacy legal expert like Richard Abood, or pharmacist-lawyers and Drug Topics contributors like Ken Baker and Ned Milenkovich. Please ask them whether the claim by the state boards that they can’t do anything about staffing levels because it is an employer-employee issue is legitimate or bogus.
I assume that the location of the state boards of pharmacy in the organizational chart of state governments varies somewhat from state to state, giving the board of pharmacy varying levels of independence depending on the state. I think that when the North Carolina board of pharmacy first proposed lunch breaks or maximum scripts/hour rules, the state rules committee said that the board was overstepping its authority. I believe that the board of pharmacy rule was also opposed by lobbyists for one of the major merchants’ associations in that state.
When I worked in North Carolina, the rule or guideline regarding the maximum number of scripts per pharmacist per shift was simply ignored by my employer. We routinely filled more scripts per hour and per shift than the rule/guideline mandated or recommended.
Understaffing is not a employer-employee issue. It is a public safety issue. The state boards are apparently giving priority to employer-employee issues over public safety issues. I will, however, grant one thing to the state boards of pharmacy. It is very hard to write a regulation mandating safe staffing levels. And it is very difficult to write a regulation mandating a maximum number of scripts per pharmacist per hour or per shift.
Why is it hard to write such a rule? In my opinion, one of the biggest variables is the quality of technicians present at any given time. In my experience, techs vary tremendously in terms of speed, accuracy, and basic knowledge. Some techs are absolutely fantastic while other techs are an accident waiting to happen. The big chains seem to view any warm body off the street as equivalent to a seasoned tech.
As far as the 150 scripts per 8 hour shift, I think that would be reasonable if there were at least one seasoned tech on duty for the entire shift, not just for part of the shift. I’ve worked in many stores in which no techs showed up for work the day I worked at that store. Or the techs who did show up were a threat to the public safety.
I would say that 150 scripts per 8 hour shift would be reasonable with a seasoned tech present for the entire shift, but, in my opinion, many pharmacists end up filling 150 prescriptions per 8 hour shift with ZERO techs present. That, to me, is very dangerous. That pharmacist would be filling about 19 scripts per hour (almost one every three minutes) without any tech assistance.
In my opinion, it is impossible to specify a safe number of scripts per pharmacist per hour or per shift without very seriously considering the caliber of the tech(s) present and, indeed, whether there are ANY techs present.
Sometimes pharmacists are able to pull a clerk off the sales floor if the non-pharmacist store manager is cooperative. Very often, all that clerk is able to do is ring the pharmacy cash register and possibly count pills.
So, the maximum number of scripts per pharmacist per hour or per shift requires a consideration of whether the pharmacist has to ring up the prescriptions himself at the pharmacy cash register because there are no techs or clerks available for part or all the pharmacist’s shift.
Another factor in determining the maxiumum number of scripts per pharmacist per hour or per shift is whether or not the pharmacy has a drive thru window. Drive thru windows can be very convenient for customers but EXTREMELY burdensome and dangerous at understaffed pharmacies. A chain pharmacist closing a drive-thru window because of unsafe staffing levels is likely to encounter the full wrath of the non-pharmacist store manager. Even pharmacy district managers are likely to criticize the pharmacist for closing the drive thru window at times of dangerous understaffing.
The big chains seem to base their business model on assuming that the equivalent of Olympic gold medal winner techs are present at all stores all the time. There are many techs who are, indeed, true superstars. Working with them is an absolute delight. Filling “X” number of prescriptions per shift can be almost bearable in some chain stores with superstar techs. On the other hand, filling that same number of scripts per shift with a rookie tech can be your worst nightmare and a genuine threat to the public safety.
Whenever local newspaper and TV reporters interview pharmacists about pharmacy mistakes, I wish those pharmacists would tell the reporters that the state boards of pharmacy seem to be intimidated by the immense political and legal clout of the big chains. The state boards of pharmacy are consequently afraid to attempt to mandate safe staffing levels.
Several years ago, I spoke with the head of a state board of pharmacy. He told me that his worst days were those at board of pharmacy hearings in which he had to fight with defendants’ attorneys. I assume he was referring to attorneys representing individual pharmacists as well as those representing the big chains.
Setting specific minimum staffing levels and maximum numbers of scripts per pharmacist per hour or per shift is extremely difficult, but something absolutely needs to be done NOW!!! Pharmacists need to hold the state boards of pharmacy members’ feet to the fire until this critical issue is adequately addressed.
The chains claim the patient safety is their number one priority. Are they lying or joking? LYING, I think.


WalGreens RPh argued with this Mom. “The dose is correct. I listened to the Doctor’s Message Twice” Fortunate for the child, “My Mommy is a Pharmacist”.

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Your best chance for DIGNITY, SELF-RESPECT & INTEGRITY at your job.

California Board of Pharmacy June 24, 2015,
Public Comment on Items Not on the Agenda/Agenda Items For Future Meeting

Aglaia Panos Pharm D, preceptor at Touro University College of Pharmacy for Pharmacist Planning Service Inc (PPSI).
I would like to request a special hearing on prescription drug errors. I have become increasing concerned about my students that have been doing an internship with me for the past 6 years at Pharmacists Planning Service, Inc (PPSI). They have been telling me about the increasing number of prescriptions they have to fill in chain pharmacies with less pharmacy and technician staff and as a consequence less oversight. Meanwhile, the pharmacist’s duties have increased as they are now often required to do immunizations, scrutinize drugs more carefully for abuse as required by the DEA and Board of Pharmacy, answer questions on Medicare Part-D and spend more time on phones with insurance companies and part D plans for $4.00.generic prescriptions. Furthermore, Chain pharmacies are putting 10-15 minutes limits on getting the prescriptions out the door.
Last Sunday, June 21, I went to a WalGreen’s at 8:00 pm to pick up a prescription for my son. It was a Nystatin 100,000 units per 5 ml. This was a new prescription and I was not offered a consultation when the technician gave it to, me. I opened the bag and read the directions and said the directions do not make sense. It read to swish 25ml in the mouth then to swallow four times day. I asked to speak with the pharmacist who kept reassuring me that the recording by the doctor did in fact say that, and that she played it more than once. I asked her if she had ever prescribed such a large dose, and perhaps she should check with the doctor again. She insisted that she had done the math correctly and that a teaspoon was 5 mls and 5 teaspoons is 25 mls and she dispensed the correct amount which was 1000 mls of Nystatin, in two individual pint bottles for the duration of the 10 days.
I called the doctor that night and left a message. My son only took 5 mls that evening. The next day the same pharmacist called before 9:00AM and said the chain pharmacy got really busy last night with her having one technician to help fill all the prescriptions in the store. She went on to say how busy they there were long lines waiting prescriptions and she also had to service the drive through window. and it almost was closing time at 9:00pm. She said to wait until she contacted the doctor. She later again called to my son and told him to take only 5 ml and if he wanted to bring in the two pint bottles she would change correct the label.
One of the best selling books of the year is by Dennis Miller, a pharmacist ,called Chain Drug Stores Are Dangerous. I have a copy here and if you have not read I suggest you buy a copy. This book should be given to all state board of pharmacy members. inspectors and investigators. as required reading
I would like to thank you for considering a hearing on medication errors at your next available subcommittee hearing.
Aglaia Panos

    You can find a link to the Amazon page that has Miller’s book for sale under BLOG ROLL in left margin Heading is LINKS. JP

From Pharmacist Steve. As Always, a Pointed Guerrilla View.

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Get your own store.
Right now I am not sure about the indy route… There was a article that I posted a few days ago of a indy closing because the PBM’s were causing him to break-even or lose on 25% of his Rxs.. If you haven’t notices CVS Health and Express Scripts net profits are growing faster than their gross revenue.. Walgreens and Rite Aid are not doing that… IMO.. it is because those two PBM’s are dragging their feet in raising reimbursement prices to stores…but.. raising the price to the ultimate payor (Blue Cross/Medicare etc ) the day they happen… when prices are doubling… tripling or more on some generics… The PBM’s are raping the pharmacies.. and with CVS Health… they are raping their competition… they can’t buy WAG’s or Rite Aid out.. but.. they are putting the financial screws to indys and then coming in and buying them out.. Why do you think that Target sold out… 1600-1800 stores was not enough volume ? With 90% of Rxs being paid for by some third party… there is no pricing power..

Then we have the Supreme Court going to rule this month on Obamacare… and the premium supplements being provided in 34 states that didn’t set up their own program.. could throw Obamacare into a tail spin.. I have heard about 8 million losing their premium supplements… which means the vast majority or all will be without health insurance in another month or two…
Then we have the wholesalers rationing how much controls a pharmacy can purchase… I have heard the number of 75 indys being totally cut off by their wholesaler.. I know personally know of three .. One is a Medicine Shoppe Franchisee… by contract she was suppose to purchase 95% of all purchases from Cardinal… who is also the Franchisor… two years ago they cut off her controls – TOTALLY… then one year later they cut her line of credit in half.. and she just got informed that they are cancelling her franchisee agreement…

nevergotcaught American corporation are – IMO – operating under the 11th commandment … nothing is illegal until you get caught …or the 12th commandment.. if you can pay the fine… do the crime…. stock price and bottom line is all that matters.


Written by Kay Geers, a pharmacy owner in Missouri and one of the original Galvestion Group that founded THE PHARMACY ALLIANCE

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This is long, but Kay put a lot into it. Respect her as a person who goes way beyond whining and look it over. JP

Honorable Chris Kelly
Missouri House of Representatives

Dear Mr. Kelly,

I own the Ashland Pharmacy in Ashland, MO. You have been in here a couple times before the elections. I’m glad to see that you won.

I have a couple issues that I have no recourse to fix except to contact the elected officials of this area.

Firstly, the Medicare Modernization Act of 2003 (MMA) has severely hindered the provision of pharmaceutical care for many patients in Missouri. Close to 5% of small independent community pharmacies in the country have closed due to this Act. I’m assuming it holds true for Missouri as well. These small pharmacies are usually in towns with populations of less than 20,000 people and a higher percentage of Medicaid, Dual Eligible and Medicare patients. Our population here in Ashland is around 2200 yet the area surrounding Ashland, as you are probably aware, has a population of around 15,000 people.

Not only are these pharmacies closing, but the ones that are still in operation, including us, have terminated our participation in several Medicare D plans due to low-ball contracts that we are not allowed to negotiate. Once we have terminated participation, most of my patients (elderly) will be required to drive to Columbia at 70mph to Wal-Mart and wait 2 hours for their prescription to be filled. The patients that choose not to drive to town are sent information on Mail-Order pharmacies that are usually in another state.

The most painful part of the MMA is that the Pharmacy Benefit Managers (PBMs) are getting away with the goose that laid the golden egg. The PBMs wrote the bill, coerced several members of Congress to pass it and wrote into the bill that there is no Government oversight at all in the program. In essence, they can do what they want and the government cannot even look at their books to see if they are hurting or helping the healthcare system.

The Centers for Medicare/Medicaid Services (CMS) has set standards for the PBMs to follow but not set out what exactly they must do. The PBMs pay us a small cost and small dispensing fee to fill the prescription and charge the Insurance Company a greatly exaggerated price. They make more money on a prescription than we do and we carry all the overhead. The average pharmacy pays close to $10 to fill a prescription, not counting the cost of the medication. I would like to meet with you to discuss what is becoming a serious problem.

Jim, here is my take on this.

The Medicare Modernization Act that created the Medicare D Prescription Program has been causing hardships on independent pharmacies since the program was instituted in 2006. In the beginning, there were a lot of eligibility problems with “True Out of Pocket Expenses and Low Income Subsidy patients. It took about 6 months to get the payments straightened out and paid correctly. It took several hours on the phone to correct these problems. Since then, the biggest problems that I see are that some pharmacies are not getting paid in a timely fashion and the reimbursement rates and MAC pricing are discriminatory against retail pharmacy. There are also little problems that are adding up to being big problems over time, like the pharmacies having to pay transaction fees to get the pharmacy claims to the PBMs, and having to pay for e-prescribing prescriptions and possibly having to pay for track and trace technology.

What has happened to our government for the people? Where does it say that the government is for large corporations forcing little businesses like mine out of business? Where were the Congressmen that WE elected when we needed protection from these large interests? They were all on the side of Big Business, the Big Business of making medications (drug companies) and processing prescriptions for insurance companies (Pharmacy Benefit Managers). Big Business can afford to pay each legislator thousands of dollars to vote in their interest. We cannot.

Did you know that the Medicare Modernization Act was passed in the middle of the night with some strong arm lobbying occurring? I’m not sure if the bill would have passed had there not been coercion on their parts. I’m sure lots of money changed hands somewhere in the process. Today, several congressmen and congresswomen that voted in favor of the raping we are now taking are holding high paying jobs with the companies they were voting in favor of.

This whole process has been a travesty for our country. As far as I’m concerned, I’ll never have the faith in our form of government that I had before. I have thought of leaving the country for Borneo to raise Orangutans or to Nigeria to help with orphaned Elephants.

All I’ve ever wanted to do is help my patients, make a decent living and retire peacefully at 50 or 55. Is that too much to ask? Every day I have to bump up against either not getting paid appropriately for a prescription or having to spend hours on the phone with a PBM who has outsourced it’s help desk to India trying to get a medication covered.

I did not go to Pharmacy School to become an insurance adjuster. My opinion is that if they want a different drug they should call the doctor themselves. We should not be involved in that process at all. We should be able to fill prescriptions that are approved by the PBM and doctor without having to jump through hoops to do it.

Now back to transmission fees. I found an article in Drug Topics in 1989 stating that it cost the PBMs $5.00 each to process paper claims. This is the same year that electronic processing became rampant. By calculating the cost difference between us paying transaction fees and the PBMs paying to process paper claims I have come up with some staggering numbers.

Given: processing 1,000,000 prescriptions/day
Average person takes: 8 rx/day-100% insurance
Patients 1,000,000 rx / 8 rx/patient= 125,000 patients
Transaction fees set at $0.10 per claim
Paper Processing would cost $5.00 in 1989
Interest 0.8% per day
Average RX costs $50.00
Average copay costs $8.00

The pharmacy sends 1,000,000 prescriptions to the PBM daily. The pharmacy pays $0.10 for each claim submitted totaling $100,000. The PBM would have paid $5.00 per claim to process. The PBM saved $5.00 per prescription = $5,000,000.

Just taking into account 1 day’s worth of business for a PBM they would have saved $5 million by not processing paper and we would have paid them $100,000 to process electronically. They netted $5,100,000 in one day.

Now let’s extrapolate that to a month and year.
30 days x $5,000,000 = PBM saves $150,000,000 by not processing paper.
30 days x $100,000 = Pharmacy pays $3,000,000 Net to PBM $153,000,000 per month
$153,000,000 for 12 months = $ 1,860,000,000 to PBM for 1 year
BUT! The pharmacy had to pay $3,000,000 x 12 months = $36,000,000 to process them electronically.

To me that’s a rip off. Why should we pay to have claims sent to them so they can have a computer process them?

There’s more!!!
CMS pays each PBM $68 per month for each patient to manage their drug benefit.
They make interest by holding our money for 14 days. (Figure 0.8% per day)
The patient pays $26.39 each month as a premium.
The insurance companies pay the PBMs $1.00 per claim for administrative costs.

PBM gets:
$68/patient/month x 125,000 patient x 12 months = $ 102,000,000 from CMS
$26.39/patient/month x 125,000 patients x 12 months = $ 39,585,000 in premiums
$1.00/ claim x 1,000,000 claims = $ 1,000,000 for Admin costs
Paid by pharmacies in transaction fees = $ 36,000,000 per year
Saved by not processing paper = $ 1,860,000,000 per year
Total $ 2,038,585,000
Yes, that’s $2 billion dollars profit they received for processing claims of which we paid them $36 million to do it. Even if we take out the money they save by not processing paper, their profit is $ 178,585,000 per year. That’s only 1 million prescriptions per day. I’m sure there are many more millions that are processed and many more PBMs.

Now let’s count the interest they make by holding our money for 14 days.
The average prescription costs around $50.00. Let’s set average copay at $8.00 so PBM will owe us $42 for each prescription.

1,000,000 rxs x $42/rx = $42,000,000 for one day x 14 days = $588,000,000 the PBM owes pharmacy.

$588,000,000 x 0.8%/day = $4,704,000 for 14 days = $65,856,000

Extrapolate this out to a year = $1,716,960,000

Grand Total Profit to PBM per year $3,755,545,000

These same 1,000,000 prescriptions per day would have cost us 365 * 1,000,000 = $365,000,000 x $0.10 trans fee = $36,500,000. That’s counting the interest we lost to let them hold our money for 14 days and on average we lose $5.00 on every prescription due to the PBMs not paying us a dispensing fee that covers overhead. So there’s $5,000,000 x 365 = $1,825,000,000 + $36,500,000 = $1,861,500,000 the pharmacy has paid and lost (in essence) to process the claims.


If the PBM processes 1 mill rx/s per day every day for 1 year they would earn a grand total of $3.755 billion, but the pharmacy has lost or paid $1.861 billion to do it.

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The Guerrilla Pharmacist Goes INTERNATIONAL

Jp Enlarged

This is the message received from a Canadian pharmacist. Maria Gutschi. The package of GOODIES contained a copy of THE COMFORT TRILOGY, Editions 1, 2, 3 of THE GUERRILLA PHARMACIST and promotional materials. ie. the coming of Rex Guevara. With Snehal back in the UK, we have two international GUERRILLAS.

The picture is the first one up when you enter MARIA GUTSCG on the Search Line at Big Images. Our Maria? Probably NOT, but a compelling young woman. THis will be OUR Maria whenever I think of her.

Think about this: MARIA GUTSCHI HUNTED US DOWN. She asked me if a Canadian could jump on our speed boat. Yes, of course. Here is her Email to me.

From: Maria Gutschi (
Sent: Fri 6/05/15 4:04 PM
To: Jpgakis Plagakis (

Hi Jim
I just received your package of goodies yesterday, and am very impressed with the content and and even better the tone.

I am sending you a money order since US citizens cashing a Canadian cheque is problematic and often not accepted. I hope that is acceptable to you.

Here in Canada the Big Chains are flexing their muscles, but pharmacists are striking back. However, I am not sure this will make a difference if the colleges (i.e. Boards) of pharmacy do not respond. Some provinces are better than others.

As you can guess, the president for Rexall is from the USA.

HOWEVER, I believe the reason for pharmacy being the in condition it is in, is likely because of our personalities and work environment. Some Canadian researchers have done great work to delineate this.

Pharmacists are:


Avoid conflict

Defer to Authority

Want to be Nice rather then Right

A perfect population for the Masters of the Universe to exploit.

Keep up the good work

Maria Gutschi


APhA Finally Makes a Statement. Straightforward Reporting. WHERE IS THE POLICY STATEMENT?

Jp Enlarged

Under pressure: Performance metrics in chains may affect safety 
June 01, 2015
pressure that many chain pharmacists feel

“It’s all about numbers. That’s all they care about. You’re there and on your feet for 8 hours, and you’re at the mercy of the volume.”

The speaker was Bill Bradshaw, BSPharm, a semiretired former Walgreens pharmacist from Arlington, TX. He was describing the pressure that many chain pharmacists feel as they try to meet prescription fill-time goals while fielding phone calls, managing auxiliary staff, and keeping up with immunizations and customers’ medication therapy needs. 

The yardsticks companies use to evaluate how well pharmacists manage these complex professional duties are known collectively as “performance metrics.” It is a phrase that pops up frequently in pharmacists’ blogs, tweets and other online forums—and not usually in a positive way. A common thread is that use of metrics to help speed prescription flow often runs counter to good pharmacy practice and heightens the danger of increased medication error rates.

“It’s time pharmacists are protected from this metrics system,” wrote Katrin Olavessen-Holt, commenting on a Pharmacy Today Facebook posting of a March 3, 2015, CBS Sacramento article headlined “Call Kurtis: Pharmacists Concerned Employer Pressure Leads to Prescription Errors.”

“Speed and money over safety. Never a good thing!!,” added Carrie Wellman Arbuckle. The article describes the potential downside of performance metrics in California. The Today posting drew more than 325 “likes” from Facebook followers.

Major chains: Different view

The three major pharmacy chains have a different view of the metrics they use to evaluate pharmacy performance. And they cite their efforts to smooth pharmacy workflow and ensure customer satisfaction and safety. 

CVS/pharmacy spokesman Michael DeAngelis responded to Today ’s request for comment with a statement saying that CVS, like other companies, “measures the quality and effectiveness of the services we provide to ensure we are meeting our customers’ expectations and helping them to achieve the best possible outcomes. Our systems are designed to help our pharmacists manage and prioritize their work to best serve their patients.”

Jim Cohn, a Walgreens spokesman, said in an e-mail that “quality, safety, and accuracy are our top priorities, and we make it clear to our pharmacists that they should never work beyond what they believe is safe, in their professional judgment.”

At Rite Aid, spokeswoman Ashley Flower stated that the chain was “highly committed to patient safety and care,” adding, “We have a strong safety record because of our ongoing education and training for pharmacy associates as well as our continued investment in technology.” Rite Aid, she said, uses “various metrics to ensure we are consistently delivering a superior customer experience and helping those we serve achieve the best possible health outcomes.”

The safety equation

While the chains do invest heavily in new technology systems, workflow design and training programs to meet the expanding demands on pharmacists’ time, there is always the risk that ever-increasing prescription volume and bottom-line considerations may tilt the safety equation to the negative side. Moreover, policies created at the top to ensure that pharmacists are well equipped to handle both dispensing and patient care responsibilities can encounter obstacles as they filter down to supervisors, who themselves may be under pressure to perform. 

David Nau, BSPharm, MS, PhD, president of Pharmacy Quality Solutions Inc., noted that many studies in the past had shown an association between volume of work and medication error rates. “One thing that makes a difference,” he said, “is that the complexity of work, or the workload issue, is intertwined with staffing and processes. Part of the issue of reducing distractions of pharmacists is finding the right balance of workload and the pace of work.”

Some pharmacists maintain, however, that the balance can be thrown off kilter by technician staffing that fails to account for the high number of prescriptions that pharmacies are called on to dispense. “They keep cutting tech staff hours, regardless of the volume,” said Steve Ariens, BSPharm, national public relations director for the Pharmacy Alliance, a pharmacists’ advocacy group. He likened it to the slave galley rowing scene in the 1959 movie classic Ben-Hur. “Rowing faster and faster: that’s pharmacy,” he said.

Bill Bradshaw said it was “practically impossible to do your job the way it was supposed to be done with the help that they gave you.” At one Fort Worth, TX, Walgreens where he worked, “it was very intense,” he said. A doctor he consulted told him that he was suffering from post-traumatic stress disorder. He finally left the pharmacy after about 3.5 years. During that time, he said, “That one store had five pharmacy managers. They just couldn’t handle it.”

‘From green to yellow to red’

One widely used performance metric tracks prescription dispensing time from customer drop-off to pick-up bin. The limit is often set at 15 minutes. David Stanley, BSPharm, a California pharmacist who worked for both Rite Aid and Walgreens, told Today that both chains used computer clocks to monitor the time. The clocks “would slowly turn from green to yellow to red,” he said, “depending on how quickly prescriptions were getting out the door.” 

Stanley added that he saw “nothing wrong” with metrics in general, particularly if used to evaluate quality, but “the problem I’ve run into is that they choose their metrics poorly. And they lose sight of the goal, which is happy customers and pharmacy practice the way it is supposed to be practiced.”

He described a prescription label policy that Rite Aid had in effect when he worked there several years ago. “We were told never to print more than five labels ahead,” he said, but “we had our own way of doing things, which was to print labels for as many prescriptions as we could and get them as close to being filled as we could. That way, when it was slow, you could work on the label pile and basically get a few out the door in between customers. It was a great system,” he said. “When we started following their directive, it actually slowed us down and it worked against their larger goal of happy customers and quality prescriptions.”

“They didn’t want to hear it,” he said.

Lawsuits against chains

Some pharmacists have brought lawsuits against chains. Joseph Zorek, BSPharm, for instance, has a current suit against CVS Health. He told Today that performance policies and “intimidation” he encountered as pharmacist-in-charge at a Harrisburg, PA, CVS pharmacy, led to various physical ailments and disability—the basis for his legal action.

Zorek described one metric CVS used to evaluate performance. “They wanted us to sign up all patients to ReadyFill,” the chain’s automatic prescription-filling program. He said his patient base consisted of a higher-than-average number of senior citizens, who “felt much more comfortable being in charge of their own prescriptions. As a result, my metric for signing up people was low.”

Zorek added that he felt he could “play ball” with most of the other requirements. “They had a 15-minute constraint” for measuring prescription fulfillment time. “That was fine,” he said, “but normally Murphy’s Law would set in, and something would go wrong.” Describing a hectic pharmacy scene in which techs were often called away to take over busy cash registers and pharmacists were forced to handle calls on 10 different telephone lines, he said, “Your mind was in too many places. The error rate started to go up. We were making stupid little mistakes: using the son instead of the father, wrong address, improper doctor. ”

Still, Zorek said, he “enjoyed the pace and working with people”—that is, until the company began cutting technician hours. His wife, Paula Zorek, who also worked at CVS, as a technician and technician trainer, said that in 2011, every store was losing technician hours. “They upgraded the computer software,” she said, “and they thought they could do more with less. It didn’t work out that way.”

2012 ISMP/APhA survey

Anecdotal complaints about the use of metrics and pharmacy workload have circulated for years. In 2012, the Institute for Safe Medication Practices (ISMP) launched a survey in collaboration with APhA. One aim was to assess the impact of prescription fill-time guarantees on pharmacy safety. A total of 673 pharmacists responded, most of them from chain drug and grocery/mass merchant pharmacies. A major finding was that 83% of those working at pharmacies with advertised time guarantees believed that the guarantees were contributing to dispensing errors. 

In response, the National Association of Boards of Pharmacy (NABP) issued a statement resolving that NABP “assist the state boards of pharmacy to regulate, restrict, or prohibit the use in pharmacies of performance metrics or quotas that are proven to cause distractions and unsafe environments for pharmacists and technicians.” 

Fewer errors: One solution

Are there solutions for reducing the potential safety hazards of performance metrics and prescription time-filling guarantees? Nau, whose company supports health plans, PBMs, and community pharmacies in their efforts to measure and improve medication use quality through its EQuIPP program, said that “we actually find that when pharmacies synchronize the refills of patients on chronic medications, it helps to smooth out the workflow and balance the ebb and flow of volume throughout the day.”

That should help lead to fewer errors, he noted. He also said that as “pharmacists do more to be proactively engaged in managing their patients’ regimens, it will help to balance the workload. So when issues arise, that communication will help to identify potential issues before they become a major event for the patient.”


Read and Rejoice. More than hope.

Jp Enlarged

Too Old.  Too Female.

You Will Love This. Almost as good as sex… ah well..

Case No.: 1:12-CV-1715-VEH

On February 19, 2015, the jury returned a verdict in favor of Plaintiff James R.
King (“Mr. King”) and against Defendant CVS Caremark Corporation (“CVS”) on
age discrimination and willfulness. (Doc. 153). In accordance with this jury verdict,
which awarded Mr. King $1,065,383.15 (one million sixty-five thousand three
hundred eight-three dollars and fifteen cents) in compensatory damages on his age
discrimination claim, FINAL JUDGMENT is hereby ENTERED in favor of the
Plaintiff, James R. King, and against the Defendant, CVS Caremark Corporation, in
the amount of $2,130,766.30 (two million one hundred thirty thousand seven hundred
sixty-six dollars and three cents). 29 U.S.C. § 626(b). See Formby v. Farmers and
Merchants Bank, 904 F.2d 627, 631 (11th Cir. 1990) (“Under section 7(b) of the
2015 Jun-03 PM 04:28
Case 1:12-cv-01715-VEH Document 179 Filed 06/03/15 Page 1 of 2
ADEA, 29 U.S.C. § 626(b), an employee is entitled to receive liquidated damages
when an employer “willfully” violates the ADEA. Upon proof of an employer’s
willful violation of the Act, the employee is entitled to receive double damages.”).
DONE and ORDERED this the 3rd day of June, 2015.
United States District Judge
Case 1:12-cv-01715-VEH Document 179 Filed 06/03/15 Page 2 of 2

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This Went Via Email to all Guerrilla Writers, Subscribers and contributors.

Jp Enlarged

To all you Guerrillas From JP

The Student Pharmacist Edition of The Guerrilla Pharmacist is ready. I will ship a whole bunch of copies to Goose tomorrow morning. He will be attending a Preceptors’ Conference sponsored by Purdue in a couple weeks. Goose will be using the Student Guerrilla to promote change. Let us be able to say, “It all started at Purdue.”

Fred Mayer has requested 20 copies. When ready, I will send them.

My view is that we either make a difference with students & new pharmacists (No matter where they went to school) or it is pretty much game over. The companies will continue to engage in gentlemen’s warfare and they will win no matter how big our guns are. You see, it is simple. No matter how big your guns are, if you don’t use them, it is like having no guns at all.

Truthfully, I don’t want to give up the fight. Not when I know that guerrilla warfare will kick the shit out of gentlemen’s warfare. We have right on our side, but we can’t depend on that to help us. It has never worked before.

I am still waiting to see results. There has been only one new subscriber in the last two months. Has anyone taken the advice given in Guerrilla?

So far, only one young man (who I have named Rex Guevara). He works for a huge retail company that has taken bullying beyond anything I have seen before. One hint, it is not a drug store company. Treating pharmacists the same way they treat the baby department employees might just seem normal to them. I still do not have Rex’s complete story, but I will soon begin the process of creating The Saga of Rex Guevara. I will give you a trailer. Rex will win and, if he has patience, he will win big time. He is a 30 year old man who has taken the advice given in Guerrilla and put it to use. He started before there was a Guerrilla. He has been reading my blog for a long time. This kid is 30 years old, he saw the value of the advice and he did not hesitate. The company managers who try to get him to engage in Gentlemen’s Warfare are doomed. One of them came to a meeting with Rex and the store manager. The message was, “Rex, you are not a good fit with XXXXXX Store.” A few minutes later, this person walked out of the meeting in tears. Guerrilla Pharmacists do not take prisoners. The Store Manager kept very quiet, kept the eyes on the floor with crossed arms.

Why only one pharmacist? I can speculate, but fear isn’t good enough. I think apathy. Rex Guevara will prove that they will not go after him because they know that it would be their assess if it proceeds beyond, we better just leave him alone.

Gary Ellis, The Independent Whisperer, expressed a concern that Guerrilla would just be another whiny bitchfest. He may have had a valid worry.
Because it looks like many of you are still hoping that things get better, still trusting that someone else will make a move, still dreaming that the APhA will go back to the days of William Apple when the organization with the magic name was active in protecting the rights of pharmacists. Still think that the State Pharmacy Boards will look out for you. Oregon, but only because it is clear that conditions and metrics will put the public in jeopardy. The rest of the boards seem to be heavily influenced by the companies.

I will get around to sending each of you a copy of The Student Pharmacist Edition. That will delay #4 for a few weeks, but you will see my thinking.

The comments that you guys send me cause me to be encouraged. But, apathy seems to be the predominant condition.

With a glut of pharmacists/robo-dispensers willing to work short weeks for short wages, it is time for action. Your $10,000.00 a month job could be reduced to $6,000.00 a month.

It is now or never. If you take guerrilla action, any attempt to lower your wage could be judged to be retaliation. Illegal.

If you want additional copies of The Student Edition, they are $5.00 each plus $1.61 postage. We can discuss the price for bulk orders.



Was it a mistake? SIX Long Years. Huge Debt. NOW THIS!

Jp Enlarged

A few years ago, a friend who is a Pharmacy Manager for CVS in rural NW Alabama reported that CVS wanted to have the pharmacy open on Christmas day. Ronald was earning $65.00/hour plus at the time. CVS offered him quadruple time to work on Christmas. $260.00/hour. Eight hours would total out at $2.080.00. QUADRUPLE TIME is not the offering for Christmas these days. Why would they have to? A boiler-plate UNION contract would get you two and a half times pay. 8 hours regular holiday pay plus 12 (Time & a half) hours pay for working the holiday. That would compute to $163.00/hour. $1,304 for 8 hours on Christmas Day.

Lets not be stupid. There are plenty of NAPLEX trained PharmDs (with pharmacist licenses) doing push ups at the local bar, waiting for the call offering her a 30 hour per week job. It would be naive and hypocritical to suggest that all of these glutty pharmacists chose your profession because they had a burning desire to practice pharmacy. C’mon, man. It was the money. You know it and I know it. It is pathetic that the kids who have pursued pharmacy for high professional reasons get screwed. Too much of anything and the price goes down. JAY PEE


I have been shown that, in selected areas, Walgreens is offering pharmacists $45.00/hour today, maybe $35.00/hour down the road. What’s to stop them? CVS is firing older pharmacists with trumped up reasons and hiring cheaper newly licensed RPhs. Rite-Aid, Target, Wal-Mart, Kroger, Safeway and others will be right behind. To rub salt in the wound, they are reducing hours. Some below 30/week to eliminate benefits. What’s to stop them?

A powerful union?
A union may be necessary. WAG, CVS, RAD and the others can only blame themselves.

It may take some time, but it MAY balance out. If they can get work done for 45.00/hour, that’s no different than an independent asking for an extra discount from a supplier. You may want to examine the possibility of having your own drug store. It is very possible.

I can’t see how all these new schools are able to find students. Maybe the students aren’t aware of the declining quality of compensation. Lets look at it this way. If this enables WAG to finally allow pharmacists to do DUR, etc, without the stress and pressure of a prick of a manager, screaming about the metrics, maybe it’ll improve the outcome for the patient. Also, maybe they’ll have a consultation/compliance specialists whose job it would be to counsel the patient, and use technology to improve patient compliance, and therefor reduce the number of drug related morbidity and mortality. It could be a win win for them. Break down the clinical and professional components of the pharmacist, from the mechanical dispensing process. Heck, next move is to have the “pharmacies from home”, where home is India, or China or Jamaica or better yet Cuba.

Times they are a changing. The at-home counseling specialist could do “FaceTime” with the patient, in their own language, even. Just imagine your face with the voice of Sanji Patel from India, speaking Vietnamese, with a British, or French accent. Actually, how would anybody know if there is really a pharmacist “at-home”. It could be a student using a specialized Google search with a bunch of canned consultations for the 50 most popular meds, in different language modules. The robot R.Ph., 12 cents an hour for electricity. Think of it.

Last word. It is YOUR profession. Not WAG’s, Not CVS’s, Not RAD’s, Not Wal-Mart’s. It is now or never. Once the snowball picks up sped, it will be impossible to stop.


“The Guerrilla Pharmacist” is the official publication of THE PHARMACY ALLIANCE. I have a proposal for you.

Jp Enlarged

Compare The Pharmacy Alliance with the APhA

The APhA enjoys a magic name:



is a magnet word.


is a magnet word.


signifies Power and an almost Union-Like presence. The name suggests that APhA will protect you, lobby hard for working conditions, push for a behind-the-counter drug class. Back in the day, APhA president William Apple did all of that and more. Apple was a hero. As long as he was at he helm, we had a powerful figure advocating for us.

I quit paying good, hard-earned money to the APhA sometime in the 1970s. I asked myself, “What is APhA doing for me?” That was all it took. I continued to pay dues to the Contra Costa Pharmacy Association because I got a lot from my membership.

My contention is that THE PHARMACY ALLIANCE will give you a much bigger bang for your buck. Compare the magazines as a start. You will read every page of THE GUERRILLA PHARMACIST. How about PHARMACY TODAY? Do you read any pages?

The APhA has Improving Medication Use and Advancing Patient Care as its stated purpose. Its agenda includes dozens of programs that most likely dilute its effectiveness.

The purpose of THE PHARMACY ALLIANCE is bringing Dignity, Self-respect and Integrity to the JOB of working as a pharmacist. PERIOD. No other agenda. It will take a revolution, probably ONE PHARMACIST AT A TIME. It will happen. There are pharmacists out there
taking the advice published in THE GUERRILLA PHARMACIST and are engaging in guerrilla action. An example is “secret” surveillance. Small, unobtrusive digital recording devices (both audio and visual) are being used to record every single meeting. Rex Guevara started recording with his job interview. He has recorded every single meeting at his job with a bullying Big Box store. These devices are readily available. Recording a meeting with a bullying non-pharmacist store manager may not advance patient care, but will advance pharmacist care.

Secret device

Using this pen recorder is as easy as reaching up to your breast pocket and clicking the clicker. The pen comes with a USB cord.
You can download to files on your PC.

My proposal is a simple one. For one year send the APhA dues money to TPA and let APhA suck eggs. It is simple. Join TPA at or contribute $100.00 or more to THE GUERRILLA PHARMACIST.

Here is what you will get. A healthy pharmacist organization that is dedicated to moving the revolution forward. The revolution, of course, is the movement to a fundamental change in who has the power in the industry that is pharmacy. Right now, non-pharmacist bean-counting MBA Masters of the Universe run our industry. TPA is dedicated to having the organizational structures of our industry be returned to the hands of pharmacists. Not easy, but like a snowball, as it continues to roll, it will gain size and speed and no company will stop it. Trust me, you want to be on this train.

You will also get a copy of THE COMFORT TRILOGY (A $29.99 value at Amazon). You will get all editions of THE GUERRILLA PHARMACIST,
including from #1 on. Your subscription will remain in force until February, 2016. You will also receive all EXTRA publications. The long-anticipated REX GUEVARA will be the first. Probably most valuable will be fast track contact with pharmacist advisers who are members of THE TPA/Guerrilla Mentors Board. You MUST be a member to take advantage of this service. For years, I have received countless requests for advice, usually on job problems, some critical. I have done my best and have forwarded some of these requests to Steve Ariens, Goose and other TPA leaders.

That is like a pharmacist not getting paid for MTM or 15 minutes of advice directly to the patient. This does not serve our purpose.
TPA members (like an Oregon RPh who joined and was given advice that led to his winning big time against RAD).

We will not do this anymore. If you want TPA membership services and advantages, you will have to be a member.

Again, tell APhA to kiss off for a year and put the dues money into TPA/Guerrilla.

What do you think of that idea, Goose, Peon, Steve and the rest of you?

I believe in this movement. It is my life right now. That’s okay as long as I also believe that the apathetic wing of pharmacists is smaller than the movers. Once I no longer believe that pharmacists will look out for themselves, I will take a good book to the Wilbanks Pool and drink Diet Coke and eat chilled figs.

Jay Pee

1 Comment


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Yeah, like the Target RPh can actually do this?


Do you have any idea of how the majority of pharmacists want nothing to do with MTM?
MTM is now just another metric. Pharmacists are expected to do a quota. They do not have time.
You know that. The stress leads to the release of the flight or fight hormone cortisol which causes
arterial plaque that causes a triple CABG (bypass) later on.

What causes my tribe to wanna sabotage the company is that RPhs get NOTHING from MTM.
Not one penny. WAG, CVS, RAD, Wal-Mart, Target and the rest get all of the money. When asked
to share, like 5 bucks, it is a gut-buster. “In your dreams, pharmacist”.

Will provider status change that? The answer to that question would get 230,000 pharmacists to read the magazine that month.

Just thought you would want to know the “hidden truth”, JS. Not much of that in the venerable 200 year magazine these days. Too bad. I miss being part of Drug Topics. I had expressed to Julia that I wanted her to know the history of JP and the mag, but she did not bite. If I have time, I will write it for you. Oh, what is Margaret Mulligan doing, by the way? What is the Pulitzer for trade publications called? Margaret had prepared a “Nominate JP” document and then was fired.
Maine staff pharmacists join Teamsters

May 08, 2015 (Lifted from Drug Topics) Mark Lowery

Twenty staff pharmacists at Osco Drug pharmacies inside 16 Shaw’s Supermarket stores in Maine recently voted to join Teamsters Union Local 340.

“We will work tirelessly, providing them with the best representation to improve their working conditions and negotiate a strong contract that puts their rights and protections on paper,” Local 340 President Brett Miller stated in a release announcing the vote.
The Teamsters will represent pharmacists at Shaw’s locations in Auburn, Augusta, Bangor, Biddeford, Brunswick, Dover-Foxcroft, Ellsworth, Freeport, Lewiston, Portland, Rockland, Saco, Sanford, Scarborough, Waterville, and Westbrook.

“Labor is under attack in our great state. Now more than ever, workers are uniting to have a voice at the table,” said Local 340 organizer Ed Marzano. “Osco pharmacists delivered that message loud and clear by voting for Teamster representation.”
In March, the National Labor Relations Board ruled that 16 pharmacy managers at the Shaw’s stores were supervisors and thus not eligible to join the union.

Shaw’s management successfully argued that some of its pharmacists are supervisors and not eligible to join a union because they hire, discipline, and fire employees. “The unequivocal testimony is that all (pharmacy managers) have the same authority, whether they work in a store with no pharmacy technicians or with five pharmacy technicians,” Shaw’s attorneys wrote.

Additionally, 35 pharmacy technicians at the Shaw stores were also excluded as agreed by the employer and the union.


Comments and FEAR

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From Rx Steve
A tired Pharmacists is a DANGEROUS PHARMACIST ?

The little girl sank into a coma and suffered permanent brain damage.
From Rx Goose.

I think that you always need some leverage and if the people you work for or with do something stupid or illegal, don’t turn a blind eye, document it and save it for later.

I don’t really think you would have to do much else if you save and document information and when confronted, just say: “I know more than you think I know.” (From Jay Pee… Then, Shut Up)

I’ll bet most retail pharmacists, without trying very hard, could accumulate some damaging data on just about any DM or Pharmacy Supervisor in a month or two.

Keep in mind that chains push pharmacy metrics and the NABP is on record against them. Send a letter to your NABP every time your metrics are posted and you are reprimanded for not meeting them.

Worried about your job? You’re just a speed bump to them. They’ll fire you anyway. Plenty of new grads out there with heavy duty loans.
Talk about leverage. Watch Your Back.

From Jay Pee
The discussion in Edition #3 of THE GUERRILLA PHARMACIST is “FEAR”. Twelve essays well written by the most progressive pharmacist Guerrillas in our industry. If you want in, you will just have to subscribe, won’t you. If you want to take guerrilla action short
of damaging property (Not recommended ever) you will have to contribute toward production costs. If you want to be a leader,
you can write “The Guerrilla Letter”. If you want to take revolutionary action, all you have to do is start practicing pharmacy in compliance with the law. COUNSELING IS A REVOLUTIONARY ACT.

I want to know why women pharmacists are so easily intimidated, especially by non-pharmacists. This MUST be changed or the profession is done for.

Here are a few paragraphs from “The Rebels of Comfort:

The Great Motivator
Fear is instilled in us at an early age. It affects our perceptions throughout our lives. For me, the world was a very dangerous place, according to my mother. The dangerous things I did were behind her back and I was still scared. Fear was a primary motivator in my life. The essential result was that I didn’t feel very good about myself. I brought much of that to my career as an employee pharmacist.
Your mid-level boss is a master at using fear to manipulate and control his pharmacists. The store managers have been tutored on how to use the dreaded write-up. I had a pharmacist complain to me that his wait time was thirty minutes and that he had been written up twice.
“I don’t have time for transfers” he complained. “I have a family to support.”
“Do you really believe that you will lose your job because of your wait time?”
“I can’t take that chance.” It was fear that controlled his life at work. A man this fearful most likely is dominated by unexamined demons.
You are afraid of crime so you work only in “safe” stores, in the suburbs.
You are single and you are afraid of AIDS so you don’t have sex even if you are really attracted to that person from the book club.
You are so afraid of immigrants that you tell a man with dark skin wearing a turban that you don’t carry losartan. You just want him to leave and never come back. You find out that he is a doctor and excuse your behavior by making the excuse that even doctors can be terrorists.
You are terrified of making a mistake. You work too fast and get distracted easily. You wake up and night reviewing prescriptions and suddenly think that Mrs. De Marco got the wrong drug.
You are frozen by fear that you could lose your license. The company sent out a memo. Company policy is to triple-check every prescription. How is that possible? Who has the time? You are not stupid. You know that the company will leave you twisting in the wind if there is legal trouble.
You are afraid that your District Manager will send you to a store 60 miles from your home if you don’t behave yourself. The life of a floater is precarious.
You are so afraid of failure that you never take chances. You have been passed over for promotions and you wonder why.
When it is time for your annual job performance assessment, you expect the worse. That fear of losing your job is always lingering in your mind. The company is very skillful at planting doubts. The MBAs have the idea that employees who are worried will work harder for their security, including working extra, off the clock.
You really want that vacation in July this year. You are afraid they won’t give it to you so you work extra shifts to cover other pharmacist vacations just to look good. You follow every rule. Your spouse has the time off and there is a family reunion.
You are always afraid that you will have to miss your daughter’s plays or your son’s games because you have not earned the time off.
Fear limits our freedom and creativity. It prevents us from thriving because fear will not allow us to takes chances. You are just plain afraid. You learned when you were young that you better obey. You obey the company without examining why.
The company takes the place of a church for many of us. We follow the company’s rules to the letter because, if we don’t, we’ll go to some kind of drug store hell.
Fear can be the reason we do things and it can be the reason we don’t. We come to work early because we want the pharmacy to be ready for the morning rush. We are afraid of what the store manager will say when there is a mob at the register.
We don’t complain about not having a technician for the first hour because we are afraid of being accused of not being a team player. The company rewards team players. The pharmacist who wins “Team Player of the Year” gets a Hawaii vacation for two. You have met the winner from last year. He had a nervous breakdown a few weeks after he and his wife returned from Honolulu. He pulled down his pants and mooned Mr. Fullovit when the CEO showed up with a cheery smile and, “Terrific job, Jimmy.” The pharmacist’s name is Jerry.
When you are fearful, it is impossible to not be totally oblivious of the power that a pharmacist has. You have immense power. You are not a clerk in the camera department. You are a medical professional with the discretion to engage in professional acts any time you feel it is appropriate.

From Jay Pee. Grow up!

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Important Guerrilla Notice

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Dignified Medical Professional?


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Yellow Propaganda Bullshit. They must Think that Jay Pee is an Idiot.

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Customers = Profit

I get these often. Offers to make an author available for interview. JP
This one is a veiled attempt to get you to say, “Oh No, Poor Pharma. And they try so hard.” Drugs approved quicker will make money faster.

FOR IMMEDIATE RELEASE: Friday, April 17, 2015
CONTACT: Erin Humiston, (972) 874-5139, or

Merrill Matthews, Ph.D. is resident scholar with the Institute for Policy Innovation (IPI), an independent, nonprofit public policy organization. He is available for interview by contacting Erin Humiston at (972) 874-5139, or

The Institute for Policy Innovation (IPI) is a non-profit, non-partisan public policy “think tank” based in Irving, Texas and founded in 1987 to research, develop and promote innovative and non-partisan solutions to today’s public policy problems.

IPI’s focus is on approaches to governing that harness the strengths of individual liberty, limited government, and free markets. IPI emphasizes getting its studies into the hands of the press and policy makers so that the ideas they contain can be applied to the challenges facing us today.

In other words, “IPI gives NO SHIT about saving lives. They just want to promote PROFIT. JP

Drug R&D Costs: $1.7 Billion And Rising
Growing Costs Due to Slow FDA, Drug Complexity, Short Patent Life

DALLAS – The significant costs of developing new, life-saving drugs and treatments has reached over $1.7 billion per drug over a span of 10-12 years. The mounting costs can be attributed not only to the growing complexity of drugs, but also due to bureaucratic red tape and the short length of a drug’s patent life, two issues which can be mitigated by legislative reforms.
“While drug companies are proceeding with research to create new and innovative drugs, drug development remains very expensive—and likely to grow even more so,” says Institute for Policy Innovation (IPI) resident scholar Merrill Matthews, Ph.D. in a new publication, “The High Costs of Inventing New Drugs – And Of Not Inventing Them.”
Matthews says in addition to the cumbersome FDA approval process that lacks incentives to expediently get drugs to market, manufacturers are increasingly developing far more complex biologic drugs, treatments, and even cures, as opposed to simpler pill therapies of the past. And while price controls are critics’ primary solution to the high cost of drugs, price controls would simply halt the R&D process altogether.
Matthews explains that economist Joe DiMasi of the Tufts Center for the Study of Drug Development recently pegged the total out-of-pocket cost to develop and approve a new drug at about $1.707 billion, a figure that nearly matches his own “back of the envelope” approach of $1.756 billion, found by simply dividing the drug manufacturers’ reported R&D by the number of newly approved drugs. “Whichever method is used, it’s clear that drug development is very expensive,” writes Matthews.
“There are ways to make new drugs less expensive—i.e., cut down on some of the bureaucratic oversight or lengthening the patent life, which means the manufacturers would have more time to recoup their investment—but both efforts would require a major legislative push,” said Matthews.
“Drug manufacturers plowed millions of dollars into finding a treatment for AIDS once it became clear the disease would take thousands of lives. The research and development was costly and didn’t emerge overnight, but being diagnosed with AIDS is no longer a death sentence,” said Matthews. “If the cost of creating new drugs is high, the cost of not having any new drugs is immeasurable.”


Seriously. What is Wrong With You People? Is It FEAR? You OWN Pharmacy if You Would Only Act Like it. Why can a European Pharamcist Stand Up, But You Just Whine?

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I had a long telephone conversation with Paula Zorek (Mrs. Whistleblower). CVS is openly at WAR against pharmacists and others. I was appalled at the stories. More coming up. CVS is, indeed, BIG EVIL.>


The following essay was the lead offering in the Premier Edition of THE GUERRILLA PHARMACIST. Read it carefully and you will think, “Hell, this is nothing new.” Read it to the end and you will think, “I could do that.” But..Do you have the courage? Or, are you waiting for the gas to be turned on, a bar of fake soap in your hand?

Make no mistake. This pharmacist was scared to death. He was not a native American. He was in Oregon because he was fascinated with America and wanted to try it out. He applied for and got a work Visa. He brought his young wife and they were on their own for quite awhile. Clearly English is not a second language to him. When we talked, I believe I identified his accent, but that is not important. What is important is that he knew when he was being worked over. He refused to tolerate shabby treatment. He said, “I’m a pharmacist. They can’t do this.” In, May, 2015, he, his wife and their 15 month old. born in Oregon, baby girl (An American, by the way, just as American as your kids) will head back to live where the overjoyed grand parents can dote on the child. He is going back with his dignity intact, his pride emblazoned on his chest. He confronted the dragon and destroyed it. How about you?

The following is his first person account. NEXT, YOUR TURN! You RAD pharmacists, especially, here is precedent.

I was working at a major chain for more than three years. I came here from the European Union and was licensed in the US in 2010.
I was the pharmacy manager in one of the Oregon Rite Aid stores. I have always experienced the working conditions as very poor in this company’s stores. The company provided very little or no training. The company does not give the pharmacists enough time to perform the tasks that we are required to perform, ethically & legally. When I talked to my store manager, he claimed that I spent too much time serving customers, something another staff member is capable of doing and it was silly not to have a Technician complete these duties. In fact, I spend 80 to 90 percent of my time performing menial tasks, such as answering the telephone, which are not appropriate for a pharmacist to perform. The company forces pharmacists to perform these tasks because the store is so badly understaffed that the pharmacist has to perform the work that others should be doing. This results in the pharmacists such not having enough time to fill prescriptions properly. In the Spring of 2011, I addressed the lack of staffing and pharmacists not having enough time to fill prescriptions in a letter. I later met with the Regional Vice President of the Pharmacy (Mr. X). I reiterated that I was not going to jeopardize patient safety, and that I was spending almost 1/3 of the time in my working day as a cashier and did not have enough time to do the prescriptions properly. He told me that I should concentrate on the prescriptions, and let the customers wait a little longer, if necessary In May 2011, the company required the pharmacists to fill all prescriptions in 15 minutes, if the customer came into the store in person. If the prescription is not ready in 15 minutes the patient receives a $5 gift card.
In the Summer of 2011, one of the criteria that the district manager used to evaluate our performance were the number of prescriptions that the company verified were filled in 15 minutes. At a later time, Rite Aid withdrew the 15 minute guarantee with a 15 minute pledge that the pharmacist will try to fill the prescription within 15 minutes. The latter change was made “orally”. Another criterion that the company uses to evaluate pharmacists is the number of loyalty cards or Wellness Cards customers have through Rite Aid. I told my manager that I could not force somebody to have a loyalty card. I wrote a second letter complaining about these requirements on July 2012. I described how in the Fall of 2011. I received a verbal warning for not giving enough flu vaccines as the goal for all stores was 500. Despite my best efforts, I was less than 100 vaccines short of my goal by the end of the flu season. I felt that the goal of 500 vaccines was too high for my store since we have a lower than average prescription volume compared to other stores. My store does very well during the flu season as a result of the prescriptions due to the flu, but the company and District Manager did not appreciate this work. In January 2012, the company gave me a written counseling letter, that stated that I was not performing well enough on certain metrics, such as courtesy refills, customer satisfaction, wellness plus and workflow. I had encouraged customers to enroll in courtesy refills and wellness plus, but cannot force them to do so, and believe that trying to force them to enroll is unprofessional. I also believe that it is difficult if not impossible to have patients use their wellness card when a large percentage of our customers are elderly and on Medicare, and therefore not eligible to receive points on the Rite Aid wellness card. I was also given a verbal warning because I insist on checking when a patient has a suspicious prescription, especially if it is for a narcotic drug such as oxycodone. I received an appraisal of “need development” in 2012. The negative comments relate to my not filling prescriptions fast enough. In my appraisal, my manager said expressly that my failure to meet the company’s metrics would lead to disciplinary action against me. As many other pharmacists, I have made mistakes because I am forced to work with low technician staffing levels, a fear of customer complaints, and the required metrics that the company has imposed. The pressure to rush has caused me to make errors. The company was surveying Express scripts patients that came to Rite Aid from Walgreens. A number of patients said that they were returning to Walgreens because the service time in the Rite Aid pharmacy was slower. However the reason the service time is slower is because we do not have the assistance we need to fill the prescriptions carefully and in a timely manner. I also stated in my letter that Rite Aid may be breaching the State Board of Pharmacy regulations if it requires pharmacists to work under time pressure and immediately serve customers in a manner that leads to prescription errors. Two weeks later, I refused to dispense a muscle relaxant to a patient who wanted to pay in cash. I believed that the prescription called for too high a dose and a refill too soon. This was at the time when on the news Michael Jackson’s doctor was under investigation for giving a muscle Relaxer eventually leading to his death so I was very uncomfortable dispensing the medication without Doctor clarification. I told the patient that I needed to contact the doctor to verify the prescription. Because the doctor did not get back in for a few days, the customer filed a complaint. Ms Y, the District Manager attempted to discipline me for that complaint and two others.

    About this time, this pharmacist telephoned Jim Plagakis. He asked if The Pharmacy Alliance could help him. The answer was YES. Within 2 hours, he became a member. Jim and Steve Ariens counseled him to simply practice pharmacy. He was advised to write a letter to Ms. Y certifying that he would comply with all state and federal pharmacy laws & regulations. With copies to the Oregon Board of Pharmacy, RAD’s corporate compliance officer (HR), RAD’s top pharmacy executive and the non-pharmacist store manager. He followed this advice. Soon, an HR officer flew from Pennsylvania to Oregon for a meeting. After ordering coffee at a coffee shop at the Portland Airport, the pharmacist immediately said, “You understand that Ms. Y ordered me to break the law.” Then he shut up. Last report.
    “They offered $15,000 for not talking about my experience to any agency, but I declined.”

At that point, I made a complaint to the Oregon Board of Pharmacy that I did not believe I should be disciplined for carrying out my duties responsibly. When more than three patients filed complaints, the store is fined $2,000, which means $2,000 is taken out of the P & L for the store. In late 2012, The State Board of Pharmacy gave me a letter that stated that I had acted in accordance with the State Rules, and it was inappropriate for Ms Y to tell me that I should have filled the prescription. After the Board wrote that letter I received a last and final warning from Ms Y based on my alleged deficiencies. In that form, she stated that any future action could lead to immediate termination. I believed that this “last and final warning” was retaliation for my having reported problems to the Board of Pharmacy, which had backed me up. At that point, I decided I needed legal representation. The company did not terminate my employment, after my attorney wrote a letter, but I also have not resolved the issue with the company over the retaliation. I have learned that Ms Y has been firing pharmacists all over the region. I shall refer to one as Ms Z who is one of the pharmacists who Ms Y fired because she complained about staffing issues, and that there were not enough staff to do the work properly. In Ms Z’s case, she stood up to Ms Y when Ms Y grew increasingly confrontational, demanding that the goal number of prescriptions needed to be filled. Ms Z was fired when she gave a different generic brand to a patient who came in with a prescription, when the pharmacy did not have the brand that was stated in the prescription. Ms Y saw the opportunity to get rid of her and terminated her. Ms Y then pressured the staff to file false statements against Ms Z. Right now I am working for a rival pharmacy chain who sponsored a temporary work visa for me. I cannot believe the difference in working conditions moving on from Rite Aid. No more 12-13 hour days without a break, no more coming in on days off without pay to complete managerial tasks. I realized working 12-13 hours a day was burning me out. I would just spend my days off sleeping. Now I just work 8-10 hour days with a break and I am still full of energy when I get home. Also, I lodged complaints about the wellness card and gift cards given to Medicare/Medicaid patients to the CMS. I got a few phone calls from investigators but was told that they may not get back to me regarding the outcome but I did hear from a colleague who is still at Rite Aid that they may have been fined by CMS in 2014 and also they were fined by the Oregon Board of Pharmacy for early refills on prescriptions in 2013.
Ms Y is no longer with Rite Aid. She claims to have left voluntarily but many of her pharmacists suspect she was eventually fired.

Appropriate Comments Will Be Pasted here.


All GUERRILLA, All The Time. If You Have a Better Way to get Pharmacy Back, Tell Me About It. Please Don’t Say APhA. I May Hurt Myself Laughing

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Forbidden Words
“Words That Managers Are Forbidden to use in your evaluation”

If YOU don’t have your own back, nobody does.

“What can dumb and fearful people always be counted on to do?”


“What is the tactic used by these same dumb people as they try to control others?”

Answer: THEY LIE

Those ‘dumb’ people may even be intelligent. They may be very well educated. PICs have to be licensed pharmacists. Disrtrict Pharmacy Managers usually are pharmacists. Managers one step above your RxDM may have a degree. You know all about the ones who have, all by themselves, ruined the retail pharmacy industry… the non-pharmacist Masters of the Universe. They learned sophisticated bean-counting methods earning an MBA. The non-pharmacist store manager is unlikely to have a degree beyond the Associates Degree that is
earned in a 2 year Community College.

All of these people are DUNB. They take staffing away from your pharmacy (Usually Technician hours) and still expect superior customer service. Why am I telling you this? You know it all.

Again, you know what they have done. I do not have to make a list for you. I can however outline how to retaliate AND

    on him or her, put it in the file.

    You will get a lot of dirt on your P.I.C. She/he may be a great person, but this is a war. If they do anything illegal or even unethical, the Board of Pharmacy may want to know. A Court of Law may want to know and you will be happy that you recorded information if you ever get fired, for any reason.

    Your RxDM. If you have damning proof regarding their behavior, start a dossier.

    This next one is low-hanging fruit. Your non-pharmacist store manager. You will get something every single week. Record it, DOCUMENT

    I will tell you something true. You say something like this, very casually, to your non pharmacist store manager: “JOHN, YOU REMEMBER THE TIMES YOU TOOK JANET (The bookkeeper) TO THE HOLIDAY INN BEFORE SHE GOT WORRIED ABOUT HER HUSBAND?” You smile a Penthouse grin. “YOU LUCKY DEVIL.” Then you just look at him for awhile and go back to work. If he responds, just say, “COME ON, JOHN. EVERYBODY KNOWS”.

    Later, if he EVER acts like an asshole about you, the technicians or the pharmacy, you, privately say, “John, you would be very wise to just leave the pharmacy alone.”

    If you have to, say, “Who has taken Janet’s place at the Holiday Inn?” If he gets really stupid and tries to intimidate you, ask him if he likes his job.

I know that every one of you can do this.

Tell what you thin about this. I know that Goose and Steve and K the “A” are gonna say, “Go for it.” I want to her the weak spine reasons why you can’t, why you are afraid.



For ALL PHARMACISTS from a Legacy Pharmacist. VIDEO

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Vintage Pharmacist Wanted.  Preferably a Good Druggist
Legacy thrown on the garbage pile

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From Pharmacist Steve, One of the Original “Guerrilla Pharmacists”

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Steve Ariens, a Guerrilla Fighter for decades.
In My Opinion.. the individuals within the profession of pharmacy… if we even still have something that resembles a profession… A profession can only exist if the individually with in the profession care more about the collective than the individuals within the professions. You just have to look at the overall memberships in especially the state and national associations.. I would bet that as a per-cent of the licensed pool of pharmacists the per-cent of membership has DROPPED in the last 10 yrs. I hear many comments about the new graduates have entered the profession because of the $$$. I saw a quote from a female Pharmacist a few weeks ago on a FB page .. in discussing having to give vaccinations.. that she became a Pharmacist because she would be a “doctor” and wouldn’t have to directly deal with pts. Is the pharmacy.. or has pharmacy moved from being pt. centric to being narcissistic ? Here is a interview with the exec dir. of the TX BOP Gay Dobson, RPH She stated that she is not aware of any chain pharmacy using metrics. Pathetic. Was Gay under political pressure or simply ignorant. No, Gay is not dumb.
If you look at the makeup of most of the BOP’s they are stacked with non-practicing corporate pharmacists. The typical action of the BOP .. will be against a individual pharmacist and/or independent pharmacist but seldom will any action be taken against a chain store or do anything that will harm the chain pharmacy industry as a whole.
The major chains are thinning the herd of Senior/Legacy Pharmacists.. this past week I heard from a 57 y/o – 34 yr. veteran of CVS that got fired over some nebulous issue that a “stool pigeon” senior tech made a mountain out of a mole hill. I also heard from a 50 y/o non-pharmacist DM… 24 yr. veteran of CVS with a top 10 rating district that got fired after trying to use a incident with a Pharmacist denying a regular chronic pain pt. their meds… as a teachable moment.. CVS claimed that she interfered with the “corresponding responsibility” of the Pharmacist. By The Way.. She never told the Pharmacist that she had to fill the Rx.
JP mentioned Pharmacists/techs using video recording pen or other means to record one-on-one conversations. Beware that pts. are starting to video interactions as well. From what I am hearing, the major chains are developing policies that basically supersedes both the practice act and the pharmacist’s individual discretion. I am also hearing from pts that some pharmacists are using “corresponding responsibility” as an excuse for not filling controls.
I don’t expect a change in the number of schools or graduates to change.. at least for the balance of this decade .. here is why that may be and even if the numbers changed.. it is going to take maybe a generation for everything to reach a equilibrium.


I Can’t Do Better Than This, Jay Pee

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“Female Guerrilla have historically proven to be the most effective at guerrilla war. Could it be “Back against the Wall?”Something hard wired like protecting their nest?”

What do you think about this one? K the “A” R.Ph. is a woman. I’d hate to be the non-pharmacist store manager with an abusive bent, a little bit drunk and leering eyes and foul mouth, all alone with her in the hallway at the annual Christmas Party.

“The Guerrilla Pharmacist” is where the best guidance is. We can get 20% of pharmacists in one chain, in one state, to take action IT WILL BE GAME OVER. You win!


The kids I work with are working OT to pay back their debt… One of them has $250,000 to pay back.. , two of them have managed to pay it back already. They can’t stand the way retail customers act and they say they are mean. One guy is looking at adding an IT degree . They are all disillusioned at the disconnect between what they were taught and what they are doing. They say they have 30 plus years to go and they don’t know how they will stand it.
Another young guy told me when he was driving to work at his chain store, he would see a concrete abutment and think “if I swerve and hit that wall, I won’t have to go in there today!”
Pretty sad. This guy is only a couple years out of school, but he is not having any luck getting in to a real pharmacy or clinical position… No experience.
This is another reason to fight. These kids are some of the best and the brightest and their talents are being wasted.
I am trying to get an article published trying to educate the public about what is going on and why they are in danger (“The Fallacy of McPharmacy”). So far I have sent it to the New York Times, the Washington Post, NBC investigative reports, AARP magazine, and a magazine called “Grand” for Grandparents. Nothing. When I first got screwed over by my former employer in 2013, I sent out emails to every investigative reporter I could find. Only one reporter responded and wanted more info. I asked SAP to help explain the situation to the guy , which he did . We never heard back.
So, I was at a low point. I don’t know how to get somebody to delve in to this story.. There is so much out there to use its ridiculous. I tell them pharmacists will be glad to talk if they are anonymous. I tell them just walk into any store and observe what is going on. No takers so far.
I am a writer, so I write to get my voice heard. Every now and then I have flashbacks about what happened 2 years ago, and I want to hide in a corner in the fetal position. Sorry for my weakness, it is temporary. I am debt free and my kids are raised , but I like my lifestyle, tame as it is. I have seen first hand what corporate can do when it rears its ugly head, I have seen how they use fear and bullying to control and demean. I have also had the experience of having a colleague I liked and trusted turn her back on me without asking for my side of the story.
I swear, I truly believe they would not be above ” eliminating ” someone permanently if it served their purpose. “if I disappear, you might want to drag the Chicago River.. I’ll be the one wearing the cement shoes”. I am only half joking.


An Open Letter to “Goose”

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I know it is bad out there, and getting worse, but this letter to “Goose” makes a Quantum Leap to a new level. WE CAN FIX THIS YOU, GUYS. The people who have no trouble on the job were smart, careful and played their cards right. It is a poker game and you have the best hands. Fuck me, you guys, WHY CAN’T YOU GET IT? You make me crazy. Check “The Guerrilla Pharmacist” for advice.
Pharmacist with look of desperation

Hey Goose.
I thought we lived in the United States, but there surely seems to be no freedom of speech or justice
when it comes to those with power and money vs those who work for them.
My parents taught me to work hard, do the right thing, stand up for what is right. Unfortunately, these values don’t seem to work anymore. I see people lying, not learning their job, calling in sick, screwing around and talking while they should be working, disappearing to do God knows what, as well as people in higher positions playing golf, getting free dinners and trips, all while playing
dirty to get their way. These same people act as if it is a crime to want any time off, but guess who is always “out of the office” on Fridays and extend their holidays at will to spend time with their families.
No matter how honest and hard working we try to be, the public does not care. Apparently, the news media does not care, because I have yet to hear back from any of them I have tried to contact regarding our issues and the patient safety issues that result.
I truly think I would have been better off working for GM or Chrysler. Through my whole career, I have never used any of my clinical skills. I have been a piece worker in a factory. Injuries? No, I have not suffered severe burns, or crushing injuries from machines. But I have had 2 hip replacements and 2 foot surgeries, and every joint and muscle hurts on a daily basis. 30 years of the same damn thing over and over again.
I did have a year or two of doing “pharmacokinetics” in a hospital, which consisted of running up to the floors to try and get all the labs off the charts and figure the dose before dashing back upstairs
to write recommendations. I still had to cover for lunches, and I had to be done by 3:30 so first shift could go home. The whole thing was an exercise in futility, as the docs never took any of the recommendations, the lab didn’t draw the labs at the right times, or didn’t draw them at all, and my training was by the seat of the pants, just like my training in mixing chemo, or preparing IVs, or anything else I have had to learn on the job.
Just because you are book smart does not mean you should not be trained properly and given time to master the skills necessary to perform manual tasks. A pharmacy degree seems to give carte
blanche to delegate any task to the pharmacist, expect them to get it right away, and do it perfectly and alone, usually on a weekend with no staff or new staff members who don’t know squat.
Why GM or Chrysler? Well, the guy across the street from me is retired from GM (line worker, not management), and has a lake front house here, a house in Hawaii, another house somewhere else, and a pontoon, 2 jet skis, a new pickup and a nice car. He also has a pension.
I am tired of being afraid and I am tired of no one listening. I am beginning to think this is a losing battle. I have wasted 30 years of my life on this profession, and I still have to work, at least 10 more years, and so, out of the time I have left in a day, does it really matter that I write some shit that could get me targeted and not make a bit of difference? Note to self: NOBODY CARES!
This is my attitude today. Your email depressed me, frankly, and I went to bed thinking I would be better off writing freelance articles for a magazine or writing a book about anything but pharmacy. Why keep putting my name out there, and, as you said, become a target?
My former employer already destroyed my professional and personal reputation in the community I used to live in, not that it was any great loss, because, since I worked all the time and crazy shifts I never developed any friendships or relationships there anyway.
Feeling old, tired, worried, scared, helpless and hopeless.


Guerrilla Action. It is time for you to step up

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Click Here
Anthem of the abused
Come gather ’round people ..Wherever you roam..And admit that the waters..Around you have grown..And accept it that soon ..You’ll be drenched to the bone..If your time to you..Is worth savin’..Then you better start swimmin’..Or you’ll sink like a stone..For the times they are a-changin’. (Bob Dylan)

    The Guerrilla Pharmacist

The OTHER GUY isn’t going to do it and your company is not going to all of a sudden become
a benevolent business that treats you like a highly trained medical professional. That’s for Damn Sure.

It is Up to You!
One year subscription is $30.00. We need and welcome your donations to help with costs. A Thank You Gift “The Comfort Trilogy” Amazon-$26.99 for donations more than $50.00
Subscribe or donate with PayPal-
Checks will be deposited to a TPA account in Sarasota
Send checks to: “Guerrilla C/o Plagakis”
1609 Bayhouse Pt. Dr. BA229, Sarasota, Fl 34231
Major Credit Cards. Order by E-Mail. We Use “Square Reader” Technology.
Send $ amount & what you are paying for. Acct #, Exp Date, Security Code, Name on Card


“This morning I sat down and read The Guerrilla Pharmacist from cover to cover. It was like a breath of fresh air! A magazine written for REAL pharmacists in the REAL world. There is nothing else like it. It is the magazine for every pharmacist. If you have not subscribed, I urge you to do so.

    This is the magazine for every pharmacist.”


JP Health Update

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Nice Lookin' Feet
It is over. Five months after my first visit to Doctors Hospital Wound Care Center, I was discharged this morning. My wound has healed. I can sell my 4 wheel walker and my knee scooter.

JP is back.

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A Million Dollars From CVS for Being TOO OLD.

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I'm The Pharmacist And You're Going To Listen To Me No Matter What.

I’m The Pharmacist And You’re Going To Listen To Me No Matter What.

Second Ala. pharmacist wins age discrimination lawsuit against CVS

February 27, 2015

By Mark Lowery, Content Editor Drug Topics.

A jury recently awarded more than $1 million to a pharmacist who claimed he was fired from a Pell City, Ala. CVS because of his age.

Pharmacist James King, who filed a complaint in 2012 when he was 65, is the second pharmacist in the same Alabama district to recently win an age discrimination lawsuit against CVS.

Is there age bias in pharmacy?

According to an article in the Anniston Star, King said he was suspended and then fired about a month after he reported the district supervisor for making disparaging comments about his age.

A CVS spokesperson, Mike DeAngelis, said the pharmacy chain disagreed with the verdict and was considering its legal options.


Wal-Mart Pharmacist Class Action Moves to Federal Court

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Walmart Slapped with Pharmacist Class Action Suit

Meghan Ross, Associate Editor. Pharmacy Times

Fed up with alleged unpaid overtime and missed rest periods, a Walmart pharmacist is fighting back against the retail giant with a class action suit.

Afrouz Nikmanesh, who worked at Walmart from 2003 to 2014, claimed that the corporation violated California labor laws by not paying him and other pharmacists for the time they spent in class studying for and taking the American Pharmacists Association’s Immunization Training programs, according to Lawyers and Settlements.

Nikmanesh said the training was “directly related” to pharmacists’ duties, according to the lawsuit.

The lawsuit would represent all United States pharmacists who worked at a Walmart pharmacy within the last 4 years.

According to Law360, Nikmanesh also alleged that Walmart did not provide employees with 10-minute rest periods during their shifts, which is a violation of state and federal law.

Nikmanesh’s case was moved to federal court on February 6, 2015, according to Lawyers and Settlements.
- See more at: Click Here

1 Comment

The Last Page of The Premier Edition of Guerrilla

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Funny, But Tells The Story.

The Premier Edition of The Guerrilla Pharmacist has been a long time coming. I have been making it a goal for a long time. It has been on the back burner for years. Finally, in January, Julia Talsma, the editor at Drug Topics fired me after 25 years and 248 columns. JP at Large came to an end in that magazine. I said to myself. “Okay, Plagakis, what is next?” Guerrilla is the answer.
My whole adult life has been about pharmacy. The last 3 decades, I have been on a mission to make a difference. I know we have to confront the metrics and the pharmacy computer programs that spy on us every minute of our working day. We need to take the rights of any employee for good working conditions.
When I realized that this magazine and what it can do was a possibility, I put out the message that we needed pharmacy writers, subscribers and donors. All the writers I invited stepped up. “Goose”, Dennis Miller and Steve Ariens have written for Drug Topics. 12 essayists stepped up. The only one to decline is David Stanley “The Drug Monkey”. It is his loss, but our loss too. David is a good writer and he knows all about how retail pharmacy has degraded.

Without Writers, Subscribers and Contributors, Guerrilla will be just another good idea that fails. It will a boutique curiosity. Let’s not have that happen. Please enroll your unhappy colleagues. Support them in taking a stand. We must have them with us to build the foundation we have to have.

This is your chance to take a stand. Ask the right questions. How is CVS treating you? Are you happy with your job? Do you want to change it? Do you want to take pharmacy back? Well, my friend, here is where you can start.

Pharmacist Steve is reporting on a vintage pharmacist getting $2,000,000.00 from CVS for age discrimination. Read all about it at Steve’s site. PharmacistSteve

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Some of You Have Asked How to Subscribe or Contribute to THE GUERRILLA PHARMACIST

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A Pharmacy Guerrilla

“The Guerrilla Pharmacist” is the best bet to get you to stop sitting on your hands. FIRST ISSUE WILL BE MAILED EARLY IN MARCH, 2015. Those of you who make a dollar contribution of $50.00 or more will receive “The Comfort Trilogy”. A Thank You gift from THE PHARMACY ALLIANCE”.

A One Year Subscription is $30.00


Contributors of $50.00 or more will receive a Thank You gift. THE COMFORT TRILOGY. This volume contains three books. “The Prisoners of Comfort” “The Comfort Demands” and “The Dangerous Book for Pharmacists”. Amazon price is $26.99.

WE can now accept major credit cards using the SQUARE technology. $$$ are sent to the TPA account in Galveston.

Please tell us what the $$$ are for. Send Account #, Expiration date & Security code. Name on card.

Checks (will be deposited to a TPA checking account in Galveston)
Make Payable to: Guerrilla C/o Plagakis

Send to:
Guerrilla C/o PLAGAKIS
Sarasota, FL 34231


Is it True That Pharmacists Are Fatally Apathetic About The Own Lives?

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Apathy is fatal

I AM VERY DISAPPOINTED IN YOU GUYS. The E-Mail response to the announcement of the coming magazine

    The Guerrilla Pharmacist

was amazing, encouraging and hopeful. There were subscriptions paid via PayPal the next morning . I thought “Rock ‘n Roll, JP. Guerrilla will make a difference in the lives of pharmacists and technicians. It can be the stimulus for bringing about a paradigm shift that will put the power in pharmacy back in the hands of the practitioners. PHARMACISTS.

But, Guerilla has to get in the hands of people with their feet on the floor behind the counter every single day. Issues will be passed around. Some of the WRITERS have indicated that they will buy extra copies (at net cost) to pass out. Fred Mayer of PPSI fame wants to give copies to key people at the C.Ph.A. meting this spring.

I am very disappointed that the subscription flow petered out after that first day. Some of you were over-the-top in praising this effort. Some cheered that “This is exactly what we need”. “I will support The Guerrilla Pharmacist completely.”

Then nothing. I expected a subscription order from PEON and others immediately. Did not happen. Can you tell me why? Don’t say apathy. “Apathy is not giving a shit that you don’t give a shit” If it is apathy, WE ARE DOOMED and deserve what we get.

Please reconsider. The Guerrilla Pharmacist has taken real effort in my house and I know that writers like Goose and Pharmacy Gal
spent a lot of capital in writing such great STUFF. Some of the essayists have contributed toward costs. Ron Cameron, Fred Mayer and Paul Trusten put their money where their mouth is. They each sent $200.00. Goose has put himself on a continuing payment plan that will mean $600.00 to Guerrilla in 2015.

Your money can make a huge difference. First—SUBSCRIBE.


The PHARMACIST Job Bubble is Bursting. Can You Spell C-O-N-S-P-I-R-A-C-Y?

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Are The New Schools Playing Into The hands of Big Evil?

From THE NEW REPUBLIC. If you are a young pharmacist, click the link. If you are a Vintage Pharmacist, click the link:

“Why Good Pharmacist Jobs Are Drying Up”

This is a very long article in a very well respected magazine. READ IT, YOU GUYS. THIS IS YOUR INDUSTRY THAT THEY ARE USING AS A PROFIT-GENERATING ENGINE and cheapening a profession that has endured for centuries.

Youngsters, scrape and claw your way into a traditional school if pharmacy is what you want. There is a difference, just like a night MBA course at your local community college is different from a degree from The Wharton School at the University of Pennsylvania. Who gets hired first for the best jobs? If you need an RPH, Purdue will give you a pharmacist while a robo-dispenser is what you get from a new for-profit school.


From 72 Pharmacy Schools to 130 Pharmacy Schools seemingly OVERNIGHT. There is a huge difference between Purdue & Touro. You will still learn how to compound at Purdue. If you want Pharmacognosy, you can get it. The new FOR PROFIT schools seem to be merely NAPLEX preparation courses. Take the time to research the new schools in your state. If you went to a traditional pharmacy school like Toledo or U.C. San Francisco, you will be appalled at the curriculum and the compressed schedule.

Karl Marx “Das Kapital” asks: WHO BENEFITS?

Not you! Not the young pharmacist with an inferior education who can pass the NAPLEX, but don’t have a clue why Rolaids is better than TUMS. Who benefits. THE CHAINS. BIG BOX. SUPER MARKETS. MAIL ORDER. They were creamed by the shortage and, I believe, they conspired with the NABP and I-Don’t-Know-Who-Else to make sure that they had plenty of cannon fodder to streamline their Prescription Mills. They did it and you and me and Fred Meyer were like deer in the headlights. We just let it happen.

I worked for a few months with a girl who got her degree from ◾University of the Incarnate Word Feik School of Pharmacy in Texas. When we ran out of Tamiflu for liquid, I said, “Compound it. You will spend 3 minutes with the calculations and another 10 minutes making a “Shake” suspension with something like OraSweet”.

Talk about a deer in the headlights. Compound? Nobody ever told me I’d have to compound. A 10 minute lesson and she was good to go. Pretty damn simple. Calculations can be done in her head. Next thing, she was offering to compound Rxs that she did not have to. Her school failed her. A legacy pharmacist brought her to the edges of what I call “Pharmacy”. Not every youngster has this benefit. I worked for WAG. I took the time and nobody complained. Could this happen at CVS? They don’t want the quintessential pharmacist. Al they want are robe-dispensers. How do we fix it? I will tell you how. Subscribe to THE GUERRILLA PHARMACIST. The strategy is defined in detail in Issue #1.



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OREGON IS OUR ONE GRST HOPE. The BOP is on our side.


A little imagination and you will get it.

A little imagination and you will get it.

FROM GOOSE: I am putting all my writing efforts into this new publication and supporting it financially. I am also urging others to do so. We need to get this rolling folks, while we have the advantage of seasoned writers who know the real issues in pharmacy.
Even if it just a few bucks, support The Pharmacy Alliance in this or subscribe. $30.00 for a year is nothing.
That’s a few days of coffee for some of you.
Peace out,

“The Guerrilla Pharmacist” is the best bet to get you to stop sitting on your hands. FIRST ISSUE WILL BE MAILED EARLY IN MARCH, 2015. Those of you who make a dollar contribution of $50.00 or more will receive “The Comfort Trilogy”. A Thank You gift from THE PHARMACY ALLIANCE”.


There were PayPal subscriptions there this morning. You Rock.
Contributors of $50.00 or more will receive a Thank You gift. THE COMFORT TRILOGY. This volume contains three books. “The Prisoners of Comfort” “The Comfort Demands” and “The Dangerous Book for Pharmacists”. Amazon price is $26.99.

WE can now accept major credit cards using the SQUARE technology. $$$ are sent to the TPA account in Galveston.

Please tell us what the $$$ are for. SEnd Account #, Expiration date & Security code. Name on card.

Checks (will be deposited to a TPA checking account in Galveston) Make Payable to: Guyerrilla C/o Plagakis
Send to:
Guerrilla C/o PLAGAKIS
Sarasota, FL 34231


WE CAN DO THIS YOU GUYS. If “The Guerrilla Pharmacists” inspires only 20 out of 100 Pharmacists to engage in battle (even small battles) WE WILL WIN. You get your dignity and self respect back. Pharmacy will be ours again. Fuck the MBA Masters of the Universe.
They can run the variety store out front.

The Pharmacy Alliance will publish the first The Guerrilla Pharmacist in a few weeks. It will be a magazine with the essays written by stud activist writers like Goose, David Stanley, me and others.

We want to kick start the revolution to get our profession back. And, well, you know


After you read Guerrilla, maybe you will be willing to step up and play the amazing TRUMP cards you have in your hand.

Cheap right now if you want to subscribe. $3.00 an issue $30.00 a year.

Send your subscription money by PayPal to: (Drop an e-mail to so I know what the $$ are for)

By check to be deposited to a TPA checking account in Galveston.

C/o Plagakis
1609 Bayhouse Pt. Dr. BA229
Sarasota, FL 34231

WE WILL. The non-pharmacist bean-counting MBA Masters of the Universe will have their assholes puckered and it will be a complete surprise because everybody knows that pharmacists are spineless lemmings. I am not buying it. There is a WARRIOR in every one of you.


From Pharmacist Steve. Comments from Blog Reader Addressing Foreign Pharmacist – H1b Visas.

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H-1B VISAS allow RAD & CVS to treat RPhs as indentured servants

Re: Drug Topics Magazine “2015-salary-survey-pharmacist-incomes-hold-steady”

THIS SHOULD OPEN YOUR EYES. Rite-Aid and CVS. WAG is not even in the picture. Current statistics from

#1 Sponsor Rite-Aid 387 H-1B
#2 CVS 308
#3 Wal-Mart 82
#4 WAG 58
#5 Winn-Dixie 20

#10 & 11 K-Mart & Kroger ties with 5 H-1B pharmacists each

From: SRA ( Passing on comments recorded on his blog

When I looked at that survey.. the numbers in the sample were very small.. All you have to look at is the number of graduates back to the early 70’s – those that would be retiring today – abt 5000 –6000 and the number of graduates coming out today.. one more pharmacy school announced today Look at the total number of net new stores … I would suspect that you will find about twice as many graduating today… than retiring… and that the net store count is fairly flat.. There are rumors that both WAGS & CVS are reviewing all of their 24 hr stores and many may pull back 8 hr over night shift of the Rx dept only and leave store open.. or pull back the entire store 8 hr over night for closure… each overnight shift eliminated will be abt 1.5 FTE RPH’s per store.

I think that if you investigate … that the number of “third RPh’s” in non-24 hr stores are in the process of being eliminated or nearly eliminated.

I have talked to RPH’s mainly from CVS that RPH’s are being reduced to 28-30 hours and many are put into “floating pools”

I have seen estimates that by 2017-2018 that 20% of the graduates will not be able to readily find a job upon graduation. Shortage/Surplus and pay seems to be in indirect proportion to population and population density.. big cities – high surplus – low pay… “out in the sticks”… more opportunities and more normal pay.

I am also hearing/seeing more harsh penalties from the BOP… on RPH’s when things go wrong as there was 10 –15 years ago when there was a dramatic shortage. The majority of the BOP’s are stacked with non-practicing corporate pharmacists and there is no longer a need to protect the labor pool.. because there are pharmacists standing in line for any job that opens up.


Retail Preceptors Should Be Ashamed. New Pharmacists Are Robo-Dispensers Because They Do Not Know Better and You Have Looked the Other Way.

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My First Drug Store Job. 1957. A Stock Boy. This Guy, Mr. Hale, taught me more than my first official preceptor.
JP’s first drug store job. 1956. Stock boy. The druggist, Mr. Hale, taught me more valuable lessons than any preceptor.

I have acted as a preceptor during my career and I am guilty of letting the students down. I worked at a pharmacy that was within walking distance of The University of Texas Medical Branch. UTMB is a major medical school. I talked with students and residents every day at work. It was apparent that they were being taught how a doctor should act. Even first year students display a certain superior panache. They stood tall, made eye contact and questioned my choices when I helped them make OTC decisions. These kids knew absolutely nothing and they would still run their doctor act at me. I liked it. They will be flying the medical system airplane even if they will have to share the cockpit in the 21st Century and I want everyone up front to be confident and competent.
Young pharmacists (old pharmacists too) often behave like little children who have not been taught how to act around adults. I blame the pharmacy school faculties for this first. There are exceptions, but most professors don’t seem to think that how a pharmacist behaves is important. There is a professor at the University of Georgia who is the exception, but I personally know of no other.
What would be wrong with a P-1 class that expressed these messages:
1. You are beginning a career as a well-educated, highly trained medical professional. Act like one.
2. You will be the last word on drug therapy. Accept that role.
3. You will be the foremost expert on all drugs, that includes Rx-Only and OTC. Act like it.
Why not tell these kids that they need to ACT like they are important professionals and not simply prescription fillers. The retail system is not designed to allow them to easily be important. The schools and the preceptors must give them permission to ACT like they are medical professionals. When they get their first job with a big box store, there will be strong forces playing against them. The companies will want to keep them in their place.
I was a preceptor three times in my career. My students were all trained by me to do well in retail. However, as I see it now, I was a dismal failure. I believe that a preceptor should assist the student in aspiring to the highest standards. I didn’t do that. I taught them to do what I did. At the time, I was a Prescription Mill caretaker. Most preceptors are equally disappointing.
Students see how their preceptors act and model their own behavior after what we do. They are effectively taught how to ACT as a second class medical professional. We show them that it is normal to have to work a twelve hour shift with no meal or rest periods. We tolerate bad language from abusive customers and the student sees, over and over, that this is the way it is.
How many preceptors have seen the student watching as they allow themselves to be intimidated by a doctor, even when the preceptor is right.
“I’m.. Uh.. I’m sorry to bother you doctor, but I believe that the dose is..”
The preceptor’s face reddens when the doctor shouts at her and hangs up the phone. She looks at the student and shrugs.
The student says, “You’re not going to fill it that way, are you?”
“I have to. The doctor won’t change the directions.”
The patient is put in danger. The student feels helpless and the dangerous slide down to second class medical professional is only iced up and slicker than ever.
Preceptors have a responsibility to strongly express these messages: Do not do it like I do it. Do it like I say to do it. Do not believe that a twelve hour shift with no breaks is normal. This is an aberration that has been perpetuated for more than three decades. The non-pharmacist store manager runs the store, not the pharmacy. I know that I dress frumpy, but you don’t have to. You are a doctor. Dress like one. And on and on.
It is immoral to allow new pharmacists to hang there, twisting in the wind, with no instruction on how to ACT like a professional. All of us veterans have a responsibility to a profession that is in transition. Pharmacy will only be as strong as its practitioners. We need to support them in ACTING proud and competent in any and all circumstances.
By tradition and according to the law in the United States of America, the pharmacist must be involved with the delivery of every single drug. Think about this: 90% of all routine doctor office visits end up with one of more prescriptions being written. The pharmacist is at the bottom of the funnel. You are where the rubber meets the road. Without you, everything stops. What about that kind of power is so hard to understand?


A Health Update for JP

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My WALKER Can't wait to be able to use it on trips longer than to the car


Some of you have asked me how I am doing. Mid-February and the ordeal will extend to six months. When amiodarone was Dced the encephalopathy went with it. The coma broke. I looked up and saw Victoria sitting in a chair. I said, “Hello Mrs. Plagakis”.
V teared up and that was that. I was discharged to Palmer Ranch Rehab Center and after 8 days went home.


October 16TH, FIRST APPOINTMENT WAS DEBRIDING. HE SENT TISSUE FOR CULTURING. NEXT WEEK, 2ND DEBRIDING AND THE REPORT. 4 AEROBIC AND 3 ANAEROBIC BACTERIA, INCLUDING GANGRENE. EXTENDED COURSES OF AUGMENTIN AND CIPRO. he said, “If you want this to heal, you will stay off it.’ I got a knee scooter and have been a very good, if not perfect, patient.






WANTED… REAL Pharmacists to Step Up Legally & Ethically. LIVE UP to your Own Personal Standards.

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After lunch at Pelican Cove around 2003

After lunch at Ferrante Winery in Grand River, Ohio around 2003

This is the 21st Century. 15 years out from Y2K, when everything run by computers would shut down at 12:59 PM. VICTORIA and I were newlyweds. We lived in Bellingham, Washington. V worked as a Level A Pharmacy Tech for Rite-Aid and I worked for Longs. We were married at noon on January 14, 1999. Lunch time. Our witnesses were the two young women who ran the business office of our apartment complex. The rent-a-minister was on the list given to us at the Whatcom County Court House Licensing office. She has a Greek name and her husband was a reporter at the Bellingham paper. That is how I made the choice.

The wedding was brief and glorious. V and I were dressed for a casual ceremony. Jacket. shirt & tie. V in a stylish dress. I bought corsages for the minister and the girls. A white carnation on my lapel. V’s Bouquet was very nice. I had a local deli deliver the food. The 5 of us ate good food. We had talked about a ceremony in the spring of 2000, but the ability to file an IRS 1040 as a married couple was too tempting.

Anyway we got a little spooked about Y2K. The media was relentless. ATM machines would jam up. Banks would not open. Credit cards
would not work. It could be dangerous with bad people looking to exploit Y2K. V and I had $1000.00 with no bills larger than a twenty. Lots of fives and ones. Y2K proved to be nothing.

Today, in 2015, my definition of a REAL pharmacist is very different than my definition in.. say… 1990 was very different. in 1990
I was most interested in keeping my good job. I loved the 10 minute commute. The job was just a PIC job. Much just floated by me. I ignored the store manager. He tried to micro-manage.

TODAY, I am looking for a few REAL pharmacists. Are there any out there? Do any of you stand up and do your job legally?

“Brenda, you are the store manager, but you are not a pharmacist. You have a bad habit of entering the pharmacy without my permission.”

“What? I do not need your permission. I’m the manager of this store.”

“But you do need my okay, Brenda. It is the law.” An icy stare. “You cannot come in the pharmacy and wander the bays, looking at the drugs. Why do you do this? Why are you so interested in handling the drugs?”

“Ah, the inventory looks too high.”

“Bullshit. You do not have a clue about the cost of the drugs.”

Don’t you trust me?”

“I do not trust anyone back there with bottles labeled Vicodin, Valium, Dilaudid (CIIs were spread out) so do not enter the pharmacy without my permission and stay at the counter when you visit. One more time, Brenda and I will write you up.”

“You can’t write me up!”

“Try me.”

Phyllis Wene is a pharmacist who is an investigator (not inspector) for the Washington State Board with police powers. She can arrest offenders. Phyllis told me this story. A store Manager at a Haggen’s Grocery Store called the board and accused the PIC of breaking the law. Phyllis agreed to meet him after the store closed. Very late, like midnight. When she got there, the store manager was in the pharmacy nosing around. Phyllis went in and listened. The guy’s accusations were nothing. The PIC was doing his job legally and ethically. She wrote her report, brief and concise. Then she asked the manager, “How did you get in the pharmacy?” He told her the key
in the safe.

Phyllis did not hesitate, she busted him. She cited the number of the law, told him that he and his boss would get a notice of the day and time to appear in Olympia. The manager was ordered to NEVER enter the pharmacy. Haggen’s had to pay a stiff fine. The board was lenient. He was told that Phyllis could have arrested him right then and there.

All of you are REAL pharmacists. Just show it once in awhile. Tell me if this piece is a dud. It is amazing what you like. I put up a letter from a Walgreens PIC during the WAG/Express dust up. She was very critical of the WAG CEO. That week, for 7 days, the number of visitors to this blog was 700+ every day. I did not expect that. The piece on the RPh must be present when an Rx is sold law has not had no comments. That is a surprise. Your life is on the line. I know that plenty of Rxs are sold with no pharmacist present. Lunch time. Before the pharmacy opens or after it closes. Sundays, holidays. I had a manager open the pharmacy because he said he heard the water running. He also used Hycodan for a persistent smoker’s cough. Yeah, water running. This guy is the grandson of the founder of the company. 400 stores. I WAS NOT a Real Pharmacist that week, that month, that year.

Are You? Just give me one shot. Write a comment. Make all of us proud.


If They (Chains, Big Box, Grocery Stores) in Collusion with the Boards try to do this, leave some Teeth and Blood on the Floor.

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No Metrics Here

This is from Washington State. I worked there for 20 years. I believed that Washington was the most progressive of the 50 states. I now believe that Oregon has earned that distinction. A couple years ago the Executive Secretary of the Oregon Board of Pharmacy commented on the fast pace, metrics and frantic pharmacists working at a Super Market pharmacy. He said, “Prescriptions are NOT Pastrami & cheese sandwiches.”

If you want to make your knees tremble with envy, visit The first article is a lengthy listing of Oregon’s pharmacist friendly (*MBA Masters of the Universe unfriendly) rules and regulations. Any Oregon pharmacist who does not take advantage of these rules is an idiot.

WAC 246-869-020 (Washington Administrative Code)
(4) Prescriptions shall be stored in the pharmacy and cannot be removed from the pharmacy unless the pharmacist is present and the removal is for the immediate delivery to the patient, person picking up the prescription for the patient, or person delivering the prescription to the patient at his residence or similar place.
I believe that all 50 states require an RPh to be present when Rxs are sold. If any board or legislature (To satisfy CVS or Rite-Aid) tries to remove this law, YOU NEED TO FIGHT FOR YOUR LIFE. If necessary, leave blood and teeth on the floor. Your life will be on the line.

How will It Be Possible to Sell One Trillion Dollars Worth Of Prescriptions Every Year? Maybe, but you have to be there.

It will not be possible if we think that the present (unexamined) model of the Prescription Mill stays in place. If we fail, if we cannot do the job, it will be the end of pharmacy at the end of the funnel. Our culture will write us off as not up to snuff.

Dollar Amount of
Prescriptions Filled
1999 compared to 2009
1999 2009
$105 Billion $250 Billion
That is an increase of $145 Billion in the decade, an increase of 138%. That is an astounding figure. In 2009, all medical care came to $2.5 Trillion. Prescriptions accounted for 10% of the total.

One Trillion Dollars by 2019?

One of you math wonks, prove it.

Exponential Growth and Decay
In many natural phenomena (such as population growth, radioactive decay, etc.), quantities
grow or decay at a rate proportional to their size (Our case # of Rx per year) In other words, they satisfy the following
differential equation
= ky; where k is a constant (1)
If k > 0; we call it the law of natural growth. If k < 0; we call it the law of natural decay.
THEOREM: The only solution of the differential equation (1) are the exponential functions
y(t) = y(0)ekt (2)
REMARK: It is easy to check that (2) satisfies (1). In fact,
= (y(0)ekt)0 = y(0)(ekt)0 = y(0)ekt  (kt)0 = y(0)ekt  k = k y(0)ekt
| {z }
= ky(t)
have fun.

You will always have a job with that kind of money ringing the registers. The MBA bean-counter MASTERS OF THE UNIVERSE would love to change it, but, as long as you must be there when a prescription is sold, they will have to pay to keep you behind the counter.

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They Are Afraid of You. You can be Very Dangerous to the MBA Masters of the Universe.

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The Poet of the Sixties

“How does it feel
To be on your own
With no direction home
Like a complete Unknown
Like a Rolling stone”

Bob Dylan

Counseling in all of its various forms is the activity that will define us in the 21st Century. Doctors will seek the counsel of some of us. We will provide MTM. There will be pharmacists who prescribe the drugs. If pharmacists want to be useful, they will counsel their retail patients on their daily prescriptions.

Pharmacists will always be the point person for triage for a certain class of patients. They will come to you because you are accessible and because you won’t charge them. You are the last medical professional standing who is still free.

I believe that it is time for pharmacists to enter the 21st Century and leave the olden days behind.

This book is not, however, about counseling. It is not about getting away from The Prescription Mill, the company’s timers and status reports. It is about acting like what you are. A highly-trained medical professional who will make a difference in your patients’ lives every single day.

The re-invention of your professional self will not be easy for anyone. There are pharmacists who have spent twenty years running The Prescription Mills for various chain drug store, big box and grocery store companies. They are institutionalized and changing the way they view themselves will not be easy.

It will take only courage for students and young pharmacists to invent themselves in the mold that the 21st Century will demand. They have been provided all of the tools needed. All they have to do is use them. All they have to do is be willing to become a Dangerous Pharmacist.

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Karen Dempsy Steps Up. Courageous! We need YOU to do something.

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It Just Cannot Be This Bad!

Dec 31, 2014 was my last day as a hospital pharmacist. I started my career in 1992 in small town independent pharmacy. It was glorious. I helped people stay healthy and I helped them get well. Over the next 8 years I watched the insurance companies compete with each other to give us the lowest reimbursement possible while the wholesalers squeezed every penny out of us they could while giving the chains the volume discounts. Frustrated, confused and desperate to practice pharmacy and move away from insurance administrator, I fled retail to become a hospital pharmacist. My brain has been doing somersaults for the last 3 years disbelieving that hospital pharmacy is following the same path as retail. So here I am a veteran pharmacists of 25 years going back to school. The health care industry needs experienced health care providers at the helm of health care reform. Layering economics on top of clinical experience just feels like the right combination. I pray other healthcare providers are having a vision that will motivate them to move on to learning new tools to combine with their clinical experience. Currently medical care is suffering from greed, and bean counter mortalities. The hospital’s cooperate consultants seem to view the pharmacist as the caboose of the health care industry. Simply because their 2+2, black and white mentalities aren’t able to wrap their brains around what a pharmacist contributes in the team. What am I going to do to help fix this problem? I don’t know right now, all I know is that I will give it my best shot. I sure hope to be accompanied by professional colleagues that have watched this all go bad over the last 25 years and are ready to stand up and make the right changes in health care reform. Seems to me we have had more than enough of this nonsense. We as health care professionals have to take our profession back from the money grubbers so that we can do what we were meant to do, Help people stay healthy and help make them well when they are ill. Jim, you have been the voice of many pharmacists. Please, through your writings, encourage everyone to contemplate the ways in which we can change health care reform to being about peoples health instead of exponentially killing off the health care professionals. How do we create a “Revolution?”

Want to help? Many hands make for light work.Contact Karen Karen Dempsy


ANGER can Ruin You or be Your Best Friend

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Fear is a Fight or Flight reaction.  Causes Cortisol and that causes Plaque

In the end, it is fear alone that keeps us acting and think like weiners.

You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself, “I lived through this horror. I can take the next thing that comes along.” You must do the thing you think you cannot do”.
Eleanor Roosevelt
The situation that thousands upon thousands of pharmacist find themselves in is not hopeless. If they see themselves as victims who are powerless in their own lives, they are most likely going to be miserable. However, if they see that they have choices at every turn along the way, there will always be hope.
I have done my best to illustrate the worst pit that many of you wallow helplessly in so that I can show you that you are not helpless and that the difference is a matter of perception, pride, dignity and integrity. Pharmacy will not make you proud. Your viewpoint of yourself and how you behave is what drives your self-respect or lack of such. It is not easy to intimidate a person with confidence and self-respect. Especially, a professional. The relative intelligence and education of the average Jailer cannot compare with yours. He knows that and does everything in the book to keep you controlled.
The sense of being powerful in our own lives is largely missing with the institutionalized pharmacist. Like a disaffected teenager, we compensate for a lack of power in our professional lives by seeking power in ways that are not necessarily healthy. For every female pharmacist who finds some power by volunteering at the hospital for children with neurological disorders, there is a pharmacist who is depressed about her life and stays at home on her days off, lying on the sofa, watching soap operas. She is so used to salty snacks that she can’t stop. There is an empty large bag of chips on the floor and a half filled 2 liter bottle of soda. She has gained weight and hates herself for it.
For every male pharmacist who is on the Board of Directors of the local school board, there is a man who gets his power the way I did, from controlling my body to the point of distraction. I cross trained every single day. I spent an hour or more on the Nordic-Track machine six days a week and swam laps four times a week. I restricted calories to the point that I was so lean that I actually looked like I was ill. A friend of my brother expressed his condolences. He said, “I’m sorry about your brother.” Mark said, “Why? What’s the matter with my brother?” The friend said, “He’s got AIDS, doesn’t he?”
What I got was power over my own life. I may have been a victim at my job, but here I was in control. Nothing was more important than my physical condition and my lean appearance. I cringe when I see pictures taken back in the day because I actually believed that I looked good.
Recovery is regaining Your Power
Essentially, the miserable pharmacist is wretched because they choose to be unhappy. There is a choice every single day to be proud of what they do or to blame the job because they are not happy. They don’t even use the best tool available to them. That tool is anger!
Anger is fuel. It is not the bad thing that your parents said to suppress as mine did. “Jimmy, nobody needs to know you are angry. You should control yourself.” We feel anger and we become frustrated when we hide it because we want to do something about it. This goes against the image of the calm, in-control professional. Instead of showing the anger, we stuff it and chug Maalox and take two 20mg omeprazole every day.
How would it look if we showed that we were angry? At work, you don’t hit that someone or break that something or throw that fit. If you smash that fist against the wall, do it in the bathroom where no one can see that you are out of control.
What we do with our anger is deny it. We stuff it so far down that we forget what makes us angry. We are institutionalized and we believe that we should not get angry. We lie about being angry at the store manager. We hide our anger at the lack of technician help. We do not express our outrage to the district manager. Doesn’t he know that it is his precious customer service that pays the price?
Some of us hide it so well that we medicate the anger and filch the occasional lorazepam to hide it even better. We are professionals and professionals are nice people. We bury our anger. We block it and we hide it.
What we do best with our anger is lie about it. Unfortunately for our spouses, we lie so well that we often take our misery out on the people we love (or are supposed to love) the most. We do everything but listen to our anger.
Listen to your anger. That is what it is meant for. Anger is not a polite request. Anger is a scream. It is a command. It is a slam of the fists down on the table demanding your attention. Anger has a right to be heard. Anger should be appreciated and valued. Anger must be listened to if you are to regain your professional balance and power. Why? Because anger is an atlas or a chart or a diagram back to living the ideals you had when you were in pharmacy school.
Anger reminds you of your boundaries and limits, the areas where no one was allowed to tread without your permission. If you can set up the periphery of your professionalism in just one area, more will follow. If you list only ten serious drugs that you will counsel on no matter what, your list will be twenty in little time. If you let the store manager know in writing that his touching you at anytime, in any manner, is unwanted, you will regain enormous power and control over your own life on the job. You can gain power simply by refusing to get wet underpants because you neglect going to the bathroom when you have to go. Documenting anything at work that makes you uncomfortable will give you surprising control.
Anger shows us where we want to go. We may not know exactly what we do want on the job, but our anger tells us, without ambiguity, what we sure as hell do not want. That is a really good place to start because anger shows us where we have been and sets us on the course of recovery. Anger is not a sign of disease. It is a sign of health. If you no longer get angry at being institutionalized, stop, take a deep breath, and examine how you will find your way back. I contend that you will find that the first sign of recovering your health, well-being and pride will be anger. Welcome it. Savor it.
It is not very healthy to act out from anger. That is childish and not productive. I quit a job once out of anger. It was a good job. I was well respected in the community. The problem was that the store manager tried to micro-manage my department. I have never bent to management from a non-pharmacist. This guy was out to bring me to my knees. I fell right into the trap. I became so angry that I brought the problem to a head with some stupid brinksmanship. My district manager did not back me as fully as I wanted, so I quit. My one-way commute for that job was less than ten minutes. The one-way commute for the next job was ninety minutes. I was like a teenager having a meltdown. I turned my anger into indignation without any examination of the circumstances. I was an idiot.
Anger is there to be acted upon. Anger points the direction. Anger is the wind for our sails as our sailing ship tacks as we move on the appropriate bearing where our anger guides us. Had I used my head and had the presence to translate what the anger was telling me, I would have made better choices.
“Damn it, I could run a better pharmacy than that!” This anger says that you want to have your own pharmacy, you just need to put all of the pieces together.
“I can’t believe it. Mildred told me that she was going to demand a transfer to the suburbs and she got it. That’s what I wanted.” This anger says: Stop keeping your goals and dreams hidden. You need to express your wants and believe that you deserve your dreams to come true.
“That was my idea. This is unbelievable. I mentioned it only once and that son of a bitch took my plan and put it to work. He gets all of the credit and I get none.” This anger says that it is time to take yourself seriously and show yourself some respect. Your ideas are good enough to do something about.
Anger is the tornado that blows away all of the restrictions and hesitations and lack of self confidence of our old lives. Anger is a valuable instrument to be used productively. Anger cannot be the master, only the servant. Anger is a deep well of power, if used properly.
Apathy, laziness, misery and gloom are the enemies. Anger is not a good buddy, but anger is a friend. Not a mild-mannered friend, but a very loyal and steadfast friend. Anger will always remind us when we have been cheated or cheated upon. It will always tell us when we have been deceived or when we have betrayed ourselves. Anger will tell us that it is time, finally, to act in our own best interests. Anger is not the action itself. It is the action’s invitation.
Watch out what you ask for
You might just get what you want and then what are you going to do? It can be scary, having dreams come true. That means that you have to take responsibility for your own life. This is not comfortable, but you will feel the power. You can no longer blame the big bad store manager wolf for your lack of integrity. You can’t say that the company made you do it. You are back in your own hands, a professional making choices every day that benefit you and your patients. This is a good thing, don’t you think?
When you take responsibility, things happen that you cannot fully understand why. You are the pharmacy manager and you tell the Jailer that you are going to do what is best for your department in all business and professional matters. You tell him that you are the pharmacist, that you know best and you request that he mind his own business. You take all appropriate actions, the department thrives in all areas. Your pharmacy is suddenly the most professional and most profitable in the company and everyone wants to know why. What did you do?
Taking responsibility is not easy. You can feel very much alone. It takes courage to do the right thing. This is a difficult and slippery slope. A pharmacist who has little self-respect and has been stripped of dignity may need assistance in making the choices that are best for both their professional and personal lives. I honestly do not think that you should rush. You have been institutionalized for years. There is no hurry. You don’t want to make a rash move as I did. You probably should not try to do this alone. Talk to someone you trust before you take any significant action.
I merely took the energy it takes to pout and wrote some blues
Duke Ellington
There is a way back. Want to talk about it?

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FEAR Runs The Ship in Pharmacy

Jp Enlarged
A little imagination and you will get it.

A little imagination and you will get it.

I have known Pharmacists who could do what they pleased because the company was afraid of them. Really? Without a doubt. You know some also. Take a good look. I was a scary pharmacist for years. For the years 1984 to 1996 I lived in fear. FEAR motivated me.
I was afraid my good PIC thing, very good thing, with a 10 minute one way commute would change to a bad thing with a 60 minute one way drive. I was afraid that I would just lose my job. I had a family of four. With a minor child and a teenager and a lazy wife.
I was afraid that my 2 day a week 3rd RPh would be taken way. It eventually happened. That brought back 13 hour shifts. That was the end of lunch periods. I was in the habit of going to the deli in SAFEWAY and eating good food, reading the paper. You can actually relax in a half hour. The 3 minute walk down the mall was good, really good. When they took away our relief, we were back to hastily gobbled bad food.

More about fear later. This is about making demands and righting our dangerously listing ship.

“Power Concedes

Frederick Douglass

The Kxxxx Hxxxx Demand
The demand is that the operation of the Drive Through window be managed by the pharmacist on duty. K H closed the Drive Through on a day when his most competent technician was absent. He was working alone with one inexperienced technician and no cashier. They were filling prescriptions at a rate of one every 80 seconds. The two of them were expected to do everything, including manning the register and the Drive Through. Mister Hoots perceived that the situation was perilous and that patients were being put in danger. He was not able to consistently counsel appropriately. K closed the Drive Through. He was fired by CVS.
The pharmacist on duty will always be authorized to close the Drive Through when she perceives that patient care is compromised, pharmaceutical care is not being delivered or a frenetic pace is endangering the patient.
I do not know if any of the 50 states in our country authorizes a non-pharmacists to have authority in the pharmacy. As far as I know, every state recognizes that the legal Pharmacist in Charge is the person with 100% power in the pharmacy. When the Pharmacist in Charge is absent, the Pharmacist on Duty is the person with all of the clout. The non-pharmacist store manager has absolutely no say-so in the pharmacy. Check the state laws where you work. Post them prominently. Document any and all incidences when a non-pharmacist usurps the pharmacist’s authority. We must demand that the drug store companies make it very clear that the pharmacist is the last call.
In the K H vs. CVS case in North Carolina, is interesting to see how the Board of Pharmacy ruled. The non-pharmacist store manager clearly usurped Kelly’s authority when he came into the pharmacy and reopened the drive through. He can’t do that. Legally, Kelly holds all of the cards. The board copped out and scolded both K H and CVS.
We demand that drug store companies make unambiguous statements that non-pharmacists have no power in the pharmacy.
I am quite sure that there are plenty more demands that I can list here, but if we get the ones I have cataloged here, life at work would take a quantum leap from the soul-crushing working conditions to a sane, safe and satisfactory work experience with no stops in between. I have only one word if the companies ignore us. UNION. Yeah sure, Plagakis.

This is our profession. We have allowed non-pharmacists to mold our jobs. That has to stop. Pharmacists must maintain oversight over the MBA Masters of the Universe and even the CEO.
The free pass that we have given them just because of their positions has to stop. If the idea is stupid, we need to tell them. If the idea is dangerous, we need to shake them and tell them. If the idea is going to fail and result in a multi-million dollar loss,

    we need to grab them by the collar and leave some blood and teeth on the floor.
    Start being the Hunter instead of the Hunted.
    They are afraid of You

They are idiots for not treating you well and you are idiots for taking abuse when you hold all of the trump cards. They do not even have a business without you. With no pharmacy, Rite-Aid is a poor example of a variety store. What about that power do you not understand?
My last words today:
Practice Pharmacy In Compliance With All Laws and Regulations

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HELLO, MY FRIENDS. 12-20-14. From Jim Plagakis

Jp Enlarged


Twenty years after Durham-Humphrey. There was no Big Pharma yet.  If they was a need for a drug, they made it. Even if it was cheap.

Twenty years after Durham-Humphrey. There was no Big Pharma yet. If they was a need for a drug, they made it. Even if it was cheap.

I have written this blog since the summer of 2005. Until recently, I wrote JP at Large for Drug Topics. The editor fired me a few weeks ago. She essentially said that I was out-of-touch since I no longer put my feet on the floor of a pharmacy, that I am retired and that what I write is no longer relevant.

I am insulted big time. She didn’t respect me enough to call. She fired me in an e-mail.

Oh, by the way, if I was physically able to put me feet on the floor of a pharmacy, my Walgreens Pharmacy District Manager in Texas all but guaranteed a job for me in Sarasota. Retired? Not really. An older guy with an active case of the “late effects of polio”? Yes. It isn’t pretty. After 4 months of forced to be off my foot, plenty of atrophy. Drop foot. Toes of right foot point inward. I think that I can recover, with extensive physical therapy. THAT’S THE BACK STORY.

What I wrote here and in JP at Large was an invitation for you to observe and make your own conclusions. My writing simple, declarative sentences would cheat you. It would be force-feeding a goose.

What I wanted was for you to live and think, “Is this really what JP writes about?”

You get home after a 14 hour 10:00 o’clock. Your spouse has a plate of food on the kitchen table.

You look at it, frown, pick it up and fling it into the sink.
“Meatloaf? I am sick of meatloaf. When will you learn?”
Your spouse is stricken. A dagger could not have hurt worse.
You grab two beers and a bag of chips and escape into the study.
You turn on the game. Your team is losing. Your stomach burns. You are consumed by guilt. What is wrong with you? This happens too much. Why does she take it? Great gulps of plaque-forming cortisol are dumped into your veins. (I know about cortisol you guys. My triple CABG was getting ready for 2014 with my first two wives)
I know that most of you are not the loose cannon depicted here, but plenty of you shook your head when you read this. “How could Plagakis know what an idiot I am?”

Had I wrote that for Drug Topics, it would have been spiked. The prevailing thinking in Cleveland seems to remain, “It can’t be that bad.”

Full disclosure, at a time of horrendous medical co-pays, losing the $400.00 a month that JP at Large EARNED is HUGE.

Buy my books..please.

I think I will take some time to redesign www,


Forever young and relevant.


VASCULAR SURGERY FOR JP. Tomorrow (12/4/14) JP at Large FIRED from Drug Topics 12/1/14

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The wound on my foot is stubborn. It is on the side of the right foot, just below the little toe. The DPM/Surgeon
did cultures after the first debriding. Cultures showed four aerobic bacteria and three anaerobic bacteria. INCLUDING Gangrene.
Antibiotics and a good surgeon working on the wound once a week and the wound is clean.

This is an ugly wound. A crater. With a Niagara of nice fresh blood, I should heal quickly. I will need Physical Therapy.
Some crazy atrophy from being essentially bed-bound since First week of October. I will be okay.


Now, the big story. JP at Large first appeared in Drug Topics in January, 1989. 250 columns. A total of around 200,000 words.

JP’s First book written solely for you.
This is my first BOOK written for Pharmacists


How does she know? She has no first-hand knowledge about what it is like doing a 14 hour shift at CVS. It might help if she
shadowed a chain pharmacist for a shift. THis person had to be dragged into the world of modern pharmacy. She often said, “It can’t be that bad”.

She insulted me. 25 years. 250 JP at Large columns. Countless messages from you that JP at Large IS Drug Topics. She fired me by E-mail. Shabby treatment, indeed. She did not get that I wrote FOR YOU.

It was a good ride. I will tell you where I end up.



“PHARMACY TIMES” Does Not Have A Clue. Our Man John, RPH sets them Straight

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I have been told that CVS has ordered 500 of these as pharmacy equipment, for a pilot project.
I have been told that CVS has ordered 500 of these as pharmacy equipment, for a pilot project. Next, will there be METRICS for this?

Good morning,

Below please find my comments regarding an article written by your Associate Editor, Meghan Ross. It is in reference to what I perceive as her trivializing one of the major issues facing our profession today when writing a news piece regarding oxycodone diversion.

Has Ms Ross ever worked under the conditions she describes as “an annoyance”? Has she ever worked in pharmacy at all? And if so, is she the one of the many who look down upon direct patient contact practitioners (ie dispensing community pharmacists) because she now considers herself “above” that portion of the profession having left it?

I am a community pharmacist who has been commended for my approach to that area of the profession. Interns from 3 major universities have claimed that I have “opened their eyes & completely changed their opinions of what community pharmacy can be”. I believe the type of work I do can move us to provider status & secure a future for the profession. But that work is easily undone by one short paragraph by those in publishing or academia who honestly, have no clue. See my comments below:

I won’t comment on this case or the veracity of the claims because I don’t have full information. I WILL comment on the Pharmacy Times author’s statement “to ease the annoyance of standing all day”. Has this author ever had a position like this? In almost two decades in the industry I have worked positions where I was required to stand for the entire length of a 15 hour shift. Often 3 days in a row. Believe me it is more than a mere annoyance. A few years of that and crippling
degenerative injuries of the ankles, knees & spine develop. Varicose veins and blood clots form. Hernias become common. There are reasons why the military and law enforcement do not allow personnel to work a standing post for that many hours. These are conditions that would be considered in violation of the Geneva Convention or called inhumane if suffered by a prisoner. Yet they continue to exist because a) employers will do whatever makes their job easier within what the law allows & b) the self congratulating “experts & pundits” in publications such as this or in professional organizations trivialize it. So instead of our government & profession seeing the danger to public health from fatigue based errors or personal health from these practices we label it as “BS” or “whining”. The result? Our profession never advances because instead of demanding professional conditions we allow ourselves to be treated like skilled labor and factory workers. You want “provider status”? Start acting like a provider, demand more of yourself, your employer & your profession and stop acting like a macho version of a sweat shop laborer claiming to be proud of how long you can sustain yourself standing or not using a restroom.

John R.Ph. From: John


From: Ryan.. Arizona State Univ. Get your Prescriptions from a Vending Machine.

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Ohmigawd. Will it NEVER END. Ryan reported that there is a telephone at the kiosk to call for counseling. Yah,
like college students are gonna take the time. What do you think of this.

Copy & Paste in your browser this link if you want to see the original newspaper article.

Vending machine replaces ASU on-campus pharmacy

By Corina Vanek
November 19, 2014 at 8:43 pm

An ATM-like vending machine dispensing prescription drugs opened Tuesday night on the Tempe campus as a replacement for the recently closed on-campus pharmacy.

The machine is created by a Minnesota-based company called InstyMeds, Christiana Moore, associate director of ASU Health Services, said in an email.

“ASU Health Services in Tempe will provide a new and innovative vending concept called InstyMeds, which will allow students to obtain prescriptions safely,” Moore said.

Moore called the machine a “secure option for students to receive prescriptions.”

Chemical engineering junior Justin Easa said he was not aware of the machine replacing the pharmacy, but he did not think a machine was the best option for dispensing drugs.

He said he thought it could be hard to monitor who was actually receiving the drugs and which drugs were being dispensed.

“I don’t know if there is a way to make it as secure as a pharmacy,” he said.

The machine contains the 50 most commonly prescribed medications to students, Moore said. These medications include antibiotics, asthma treatments, antihistamines, probiotics, anti-nausea medicine, medications used for quitting smoking and vitamins, Moore said.

“Narcotics and controlled substances will not be dispensed,” Moore said.

Students must visit an on-campus Health Services provider to gain access to the machine, Moore said.

Students will be issued a personalized security code after their appointment, and the code is only good for 24 hours, Moore said.

“In order to receive medications from the machine, students must input the security code and their date of birth,” Moore said. “For security purposes, the medication is scanned three times prior to dispensing to ensure precision and accuracy.”

Students can pay for the medicine using their own insurance and can charge the costs to their ASU account using the machine, Moore said.

According to the InstyMeds website, a doctor can electronically enter the prescription information and give the patient a voucher to access the medicine from the machine. It takes about 90 seconds for a prescription to be distributed.

The website says the machine is designed for a first fill of a prescription, meaning if a patient has a prescription he or she needs to refill, the patient would have to go to another pharmacy. The medicines inside are “short-term” type medicines, so patients with chronic health conditions will need to use a pharmacy.

The types of drugs in each machine are tailored to the needs of the environment, but allow quick access for people who need an available medication on site.

According to the website, the machine eliminates the danger of a person receiving the wrong prescription because if a medication is in the wrong place, it will not pass the barcode scan and will not be dispensed.

Moore said a phone attached to the machine will allow students to speak with a pharmacist or billing representative if they have questions about their medications or what they cost, Moore said.

Pharmacists generally advise patients about potential drug interactions, as well as if drugs should be taken with food or drink.

Students may still be feeling the pain of not having an on-campus pharmacy, but Moore said ASU Health Services hopes to make the switch easier with transferring options.

“ASU Health Services is committed to excellence in health care and provides innovative health solutions that meet the needs of ASU students,” Moore said. “After the closure of the pharmacy located on the Tempe campus in September 2014, students now also have the opportunity of receiving e-prescribing services that allow medications to be sent seamlessly to a pharmacy of the student’s choice.”

Reach the reporter at or follow her on Twitter @corinavanek


If it is From PAULA, it is Golden. View it.. Read it.

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They Are All POISONS.  Doesn't CVS Understand That?

THE LINK FROM PAULA. (Copy And Paste to your browser)



A metro family said this dangerous mix-up could have turned out a lot worse.

A SW Oklahoma City pharmacy gave the wrong medication to a man, and after several doses, his wife knew something just wasn’t right.
Curtis Isaacs, 51, went to the doctor for a checkup Friday just to be on the safe side. Well, he was told he needed to head to the emergency room as soon as possible!

Isaacs, according to his wife Teresa, does not have a history of health issues.

“Never ever. Doesn’t drink a beer, doesn’t do anything. He thought he was taking something after having three wisdom teeth pulled,” said Teresa Isaacs.

He got those teeth pulled on Nov. 5 and was prescribed an antibiotic along with ibuprofen
In fact, the labeling on the bag said just that.

“He took 300 milligrams at one time, more than once of this medicine thinking it was ibuprofen,” said Isaacs.

Teresa said he took it for at least two days and she noticed he started acting extremely sick, almost as if he was drunk after each dose.

“It’s a scary thought,” said Isaacs. “We don’t know what kind of damage it could have done to him.”

She’s the one who realized Curtis was taking someone else’s anti-depression medication. She said she immediately called the CVS Pharmacy on the corner of 44th Street and Western Avenue to let them know about the mix up.

“It’s very serious, you know. Mistakes are made in life, but as a pharmacist, you can’t make a mistake because people’s lives are in your hands every day,” said Isaacs.
Mike DeAngelis, a corporate Public Relations Dir. for CVS Pharmacy released the below statement:

“The health and safety of our customers is our number one priority and we sincerely apologize to Mr. Isaacs. We have comprehensive policies and procedures in place to ensure prescription safety and errors are a very rare occurrence. If one does happen we fully investigate the incident to determine what happened in order to prevent it from occurring again.
We are committed to continually improving our processes to help ensure that prescriptions are dispensed safely and accurately.”

    That was little comfort to Teresa as her husband sat in the hospital with extremely high blood pressure and heart palpitations.
    “I don’t call that a mistake, I call that negligence,” said Isaacs.

Teresa said CVS corporate has offered to pay for medical expenses.


It is the Dawning of the Age of Independents

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The Home of a Druggist. 1937. I like it.
Those of you who have followed my developing thoughts on the viability and profitability of owning your own store know that I believe that it is a terrific opportunity RIGHT NOW.

We know that the chains, Big Box, grocery stores and others run by metrics DO NOT give personal attention. Consumers want service, a friendly pharmacist and the confidence that their Rxs do not have errors. An independent can give them what they want. That could be you.

If you have read the comments on this site, you know that Broncofan7 has been a big time winner in his store in Texas.

This was recently his comment.

    Select comment
    353 approved

    broncofan7@ymail.com76.185.18.53 Submitted on 2014/11/02 at 9:18 am

    I’m looking for a PIC at my store in Texas (if you happen to be licensed in TX)..or if there is any TX RPh. out there looking to work M-F only with all holidays off.

Think about this. Would a marginal store need a PIC other than the owner? Broncofan7′s pharmacy has to be a winner.



If This Doesn’t Pucker Up Your Butt, Nothing Will

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Take a good look. Well worth your time.

Copy the link and paste it into your browswer. You can see the entire spot.

If this kind of exposure and negative publicity continues regularly, we will win. The Pharmacy Alliance has been riding this horse for a long time now. DOES TPA get any credit? Jay Pee
Thank you, Paula, for passing this on. The stuff you send is always valuable. You are not a whiner. You are a soldier.

Metrics and the too smart MBA Masters of the Universe

The following us the entire transcript of the TV show.

KHOU Television, HOUSTON — When it comes to what happens behind the pharmacy counter, some industry insiders say the public has no clue.

“Wrong patient names, wrong drug, wrong directions,” said Texas pharmacist Bill Bradshaw, remembering the errors like a litany.

“It’s scary,” he said.

“I have gone home and said a prayer asking God to please not let me have made any mistakes that could have caused harm to a patient.”

The reason for his anxiety is something that the I-Team heard from pharmacists and pharmacy trade groups from across the state and the nation: That they’re being pressured to fill prescriptions faster, to do more with less, and with less qualified support staff.

It’s a change in the business that most of them say started happening primarily at big-chain pharmacies about ten years ago. And now they worry, it’s reached a breaking point.

“I kept saying ‘we’re going to hurt a child or hurt a senior citizen,’” said Joe Zorek, who worked as a Pharmacist In Charge at a CVS drug store.

According to Zorek, speed often competed with patient safety. He said at his store, they were timed on just how fast they filled prescriptions. If he was too slow, his computer would give him a warning in red.

The result?

“You would do whatever you had to do to push those scripts through,” Zorek said.

In addition, Zorek said his area manager would track his performance through reports called “metrics.” Those would measure whether he made prescription-filling time limits and if his store met many other quotas such as the amount of flu-shots and immunizations given.

“He would call daily to know what our numbers were,” Zorek said.

“And that we would have to get them up,” he added.

But Zorek claims there was another way that management would boost the store’s profitability. In a wrongful termination lawsuit that he filed against CVS/Pharmacy in federal court, Zorek argued that often the pharmacy’s manpower would be cut, in particular their support staff, the “pharmacy techs.”

The result, Zorek claims, was an increased workload that led to a marked increase in prescription dispensing errors and a possible threat to his patients.

And the I-Team found that when drug errors happen, the risk of harm is real.

“It’s a pain I’ve never had before”, said Dana Flink of an episode he had last November.

“I felt like my brain and my spine were actually expanding inside my head.”

Flink is describing how he felt after taking what he thought was a common antibiotic. The prescription medication had been filled at a CVS in Spring.

He eventually discovered that what he had actually been given was something he didn’t need–a medication for diabetes, a condition he didn’t have.

“I was stunned,” he said. “I mean I couldn’t believe I was taking something that was completely wrong.”

CVS says it has apologized to Flink for the error. (See statement below.)

But what happened is no shock to pharmacy experts like Professor Daniel Hussar of the University of Sciences in Philadelphia.

“The general public does not know what’s going on”, Hussar said.

Hussar has studied the science and business of pharmacy for decades.

He said that increased business competition and the desire to please stockholders has made some big-business pharmacies lose sight of their primary task, helping patients.

Instead, Hussar said the focus is numbers, profit, and money–and how to get more of it.

“For major corporations, in my opinion, errors have become a cost of doing business,” Hussar said.

But it’s a cost that concerns groups like the National Association of Boards of Pharmacy. In 2013, pointing to research and polls showing that the use of metrics tend to increase errors, the NABP asked states to restrict, regulate or prohibit their use.

So what about Texas?

The I-Team did an interview with Gay Dodson, the executive director of the Texas State Board of Pharmacy.

During that talk, she made a surprising statement.

Dodson: “I don’t believe any company in Texas is using metrics to say a pharmacist has to fill so many scripts.”

I-Team: “You’re telling me that not a single Walgreens, not a single CVS in this state is putting pressure…”

Dodson: “We haven’t seen it. We have not seen it. That it all I can go with.”

I-Team: “With due respect, a lot of organizations would say you’re blind.”

Dodson: “Uh, I understand.”

As for Walgreens and CVS, both declined an on-camera interview but sent us written statements.

Director of public relations Michael Deangelis of CVS/pharmacy told us:

“The health and safety of our customers is our number one priority and we have comprehensive policies and procedures in place to ensure prescription safety. We apologized to Mr. Flink for dispensing the incorrect medication to him last year. Prescription errors are a very rare occurrence, but if one does happen we fully investigate the incident to determine what happened in order to prevent it from occurring again.

As a health care company that strives to help people on their path to better health, we seek out new technology and innovations to enhance safety, we engage with industry experts for independent evaluations of our systems, and we are committed to continually improving our processes to help ensure that prescriptions are dispensed safely and accurately.

Pharmacists are the most accessible health care professionals in the community, and the services we provide in our pharmacies such as medication adherence outreach and immunizations are designed to help our patients stay healthy while lowering their overall health costs.

Like other companies, CVS/pharmacy also measures the quality and effectiveness of the services we provide in our pharmacies to ensure we are meeting our customers’ expectations. Our systems are designed to help our pharmacists manage and prioritize their work to best serve their patients.”

And Jim Cohn of Walgreen’s Media Relations wrote to us that:

“Our pharmacists today are able to provide a range of health care services that enable them to practice at the top of their licensure and training, while playing a more important role than ever before within the U.S. healthcare system. Quality, safety and accuracy are our top priorities and our quality team continuously tracks these criteria at every touch point within the pharmacy. We never ask our pharmacists to work beyond what they believe is safe, in their professional judgment. Walgreens has always been among the industry leaders for pharmacist pay and benefits, and a long-standing employer of choice in the industry.”



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Wal-Mart sucks hatred from the clouds

Another Wal-mart Pharmacist. I had just over 20 years and was fired for “forging a prescription”. I filled my own call in by a doctor like I had in my many years and suddenly I get fired. I was sole support of my family and now have my pharmacy license suspended since my jerk of a Health and Wellness Manager reported me to the Board of Pharmacy.

Jay Pee. Wal-Mart has a no forghiveness policy. There are too many RPhs out there. Be careful. All they want for their store is a warm body with a license.

Wal-Mart is NOT alone. Go to work for an independent.

It’s more challenging to be a retail pharmacist today than ever before. The health care system makes endless demands on you. You are being pulled in a dozen directions, all at once. Your workload is heavier and the expectations of you are higher. Credentialing and CE requirements remain arduous, yet you operate in a persistently growing “McPharmacy” environment. With this book, you’ll discover humor in all those things you now find exasperating: • Managed care • Corporate “suits” • Impatient patients • Doctors • Lawyers • And much more You deserve to get off the retail pharmacy hamster wheel! And now you can, because Dispense-sation is your prescription to get off your feet, take a break and have a laugh!

DISPENSE-SATION by Christopher Holl Find at Amazon.


Pay $90 Million in Fines. $10 Million Profit

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Published on Drug Topics (

CVS’ PBM settles Medicaid reimbursement fraud charges
Mark Lowery, Content Editor
Publish Date: OCT 02,2014

CVS Health’s pharmacy benefits management company will pay $6 million to settle federal charges it failed to reimburse Medicaid for prescription costs also covered by private plans, according to the U.S. Department of Justice.

The government had accused Caremark of improperly processing claims of “dual-eligible” patients. Such were patients whose prescriptions costs were paid to Caremark by both private insurers and Medicaid. Caremark was accused of not reimbursing Medicaid for its overpayments.

Caremark pays to settle Medicaid fraud in 5 states

A former Caremark employee, Donald Well, told the government about the dual payments and will receive $1.02 million plus interest as a whistleblower.

Christine Cramer, CVS spokesperson, said the company denies wrongdoing and settled to avoid protracted litigation. She said the allegations did not involve CVS’ pharmacy or Medicare Part D businesses.

According to the Justice Department, Caremark improperly deducted co-payments or other money when calculating payments on some claims. That caused Medicaid to cover prescription drug costs for dual-eligible patients that should have been paid by private health plans.


1 Comment


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THREE WEEKS AGO, Victoria, JP’s wife and advocate, was making funeral arrangements for your best buddy Jay Pee. I was in a coma. Too many experts were telling her that it was hopeless.
Amiodarone Encephalopathy. The 0ffending agent was DCed and I woke up in awhile. I believe 3 days, but how do I know?
I said,”Hello, Victoria.” Her eyes opened wide and she smiled and wept at the same time. For days, V held the flame of my life in her hand and she would not let anyone put me down. She cornered the personal care technician. “Clean him up now. That diaper is 3 days old. That poop is like a rock. “Don’t argue. Just do it.” Unless V was there to feed me, my food trays came and left untouched. Finally, V caught on and you can pity the nurses who believed it a waste of time to feed the old dead guy in a coma. V confronted the nurses. I was fed until I woke up.
Here is my year of 2014. It is amazing that I am alive. I have lost a lot of weight. I am eating and eating and eating.
January the stroke, affecting my left side lightly. 12 weeks of physical therapy.
Then, I fell. Then I went blind in my right eye.
I never suspected heart disease, but, on retrospect, my brain was not being nourished. Not enough oxygen. I was off the wall in my thinking and talking. I really believed that there were people in my living room conspiring to harm me.
I fell again. I hit my bedside cabinet really hard. our bed is the original memory foam and high from the floor. The fall damaged my left shoulder (Rotator cuff they tell me). I do not remember this, but V tells me that getting me back to bed took the rest of the night. The EMTs again, with attitude. They Did not want to take me to the hospital ER. Their argument.. No angina. No heart attack. So, I lied. Yes, I had chest pain
and left arm discomfort. Honestly, not pain one, but I DID have a heart attack.
They put me in a bed at the Cardiac ICU. Difficult. Noisy, hard to sleep. The woman next door kept calling for “Mother” and “Father”. My male nurse violated HIPAA rules. “An addict,” he told me. “Withdrawal and a heart attack”.
Finally, they did tests and decided it was time for the heart cath.
When I woke up, V said, “You have to do this.” THIS WAS OPEN HEART SURGERY. A TRIPLE BYPASS. I was cogent enough to know that the quality of my life would be shit if I refused the surgery.
V squeezed my hand. “Our life is good, Jimmy. I want you there for a long time.”
I squeezed back and nodded and smiled. The surgeon came over, “I’ll give you time to discuss it and come back.”
V said, “We don’t need time. We are doing it.”
I nodded and gave the surgeon a thumbs up.
“Okay, people, let’s get him prepped.”
after THAT, I know nothing until the coma broke. I believe I went home, but the only evidence is shirt off selfie of me smiling and showing off my ugly black incision. It is pink now and hardly noticeable.
I put up with a bed on the regular Cardiac Unit on the 5th floor. Did a little PT, like walking with a walker. An Occupational Therapist announced that I did not need her. I could dress myself, feed myself, shower, all of it.
I began the quest of getting referred for in-patient rehabilitation. The
Hospitalist began his fight with Humana. Five days later, I was transported to PALMER RANCH REHABILITATION CENTER. A very nice place 5 minutes from my house. Since I had lost weight during the coma, marching orders to the manager of the kitchen, “Fatten him up.” I ate good food and often had seconds. I asked for, and got, food for the middle of the night. The 15 hours between dinner and breakfast was too long for a very skinny Jay Pee. To my room: Mac and cheese, blueberry pie, chicken pot pie, sandwiches. turkey and cheese, ham and cheese, chicken salad on a croissant, milk (white or chocolate). ice cream. They always surprised me, but my 2:00 meal was satisfying. When I was discharged, I had gained 4 pounds of the 10 or more I had lost.
I can thank my therapists for my being at home and at about 40% I saw 3 therapists, an hour each, every day. Palmer Ranch has 15 or so therapists on staff. I saw 7 of them. Occupational, Speech & Physical. The PT girls worked me over. They knew that my goal was to climb 15 stairs unaided, competently and safely. There are 15 stairs from our car port level to our front door. Sally (first team PT) took me to the adjoining 3 store assisted living building. They have grand staircase. 15 steps up to the first landing. You know what I did every day.
So, my friends. This is a rambling post, but I wanted you to know that I am alive and looking for a full recovery.
My legs are really skinny. Add the Post Polio Syndrome and I got some weak spindles. Upper body. My waist line XS fat is gone. My arms are ok. My left shoulder is a problem. What the hell.. It’s what I got.
I am lonely. In bed due to a lesion on my foot that I will go to the wound care center at Doctors Hospital, Hopefully
After that, I will be more mobile. I can walk outside. I have a 4 wheel walker. I can walk to the Pavilion pool, the library, the Sunday night movie, The Tuesday morning “Coffee”. Coffee, tea, pastries from an Amish bakery. A lecture. Some good, some not so. Health is a function of participation.
Still, I am lonely.
CALL MY CELL- 941-281-9096
I gotta take a nap. I am exhausted.
Your JP is not dead.


WHAT THE? Enough, Please! Or.. does CVS have undercover……………

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I woke up Sunday morning and discovered that I AM FUNCTIONALLY BLIND in my right eye. Two days later, doctors involved, quite a few W T F? thoughts and I am still right eye blind. The ophthalmologist ASSURED ME THAT FORTHWITH I CAN BE CALLED “One Eye Jimmy.” Going to bed. I am really tired. This kind of stuff drains you quickly.


Walgreens To Move Corporate Headquarters To Switzerlnd?

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Julia & Julianne. Will you put this story front and center in the magazine?
All of pharmacy's problems would be solved if more RPhs did THIS!

Julia Talsma & Julianne Stein are the Editors at Drug Topics.
Walgreens will move its citizenship to Switzerland. Well, perhaps. I believe that that will leave an Xtra $80 billion a year in WAG’s pocket. I do not know if this will happen or if it has already happened.

WAG benefits from all kinds of govt. programs. Medicare-D, Medicaid included. Walgreens was born here and grew here. WAG has benefitted greatly from being allowed to grow under the protections of the United States. Walgreens headquarters are now (and always have been) in Illinois. Dick Durbin is a U.S. Senator from Illinois. When WAG stood up to ExpressScripts, Durbin was unapologetically a flag waving homer. He sought out spots on National talk shows such as TODAY and Good Morning America. WAG was good. Express was bad. That is what you want your Senator to do.

Recently, very recently, Durbin asked, Is the Corner of Happy and Healthy somewhere in the
Swiss Alps?”

Walgreens has the responsibility to be a good corporate citizen of the U.S.A. The Executives and the Board of Directors apparently think it is ethical to move the filing
cabinets and furniture to Switzerland to avoid taxes. Period.

Well, perhaps Wasson’s wife wants to live there for the vibrant cocktail scene. Terrific private schools for kids. Bad Ragaz is better than Zermatt. No skiing, just great family friendly hot springs. A bit like Harrison Hot Springs in the Fraser River Valley in British Columbia. This will make it up to Greg Wasson (WAG CEO) for those Houston years. The drive to the Hot Springs at Big Bend is huge and the Texas amenities are not up to the Swiss. At least, that is what I think.

That is tongue-in-cheek. Well, some of it. Just the idea that a successful American drug store company can do this rattles my sense of good order. They can do anything they
want with the VARIETY STORE, but not the pharmacy part. The people of the United States grant WAG licenses to conduct the pharmacy business. There is no integrity in using our licensure system, operating with protection from the police and fire departments. Using the Paid-By-Americans infrastructure and then taking the profits to

I will Bcc this to my Pharmacy District Manager in Texas. We will see if he has an opinion. I do believe that the WAG culture will not punish him for expressing his ideas on this. We shall seHey, to all of you JAY PEE Watchers. I just sent this to Julia Talsma & Julianne Stein. They are the engines (editors) that make Drug Topics go. Of course, I want the two Jays to go with this story. What are your thoughts?


Pharmacists have LEGAL Obligation to WARN.

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The jury in the case Cynthia Robinson v. R.J. Reynolds Tobacco Company sided with Robinson, a Pensacola woman, to award her more than $16 million in compensatory damages on Thursday, and awarded $23 billion in punitive damages on Friday.
An Escambia County jury on Friday night returned one of the largest verdicts ever against a tobacco company.
The jury in the case Cynthia Robinson v. R.J. Reynolds Tobacco Company sided with Robinson, a Pensacola woman, to award her more than $16 million in compensatory damages on Thursday and awarded $23 billion in punitive damages on Friday.
“I think the jury wanted to make a difference,” trial attorney Willie Gary said. “All the cards were put on the table to show how the tobacco industry lied and failed to disclose information that could have saved lives, and that’s what the jury ruled on in this case.”







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WALGREENS NEW ‘PHARMACIST OUT FRONT’ MODEL IS GOING TO CRASH. MANY OF YOU HAVE EXPRESSED DOUBTS THAT IT CAN WORK WELL FOR THE PATIENT, THE PHARMACIST, THE TECHNICIAN OR FOR WAG. I liked it initially, then set it aside and now agree that our industry (and the way our profession provides product) is not ready for “WELL EXPERIENCE” it is as if a non-pharmacist MBA bean-counter MASTER OF THE UNIVERSE took a real good pharmacist paradigm for counseling and came up with “WELL EXPERIENCE”. Pharmacy law will not support this.

Walgreens WELL EXPERIENCE model
This is from Journal APhA.

As pharmacies rapidly expand their health care services, America’s largest drug chain, Walgreens, is
beginning to implement a radical change to its pharmacies by removing pharmacists from their traditional
work area and placing them at a desk “out in front” of the counter. The stated purpose of the model,
branded “Well Experience,” is to make pharmacists more accessible to patients and broaden the focus of
the pharmacy by expanding services Walgreens can offer in its drug stores, such as vaccinations and
acute and primary care. Today, the company has pharmacies with out-in-front desks in more than 20
states and has said it hopes to expand the model to every state in the country.
Pharmacy boards in several states have expressed concerns that, by relocating the pharmacist and changing the way
pharmacists supervise the filling of prescriptions, the Well Experience model increases risks to the safe practice of
pharmacy. To understand these issues, Change to Win (CtW) Retail Initiatives investigated Well Experience pharmacies in
Illinois, Indiana and Florida—three of the largest markets for the new model—in June, July and August 2013. Field
researchers made 100 visits to 50 stores and conducted more than 32 hours of observation.
The investigation’s results identify risks this new model poses for medication safety and patient privacy, such as:

• Increased interruptions and distractions for pharmacists. Over the
course of 32 hours of observation, field researchers noted 442 individual
interruptions or distractions to pharmacists, and more than a third of
these were specific to the pharmacist’s new location in the Well
Experience model. Research suggests that interruptions and distractions
are related to increased medication errors.

• Widespread violations of patient privacy. Patient information was left
unattended and visible to anyone in the pharmacy at 80 percent of
stores visited. This included sensitive information about patients’
prescriptions and medical histories, which pharmacies are required
under federal law to protect.

• Insufficient prescription medication security. In 46 percent of
stores visited, prescription medication was left unattended on or near the
pharmacists’ desks, within the reach of customers in the pharmacy
waiting area. Insufficiently secured prescription drugs were frequently
bottled and labeled for patients and included leaflets containing private
health information. Medications left unattended included hydrocodone,
formulations of which are schedule II and III controlled substances and
frequently abused painkillers targeted in pharmacy robberies.
In the Well Experience model the out-in-front pharmacist uses a computer to
check the accuracy of prescriptions by reviewing photos of medications and
labels. The photos are taken by technicians filling prescriptions in a separate area.
The new interruptions and distractions associated with the model’s design could
compromise the attention to detail required for this critical task. Additionally,
medications such as liquids or tablets with small imprints may be difficult for
pharmacists to identify on a computer screen. Removing the pharmacist from the
pharmacy production area also diminishes the amount of direct supervision
pharmacy technicians receive as they prepare medications.

I • BEHIND THE DESK Risks to Public Health, Patient Privacy and Drug Security under Walgreens’ New Pharmacy Model

Flynn EA et al. “Impact of interruptions and distractions on dispensing errors in an ambulatory care pharmacy.” Am J Health Syst Pharm. 1999 Jul 1;56(13):1319-25. Westbrook J et al.
“Association of Interruptions with an Increased Risk and Severity of Medication Administration Errors.” Arch Intern Med. 2010; 170(8):683-690.
In Well Experience pharmacies, the pharmacist sits at a desk out in front of the counter while technicians fill prescriptions in a
seperate area behind the counter, off to the far right (not visible in photo). Pharmacists, who check prescriptions for accuracy by reviewing photos on their computers, often work in busy waiting areas and face new kinds of interruptions specific to the model.

Despite Walgreens’ suggestion that the relocation of the
pharmacist facilitates more counseling, CtW’s investigation
did not find evidence of this. Only 8.2 percent of patients
observed to be picking up prescriptions were observed to
be counseled during field researchers’ visits. Two studies
in chain retail pharmacies using secret shoppers to
measure offers of and completed counseling, not prompted
by shoppers, found that rates of verbal counseling ranged
from 27 to 53 percent, the lower counseling rate CtW
observed raises questions about Well Experience’s
effectiveness at promoting consultations.
In light of this investigation’s findings and objections raised
by several state boards of pharmacy, Walgreens and state
boards across the country should do a systematic
re-evaluation of the Well Experience model. This review
should ensure that Walgreens’ plans to revolutionize the
pharmacy does not interfere with pharmacists’ ability to
perform their core duties of providing safe prescriptions,
counseling patients, protecting customers’ personal
information and keeping medications secure.

Allan EL et al. “Dispensing errors and counseling in community practice.” Am Pharm. 1995;NS35(12):25-33; Flynn EA et al, “Dispensing errors and counseling quality in 100
pharmacies.” J Am Pharm Assoc. 2009; 49:171-80.


CVS Threats, Again. Bitchy Customer ComplainS and You Are TERMINATED

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What? Pharmacists Fired for low scores in
Hi Jim,
Long time reader of yours. I wanted to fwd this email going viral on Facebook. I’d love to see you write a scathing blog about this. This types of emails intimidate rph’s from even exercising prudence in filling Rxs out of fear of getting complained on.
For the record, I’m not a cvs rph (wmt rph). I just hate to see our colleagues subjected to such unprofessional conduct.

This is difficult to read. If anyone out there wants to contribute by writing it clearly. Please do. Send it to me in a comment or e-mail to I will put it up here. so everyone can easily read it.

Well, hell, I cannot get it pasted here. It is a wrinkled E-Mail. It looks like I can type it for you. STARTS NOW.

IpAD 7:38pm 84%

Recently we had a conference call in which all PICs and Store Managers were in attendance. On that call, we talked about resetting expectations around customer service with our store teams. This included offering good old fashioned excellent service, as well as doing so with integrity regarding our customer service survey. Well, today alone, Gloria and I received 4 corporate complaints and
who knows how many called into the office. Our REAL TIME SSS is horrible. We have talked about our teams (EVERYONE!)
taking ownership of our customers and ensuring that complaints are solved at then store level. We also talked about what would happen if folks are rude or so violate our customer service standards- it would result in termination of the individual. All PICs and SMs held huddles to go over these issues with their staff over the last couple of weeks.

Obviously your discussions had little bite with your staff, so Gloria and I have decided to go a little farther with our customer service agenda. Here on out, our district will have a “NO TOLERANCE POLICY” on customer complaints. If a complaint comes in to the Corporate Service Line on any store that suggests our staff was rude or did not meet our service standards, that person will be terminated. Secondly, the Store Manager or PIC who is responsible for training this team member will be held accountable for poor customer service as well. This will involve a coaching and counseling the first incident, a final job warning the second and a termination for the last incident. While Gloria and I hate to lose managers and pharmacists over customer service, you have to find a way to train and hold your staff accountable for service.

I am done with customer complaints. District 6 is now a “No Tolerance Zone” for poor service. If you and your team cannot operate in a no tolerance customer service environment, you need to find other employment. Again, I am done with complaints from our stores, poor service from our associates, and lack luster leadership from our management team. Get this fixed now, or consequences will follow.

Thank you, Jay

P.S. If you read this note and then not doing anything or hafway doing anything about it is your plan, think again. If I get a complaint from your store I plan to talk with your team and ask them about the discussions you had. If you did not do your discussions as you should it will be readily seen—from the complaints we are seeing this already seems to be the case.

Jay Barefoot
CVS Corporation District Manager, Raleigh District
3500 Wake Forest Road
Raleigh, N.C. 27609

COMMENTS From RPh Readers

From: Goose.
This is the scenario that I see here. This DM’s Regional Manager probably is leaning on Mr. Jay to increase his district Triple S score, likely some of the lowest in the Region. Jay likely doesn’t have a clue hoe to do this in a reasonable manner, so he goes straight to the book. i.e. low SSS scores= poor customer service and many complaints.
Jay, the wonder kid, has had his flex schedule cut again and he cannot make the connection between less people in pharmacy+ same or increased volume=poor customer service.
Jay cannot also see that with this shotgun approach to his problem, he will eliminate the good with the so-called bad, therefore compounding his problem.
Jay has no one to turn to for help as his fellow DMs, sensing he is on the way out, are distancing themselves from him and he has lost all support at the store level, even the tattletales and snitches can lose their jobs at this point.
Jay is looking at being demoted and returning to the environment he hates, that is if he is a pharmacist (many CVS DMs are), otherwise he’s gone.
Seen this before at CVS and you that work there will see it again.
It has been more than 7 years since I worked in a CVS store and almost 9 since I was an Emerging Leader (PS or DM candidate) and nothing has changed. This company still uses highly suspect Triple S scores to rate it’s PICs, PSs and DMs and these scores are gamed all the time with full support of management. That’s what Jay was talking about when he mentioned intregrity regarded the SSS scores.
If he takes the high road here and uses actual surveys called in by real customers, he’s in the minority, at least in the atmosphere at CVS I’m used to.
He also will soon be unemployed.
See what bullshit this all is? That’s chain pharmacy now. Bullshit administered by the bottom of the corporate food chain assholes.
It has been more than 7 years since I worked in a CVS store and almost 9 since I was an Emerging Leader (PS or DM candidate) and nothing has changed. This company still uses highly suspect Triple S scores to rate it’s PICs, PSs and DMs and these scores are gamed all the time with full support of management. That’s what Jay was talking about when he mentioned intregrity regarded the SSS scores.
If he takes the high road here and uses actual surveys called in by real customers, he’s in the minority, at least in the atmosphere at CVS I’m used to.
He also will soon be unemployed.
See what bullshit this all is? That’s chain pharmacy now, bullshit administered by the bottom of the corporate food chain assholes.
Jay, per his LinkedIn profile is a 1990 UNC grad, BS in Pharmacy. He has been with CVS since 2004, no mention of what he did from 1990-2004.
Sounds like the usual CVS hack.

From: BC MiGal
Goose, no one makes the connection between one person expected to do the work of four and low “My Customer” scores except the pharmacy staff. Tech hours were cut Monday and again on Tuesday. There is not enough time to check a prescription properly let alone make repeated calls to doctors and customers.
Mr Barefoot should update his Linkedin profile. In this day of instant dissemination and the potential of any communication to “go viral”, he may soon be a free agent.
I am unable to be sympathetic to “Unhappy” since I work every Saturday. I would love to have every other weekend off. On the other hand, I agree that the floater pool has become very sparse. Most pharmacists have had their hours cut to 32-34 hours per week and/or 5 to 6 hr shifts yet the scheduler begs for coverage every single week. Most stores have zero overlap and tech hours have been reduced once again just yesterday. Seems speed = customer service. This must be all they teach the new grads. We had one newbie calling the MD for strength on Macrobid. I heard another tell a pt that Pataday was for intraocular pressure. Another did not know what Lariam is. But, what the heck, at least they can verify an Rx in 30 seconds.
I failed to mention that they have no clue what a PDMP is (let alone how to use it). Nor do they have any idea how to fill a Medicare Part B prescription to comply with CMS regulations. They don’t read the “notes” on the pt files i.e.. who wants certain manufacturers or who is “never give me generic”. Instead, these issues have to be resolved at the register at the busiest time of the day when only a pharmacist and one tech/cashier are on duty. BTW, these folks are now the PICs. And the DM wonders why our scores are low. Lord, deliver me!

From: Unhappy Pharmacist
CVS is a bully!!! They are now forcing extra hours on pharmacists! Many of us work every 3rd weekend, well all of a sudden we HAVE to work every other weekend! They claim they don’t have enough floaters to fill the empty weekends!!
HMMMMMMMM!! What happened to the over abundance of pharmacists????
I take a break whenever I can! It is by no means a lunch break, but more a mental health break! I have to walk away for 10 mins. every once in a while or I will explode! I am still in building & available, but I tell techs it’s time for a “sanity” break & they get it! CVS be damn!
Goose, no one makes the connection between one person expected to do the work of four and low “My Customer” scores except the pharmacy staff. Tech hours were cut Monday and again on Tuesday. There is not enough time to check a prescription properly let alone make repeated calls to doctors and customers.
Mr Barefoot should update his Linkedin profile. In this day of instant dissemination and the potential of any communication to “go viral”, he may soon be a free agent.

From: Boston2AZ
This a dreadful and sad commentary on what our profession has become. I’m glad that I’m at the end and won’t have to put up with it much longer.
As far as the posting from Betty, guess what? I wouldn’t have wanted to see the ties either. If I’m a customer, I’m there to pick up my RX and I don’t care to see religious clothing when I do. I know, I’m a bad guy, but if I were the PIC there, I would have made him change, too. At my hospital, we had a woman who used to put Bible quotes in her business email. They made her stop and I was very grateful. Practice whatever faith you want in private.


Who Gets Terminated Over This?


This Can Make a Difference. Give it some time.

Jp Enlarged

Give us some help.   We CAN win

We Need Anything And Everything You Have On “PRESCRIPTION ERROR STATISTICS”.

Do NOT send in a Comment. Send to

I cannot stress strongly enough how important this is.

Pharmacists generally believe that the risk of dispensing errors is increasing. In one survey, this view was held by 82% of pharmacists.18 A number of reasons for errors are cited by pharmacists in surveys and studies designed to examine the causes of errors, including high prescription volume, distractions, shortage of support personnel, look-alike/sound-alike drug names, inadequate opportunity to counsel, illegible handwriting, and fatigue. It is well known that the volume of prescriptions has been on an upswing.

Most Common Causes of
Errors Cited By Pharmacists
1 Too many telephone calls (62%)
2 Overload/unusually busy day (59%)
3 Too many customers (53%)
4 Lack of concentration (41%)
5 No one available to double-check (41%)
6 Staff shortage (32%)
7 Similar drug names (29%)
8 No time to counsel (29%)
9 Illegible prescription (26%)
10 Misinterpreted prescription (24%)
Many pharmacists intuitively believe that job stress can have a deleterious effect on their performance. One analysis of stress has suggested that it may have four different adverse effects on the cognitive system, which may increase error rates and interfere with error detection.16 Stress may increase the rate of information processing and may lead to exceeding the optimal capacity for processing information. Thinking about stressful events may distract attention away from critical tasks. Stress may lead to alterations in work patterns and shortcuts that may promote inaccurate behavior. Stress may also cause cognitive systems to default to responses that emphasize past habits instead of recently learned adaptive strategies.

In addition to contributing to dispensing errors, an increased workload also increases the likelihood of dispensing a medication that could cause a drug–drug interaction. A survey of pharmacists in 18 metropolitan areas revealed that drug–drug interactions increased with pharmacy or pharmacist workload, increasing by approximately 3% for each additional prescription dispensed per hour.24 The authors attributed this to a reduction in the time available to assess potential interactions.

The relationship between workload and errors is not simple. Some studies have failed to show a correlation between higher workload and higher error rates. One study failed to find an association between the rate of potentially serious errors and increasing work volume in a high-volume, hospital-based, outpatient pharmacy.25 Nevertheless, this study detected variations in the error frequency depending on the time of day, with peak error occurrence noted during the lunch hour and the hour before closing.

In another research report, pharmacists were found to be most vulnerable to making an error when they were less busy, or during a dramatic shift in the number of prescriptions presented (i.e., going from high to low and vice versa).16 This was especially prevalent in high-volume settings. One explanation provided is that when pharmacists are especially busy, their mental faculties are highly engaged, and they are very focused on their tasks. During slower periods, boredom may contribute to lack of attention and more errors. The author emphasized that workload alone could not predict a pharmacist’s performance, although he acknowledged that working at a faster pace increases job-related tension. The author concluded that the quality of a pharmacist’s performance was also determined by personal attributes, such as how the pharmacist perceived and responded to workload conditions. Pharmacists who were more satisfied with their jobs and the quality of their breaks made fewer errors even though they filled more prescriptions per hour than those who were less satisfied. Other sources of stress also contributed to errors. For example, pharmacists who reported high levels of stress in dealing with third-party payers made more errors than those reporting less stress.

Other factors in addition to sheer workload volume have an impact on errors. The Massachusetts Board of Registration in Pharmacy conducted a retrospective pilot study in an attempt to identify causative factors associated with medication errors.26 The study revealed that pharmacists perceive a number of different elements as causative factors for medication errors (TABLE 2)

Now, you are talkin’. Throw the rest of the bull shit excuses in the garbage can in the offices of the MASTERS OF THE UNIVERSE.

THIS NEXT IS A SERIOUS QUESTION. NEW WRITEN PRESCRIPTION FOR Budesonide 3 mg tid. The veteran, competent pharmacist dispensed Risperdal 3m mg qd. Can any of you even imagine, invent how this could happen? The patient is a 92 year old female. I don’t get this one. If the Rx was typed by a technician, what happened? If it was typed by the pharmacist, what happened?

Do you agree that this error would have been discovered and corrected in the counseling process?

The pharmacist says to the patient’s daughter, “This medicine for your mother’s schizophrenia has side effects.”


We have a duty to warn. Legal, professional & ethical duty.

If this woman is harmed, should the pharmacist pay or should his employer be held accountable for the standard of care that ignores he pharmacist’s duty to warn? As fact, counseling is seen as an unnecessary and time consuming event that causes the employer to be at a competitive disadvantage.

Have we allowed our industry to sink this low? Where profit is king and MBA non-pharmacist Masters of the universe ruin our profession?

You can get it back, you guys. Just practice pharmacy and dare them to tell you that, for example, you cannot counsel because it is an unnecessary time-waster.

No Comments

A Cancun Vacation At Forest Labs Corporate Condo. Yeah, sure, Ah Huh.

Jp Enlarged


An old Doctor who could have saved Minnie if he would have known about drugs.

An old Doctor who could have saved Minnie if he would have known about drugs.

I was working when the technician said that there was a pharmaceutical rep who wanted to talk with me. I will always take the time to talk with a detail person. They disrespect us by not coming around enough. When there is a new drug, it is pathetic that we have to learn about it in a magazine ad or scramble when we see the fist prescription. This person had something else in mind.
He shook my hand and then asked an odd question: “Are you the only “older “ pharmacist who works here?”
I answered that if he wanted “older”, I was the one.
Then he blustered, “I want you to cease and desist from telling patients they should use citalopram instead of Lexapro.”
“Oh,” I said, a bit amused. “You do, do you.”
His face was red. “Doctor XXXXX told me that some of his patients have been asking for the change and he has been complying. You have to stop or….”
“..Or what?”
“Lexapro is a superior drug. You have been telling patients that citalopram is just as good.”
“And cheaper. I always advise a cash-paying patient or those with high brand name copays to switch.” I looked at him. “Or what? What are you going to do about it?”
“Listen, buddy. Therapeutically, they are Sam and Bam and you know it. Lexapro is on the market basically as a patent extension. Forest is notorious for this. Read The New York Times. Forst is all over the place and none of it is good.”
“You have to stop.”
“I’m a pharmacist, man. I consider it part of my job to save people money when I can and this is an ideal opportunity. Anti-depressants are flaky therapy for most people diagnosed with moderate depression anyway.”
“What do you mean…flaky?” This guy was ready to come over the counter after the “older” pharmacist. I would welcome that. Forest could be paying me for the rest of my life. I should have said “Yada Yada Yada, Pants on fire.”
“You are frikkin’ brainwashed, man. Lexapro is basically a placebo for the majority of patients. You already know that. Certainly Forest has primed you how to counter reams of articles that say that.”
“Shut up,” he said. He was out of ammunition.
“I will tell you what. I will stop urging patients to switch from Lexapro to citalopram if you will do one thing and it is not a pizza.”
“I’ll get you a pizza, two if you want.”
“I said NOT A PIZZA.”
“What is it then?”
“You send my wife and me to Cancun for a week in January. You pay hotel and air fare and we’ll buy our own food.”
“What are you a wise guy?”
“I’ll go wherever Forest has a corporate beach house.”
“Fuck you,” he spat.
I told him that my name is David Stanley and he wrote it down.

Document Details Plan To Promote Costly Drug

The New York Times

The pharmaceutical industry has developed thousands of medicines that have saved millions of lives, but it has also used its marketing muscle to successfully peddle expensive pills that are no more effective than older drugs sold at a fraction of the cost.
No drug better demonstrates the industry’s salesmanship than Lexapro, an antidepressant sold by Forest Laboratories. And a document quietly made public recently by the Senate’s Special Committee on Aging demonstrates just how Forest managed to turn a medicinal afterthought into a best seller.
The document, ”Lexapro Fiscal 2004 Marketing Plan,” is an outline of the many steps Forest used to make Lexapro a success. Because of concerns from Forest, the Senate committee released only 88 pages of the document, which may have originally run longer than 270 pages. ”Confidential” is stamped on every page.
But those 88 pages make clear that one of the principal means by which Forest hoped to persuade psychiatrists, primary care doctors and other medical specialists to prescribe Lexapro was by finding many ways to put money into doctors’ pockets and food into their mouths.
Frank Murdolo, a Forest spokesman, said the company was ”aware” that its marketing plan was circulating around the Senate.
”We’re aware of it but I can’t give you any other comment on it,” he said.
In February, federal prosecutors in Boston announced a civil lawsuit against Forest claiming that the company illegally marketed both Lexapro and a closely related antidepressant, Celexa, for use in children and paid kickbacks to doctors to induce them to prescribe the medicines to children.
It is illegal to pay doctors to prescribe certain medicines to their patients. It is not illegal to pay doctors to educate their colleagues about a medicine. In recent years, federal prosecutors have accused many drug makers of deliberately crossing that line.
Lexapro was the sixth drug in a class of medicines that includes Prozac, Paxil, Zoloft, Luvox and Celexa. Forest licensed Celexa from Lundbeck of Denmark and introduced the medicine into the United States in 1998. But because Celexa’s patent life was relatively short, the company quickly developed a new version of Celexa by tinkering with the molecule in a way that is standard in the industry. The company called the new medicine Lexapro and introduced it into the United States in 2002.
Forest’s executives and paid consultants have long implied that Lexapro is superior to Celexa and other antidepressants. But the Food and Drug Administration did not require Forest to test this theory in any statistically valid way. The F.D.A. views the two medicines as so interchangeable that the agency recently approved Lexapro’s use in depressed adolescents based in part on the results of a study Forest conducted using Celexa.
Lexapro had $2.3 billion in sales in 2008 even though generic versions of Celexa and every other drug in the class sell for a fraction of Lexapro’s price. For example, a month’s supply of 5-milligram tablets of Lexapro costs $87.99 at, compared to $14.99 for a month’s supply of a generic version of Prozac. Forest has recently been raising the price of Lexapro to make up for a decline in its use.
Many doctors say they believe that Lexapro is the best antidepressant, so they prescribe the drug despite its cost.
It is impossible to unpack all of the reasons for these prescriptions, but some industry critics say one reason could be the money doctors make from Forest. Psychiatrists make more money from drug makers than any other medical specialty, according to analyses of payment data. And Forest gives more money and food to doctors than many of its far larger rivals. Vermont officials found that Forest’s payments to doctors in 2008 were surpassed only by those of Eli Lilly, Pfizer, Novartis and Merck — companies with annual sales that are five to 10 times larger than Forest’s.
Forest’s 2004 plan for marketing Lexapro offers detailed information about how the company planned to direct this money to doctors.
Under ”Rep Promotional Programs,” the document said the company planned to spend $34.7 million to pay 2,000 psychiatrists and primary care doctors to deliver 15,000 marketing lectures to their peers in one year.
”These meetings may be large-scale dinner programs with a slide presentation, small roundtable discussions or one-on-one advocate lunches,” the document states.
Under ”Lunch and Learns,” the company intended to spend $36 million providing lunch to doctors in their offices. ”Providing lunch for a physician creates an extended amount of selling time for representatives,” the document states.
An entire section of the marketing plan, titled ”Continuing Medical Education,” outlines how the company intended to use educational seminars for doctors to teach them about Lexapro. The Senate’s Special Committee on Aging held a hearing in July on whether industry funding of medical education classes leads to tainted talks.
”At our recent hearing we asked the question, ‘Is the line between medical education and marketing blurred?’ ” said Senator Herb Kohl, a Democrat from Wisconsin who is chairman of the committee on aging. His panel was given the Lexapro document by the Senate Finance Committee, which has long been investigating drug maker marketing efforts. ”These documents show that for these companies, there is no line,” Mr. Kohl said.


Procedure vs. Essence. I believe that a battle is being waged at WAG over this.

Jp Enlarged

Walgreens wears the white hats. I have believed that for awhile, but when WAG went mano a mano with Express Scripts, they did more for our industry than any company ever.

The dispute about how the prescription-providing industry will move forward is long over. It ended in a virtual deadlock. However, the issue of money has tilted the game in favor of those who defend the bits and pieces like Wait Times, Metrics and the Low-Profit (18% GP) High-Volume business model.
These are the PROCEDURE people. They say that the PROCEDURE model has proven itself, over and over. The most important thing is putting out lots of product by using the correct PROCEDURE. The PROCEDURE will guarantee that pharmacists do not deviate from a winning plan. If they resist, bully them with the dreaded write-up, below the line performance reviews, with new pharmacists (Robo-dispensers) begging for jobs put them on the list for termination. The PROCEDURE will eventually calm the ESSENCE people. They throw in MTM, BP screenings, Hemoccult programs, immunizations and they say, “See what good boys we are. We are all about professionalism, the ESSENCE. This is what you want, isn’t it?
The PROCEDURE people are not usually pharmacists. They hold powerful positions that did not even exist when pharmacists (ESSENCE) were directing the profession. The PROCEDURE people (Call them Masters of the Universe) crunched numbers and came up with some radical new business strategies, but they have neglected patient care, the ESSENCE of any medical profession. I suppose had they paid attention to the fact that pharmacy is a profession and not just another variety/grocery/big box store department they may have had something that could be worked with. Alas, they don’t get it and they never will. Not a pharmacist, never a pharmacist and unable to think in the retail box that was perfected by a dying breed..the DRUGGIST. I mean totally incapable of getting what DRUGGISTS did to satisfy the patients and make a damn good living with the moderate to high profit (40% GP) Low Volume business model.
Those who still emphasize ESSENCE, argue that the Masters of the Universe are defined by their business school beliefs. The ESSENCE people, like me, reject the idea that a pharmacist is a fucking drone, run by a productivity program at the company’s headquarters. When you turn a profession over to business school Fanatics of the Universe, you have done nothing to advance the PROFESSION. The Masters of the Universe are all about profit. The patient be damned. The major pharmacy retailers (Chains, Groceries, Big Box) have been allowed to subvert the profession and worse, the Boards of Pharmacies have sat back and watched. If your mandate is to protect the public from dangerous pharmacy practices and you do not even wink at violations of counseling laws because the PROEDURE leaves no time, are you a hypocrite or a fucking hypocrite.
The important thing is to get people like that out of power, even if it takes a program designed to OUT the BOPs to the public. The goal is to weaken the PROCEDURE, by nearly any means.
It was all ESSENCE when I was a new pharmacist. My goal was to get a job with Horton and Converse, a real pharmacy chain in Los Angeles. Horton and Converse ran operations that would cause any ESSENCE pharmacist to get over-excited, but the stores were small, with a small OTC out front and a huge pharmacy in the back. Of course, a decent size pharmacy counter with like three typewriters. One counter back was a large compounding area. They were 24 hour operations. This is a 50 year memory. I did not get a job with Horton and Converse because every new pharmacist applied. I was told, “You are new from Ohio. Frankly, we will hire California graduates first.” I went to work for Thrifty Drug Stores up in the San Francisco Bay Area. My first job in a PROCEDURE based store and the PROCEDURE in 1965 would be to die for in 2014.
The events of the last 50 years have vindicated the PROCEDURE people. Population growth. Many more drugs. In 1964, the choices for blood pressure with a diuretic and either hydralazine, reserpine or a combination. Today.. count them and count the patients who are on two or three. Third parties. With only a copay, drugs are cheap. The boomers. Every single thing says to the PROCEDURE folks that their way is the only way. The ESSENCE pharmacist, forever, will say, “Patient care is the most important thing. This is pharmacy we are talking about. Not dispensary. No pharmacy no need for the pharmacist. A dispenser in the PROCEDURE model could be a well-trained high school graduate. I have harped in the past…. The law that you be ready to go to the barricades to make sure it is sacrosanct is the one that says, A PHARMACIST MUST BE PRESENT WHEN A PRESCRIPTION IS SOLD. What do you think will happen if you let that one get away? If you believe that the PROEDURE Masters of the Universe will NOT find a way to get rid of you then you are the guy who believes that the stripper will change her ways after you marry her.
PROCEDURISTS have shown that they can run effective and profitable departments as long as they keep the sword over the head of the pharmacists. “You want the job, you make the metrics sing.” You know what, they lack the mental equipment to govern a profession. They aren’t pharmacists to start. But, once they have the power, they are always going to centralize that power and undermine creative thinking in the stores. Once the PROCEDURISTS got the power, they subverted any review from the pharmacists in the stores. Do you think that $25.00 gift cards for a transfer would be the gold standard promotional tool if pharmacists got to sign off? Not my bet.
The Masters PROCEDURISTS have built a tight-knit cadre of mid-level managers that is resilient. (The also did not exist 30 years ago). The ESSENCE crowd has not a chance in hell unless someone wakes up and points “Look, the emperor has no clothes.” When I read that in the Wall Street Journal of the USA Today with statistics of probably harm due to non-counseling, I know that the PROCEDURISTS can feel their rear ends pucker up. I honestly believe that, in marketing pharmacy, that incompetence is built into the intellectual DNA of the PROCEDURISTS. Oh, there are pharmacists among the PROCEDURISTS.
The ACPE, The NABP, the APhA, the Boards of Pharmacy and the Colleges of Pharmacy have not handled this situation particularly well. The schools have shown disgusting deference to the money bags, the big prescription-sellers. They want good relationships with the PROCEDURE people who can write a whopping nice check for that new laboratory. Put on a nice shiny brass plaque. THE WAL-MART DISPENSING LABORATORY. The ESSENCE people cannot compete. They are much better preceptors however. They must teach these kids about what it takes to be a DRUGGIST. It is the only hope for pharmacy.
The status quo is bad. Most of you have absolutely no practical idea how to make things better. You all believe that you will end up on the float team, have your hours cut or out of a job. Small thinking. With so many ESSENCE fans still out there, what is the problem? You could overwhelm the PROCEDURISTS when enough of you get together and slow down and actually practice pharmacy. The numbers alone would rattle some cages. You are not going to do it alone though.
If the brand new pharmacists lose the traditions of pharmacy, and I like to call it THE WAY OF THE DRUGGIST, it is all over.
If you keep your feet on the floor in a pharmacy department all week long, you cannot deny that all that I have outlined is the distillation of what we are facing as we enter a period of incredible growth in the number of prescriptions filled. The companies need you. The procedurists are also theorists, They have never called a doctor with bad news for any egocentric practitioner. “You made a mistake.” They have never stood at the drive-through with the woman who thinks it is DRIVE-UP-AND-WAIT pumping poison fumes into the pharmacy. Procedurists can’t even count pills legally.
My call is to just PRACTICE YOUR PROFESSION. Your way. You have discretion.


Is C.V.S. Run By Goats?

Jp Enlarged

Employee Promotional from company handbook

How stupid is this? First they (CVS) have a regular training where they hand out the employee handbook. Then they tell you that what you have been waiting to get for years (uninterrupted 30 minute meal break and an additional rest break of 15 minutes) IS NOT FOR YOU BECAUSE YOU ARE A PHARMACIST. CAN YOU IMAGINE WAG ENGAGING IN THIS KIND OF AMBIGUITY? This is begging for trouble. CVS exposes this all by themselves. Why mention it if you are not going to honor #12? This can only be trouble, man?

I simply needed another job and saw a store which I think won’t be too bad. However just what I’ve seen compared to other companies has been shocking (keep in mind I was already very well prepared).

So the basics are as follows:
1. I take a position with CVS and get scheduled for regular training at the business office with others (pharmacy and non-pharmacy)
2. During this we are handed a binder with powerpoint slides to follow the presentation
3. I get the employee handbook
4. On slide #12 of the presentation comes what I was waiting to see. And this is not exact, but what I’ve got from my best memory.
• All employees, including minors, must take one 30-minute meal break for shifts worked over x number of hours. (I think 8?)
• In addition, all employees must take one 15-minute paid break for every x number of hours worked.
5. This is all the slide included. I don’t recall the exact hour numbers because I was more focused on who this was regarding. NO one employee group was singled out. i.e. Exempt employees, salaried, full time, management, pharmacy, professional, …or pharmacists. Trust me, I read every word three times and confirmed with the pharmacist sitting next to me.
6. Slide #12 was NOT included in our handout.
7. Verbal instruction from the trainer was “this obviously doesn’t apply to our pharmacists”

This is frustrating to see, but even more so in my state. A statute exists which requires employers to provide these breaks uninterrupted and away from work. Only a handful of states require this and my state requires the two 15 minute breaks as well. The slide CVS presented follows the law in our state to the letter.

The answer I always hear when this is discussed is that “oh, well, we’re exempt.” I simply let them know that FLSA does not have anything to do with break periods and being exempt is unrelated. This is always a surprise to whoever is talking about the exemptions.

Also I recorded the entire training presentation since I thought it might be interesting.


Jay Pee is Asking for Some Help. Information Please!

Jp Enlarged BRAIN ATTACK is modern name for STROKE

I had the ‘Brain Attack’ at around 4:00 AM, January 11, 20214. The modern designation of ‘Brain Attack’ to talk about an ischemic stroke seems about right to me. My brain was attacked. I did not get the significance until later. My left hand was not very useful. I used up all of my Medicare Physical Therapy benefit. About 15 sessions. I came out with a hand that worked like it was supposed to about 90% of the time. I felt good. I believed that the left hand was the ‘stroke’. Not so.

I should have known. The label ‘Brain Attack’ was meant to ride on the same neurological pony that ‘Heart Attack’ has rode forever.

Some time in the late weeks of April, I began to notice residual effects that I do not like. I use a cane now, when walking. It is meant more for balance and steadiness. A flat surface with some traction and I am good. Get me off the path and onto the green lawn and the cane is not much help. Too many soft spots and small rocks.

I have lost some leg strength and that could be the post-polio muscular atrophy talking. I’d love to get some leg strength back, but I’m not holding my breath.

I think just like before, but when I have a fully formed thought my ability to express it is affected. I can slur my words, especially when I am tired. I stumble over words that I have used regularly for decades. I completely lose favorite words like
INTERMITTENTLY. I hang with it for awhile, all the time watching the face of the poor person I am talking with. They struggle along with me Some seem to be horrified. Then smile and use ONCE IN AWHILE.

I point at my head, laugh lightly, and say, “It is perfect up here.” I point at my mouth, “Not so perfect here”. I have little problem typing my thoughts and pen on paper is no problem at all.” I call this “Fuzzy Thinking”.

I do not expect this to continue. I hope not.

Sleep. I can sleep anywhere, any time. That is no shit. Any Time. I fall asleep in minutes at bed time, but I wake up too soon. I put my book down at 10:00 PM last night, was awake before midnight. At 1:48 AM, I wanted it to be 4:48 AM, so I could get up. Early is good, but any time before 5:00 AM is too early. I probably checked the time 5 times. The 5th time was 5:05 AM.
Victoria calls my day time sleeps NAPS. I suppose that NAP works since my night time sleep is interrupted so often.

I guess I have episodes of sleep apnea. I have been told by bed mates for 40 years that I stop breathing at night. It did not bother me. I am asleep after all. It bothers Victoria. It keeps her awake and sends her to the guest room. I did a sleep study test and the recommendation was a sleep study titration. I paid my $300.00 copay. I talked with Kenny, the center manager, while he wired me up. It too 50 minutes, you guys, with 47 placed sticky electrodes. The results came in an ill-advised phone call. I expressed my displeasure about being called by a clueless nurse. I will keep this short. I was told that I have the common obstructive apnea and central apnea WHICH MEANS… MY BRAIN STEM FORGETS TO TELL ME TO BREATHE. That spooked me. My Brain forgets to do an autonomic function? Ged oudda Here.

Have any of you heard of that one? I do not like the idea of having to use a combo CPAP-VENTILATOR MACHINE. Called an Auto-Servo machine. I do not have a lot of confidence in the people who have had responsibility for my case. I may just move on outside the Intercoastal Medical Group.

There are other issues, but I don’t want to intrude anymore. I expected to have to work my left hand, but all of these subtle post-stroke issues bother me more than the big ones.

If you know anyone who has ‘Brain Attack’ recovery strategies, please share. Tell me the stories. Jay Pee


C.V.S. Engages in Identity Theft… For a profit ! Will it Ever End ! When Will Practicing Pharmacy be the Goal ?

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By Sarah Wallace

Thursday, June 05, 2014

An Eyewitness News exclusive as private patient information, intended for a doctor, mistakenly faxed by a nationwide pharmacy chain to a man in Queens.

It’s a breach that raises questions about the safety of your information when you get prescriptions filled.

This breach involves CVS which has thousands of pharmacies around the country. We were contacted by a food distributor from Queens who suddenly started getting faxes on his email from various CVS pharmacies in California.

There was a lot of private information on those faxes. And what’s worse, he says those faxes kept coming, even after he flagged the company.

“As you can see here, there’s an inbound fax from an 800 number … that’s actually CVS’ fax number,” said Mike Pupo.

Pupo said the faxes started coming to his office computer in Queens in late April. “I had a FAX from CVS pharmacy for a request for a controlled substance,” adds Pupo.

He has an internet service that sends all faxes to his Microsoft outlook.

“This has the prescription’s information, this has the patient’s information, and it has their date of birth, it has their phone number, it has their personal home address; it also has the doctor’s information as well as the doctor’s DEA number.”

The prescriptions were all from the same doctor, but from different CVS pharmacies in Northern California.

“I believe I have 15-16 prescriptions altogether…It’s a huge violation of privacy. I have a lot of information that I shouldn’t have,” he says.

SARAH: “It could be a bigger issue than just you getting this.”

Pupo: “Absolutely. If this was given to the wrong hands, God forbid, they could really have a field day with all of this information.”

In a statement, CVS responded, saying it has worked to correct the problem. “CVS/pharmacy’s commitment to protect the privacy of our patients’ health information is central to our role as a health care provider. We apologize for the faxes that were inadvertently sent to an incorrect number. Upon learning of this matter on May 23, we immediately took steps to prevent it from occurring again. We have apologized to Mr. Pupo and thanked him for bringing this matter to our attention,” the statement said.

Pupo believes it happened because the doctors fax number is similar to his but wonders why CVS doesn’t have better safeguards on faxing prescription information.

“You kind of wonder, if it’s happening to you. If it’s happening to other people. Oh absolutely, that’s a huge concern of mine. When I go to my doctor and he fills out a prescription, I don’t want it to go to some random person.”
He says he called the CVS pharmacies individually and the headquarters in Rhode Island.

Sarah Wallace was able to reach one of the patients by phone in California who’s personal information was faxed to Pupo.

SARAH: “And you had not heard about this until we contacted you?”
VICTIM: “That’s correct.”
SARAH: “How much of a shock was it when you got the phone call.”
VICTIM: “It was a bit of a shock. They should have done something. They should have called me to tell me they were screwing up.”

Pupo fully blames CVS. “I look at it as a really huge mistake on CVS’ pharmacy’s part…If I was a criminal and identity theft professional, I would probably be making a lot of money right now.”

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I Remember When………A Pharmacist’s Dry Martini and Cigarettes

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Example.Shirt Waist Uniform. Very popular with medical professionals 1950s thru 1970s. Still, I vote sexy. How about you?
The Shirt Waist Uniform. Very Popular with Medical Professionals. 1950s thru 1970s. Sexy then. Use your imagination. Sexy Now. What IS YOUR VOTE?

Again and Again, you write stories about being mistreated by your company. You tell us that you feel dreadful that something so appalling can happen to a medical professional who has been trained to do so much more than ‘Beat the Clock’.

Here is one for you. I know that you guys have stories like this. Please share them with us.

1966. The depths of winter. A blizzard blowing down from the arctic, across Canada, a rush down Ontario, a blow over Lake Erie to gain strength.

It was around eleven and I was driving my VW Bug down Main Street. There were big Detroit-made cars abandoned for the night, pulled over and locked. A Policeman, Brad Heino, was sweeping the snow off the cars to make sure no one was inside, asleep, waiting to die. They would die. If they were old. Fall asleep in an iced-in car with a minus ten temperature and it would be municipal homicide. Brad Heino’s one sweep was all the city would do.

Heino knocked on my driver-side window. “Yamis,” (Finnish phonetic pronunciation of JAMES). “You are gonna freeze in this Kraut car. They have sleeping bags over at the gym at the high school.’

The VW had a lot of weight over the drive wheels in the rear. Just like that, I went down the alley. The drifts were three feet tall and the wind-blown blizzard swirled up above where the second floor windows were dark, except one.

I had the key. The drug store would be warm. I could sleep on the examination table that was used for truss fittings. Right inside the back door, where the gallons of KCl liquid, Phenergan VC expectorant with Codeine, Cheracol and fifty others were shelved, it was nice and warm.

I walked to the Prescription Room. More than a ROOM. The front area was what you would find in any modern pharmacy. Behind a five foot wall was the compounding area, twice the size of the Prescription Room.
More shelves, but all behind glass doors, framed by varnished blonde wood.

I threw my coat and overshoes on the floor. I sat down and closed my eyes and fell asleep. I came out of my skin when a hand grasped my forearm and squeezed.

“Help,” I hollered. This was knee-jerk. Automatic. “Help me.” My heart was pounding a staccato beat. I did not dare to open my eyes.

“Jim, it’s me.” A soft feminine voice.

It was Thelma Jane, the 29 year old closing pharmacist. The storm raged when it came time to close the store. T.J. was a smart girl. She was hunkered down in a corner. She had made a bed using every soft thing she could find, jackets, clothes, white lab jackets, towels.

What the hell do I do now? I was a naïve 24 year old. I liked women a lot and had evidence that women liked me, but Wentling’s was not a bar.

T.J. and I talked about the boss. There were issues with him, but this was not the time or place. At one point, T.J. took a quart-size brown bottle from the shelf. It was Carling Black Label, a popular beer. She put it to her lips, leaned her head back, and knocked back a deep swallow.

I said NO when she offered the bottle.

T.J. frowned. “Jim, come on. You are a drinker. What better time?”

She smiled and held my gaze for a long time. A warmth settled over me.

T.J. said, “Drnk up. I don’t want you all shy when we”, she paused and gave me a look I had never seen. T.J. squeezed my arm again. “Jim,” her voice was husky-sultry-like. “You are going to sleep with me tonight. I hate being cold so you are my heater.”

T.J. had a boy friend, Vince Grazioso. I was scared of Vince. He was a boxer and he beat people up.

“Don’t worry about Vince.” She poured a glass of Carling’s for me.

“It’s cold,” I said. “Cold Carlings quarts. Who sells them cold?”

T.J. pointed at the fridge. I felt like an idiot. All I could think of was NAKED. I certainly was not a virgin, but my partners had all been girls. T.J. was a woman from Pittsburgh. She probably knew things. I could feel my penis shriveling with that thought.

Then T.J. did something that you’re not supposed to do. She pulled down the gallon of Absolute Alcohol. 180 Proof. She used two 60 ml conical graduates. She poured 30 ml of EtOH in each one. T.J. poured hers into her Carlings. She knocked down a good chug-a-lug, made a noise like “Wheeew, Buddy” and grinned.

I liked to drink Scotch and beers when I was impressing a girl in a bar, but I never mixed them. So, I knocked down the whole 30 ml. This was death and I now knew all about it. The 90% EtOH is so hygroscopic that it sucks all moisture from your esophagus. I cannot adequately describe it. It got my attention. It made me stop imagining T.j.’S perky breasts. She was still wearing her white shirt-waist, her choice of professional uniform. T.J. poured more EtOH for me. When she leaned to pour the 30 ml into my beer, her hem slid well above her knee. The human nervous system is amazing. When it is serious-business there is no hesitation. No lag-time. A young woman’s bare thigh, the inside skin, is white in the winter. It is also soft and cool to the touch. No lag-time. My shriveling penis problem was solved.

We slept, all bunched up on her pile of stuff, until around eight o’clock. Main Street was covered by drifts. Many places, along the sidewalk, ten feet deep. There would be no escape from the drug store until the snow plows. Then, I had to clean off my VW. Then shovel out a path. I told T.J., “We will be here a few hours.” I blushed.

T.J. brushed herself off, used the bathroom, combed her hair, put on make-up and a pair of paint-stained dungarees. She had volunteered to help when the boss held a painting party.

We did not talk about the boilermakers or the hangovers. Not one word about the night. I was making up stuff about that, but I can’t be sure about anything. If T.J. and I did it, I can’t verify.

We talked about the boss and the lousy way he treated us. Nothing changes, does it?

Later, during my shift, (I had volunteered to do the closing shift. Chivalry, huh?) I noticed a blue plastic casing on the top in the garbage. It was the container that a “Four X” condom came in. I dug down and hid it at the bottom of the garbage container. Not a big deal. In the pharmacy there was an entire drawer filled with Four X samples. The boss was extra friendly with the manager of the Camera Department. People talked. As much as I would have liked a vicious snow storm fantasy, I will never know.

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“It’s not personal, it’s just business.” How many pharmacists out in PharmLand have heard some variation of this quote just before your boss tells you something you really don’t wish to hear? According to the Merriam Webster online dictionary, personal (adj.) is used to describe someone whose job involves working for or helping a particular person. What industry could be more personal than healthcare? Our business consists of highly trained and skilled persons providing care and services of value to other persons. The value of the service results in the exchange of money and thus profit to the business. The job is about people… on both sides of the transaction. Has our leadership forgotten this simple fact?

    THIS ENTIRE THEME IS FROM “PHARMACY GAL”. I ENJOY READING HER THOUGHTS AND, AS USUAL, SHE ASKS IMPORTANT QUESTIONS. I LIKE HER RELAXED STYLE. Gal is one of the few who Can discuss these issues without slipping down into a RANT. Jay Pee

Perhaps you are wondering what started this train of thought. A couple of days ago, someone whom I trust suggested that my working conditions were inhumane. I would have never thought to use this word to describe my job or workplace. Inhumane has always been a word I have reserved for extreme or dire circumstances involving abused animals or starving people. But, according to Webster, inhumane (adj.) means not kind to people or animals. Not kind? Of course! According to Webster, kind (adj.) is having or showing a gentle nature and a desire to help others: wanting and liking to do good things and to bring happiness to others. Isn’t being kind to others (in the special way that only a pharmacist can do) the reason many of us have entered the profession? I don’t think too many pharmacists would argue now that their employers treat them in an unkind or inhumane manner. Keeping a pharmacist locked to a chair in the basement of the hospital and turning them into an order entry robot for 8-12 hours a day is inhumane. The human connection in this case has been entirely removed from the transaction. Expecting pharmacists to stand on their feet behind the counter and stay sharp for 14-hour shifts with no meal or restroom break is inhumane. Too many pharmacy employers today are treating their employees as they would treat non-human assets. They use their employees up and then replace them with newer, younger models. They do not treat their pharmacists kindly or humanely. I think it is time to change that awful phrase to, “This is not just business, we are personal.” Our business is people taking care of people.


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It Seems To Me That This Writer Has Some Great Opportunities

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Is This A Division of The APhA?  Why Not?  I MEAN IT.   WHY NOT?
Thanks for the quick response. As you can see I am up at 5 am here in Uniondale, and have been awake most of the night. It is probably a good thing I am in group counseling. Even though it is for a positive drug screen I will deny it to my grave.
My counselors are helping me to make the difficult but necessary decision to change careers. I have some money saved. I have my kids through college. I would rather quit on my own terms than have my character further maligned by this company and its minions. I have put in too many good years to go out like that. They say when you don’t like the person you are when you are with somebody, it’s time to leave. Well, Walgreens and I will be getting a divorce very soon!

    From JP.. You are not the first to have a positive drug screen. A CVS victim did everything that was demanded after a lorazepam Rx goy out of control. He talked his DO into refills by whining that he needed something to take the edge off when he worked the evening shift. The CVS DM said that the edge could not be that bad and sent him to mandatory AA meetings and random drug tests. The CVS DM also said no alcohol for one year. No problem for our friend. However the guy became a compulsive user of EtOH hand cleaning girls during the big flu scare. Like after every instance when he handled money and even a paper Rx. The modern tests for alcohol measure a micro metabolic chemical and it goes out to a week, I was told. The test is also incredibly accurate. Ya gawd id. He was fired for breaking his signed agreement. So, your positive screen tells me nothing.

Thank you for the information about the attorneys working for us. I will definitely get in contact with someone and get hooked up with this group. Not so much to keep my job, which I am essentially done with, but to have an outlet for my frustration and grief over the shabby way I have been treated. I am still in shock, but in a sense, I am grateful, because something like this, that is so ludicrous and insulting and soul crushing….Walgreens has broken my heart….is the only thing that would have made me abandon this God forsaken profession.

    How about God Forsaken JOB. I have been telling you guys for years IT IS NOT THE PROFESSION. It is the JOB. And that is the fault of every single one of you who is reading this. You want a profession, well start acting like a professional and leave the TECHING to the technicians. Manning the PRESCRIPTION MILL is 90% technician needed and 10% pharmacist needed. That is close to being the way it is for WAG in Florida and soon Texas. I left WAG in Texas in April, 14. The Prescription Mill was a 50% pharmacist needed procedure. The point is: Be a professional and that means START COUNSELING. No Rx DM is going to be stupid enough to tell you to stop counseling.

I am going to go through the motions and go back so I can leave on my own terms. I may just get a job for awhile that just provides insurance so I can recover from this mess. I’m sure the government will miss the tax money I cough up every year for them to piss away!
The pharmacy is closed, go bother somebody else! Do you know if I pull something like a no call no show to get fired if I can collect unemployment? I am not used to being devious and playing games, but all bets are off as far as anything that will screw the company. I have over 200 sick hours banked. Next year they are grandfathered into Personal Time Off. Do you have any information on anybody calling in sick and blowing out those sick days and not getting canned? I see the techs do it all the time. I know all of the pharmacists have banked sick and vacation….we are SOOOOO….valuable to the company that we can’t get the time off we need. Kind of funny how they could come in and remove me on a moment’s notice and cover my shift for 2 months!!

    FROM PHARMACIST STEVE:As I remember unemployment.. you are only entitled to unemployment if you are laid off.. if you are fired.. there is a automatic 4-6 month wait to collect. Unless they have changed the laws.. when you leave an employer.. they are only required to pay you accrued vacation time.. “sick leave” they are not required to pay you.. I don’t know if “personal time ” is considered vacation or sick leave time.. if they are converting everything over to personal time.. I would suspect that it is because they wont have to pay up when the person leaves.. just imagine the tens or hundreds of thousands of dollars that they will save when they start walking Senior RPh’s out the door that have 3-5 weeks or more of “personal time” accrued ? No “Golden Parachutes” for rank/file RPh’s ! An employee is entitled – by Federal law – up to 12 weeks personal medical leave.. Get a medical excuse from you doctor/therapist that you need to deal with a personal health matter.. Knowing today’s corporate attitude.. if you got 200 hrs at a RPH’s pay scale that is 10K + that they could save… – or steal from you – if they have you headed for the front door and out to the curb.

    MORE FROM JP..Time off. Personal Time? Sick Time? I watched a RxM call out with little or no notice when he or his wife or toddler son had the sniffles. It was crazy. And, honest to gawd, when he had the sniffles, you could count on him calling out. Note: He is a Muslim and since he lived with his parents, he was expected to do Islam in his sleep. His wife was not allowed to go to a doctor by herself for her care or the little boy’s care. This is Walgreens, by the way, SE Texas out of Houston (Where the CEO was groomed) I was very impressed by how I was treated and I observed old, incompetent RPhs given extra chances. They were moved to very slow stores to help them out. That Muslim, by the way, is not suitable for the RxM job at Walgreens, but rather than firing him, he was moved to the slowest store in the district with a 10 minute one way commute. Go figure. They did not fire a veteran Float Team guy who was so slow, his wait time was an automatic half hour for one Rx. When you start at 30 minutes, the patient will be lucky to get out in an hour.
    I will ask some expert to help on the unemployment. Using your 200 hours. Getting fired. I believe that unemployment is a benefit if you are fired. I am not certain. I will call upon Goose or Rx Gal or Steve or anyone else to help out on any of these paragraphs. Leave them in COMMENTS. I will copy and paste right here.

Any advice on how to manage my exit to my best advantage would be appreciated
My family is tired of hearing this stuff and worried for me, but they will never fully understand the way a fellow pharmacist would.


$25 per hour for Experienced Pharmacist?

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$25.00 / Hour WAS A BAD WAGE FOR THE MID-1980s
Hi Jim,
I wrote to you several years ago and was disenfranchised about out profession. My body was breaking down from repeated 14 hour shifts with no breaks and no flexibility to have a balanced work/life balance. I worked for CVS for 6 years before I got out of chain retail hell. I recently took a 2/3 paycut to do a community pharmacy residency with an independent pharmacy. I am now looking for jobs as my residency ends at the end of June. I have 7 years of pharmacist experience in community pharmacy, long term care experience, MTM, vaccinations, diabetes education, you name it i’ve got it. I applied to work at an independent pharmacy this week, spoke to the manager who’s first question was how much i wanted to make per hour. I didn’t want to say a specific number because i knew it would be lower than what I was getting at CVS, after all it was an independent. She told me that they were going to pay $25 per hour (less than half of my previous salary). I asked her why so low, and she said that she could get a new grad for that price. New grads can’t be picky with loan payments starting to come in, but no pharmacist can make a living wage at $25 per hour. I wrote you today because I am outraged and want this blasted on the internet. I don’t know if i’ll ever make a decent salary again, this is so sad! Please don’t post my name or contact info if you choose to use this information for your blog.


Leave The Pharmacist TWISTING in the Wind, Then Throw Her Under The Bus

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Safeway has laid off 21% of staff.  Profits increased by 41%
This is your chance to make a difference. The big and bigger retailers that sell prescriptions have had their way for decades. And………..SELLING PRESCRIPTIONS is what they do. MORE, BETTER, FASTER. Practicing pharmacy? You laugh so hard your spleen aches. They don’t let you practice pharmacy. It takes too much time. Do I need to explain this to you? I thought not. They give lip service to pharmacy practice, but, in reality, do any of you think that Safeway encourages you to slow the Prescription Mill to a near stop so you can counsel a teen age single mother on the use of a Prednisolone oral liquid for her 3 year old. Get outta town, girl. There are prescriptions to be checked. The phone is ringing. The cashier is headed for her lunch break. Yes, a break. The cashier is the only pharmacy staff person to actually get a break. The pharmacy manager is a 32 year old woman who has dealt with hypoglycemia for her entire adult life. A Bigger Grab Fritos and a chocolate milk for breakfast, multiple 20 ounce Mountain Dews, a bag of fun-size PayDay bars, a pint of Chunky Monkey at 8:00 PM to get her to closing. Much of the day, she is compromised.

What about you? Multi-tasking is your game, but you wonder about that new pharmacist. At 2:00 PM, all telephone lines are whining. The lines at the register is 5 customers deep. The store manager has written up the lead tech for saying, “How the fuck do I know?” when a snotty woman demanded, “Where are the Bella Mia Italian Lipsticks that are on sale?” Do I have to go on? 14 hours straight of this stuff.

And your company will always let you twist in the wind. Safeway will always say, “Our pharmacists are expected to practice pharmacy in a professional manner and to carry out their duties in a way that will always protect the patient. The welfare of every patient is the number one job of every Safeway pharmacist.”

That is all nice and accurate background, but the following is real. It really happened and the legal implications continue.
A Safeway pharmacist in Northern California made a dispensing error. He dispensed RISPERDAL 9mg. The prescription was written for BUDESONIDE. The patient is 92 years old, cogent an aware, but compromised. The last I heard is that she will most likely die soon.

The attorney that I am doing research work for is demanding both the pharmacist and Safeway take responsibility. When the patient dies (sooner than later) the game changes dramatically.


My attorney is asking this question:

Safeway’s system. This is it, you guys. If Safeway’s system is shown in court to be the cause of errors, a huge crack will suddenly appear in the fascade of all and every retail company that puts speed and profit before the patient’s welfare.


Please contact us immediately.

*If you work as a pharmacist (or have in the past) for Safeway.
*If you know any pharmacist who work (or has worked) for Safeway.
*If you know anything about Safeway’s system.

Contact me at
Send Cc to

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What Does This Tell Us? Harbringer Of What’s To Come In Retail? Is The Load Diminishing? I Do Not Think So.

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18% Profit and they are killing off thousands

The Profession of Pharmacy is no longer run by PHARMACISTS. It is a BUSINESS and run by MBA Masters of the Universe. Pathetic. How did this happen? It started when pharmacists started taking jobs with MONEY as the sole criteria. “Hey, Bub, I am going to work for REVCO. Look how much they pay”. Can we get it back? We can, I believe. They still gotta have pharmacists and pharmacists still can say YES or NO. It may be scary to take charge of your own life, but it IS YOUR life, Jay Pee 5-1-14

TAMPA — Express Scripts, the nation’s biggest pharmacy benefit manager, is planning to cut hundreds of jobs across the country. But the 390 employees the company plans to fire from its Tampa operation constitute the largest layoff in Tampa Bay in 2014.
That’s more than half of the company’s 720-person workforce at 5701 E Hillsborough Ave.

    The Tampa layoffs include nearly 150 high-paying pharmacist positions.

Now the company said it has to shed 1,890 jobs in the coming year in light of a drop in prescription volume.
Orders fell from 390 million prescriptions in the first quarter of 2013 to 320 million in the first quarter of 2014, a company statement said.
Company revenue fell by $2.3 billion in the first three months of this year compared with the same time period last year. That was a 10 percent drop in revenue, to $23.7 billion.
The company attributed the declines to several factors.
Express Scripts blamed the severe winter for hampering the number of prescriptions it handled. The company also said it did not anticipate that so many of those who recently enrolled in health care exchanges would wait until the last minute to do so. Many also were already enrolled in Express Scripts, so the company didn’t get quite the bump in business that it had hoped.
Chief executive officer George Paz said Wednesday during a conference call with investors that he still thinks the Affordable Care Act will ultimately benefit his company.
“We are still bullish on health care reform,” Paz said, according to a transcript.
Express Scripts employs 2,400 people in Florida, split between Tampa and Orlando. The Tampa operation is a “front-end pharmacy” where pharmacists review doctors’ prescriptions and make sure the medications are appropriate for patients before the orders are filled and sent out.
Express Scripts has headquarters in St. Louis and employs 29,000 people across the country. The company said it plans mass layoffs in three other states — 290 jobs in Ohio, 370 in Nevada and 580 in Texas at two facilities that will close.


Can CVS Throw Money to Hide From This?

Jp Enlarged Pharmacists are more activist than ever

  • CVS sued for suspected fraudulent Rx reimbursements
  • By: Mark Lowery, Content Editor- Drug Topics

    CVS Pharmacy is once again in hot water regarding its handling and dispensing of controlled substances—this time being sued by an insurer and 18 states that claim the pharmacy chain collected hundreds of millions for invalid prescriptions that were diverted to the black market.

    According to a report by Courthouse News Service, insurer Fox Rx, the United States, Chicago, New York City, Washington, D.C., and 18 states filed suit in federal court in New York alleging CVS violated the False Claims Act when submitting some claims to Medicare for controlled substances such as codeine and oxycodone.

    Prescriptions for controlled substances require a registration number issued by the Drug Enforcement Administration (DEA). However, the lawsuit claims that one out of every five of the claims submitted by CVS between January 2008 and 2010 did not have a number.

    “CVS Pharmacy’s failure to include DEA numbers was not mere error – it was a profitable business practice,” Fox Rx stated in the lawsuit. “As a result of its practices, CVS allowed federal and state funds to fund the purchase of dangerous drugs for black market sale and abuse.”

    Can CVS survive the legal attacks? Their cheatin’ ways are catching up. Do an Internet search. They are being sued everywhere you look.
    I DID NOT COPY THE ENTIRE ARTICLE. TO FINISH IT, GO TO DRUG TOPICS. You can find a link in the lrft column. JayPee


    Important Words from “Goose”

    Jp Enlarged Rawlings. Goose does something about it.
    The following is from Goose. Succinct, to the point and spot on. It is FEAR that keeps us going in every day and swallowing our rage because we perceive
    a horrible result if we stand up for ourselves. WHATCHA GONNA DO, you guys?

    I am constantly reminded of one of my former clinic patients. Born Jewish in Germany in the 20′s, he only survived because his parents sent him to England when the Nazis came to power. This was part of the “Kinder” transport that saved thousands of Jewish children from Germany.
    My friend said the last time he ever saw his parents was the day he left. He has no idea what happened to them.
    He also said, if you are oppressed and do not stand up for yourself, the same thing will happen to you. Those in authority will take and take until they get it all. Fear of losing everything is what cost many people in this situation their lives. In the end by not starting an uprising, they lost everything anyway.
    If you don’t think this is similar to our current situation

      you are crazy

    . Doing nothing will always get you nothing. What do you have to lose that you will not lose anyway?


    More of You Need To Be Asking the Questions. “The Squeaky Wheel is the One That Gets Greased”

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    Brent Owns The Store. He NEVER misses lunch. He has coffee when he wants. Bath Room Breaks Arte Never Delayed” />
    My advice is NEVER LECTURE. Always ask those questions that you already KNOW THE ANSWER. DEMAND THAT THEY ANSWER YOU AND DOCUMENT.


    I am a 32 year old pharmacist who recently left Rite Aid full time and moved on to an amazing state pharmacist job. I could not be happier with my decision and my ability to have a lunch/bathroom breaks and coffee as I please. I want to thank you for your website, for speaking the truth in drug topics as the sheep keep their heads buried in fear. Fear of losing the only thing that brings joy to a retail pharmacist, a pay check. The world of retail has become a frightening thing. I still work per diem for a little reminder of the pain, but wanted to share this with you. There are more tasks for an overworked pharmacist than ever and less help to complete them! It will only be a matter of time before people start having mental breakdowns. I have done over 500 Rx’s in a 13 hour day by myself (no breaks) only to be told later that I did not complete the required amount of flu shots. I have had customers tell me to Fu$k myself only to be rewarded with a gift card after they complained about “my bad attitude”. I have millions of these sob stories! I could go on for hours about how we are viewed as nothing more than overpaid deli workers. I could vent for hours, but I will stay focused and ask my main question. How can we change the direction of pharmacy? I will attach a response from NYS board of pharmacy when I emailed them. Is there anyone out there to save this drowning field? They want us to Med interventions now, known as CMR’s (comprehensive medication reviews)! Not that we get any extra help for this, in fact it is supposed to be incorporated into our work flow. Not that they care about patients health, just that fact that it is another thing to bill and generate revenue. So here it is, addition of immunizations (makes company money), CMR (makes company money).These equal more tasks/time for pharmacists with zero additional help/financial reward! It also equals more liability, but who gives a shit about that. The tasks keep adding up, with no additional help to complete them. We are getting squeezed like a dried out lemon and if you voice up you shall be replaced by a young mostly incompetent pharmacist who will accept 10$ less an hour. How do we get representation to adequately staff our store for the tasks that we are demanded to do? Do we unionize? Most pharmacist I know have zero balls and would be the first scabs to run for a pay stub! I worry about this profession, I am a realist and see no way this ship will right. Too much glut and indebted desperate newcomer pharmacists. The demands are unrealistic and the pressure is cancerous. Its no wonder we have such high depression/suicide rates in our field. Anyway I am simply writing you to thank you for the balls and common sense you exude. One final thing. If you are told you have to attend a meeting without question on your day off, should you receive compensation? We were given a 20$ hour(1/3rd pay) stipend for a meeting we could not miss (termination). How the hell is that legal?

      Here is the response from NYS board of pharmacy! Sounds like a corporate asshole wrote it. Be well and thank you again !!!


    You reference the AMA and ADA. Pharmacy does have the APhA and other organizations.

    However, the issue you raise is a serious concern to many. The need for pharmacists, however, will depend on the need for cognitive services. Technology will likely continue to find faster and less-expensive means of packaging medications. We believe the future lies in Medication Therapy Management and Collaborative Drug Therapy Management, and other essential services such as immunizations.

    There is no limit on the number of colleges. However, every college of pharmacy must meet the rigorous qualifications of the Accreditation Council on Pharmacy Education, and in this State must also meet the requirements of the Education Department and the Board of Regents. We play a prominent role in reviewing each program.

    I will share your concerns with the Board of Pharmacy which is aware of the capacity issues faced when new programs are proposed or existing programs wish to expand.

    NYS Board of Pharmacy
    89 Washington Ave., 2nd Floor West
    Albany, NY 12234
    Phone: 518-474-3817 ext. 130
    Fax: 518-473-6995
    General question
    From my 5 years of working as a pharmacist I have noticed a major swing in the job market. We appear to be flooded now more than ever. I see no situation where our market will turn around, with the constant increase in graduates per college and pharmacy colleges arising. Is there any organization that is looking out for us? MD’s have the AMA, dentists the ADA, what do we have? I know many who are hundreds of thousands in debt and fighting for a job in a dried up market? Who is looking out to protect us, just curious if there is an organization? Also curious what system of checks and balances keep these pharmacy schools in check? Is or are there any? When we flood the market as we are doing now more than ever what is to become of all these kids with no jobs? More importantly, what is to become of their student loan debt?


    A Crushing Commentary on your APhA, written by a member of The Pharmacy Alliance

    Jp Enlarged

    Who Paid for This Building?

    PHARMACIST TODAY is the rag that APhA publishes. John’s thoughts on our national pharmacists organization has evolved. He expresses himself here.

    Pharmacy Today, I have finally decided to approach you about the “elephant in the room”.
    >> Your publications DO provide a beneficial service. New, CPE, product, industry, and professional/legal updates. These are all very welcome. However, your publications DO NOT, in any way, reflect the real world of the pharmacist today. Let me inform you of the current state of your average or even “above average” pharmacist today:
    >> -15 hours shifts – often back to back
    >> -no sitting, eating, drinking, or use of the rest room in those periods
    >> -being denied our basic right to things like voting or jury duty because of shift length
    >> -told we must arrange our “own coverage” for sickness, family deaths, etc.
    >> -bullying and professional coercion from “non-licensed” supervisors & managers
    >> -crippling injuries and illness directly related to our working conditions
    >> -practice policies that place the liability due to the fatigue, distraction, etc., created by these conditions upon the individual pharmacist as the “licensee” and not the “un-licensed” corporate personell who create them
    >> -practice policies designed to shift the legal liability of “inappropriate dispensing” away from the companies who push for “sales” and onto the individual pharmacist
    >> -pharmacists whose worth is determined not by clinical or patient care excellence but instead by how well they drive marketing and loyalty initiatives (the commoditization of immunization that has occurred is an absolute embarrassment)
    >> -conditions created by corporations that pose a massive risk to public health & safety but place the responsibility for this risk upon individual pharmacists who are forced to accept them as a condition of employment
    >> So what does this mean? As a preceptor who still believes in and attempts to create change in the proession for both ourselves and our patients, each day I have been told by students:
    >> “I have never met a pharmacist yet who is happy or would choose the profession again”
    >> “I know, my brother is a pharmacist – until the conditions/pressures drove him to substance abuse”
    >> “I only plan on doing this for a short time – until I find something else”
    >> “I’m not doing this for the rest of my life – maybe part-time”
    >> I have to tell my students:
    >> “you are entering a profession where your future is likely to include suicide, substance abuse, crippling injury or illness, incarceration, workplace violence.”
    >> Do you understand how it breaks my heart to see the future of our profession and part of the future of healthcare enter into a world of hopelessness and despair KNOWINGLY!?
    >> Yet, do we ever see these things addressed in any APhA publication? Does APhA, truly represent the pharmacist as the American Pharmacists Association? I believe your publications & our “Association” represent perhaps more the “industry” that is practicing pharmacy. They spend most of their time and space congratulating ourselves on how wonderful we are, while ignoring the glaring and shockingly disturbing conditions each pharmacist faces daily. “The Emporer’s New Clothes” comes to mind.
    >> Instead of featuring the rare, 1 in a 100 or 1 in 1000 unusual case that is an unlikely success, perhaps it is time to address the immediate needs and concerns of the common majority, the 99 out of 100 who are miserable to the point of endangering their health, their lives, and our profession. Currently this publication, as others from APhA, seems like a magazine that chronicles the lives of occasional lottery winners in an impoverished nation where the majority of the populace is starving.
    >> Perhaps it is time for the American Pharmacists Association to start representing PHARMACISTS and not representing false hope?

    1 Comment

    “ANGER” is Fuel for the Battle. USE it well.

    Jp Enlarged

    Recovery is regaining Your Power
    Essentially, the miserable pharmacist is wretched because they choose to be unhappy. There is a choice every single day to be proud of what they do or to blame the job because they are not happy. They don’t even use the best tool available to them. That tool is anger!
    Anger is fuel. It is not the bad thing that your parents said to suppress as mine did. “Jimmy, nobody needs to know you are angry. You should control yourself.” We feel anger and we become frustrated when we hide it because we want to do something about it. This goes against the image of the calm, in-control professional. Instead of showing the anger, we stuff it and chug Maalox and take two 20mg omeprazole every day.
    How would it look if we showed that we were angry? At work, you don’t hit that someone or break that something or throw that fit. If you smash that fist against the wall, do it in the bathroom where no one can see that you are out of control.
    What we do with our anger is deny it. We stuff it so far down that we forget what makes us angry. We are institutionalized and we believe that we should not get angry. We lie about being angry at the store manager. We hide our anger at the lack of technician help. We do not express our outrage to the district manager. Doesn’t he know that it is his precious customer service that pays the price?
    Some of us hide it so well that we medicate the anger and filch the occasional lorazepam to hide it even better. We are professionals and professionals are nice people. We bury our anger. We block it and we hide it.
    What we do best with our anger is lie about it. Unfortunately for our spouses, we lie so well that we often take our misery out on the people we love (or are supposed to love) the most. We do everything but listen to our anger.
    Listen to your anger. That is what it is meant for. Anger is not a polite request. Anger is a scream. It is a command. It is a slam of the fists down on the table demanding your attention. Anger has a right to be heard. Anger should be appreciated and valued. Anger must be listened to if you are to regain your professional balance and power. Why? Because anger is an atlas or a chart or a diagram back to living the ideals you had when you were in pharmacy school.
    Anger reminds you of your boundaries and limits, the areas where no one was allowed to tread without your permission. If you can set up the periphery of your professionalism in just one area, more will follow. If you list only ten serious drugs that you will counsel on no matter what, your list will be twenty in little time. If you let the store manager know in writing that his touching you at anytime, in any manner, is unwanted, you will regain enormous power and control over your own life on the job. You can gain power simply by refusing to get wet underpants because you neglect going to the bathroom when you have to go. Documenting anything at work that makes you uncomfortable will give you surprising control.
    Anger shows us where we want to go. We may not know exactly what we do want on the job, but our anger tells us, without ambiguity, what we sure as hell do not want. That is a really good place to start because anger shows us where we have been and sets us on the course of recovery. Anger is not a sign of disease. It is a sign of health. If you no longer get angry at being institutionalized, stop, take a deep breath, and examine how you will find your way back. I contend that you will find that the first sign of recovering your health, well-being and pride will be anger. Welcome it. Savor it.
    It is not very healthy to act out from anger. That is childish and not productive. I quit a job once out of anger. It was a good job. I was well respected in the community. The problem was that the store manager tried to micro-manage my department. I have never bent to management from a non-pharmacist. This guy was out to bring me to my knees. I fell right into the trap. I became so angry that I brought the problem to a head with some stupid brinksmanship. My district manager did not back me as fully as I wanted, so I quit. My one-way commute for that job was less than ten minutes. The one-way commute for the next job was ninety minutes. I was like a teenager having a meltdown. I turned my anger into indignation without any examination of the circumstances. I was an idiot.
    Anger is there to be acted upon. Anger points the direction. Anger is the wind for our sails as our sailing ship tacks as we move on the appropriate bearing where our anger guides us. Had I used my head and had the presence to translate what the anger was telling me, I would have made better choices.
    “Damn it, I could run a better pharmacy than that!” This anger says that you want to have your own pharmacy, you just need to put all of the pieces together.
    “I can’t believe it. Mildred told me that she was going to demand a transfer to the suburbs and she got it. That’s what I wanted.” This anger says: Stop keeping your goals and dreams hidden. You need to express your wants and believe that you deserve your dreams to come true.
    “That was my idea. This is unbelievable. I mentioned it only once and that son of a bitch took my plan and put it to work. He gets all of the credit and I get none.” This anger says that it is time to take yourself seriously and show yourself some respect. Your ideas are good enough to do something about.
    Anger is the tornado that blows away all of the restrictions and hesitations and lack of self confidence of our old lives. Anger is a valuable instrument to be used productively. Anger cannot be the master, only the servant. Anger is a deep well of power, if used properly.
    Apathy, laziness, misery and gloom are the enemies. Anger is not a good buddy, but anger is a friend. Not a mild-mannered friend, but a very loyal and steadfast friend. Anger will always remind us when we have been cheated or cheated upon. It will always tell us when we have been deceived or when we have betrayed ourselves. Anger will tell us that it is time, finally, to act in our own best interests. Anger is not the action itself. It is the action’s invitation.
    Watch out what you ask for
    You might just get what you want and then what are you going to do? It can be scary, having dreams come true. That means that you have to take responsibility for your own life. This is not comfortable, but you will feel the power. You can no longer blame the big bad store manager wolf for your lack of integrity. You can’t say that the company made you do it. You are back in your own hands, a professional making choices every day that benefit you and your patients. This is a good thing, don’t you think?
    When you take responsibility, things happen that you cannot fully understand why. You are the pharmacy manager and you tell the Jailer that you are going to do what is best for your department in all business and professional matters. You tell him that you are the pharmacist, that you know best and you request that he mind his own business. You take all appropriate actions, the department thrives in all areas. Your pharmacy is suddenly the most professional and most profitable in the company and everyone wants to know why. What did you do?
    Taking responsibility is not easy. You can feel very much alone. It takes courage to do the right thing. This is a difficult and slippery slope. A pharmacist who has little self-respect and has been stripped of dignity may need assistance in making the choices that are best for both their professional and personal lives. I honestly do not think that you should rush. You have been institutionalized for years. There is no hurry. You don’t want to make a rash move as I did. You probably should not try to do this alone. Talk to someone you trust before you take any significant action.


      THE PRISONERS OF COMFORT, Jim Plagakis, R.Ph.

    I merely took the energy it takes to pout and wrote some blues
    Duke Ellington


    More Good News From The NorthLeft. Washington Says “As Oregon Goes, We Follow”.

    Jp Enlarged

    Washington State Enacts Comprehensive Pro-patient, Pro-Small Business Pharmacy Legislation

    ALEXANDRIA, Va. (April 3, 2014) – The National Community Pharmacists Association (NCPA) commends Washington State Governor Jay Inslee (D) for signing ESSB 6137 into law. This legislation is modeled after a similar law that was passed in Oregon in 2013. ESSB 6137 applies reasonable standards to how Pharmacy Benefit Managers (PBMs) audit community pharmacies; provides increased transparency into generic prescription drug reimbursement; and ensures that PBM administrators of prescription drug claims are registered within the state.

    The legislation passed both houses of the legislature with overwhelming support.

    “NCPA commends the hard work of the Washington State Pharmacy Association (WSPA) and the local stakeholders who helped guide this comprehensive bill through the legislature. NCPA was proud to work with all those involved in this effort including the WSPA, NACDS and local pharmacists,” said NCPA CEO B. Douglas Hoey, MBA, RPh. “Passage of this legislation is further evidence that when legislators take a close look at PBM practices, they come to the conclusion that a legislative remedy is required.”

    With Governor Inslee’s signature, Washington becomes the 30th state to address abusive pharmacy audits. The bill provides mechanisms to ensure pharmacy audits are focused on their intended purpose of combatting fraud, waste and abuse. The bill also implements safeguards to prevent audits from being utilized as a PBM profit-making scheme by forbidding recoupments in the cases of minor clerical or typographical errors.

    ESSB 6137 provides pharmacists with basic insight into how they will be reimbursed for dispensing generic medications and provides some transparency into how a product is designated for a maximum allowable cost (MAC) list. The legislation requires PBMs to update their MAC list on a regular basis and reimburse pharmacies based on current market conditions and acquisition costs. Washington is the sixth state to address this issue.

    Finally, the bill establishes a modicum of regulatory oversight of PBMs by requiring PBMs to register with Washington’s Department of Revenue.

    “NCPA applauds Governor Inslee and the legislature for enacting this common sense legislation, and encourages other states who may consider PBM legislation in the future to look to the Pacific Northwest as a model,” Hoey concluded.

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    CVS Sued for Hundreds of Millions

    Jp Enlarged


        CVS Pharmacy Sued for Hundreds of Millions

    MANHATTAN (CN) – CVS Pharmacy sought coverage from insurance plans for invalid prescriptions of controlled substances that would inevitably land on the black market, an insurance company claims in Federal Court.
    Fox Rx, the United States, Chicago, New York City, Washington, D.C., and 18 states claim CVS violated the False Claim Act by submitting claims to Medicare for controlled substances such as codeine and oxycodone.
    Such prescriptions require a registration number issued by the Drug Enforcement Agency, but between January 2008 and 2010, Fox claims, one out of every five of the claims submitted by CVS for the drugs lacked such a number.
    “CVS Pharmacy’s failure to include DEA numbers was not mere error – it was a profitable business practice,” Fox claims in the lawsuit, which was filed under seal in September 2013 and unsealed in late March.
    “As a result of its practices, CVS allowed federal and state funds to fund the purchase of dangerous drugs for black market sale and abuse,” according to the 36-page complaint.
    Fox wants CVS to pay treble damages for what the federal government lost, which it estimates to be hundreds of millions of dollars, plus up to $11,000 for each prescription that was issued without a DEA number.
    It’s the latest in a series of legal woes for the pharmacy giant in the past year.
    In April 2013, CVS agreed to pay $11 million to the federal government to settle a lawsuit accusing it of failing to keep proper records of the controlled substances it distributes.
    In December 2013, it agreed to pay $4.25 million to settle accusations that it failed to reimburse Medicaid for prescription drugs.
    Joining in the unsealed lawsuit are California, Florida, Georgia, Hawaii, Illinois, Indiana, Louisiana, Massachusetts, Michigan, Montana, Nevada, New Jersey, New York, North Carolina, Tennessee, Texas, Virginia and Wisconsin.
    The lawsuit was filed by Robert Sadowski with Sadowski Fischer.

    1 Comment

    Pay Attention. Revolutions Take Place In The Blink Of An Eye. Essentially A Shifting Of Power. It is Called “Pharmacy” Pharmacists Should Have The Power, Not Clueless MBA Masters of the Universe

    Jp Enlarged

    Whistleblower= Courage, Integrity, professional standards
    This letter is from a member of The Pharmacy Alliance who wants to support Joe and Paula during some stressful days when the court battle involves Joe’s law firm against the battalions of lawyers that CVS can muster. We all need to step up. Joe is doing it for US.

    Dear Mr. & Mrs. Whistleblower;

    I am a far too casual member of the pharmacy alliance, and Jim P sent us a note about what you are going through. First, I would like to say, God bless you for what you are doing. I have worked as a pharmacist in retail, I know how hard it is to just do the job well. And when corporate is always after you about nonsense like tech hours and staff levels and getting your numbers up, you realize that they are completely clueless. Corporations like CVS do not give a damn about their patients. They want more and more while giving less and less, and it is setting the pharmacist and the patient both up for failure. There is no way anyone can do their job well under the circumstances we are expected to work in. So each of us is set up to fail, and the company then blames us for not being able to make an impossible situation work. It is corporate bullying in the purest sense.

    So! I really just wanted to tell you how proud I am to be a pharmacist when I hear about people like you. You make our profession SHINE. Your patients are the luckiest people on earth to have you going to bat for them, and at such a cost. You make each of us look great.

    I understand from Jim that you have had a recent personal loss, and I hope it helps a tiny bit for you both to know that people you may never meet are sending positive thoughts your way. Jim wants us to come and wash your car :) Since I am on the Left coast these days, it’s a little bit of a reach for me, but I can tell you this; if you are ever in Portland, OR, you have a place to stay. I am about 40 miles west of the city. You folks are welcome. It would be an honor to host people with your level of integrity and commitment.

    Thank you for not moving to the back of the bus. You stay right up front with your patients, and bless you for keeping their health and interest at heart.

    1 Comment

    The Elephant In The Corner. Finally, Someone Says, “Hey, That’s An Elephant”

    Jp Enlarged

    Is That Walgreens sitting there?
    Did pharmacy board give Walgreens special treatment?
    APR 02, 2014 Drug Topics
    By: Mark Lowery, Content Editor


    That’s the charge being made by a government watchdog group and a labor federation, which alleges that the Indiana Board of Pharmacy in 2011 approved Walgreens’ new pharmacy design with the help of the former board president who is employed by the drug chain.

    Indiana was the first state to approve Walgreens’ new Well Experience pharmacy layout, which moves pharmacists from the back of the pharmacy to a desk closer to customers. At the time of the approval, William J. Cover, RPh, was president of the state pharmacy board. He is employed by Walgreens as its corporate manager of pharmacy affairs.

    Recently, the U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights launched an investigation into alleged patient-privacy violations at Walgreens, following complaints that the chain’s new pharmacy design is putting sensitive patient information at risk.

    Common Cause Indiana and the labor group Change to Win have filed an ethics complaint with the Indiana inspector general’s office, claiming that Cover’s involvement with the decision to allow Walgreens to proceed with its new design violated the Indiana ethics code. The redesign of Walgreens pharmacies throughout Indiana was a $100 million project.

    And the Indianapolis Star has published emails in which Cover seemed to serve as a liaison between board members and Walgreens officials. The emails are from 2011 and showed Cover connected state regulators with Walgreen officials months before the remodeling project became public.

    1 Comment


    Jp Enlarged

    The Phantom Pharmacy Refrigerator
    I believe that it was Karl Marx who asked, “Who Benefits?” In the Prescription-selling industry, the answer is clear. Not you!
    Cui bono

    From Wikipedia, the free encyclopedia
    (Redirected from Cui Bono)

    Cui bono /kwiːˈboʊnoʊ/ “to whose benefit?”, literally “with benefit to whom?” is a Latin phrase that persists.[1]

    The phrase is a double dative construction. It is also rendered as cui prodest.

    It is a Latin adage that is used either to suggest a hidden motive or to indicate that the party responsible for something may not be who it appears at first to be.[2]

    Commonly the phrase is used to suggest that the person or people guilty of committing a crime may be found among those who have something to gain, chiefly with an eye toward financial gain. The party that benefits may not always be obvious or may have successfully diverted attention to a scapegoat, for example.

    WHO BENEFITS WHEN YOU ARE INTERRUPTED WITH THE QUESTION: “HEY YOU! WHERE ARE DA BUY ONE, GET ONE FREE CHICKEN POT PIES?” The questioner is a large man wearing a soiled Tee Shirt hanging over his belt line. The shirt reads “Fuck Obamacare”. Close to the collar were red stains. Ketchup? Blood? His cargo shorts were camouflage. Attached to his belt was a K-Bar knife. The tattoo on his neck, a black cobra.















    “THEY ARE ‘Write Ups, correct?”

    “Yes, they are. Why couldn’t you just tell that biker guy where the pot pies are?”


    “That’s the second one. Geezuz, man, don’t I have enough trouble with Ayella? Where do they find these pharmacists?”


    “Why did you insult the doctor?”


    “YOU HAVE TO.”


    “You can’t……”

    “Yes, I can and, Don, I will if you can’t retreat your sorry ass out of the pharmacy and not come back until you are invited.”

      That burning sensation in your stomach indicates certainly NOT YOU.

      It is called PHARMACY. The answer to the question would be different if PHARMACISTs were the ones navigating the ship.

      The End


    Maureen Answers Goose’s Wife

    Jp Enlarged

    Thank you to Goose’s wife for your heartfelt letter. You touched an area of my soul that I try to keep repressed and compartmentalized in order to stay sane. I dreamed of a pharmacy career. What I got is a job that sucked the life out of me. I am just a shadow of my former self. You have reminded me how much it hurts our spouses to see the pain and despair in our eyes. I could actually introduce you to several spouses that feel the same as you…including mine. A friend and I half-jokingly say that the spouses need a support group!

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    Where Are The Women?

    Jp Enlarged

    Where are the women when we need them?  When they need themselves?  Are they sitting back and hoping that the men will do it for them, rescue them from the seedy guy with the pencil mustache?  That is so 20th Century, you guys.  Let’s examine this.  Could we have a more formidable force to assert our rights and position in the chains  if the women were more strident?  Would we get more attention when the men and women hook arms to claim the profession as ours, not theirs.  That one won’t be difficult, by the way.   It gets sticky when we say, “The business is ours to manage, not yours.”  The Profession and the Business are separate and shall never meet.  The Profession is a stainless obelisk.  The business is just a minor rusting problem down near the base.  If you allow non-pharmacist forces to have any say in the conducting of the Profession, you are .. I won’t insult you by using the word ‘Idiots’.  A reader recently wrote and told me that my use of the word ‘idiot’ to describe any pharmacists was a insult.   I wrote back and told him, “No shit, Sherlock”.

    Quickly, my column in Drug Topics has rules.  I do not use profanity.  If I insult CVS or the APhA, it is subtle and never a simple declarative sentence such as:  CVS is the asshole of our industry.  First, I know better and Second, Julianne Moore, the woman who polishes my diamonds, would never let me get away with it.  My columns are almost always submitted with 750 words, rarely any more or less.  Really, if it is 755, I’ll hunt down 5 words to delete.  By now, 24 years later, you would be amazed to see my work come out at 750 words without trying.  In a word, my “JP at Large” columns are disciplined.  Not here. My blog posts are anything but disciplined.   To this point here, I have 316 words and I haven’t even started really.  I just wanted you to know the difference.  

    Back to the influence of women on our profession and business, actually I prefer to call the two of them together, our industry.  We have not captained the ship for, it feels like, a long time.  Female pharmacists can change this.

    I have never been an authentic follower of astrology, but I really believe that the Age of Pisces ended at Y2K and we are both feet, spirit and body into the Age of Aquarius.  These periods are 2,000 years.  The Age of Pisces was 2,000 years of stealth, lying, manipulation and, I’ll jump to, subjugation of women.  Women were squashed, crushed, held down. treated as objects and used by men for pleasure, political gain and as the workers who kept the households neat, clean and peaceful.  Female pharmacists were a rare phenomena.  As late as 1995, I was given a ration by a non-pharmacist store manager because I hired a woman (who was clearly the better candidate) rather than the man he preferred.  At Y2K, it really was the dawning of the Age of Aquarius.  Just look At the Supreme Court.  Sotomayor, Kagan, Ginsburg.  Nearing the end of the Age of Pisces, Sandra Day O’Connor graduated from  Stanford Law School third in her class in 1952.  But Yipes.. This is from Wikipedia:  After graduation from law school, at least 40 law firms refused to interview her for a position as an attorney because she was a woman.  She eventually found employment as a deputy county attorney in San Mateo, California, after she offered to work for no salary and without an office, sharing space with a secretary.  The Age of Pisces.

    You would have to be blind, dumb and an idiot not to see the difference that the dawning of  the Age of Aquarius is showing.  Elizabeth Warren.  Hillary.  The only that are still holding on to Pisces are religious institutions.  In America, notably the Roman Catholic Church and .. you would have to be a double idiot to not have noticed Jorge Mario Bergoglio.  Even the Mormons, who  famously subjugated women to the point that LDS wives believed that it was their duty to engage in sex whether they wanted to or not, have loosened up some.   Females with muscles are fire fighters, police officers and carpenters.  The military has authorized women to actually be assigned to combat groups.  Officially, for the first time, women can fight the enemy and kill and be killed.   Women are physicians, lawyers and pharmacists.  There are more females entering our industry than males these days.  There was one girl in my graduating class of 20.

    This is the Age of Aquarius, girls.  2,000 years of truth rather than lies, fairness rather than cheating (Remind CVS),  the empowerment of women rather than squashing them.  It is time for you to step up and engage in the guerrilla war with me, Steve, Goose and Peon among others.  It should be clear that we cannot do this without you.  You represent more than one-half of our profession.  We need you if we are going to win this thing.  The boys cannot do this alone.  

    I know that all of you were born in Pisces and were influenced by the powers of that Age.  You can start by STOPPING saying “I’m sorry” when it is not your fault and you didn’t do anything wrong.  Think about that.  Please step away from your childhood view of yourselves.   If you had a dominating male (father, step-father, teacher, or others like a Priest) influence in your life, step away from it.  You are no longer a child and we need for all of you to start asserting yourselves.  You can do this.  I know you can.  I have seen women RPhs bring non-pharmacist managers to their knees.  Not often enough because I still see trembling, weepy little girls of age 35 allowing male non-pharmacist managers to mangle their self esteem.   

    I am inviting you to step up and join the fighters.  The satisfaction is enormous and there will be change when enough men and women start demanding respect and autonomy.   This will not be easy, but it is guaranteed if enough of us band together and demand what is ours.  We are PHARMACISTS and it is called PHARMACY.  

    Women have an edge.  Sexual harassment.  This is no joke.  Men can use this weapon also, but the effect that you get is exponentially more powerful than what I could get.  A simple thing as a non-pharmacist saying, “Hey, Honey. is enough to put you in a position where the company CANNOT retaliate.  You could be totally protected, unless you do something really stupid.  Let’s pretend you work for Walgreens and a manager calls you “Honey”.  

     All you do is say, (Preferably with a witness or your phone clicked on ‘Voice Record’) “Tom, I don’t like your calling me ‘Honey’.  Please stop”.

    The next time he calls you “Honey” (having a witness will help) all you do is write a letter of complaint to Laura Merten, Chief Compliance Officer.  Laura is Walgreens’ TOP COP.  (Every company has one.  Some call Head of HR)  It is Laura’s job to make sure that Walgreens is protected from stupidity that could cost them a lot of money.  I guarantee that when Laura Merten gets your letter, Tom’s ass is grass and he will keep away from you.  His job is in danger and if you charge him with retaliation, imagine what Laura Merten does then.

    In the guerrilla war, women have weapons that men can only dream of.  If we are going to solidify the fact that the profession is ours, period, no argument…. we need the women to join the battle.  If we are going to have any hope of  just having a spot at the business table, we need the women to step up.  Come on, let’s get going.

    I have for sale a pamphlet entitled “Basic Strategy to thrive as a Retail Pharmacist.  Protect Yourself Legally”.   I have added an in depth Appendix “What is Sexual Harassment?”   It is ten pages and complete.  Did you have any idea that sabotaging your work is legally sexual harassment?  You can get this pamphlet right here.  Up Above, click on “Buy From Jim”.

    I don’t want to let this go.  It is so important, but I have 1,377 words already. That’s enough.  Jay Pee


    I just read the first 4 comments to this post.  There is something going on.  I hesitate to mention the Stockholm Syndrome and claim that what we see in pharmacies is some variation on the Stockholm theme.   But, it feels like that.  If  you go back and read Steve’s comments on many essays, you will find the same advice. It will work.  I have been peddling two of  my books for awhile.  ’THE PRISONERS OF COMFORT” and “BASIC STRATEGY TO THRIVE AS A RETAIL PHARMACIST” for a long time.  Both of these directly address your Stockholm/Prisoner situation.  It angers me that non-pharmacist threaten you with: “IF YOU CAN’T DO IT,. WE’LL FIND SOMEONE WHO CAN”.  That is enormously disrespectful.  Pharmacy can never be directed by non-professionals.  To even think of such a thing is fucking ridiculous.  You need to get some steel in your spine.  Go ahead and make double mortgage payments.  Go ahead and follow the business direction that your company demands, but don’t stop practicing pharmacy.  Do not ignore pharmacy law because it is your Ace of Trump.

    About a year ago, a pharmacist in Oregon who worked for Rite-Aid had a problem.  It was regarding a refill.  He refused and the DM demanded that he fill the Rx early because it was a muscle relaxant and not a controlled substance.  He refused and found himself seeing signs of termination.  He contacted me.  I asked Steve to offer his two cents.  The kid followed our advice.  A guy from HR (Chief Compliance Officer) came all the way from Pennsylvania to try to put out the fire.  Long story short.  The pharmacist was offered a $9,000.00 settlement to promise not to sue Rite-Aid.  He declined and the last I heard he was examining the possibilities and rewards of suing Rite-Aid.   Again, Steve and I said, “Do This”.  He did.  ”THE BASIC STRATEGY ….”  is a definitive ‘how to’ and includes the advice that Steve and I gave this pharmacist and more.  Practicing pharmacy and complying with pharmacy laws and regulations is  far more important than manning the Prescription Mill.

    Please don’t continue to be a lump.  PRACTICE PHARMACY!  Practice pharmacy!  PRACTICE PHARMACY!    


    That’s Why You Make The Big Bucks… Donut money

    Jp Enlarged

    At 7:30 AM, every fourth Friday, this young (25 Y0) pharmacist has to go to a “A Store Meeting”.  I’d guess that rarely do they ever discuss pharmacy issues. Probably because they are ignorant of what goes on in the pharmacy.  They can’t fit the pharmacy into the variety store paradigm.  It is a mind-bender for the cosmetic girl.  The guy who stocks the OTC section wonders out loud why the pharmacy staff can’t face his shelves.  I honestly think that the companies that keep a thick firewall between the pharmacy and the store floor will be the most successful.  It does not work to have a night school assistant manager threaten to write a pharmacist up because she refuses to refill a hydrocodone/APAP Rx because it has No Refills.  The patient shows the vial with 1 refill remaining on the label to the assistant and the manager goes ape-shit.  The result is an interruption in the flow of the pharmacy.  The pharmacist has to call the Pharmacy District guy.  The DM has to call the store manager.  By now, the write-up has been circulated among the other managers at this store.  Some of them share this with managers in other stores under the file name: Stupid Pharmacist.. Again.

    The firewall that we need must have this over the door.  Mind your own business.

    The 25 Y0 pharmacist wrote this.  He asked that I not mention where he is and to make it anonymous.  Tell me. why are so many pharmacists so scared?  

    Mister Plagakis. 

    We have donuts at the monthly store meetings.  It was my turn to bring the donuts.  The store always reimburses the employee for the expense.  Ours is a busy store.  Especially now with all of the Snow Birds coming to town.   We have over 20 employees, but less than 30.  I went to Dunkin Donuts.  It was out of my way.  I bought 4 dozen donuts.  Two dozen fancy ones and two dozen plain.

    When I gave the store manager the receipt, he said, “What is this for.”

    “It’s the receipt for the donuts I bought for the meeting.”

    “I’m not paying you for all of the creamy ones.”

    “You have to,” I argued and the discussion got loud.  

    He just ignored me.  He dismissed me with a wave.  ”That’s why you get the big bucks,” he said to my back.  ”You can afford it.”

    I called my District Manager and almost lost it when he asked me,  ”Why am I always having to put out your fires?”

    This happened the morning of December 6th.   He still hasn’t given me my money back.  My husband says that I should be more forceful.  He offered to go in to the manager’s office and get it for me.




    “California Dreamin’ .. On a Winter’s Day”

    Jp Enlarged

    CVS Settles for $658,500 for Improper Drug Consultations

    (California is Back.  The left coast is very busy.  First Oregon, then Washington and now California.. Jay Pee)  This is from Paula, The Whistleblowers wife.

    Bonnie Dumanis: “Pharmacist consultations prevent drug errors and ensure that patients have the correct prescription for their condition.”

    Posted by Steven Bartholow

    Prosecutors Monday announced a $658,500 settlement in a lawsuit alleging that CVS pharmacists throughout the state frequently failed to comply with rules requiring personal pharmacist consultations when customers receive new prescriptions or new dosages of existing prescriptions.

    San Diego, Riverside and Alameda counties will share the proceeds of the settlement, which resolves a civil complaint that was filed in San Diego Superior Court in 2012 under California’s unfair competition laws.

    “Pharmacist consultations prevent drug errors and ensure that patients have the correct prescription for their condition,” said San Diego County District Attorney Bonnie Dumanis. “Without these checks and balances, patient health can be put at serious risk.”

    Working with the Board of Pharmacy, prosecutors in the three counties conducted an undercover investigation of the consultation practices of a number of the major pharmacy chains in California.

    Regulations enforced by the board require that a pharmacist provide a personal consultation to a patient receiving a prescription drug not previously dispensed to that patient, or a prescription drug in a different dosage form or strength, or on the patient’s request.

    Uninformed or improper use of  prescription drugs harms an estimated 150,000 Californians each year and contributes to an estimated $1.7 billion in economic losses throughout the state.

    California is on a roll.  First- Provider Status for All Pharmacists and now “Your pharmacists  better counsel or your corporate ass is grass.”  Pay attention, California Pharmacists, this fine opens the door for you.  ”Hey, Mister District Manager Man, I gotta counsel.  If I don’t, CVS will be fined again and, next time, maybe it’ll be my ass that’s grass.”


    How Do You Answer This One? Ladies Room Beat Down.

    Jp Enlarged

    12-22-13   A day later.  Honestly, I wondered if someone was playing with me.  A good story true or not.  In my mind’s eye, this pharmacist looks like Abby Wambach.  A tall, strong woman of the Wonder Woman template.  I will follow up and if she relates how this goes, I will share it with you.

    Okay. I get at least a half dozen E-mails every week from pharmacists who want to share their story, but insist on remaining anonymous.  I usually quickly reply with a “Thanks for the message” or “You don’t have to put up with that” or “At least stand up for yourself”.  Occasionally, when the company is so close to being illegal, I give advice.  Then, I get something like this.  What do I say to her?

    Dear Mr. Plagakis

    I never write my complaints, but this really bothered me.  Should I quit my job?  I had to use the bath room after being on duty for four hours.  I take HCTZ because I am a tightly wound woman and my BP tends to run high.  I worked hard from 8 until noon and couldn’t hold it anymore.  The technician got upset with me  because we had people waiting.  She is a very take charge tech and seems to think that making the metrics is her first job.  We had already filled about 200 Rx and I needed to go, so I went without one more word.  I did not hurry because this might be the only chance to get a break is what I was thinking.  I washed my hands, threw water on my face and brushed my teeth quickly after I used the toilet stall.  I put a handful of water on my head and massaged.  Not a problem since I wear my hair short.  I arranged my clothes, even pulling my underpants up tight.  I buttoned my blouse and was just puttimg on my white jacket when I heard a voice.  

    “So this is what you do when you have 20 prescriptions on the counter to be checked.”

    I actually jerked I was so shocked.  A female assistant manager was standing in the door of the farthest toilet stall.  ”Have you been watching me?  Have you been there all this time?”  I stepped toward her.  She stepped back.  I am no wilting violet.  I was on the field hockey team in college.  Title IX taught me that it is okay for a woman to be physically strong.  ”How dare you spy on me.”  I pulled the stall door open and demanded that she get out.

    “I’m just doing what I was told to do.”

    “Who told you?”


    Phil is the store manager.  I grabbed her arm.  ”If  you try this again, I will……..”  I didn’t know how to end that.

    “Phil is the store manager”, Brenda said like Phil was Jesus Christ.  ”Let go of me.  You are hurting me.”

    With a clear head, I know that I should have just gone back to the pharmacy, but I didn’t.  I squeezed her arm and twisted and I loved that she sat down on the floor, actually plopped down on her butt, pretty hard.   “Spying on me in the bathroom has got to be against OSHA.”

    “You always take too long and Phil wanted to know why.  I didn’t do anything wrong.”  She struggled, but I just squeezed tighter.  ”Let go of me, you.. you dyke.”

    That did it.  I like men.  Okay?  I enjoy being big and strong.  When men talk with me at the club, they are always respectful.  I am NOT a lesbo.  I lost control and slapped her.  She started to cry and I slapped her again.  You know, a simple bitch slap.   I didn’t want to hurt her really just embarass her.   When I let go of her arm, she ran out of the women’s room and I could hear her screaming down the hall.  I looked in the mirror, took a deep breath and said to  myself,  ”What did you just do?”

    I went up to Phil’s office then and demanded that he apologize.  He laughed.  I didn’t expect anything else, but I wanted to be proactive.   Now I am waiting.  I have  the weekend off and not one word.   I don’t know what to do.   If I get fired over this, I am going to catch Brenda somewhere and scare the crap out of her.  I don’t think I will beat her up, but she is going to think that is what is coming.   Maybe, I will beat up Phil.  He is a punk night school tough guy who brags about his flag football days.  I have two inches on him and probably 20 pounds.  

    Thinking like this makes me worry that I really am a lesbian.  Do straight women ever think like this?  Please help me JP.  I have been worrying all weekend.  

    I do not know what to tell her.  I did advise her to watch this spot.  You guys might be able to help her out.  



    More On Pharmacists Providing Primary Care AND GETTING PAID DIRECTLY

    Jp Enlarged

    From Broncofan.  This is important stuff.  You should be all over this.  On the phone.  Telegrams.   If you do not get this handled, CVS will be getting the money, not you.  Do you want Primary Care to go the way of Flu and Shingles Shots?

    How fucked up will it be when you diagnose, monitor, follow up, prescribe drugs and and are known around town as Doc Bronco and Rite-Aid gets paid and you get nothing more than your RPh wage?

    40 Million Brand New Insured Americans getting adequate health care for the first time and NO new doctors.  Pharmacists WILL be providing Primary Care.  You will be the Family Doctor.  You can bet that they are talking his over up in the MBA Masters of the Universe long able meeting room up in Illinois.  WAG is always slow and methodical.  The moves are well thought out.  The only problem is that  there is a battle going on at WAG.  The Throw-Money-Gift-Card-For-Transfer Dinosaurs are fighting behind the doors with the Provide-High-Quality-Professional-Services-And-The-Cream-Will-Rise-to-the-top guerrillas.  Who will win?  You know who I would fight battles with.  Pharmacists as Family Docs is going to be huge.  Start the dialogue NOW or you will be fucked.  So.. Bend Over or get going………  Jay Pee

    Goose, Peon, Steve, Pharmacy Gal, what say you guys.

    Hello Jim,I was just made aware of this today...sorry for the short notice. Exposure on your blog may do some good. 

    Got a second to help with provider status? Call your senator right now!

    December 12, 2013

    It is an exciting time here at 2215 Constitution on this cold but bright Thursday morning. Later today, we hope pharmacists in America will be plugged into providing patients team-based care in greater numbers than we’ve been able to achieve without recognition as providers at the federal level. You can help in getting pharmacists recognized as providers in accountable care organizations (ACOs) – but you have to act fast!

    At 10 a.m. this morning Eastern time, the Senate Finance Committee is scheduled to mark up its sustainable growth rate formula (SGR) legislation—the “doc fix” bill. This is the last step before the committee votes on the legislation and sends it to the floor of the full Senate. More than 100 amendments, a number of which affect pharmacy, have been proposed to the Chairman’s Mark, including an amendment by Senators Grassley (R–IA) and Carper (D–DE) titled “Inclusion of Pharmacists as Providers in Medicare ACOs.”

    Check the Senate website and see if either of your Senators is one of the 24 members on the Finance Committee.Many of the most populous states are represented—New York, New Jersey, Pennsylvania, Ohio, Michigan, North Carolina, Georgia, Florida, Texas, Washington—along with Maryland, Delaware, West Virginia, South Dakota, Iowa, Kansas, Wyoming, Colorado, Utah, Oregon, Idaho, and Montana (home of Finance Chairman Max Baucus). If so, contact him or her this morning to express your support of the Grassley–Carper amendment being voted in committee today.

    We are so grateful to the Senate Finance Committee and its staff, and in particular these senators, for their concerns with medication use and for their ability to see the benefits of having pharmacists on the ACO health care team! Thanks to our APhA Government Affairs team members for their work as resources to the Senate Finance staff as this language was developed.

    Just to “calibrate” folks, this legislative step forward for the pharmacy profession comes in large part because the Senators wanted to help their constituents’ medication use with access to pharmacists’ services. Importantly, this applies to services provided on a team within an ACO. In addition to work needed to get this amendment through the Senate, and through the House and/or conference committee, we’ll continue working on the larger proposal to get pharmacists more broadly recognized as providers in Medicare.

    We appreciate all of pharmacy for everything you do to advance our profession! Thank you in advance for sharing with members of the committee the importance of the Grassley–Carper amendment.

    Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA
    APhA Executive Vice President and CEO

    Jay Pee 12/17/13

    I just read the comments and my knees started to shake, like a little puppy, I was so excited.  The more I sit with the idea of pharmacists gaining provider status, the more it sinks in.  As AJ wrote, “It really is GAME ON”.  I agree with AJ that this is a terrific reason for visiting the U.S. Small Business Administration for a low interest loan to get the lights on in your own store.  When young, energetic, motivated, well-educated Pharm Ds open stores with well built spaces like the Take Care Clinics at Walgreens, It will truly be game on, AJ.  Particularly if you are a nice, caring person with what people call a good personality you will be driving a stake in Dracula’s Big Evil heart.  If you are near a Big Stupid.. Oh my Gawd, what fun that would be.. calling ten times a day for transfers.  Immunizations would be a significant part of your practice.   I know about a neighborhood in Washington State where the MDs only keep the rudimentary vaccines.  Pediatric patients are sent to the local pharmacy for all immunizations.  Just one niche business.

    It will not be long and there will be another pharmacist shortage.  The shortage will be of smart, competent, experienced pharmacist/merchants.  The Chains, Big Box & Grocers would be smart to be proactive or they will end up with rudimentary dispensaries staffed with marginal robo-dispensers.  Come on, the Jay Pee visitors look fondly at Broncofan.  He will gladly share his winning formula.  Imagine competing with a Rite-Aid  where the PIC is a first year out of Touro who has never even worked in a pharmacy other than a rotation in what they label a Professional Pharmacy that serves nursing homes.  Poor bastard.  What will he do the first time an obese woman asks about the rash under her heavy breasts and pulls up her tee shirt and shows him?  Probably send her to you.  What about the tough guy who comes in after a fist fight and asks the Touro kid to help him pull the other guy’s teeth out of his fist.  Dramatic and rare examples of why you are gonna kick some Big Stupid ass.  

    I honestly believe that the employers of pharmacists who treat you badly will have to start throwing money at you again.  Suddenly, out of nowhere, the Affordable Care Act starts treating pharmacists with respect.  Suddenly, guys like AJ will turn in the CVS keys and open their own shops.  

    You know, CVS has been treating pharmacists so badly that I don’t know if throwing money will help.  Possibly the money and iron-clad employment contracts might get guys like AJ  to hang around awhile.  I’d love to be 42, 52 even instead of 72 with legs like spaghetti.  It would take me about a minute to make the call.  

    Click here: or Call 1-800-827-5722


    From our Friend Olga. What do you make of this? Is this America?

    Jp Enlarged

    Ok so Today of all Days this has to happen to me I AM POSTING THIS SO EVERYONE KNOWS WHAT KIND OF SOCIETY WE ACTUALLY LIVE IN. Since 1992 I have been trying to own a store- a Pharmacy to be exact and for the last number of years I have learned the following: Private Business is allowed to be prejudice, There is no Department of Small Business in the White House, A larger Multinational Corporation or Chain is allowed to keep a small store ‘EMTPY AND MAKE THE NEIGHBORHOOD LOOK LIKE SHIT’ AND KEEP IT empty if they want to sabotage a business…YES A CHAIN IS PAYING FOR A LOCATION TO BE KEPT “FREE FROM A PHARMACY BEING LOCATED IN IT”. THE FINAL PAYOFF for me is the following. Finally I find a store, good location, decent rent, I tell them I am opening a pharmacy and in the pharmacy will be a combination/physicians office as well- I am going to open a Phase I research unit and help young physicians sublet the space and learn their trade until their ready to fly off and open up their own Medical Offices. I am mortified at what I am about to tell you. I explain this to the real estate agent. Suddenly the phone goes dead….as if NELSON MANDELA caused the line to go dead for a reason- I did not know he just died. The guy calls me back and leaves me this message, ” My clients are worried as to what type of business you are going to open up, what kind of people are going to come to your office/out patient pharmacy….we don;t understand what it is you are doing- we are worried- We don;t want you to OPEN UP AN AIDS CLINIC…….when I listened to the message I was ready to have a heart attack- I was upset, I was dismayed, I was so disgusted at my fellow American saying this “UnAmerican shit to me” if I had been on the phone I would have cursed him and lost the store. I composed myself… angel must have flown in me and I called him back. I said, “I received your message and I want to let you know that I have no intention of opening an Aids clinic. I am simply going to have a small outpatient pharmacy, with two exam rooms and a small lab- to help young doctors begin their trade……I will dispense FDA approved medication and Specialty Pharmacy supplies”…NOW THIS STORE IS NEXT TO A LIQUOR STORE AND DOWN THE STREET FROM A DAMN PUB!!! What has gotten into the Americans of this country!! I told him I was upset that he would say what he said- he told me we have an Abortion Clinic in a very posh town out east which I won’t mention……and we have people that picket the office once a year. I then reinforced ‘MY BLATANT CHRISTIANITY” AND TOLD HIM I WAS PRO LIFE WHICH IS WHAT HE WANTED TO HEAR…….I am appalled that these idiots have the power to say these things to me…a person who holds the constitution higher than even the Bible……..Can someone please tell me- Am I crazy???


    Time to Take a Break and Laugh To Keep From Crying

    Jp Enlarged

    1 Comment

    The Pharmacist as the Doctor’s Nanny? The Time Has Passed

    Jp Enlarged

    I quit covering doctor’s ass sometime around 1995.  Before that it was part of my pharmacist DNA.  I just did it.  If the doctor made a mistake, I quietly got him on the telephone and we very quietly corrected the problem.  In the beginning, my standard fix-it line to the patient was:

    “The doctor has decided this is a better choice.  Can I deliver this new drug to you and pick up the old one?”  I was good at smoothing it over, like the pharmacist’s vanilla frosting on the doctor’s shit pie.  ”No, don’t worry, just don’t take anymore of the first drug.”  

    An extreme example, but it actually did happen a few times that the bad drug got out of the store and into the patient’s medicine chest.  Usually, there was an uncomfortable nagging feeling that began a few hours after I filled the Rx.  I’d do my research and BINGO.  The dummy did it again.  Usually, one of a small coterie of doctors who buried their mistakes.

    1971.  The doctor was in the habit of prescribing tetracycline 250 mg qid with the added insruction “Take with Milk”.  I never put that on the label, but finally had enough.  My mood that day was dark and I was pissed off so I took it out on the doctor.  I called and told the maternal-acting receptionist that I would not leave a message.  ”Just et the doctor”.

    He made it to the phone and I went off.  ”You can’t order tetracycline to be taken with milk.  What are you thinking, man?”  This was still the hippie generation.  Everybody was man.  

    “You can’t call me MAN.”

    “Okay, Doctor Prince.  I’m Mister Plagakis.”


    “Plagakis. That’s Pee Ell Aye Gee Aye Kay Eye Ess.  Plauh Ga like in gas kis.”

    “Oh, I always order milk with antibiotics.  It prevents stomach distress.”

    “It also prevents the drug from working.”  I explained.  I will tell your patients to always avoid milk or calcium-containing products with tetracycline.”

    He got all flummoxed to the point of stuttering.  ”You can’t do that.  That is interference with the doctor/patient relationship.”

    “So sue me.”  That evening I put a package insert from an Achromycin V box in the mail with the milk warning highlighted.  ’Take with milk’ was missing from his tetracycline prescriptions after that.

    I still covered his ass.  Patients were never made to know of their doctor’s stupidity unless the doctor refused to fix the problem.  

    What put me over the edge and caused me to never, ever again cover for the doctor was the 1995 incident.  The patient was an elderly woman.  It was Friday.  She was very ill and had been sitting in the waiting area for an hour.  The doctor told her that she would have to promise to take the medicine exactly as prescribed or she would have to be hospitalized.  Her daughter and son-in-law were with her.   They were from out of town and had taken Friday off to be with her.  They planned on staying the weekend to make sure she followed the doctor’s orders.  The problem was there were NO orders. 

    She was a 30-something internist.  Her husband was a 40-something psychiatrist.  They had a three bedroom ‘cabin’ on the water over on the Olympic Peninsula.  The two of them and their 2 kids were taking a 4 day weekend.  They took a nanny with them.  The husband and wife were looking forward to some tender hours at Sol Duc Hot Springs at the olympic National Park.  She had forgotten to call in the prescription.

    We didn’t get her nurse on the phone until around 3:00 PM.  To make this horrible story short, the nurse could not help because the doctor had not completed her charting.  The doctor left orders not to be bothered and she was so serious about it that she and her husband had turned off their phones and had left them in the glove box in the car.  they were primed ready for a red-blooded American family weekend.   

    The patient was admitted to the hospital around 6:00 PM and the new doctor had to start from scratch.  

    I got a call from from the first doctor on Monday evening.  She was all over me.  I was having none of it.  I told her that she had screwed up.  I told her that her nurse could have gotten on her horse and drove over to the ‘cabin’, but she had snickered at that idea.  I asked her why she wasn’t talking to the daughter or the new doctor.

    The new doctor was unavailable and the daughter refused to talk with her.

    She gave up her ‘I-Am-The-Doctor Act’ and sounded so pathetic at this point that I took pity.  ”Better get your attorney involved,” I said.


    “Because they have.   I am being deposed on Wednesday about this. “

    “What does deposed mean?” 

    “They will ask questions and I will answer them truthfully.  I believe your attorney can be there.”  I remember pausing.  ”Not getting the needed antibiotic in a timely manner did cause harm.  Financial harm and physical harm.  The daughter is really pissed off  and she is going after you like the Indians went after Custer.”

    A very long pause.  Her breath was coming in gasps.  ”Are you okay?”

    “No, I am not okay.  I am a doctor, not an attorney.”  Another long pause and then the statement that caused me to go telephone postal.  She added, “I believe that I DID call in the prescription.  You lost it or something.”

    “And you are fucking crazy, Doctor, if you think you can make that fly.  Do you know how easy it would be for me to have PacTel give me a list of the source of every single incoming call from Friday?  Take responsibility like an adult.  Call your lawyer.”

    She hung up on me and I decided right then that I would never again cover any doctor’s ass.  After that, whenever there was a problem that caused harm, I went into full disclosure mode directly to the patient.  I took names of nurses and receptionists and gave them to patients with the advice, “Give these names to your attorney.”

    I felt much better after that.  I even took that course with PBM Prior-Authorization Agents.  I know that it is really not a pharmacist’s job to go after Prior Auths, but there have been times when I believed that it was important.

    I remember asking the name of  A PBM CPhT who was refusing the Prior Auth.  She was uppity and in charge, she thought.

    I said, “This patient, your client, is standing right in front of me with a puddle of blood around her feet.  There is blood running down her leg.  I am going to tell her, Brenda, that you have refused to authorize payment for the drug that can stop the bleeding because it is expensive.  I am going to advise her to give your name to her lawyer.   I will suggest that your name be on the lawsuit.

    She asked me to wait for her supervisor.  I said, “No, I am not waiting for anyone.  Do NOT put me on hold.”

    The Supervisor came on the line in about 2 minutes.  I asked her name and she ignored that request.  However, she gave me the Prior Auth number with PRN refills for 6 months.

    There are times, you guys, when you just gotta go out there and be Wonder Woman or Bat Man.  It is actually fun and the reward is enormous self respect.   Yes, I did that.  I made a difference.  I fought the system and I won for the patient.”

    I got a little off the track at the end, but contextually it is all the same.

    Jay Pee



    Never Sign Anything and I am Not Blowing Smoke

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    There will be a time when you are called to the office to get a lecture and being “written up” for being rude.  It is very likely that you are guilty of being busy, multi-tasking and not jumping front and center when tight-ass Mrs. Doremus wanted you to explain why her co-pay is $30.00 instead of $5.00.  The technician has already explained the variance between brand and generic.   She whined that since the doctor wrote “Do Not Substitute” on the Rx she should get the $5.00 toll.  You said, “I cannot explain it any better than Tom. Call the 800 number on the back of your insurance card.  They can explain.  That is their job.  It is not our job.”  You were polite.  You smiled.  You thanked her for trusting Walgreens.  She went for your throat.

    Here are the basic rules for your behavior in the office.

    1. BRING A WITNESS.  A FELLOW EMPLOYEE IS FINE.  No witness, record the meeting with the voice recorder on your smart phone.  If Billy Bob says NO, the meeting is over.

    2.  DO NOT SIGN ANYTHING.  EVER.  Even if the Store Manager observed your transaction with Mrs. Doremus. Sign nothing.  Signing says that you admit that you are guilty of being rude.  You were not rude.  Do not argue though. Ever.  Your choosing not to sign is a definitive statement that you do not agree that you are guilty.  Billy Bob, night school Junior College Business School Vet, can do nothing.  Trust me.  He is out of the water. If he gets loud and abusive.  When he tries to bully you, do your best impression of the Dalai Lama.  Just sit there.

    2.  Make eye contact.  Often and hold it until BB looks Away.  This is tough, Jessica.  Young women in Texas are not trained to be this assertive.  Just DO IT.

    3.  DO NOT GET ALL HUFFY AND WALK OUT OF THE ROOM.  If needed,  just sit there.  Silence is your ally, not BB’s.  If he gets abusive and demands that you talk, record it in your head and document when you get home. 

    4. DO NOT LAUGH AT HIM. Not a good idea.  He is the Nazi jailer doing the dirty work of the company. It is his tiny ass if he doesn’t do it.  

    5.  DO NOT USE, BAD, VULGAR OR INSULTING LANGUAGE.  Saying, “You are one big dick, Billy Bob” will ruin it all.  It could cost you your job.  If you are one of us who rocks CVS’ boat by counseling or giving attention to the elderly woman who needs your help picking a laxative, they may have a bullseye on your back.  You know, with the sudden influx of Robo-Dispensers from the new for-profit schools of the Phoenix mold.  Check out the Touro University cirriculum.   These kids need to work.  Entry level is probably 15% less than what you make now.  You may be targeted.  Cover your ass.

    6.  DO NOT TOUCH BILLY BOB.  It would be the touch of death.  Picture this.  Billy Bob reads the “Write Up” to you.  It is pure bull shit.  It accuses you of some bad behavior.   You want to get his attention so you grab his arm.  




    Oregon Board Repeats 2011 RPh Survey on Working Conditions for 2013

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    The 2011 Survey produced results that caused the Oregon Board of Pharmacy to Change the Rules with statements such as “The Pharmacy Is Not The Deli.  Pharmacists deal with life-saving drugs not Corned Beef and Swiss Cheese.”  I was so encouraged that I called Oregon the first state to enter civilization.  Thanks to a guerrilla fighter in Oregon for alerting us.  He suggested that he will send Comments if he can secure them.  And..The Beat Goes On.  Sonny is dead, but Cher is still rocking on.  Sonny, by the way, died when he was skiing and ran smack into a tree.  Sonny was a very good skiier.  He was also on Vicodin.

    Posted November 21, 2013

    Board Conducts Survey on Working Conditions

    The Board has continued to hear concerns regarding working conditions in the pharmacy from
    Oregon licensed pharmacists.

    In July 2013, the Board conducted a follow-up Working Conditions Survey (a duplicate of the
    2011 survey) to solicit opinions from those pharmacists licensed in Oregon via an online
    survey. Over 1640 individuals responded to the survey with more than 492 providing one or
    more specific comments. The Board appreciates each person who took the time to participate
    in the survey and provide comment.

    The Board of Pharmacy staff has summarized the results. This data will be statistically
    analyzed and compared to the survey results from the 2011 survey.

    The top four areas of concern expressed by the comments include:

    • Staffing Conditions
    • Meal Periods and Breaks
    • Patient Safety
    • Other Stressors

    The data does not indicate whether these comments were positive or negative; it just indicates
    that comments were made.

    The following are the initial survey results and additional sorted data for your information. The
    Board will continue to analyze the survey data results. The Board also expects to take future
    action to enhance patient safety and safe working conditions

    Read Entire 71 Page Survey Results- Click here

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    A Battlefield Victory In The Guerrilla War

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    The tide is turning, my friends.  Ten years ago, just the idea of this happening would have had us gagging with laughter.  Jay Pee

    Pharmacist wins age discrimination case against CVS

     NOV 21, 2013

     After celebrating his 65th birthday at the beach, pharmacist Roger Harris returned to his Anniston, Ala. workplace to find a surprise waiting for him: He had been fired and replaced by a 27 year-old.

    Harris sued CVS Caremark, alleging the retail chain violated the federal Age Discrimination Employment Act when it fired him in 2009. And after a two-week jury trial before U.S. District Court Judge Virginia Hopkins, a federal jury agreed with Harris and awarded him $400,000 in back pay. Harris could be eligible for an additional $400,000 in damages. Judge Hopkins has yet to rule on damages.

    “The termination document was dated August 13, 2009,” said Kenneth Haynes, Harris’ lawyer, told the Birmingham News. ”He was celebrating his 65th birthday at the beach. When he returned to work he was informed on August 17, 2009 of his termination.”

    A CVS spokesman said the chain is considering an appeal.

    “We respect and appreciate the jury’s effort in reviewing this case, but we strongly disagree with their decision,” Mike DeAngelis, CVS Caremark’s director public relations told the newspaper. “CVS Caremark has a firm non-discrimination policy, and we do not tolerate discrimination in our workplace on the basis of age or any other legally-protected trait.  We are considering our options for appeal.”


    - See more at:


    What did I tell you? A Stethoscope Over Your Shoulder Won’t be Simple Posing.

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    You can bet that WAG, CVS, RAD, Wal-Mart, Kroger and the rest of them are working overtime to figure out how they can get your money and call it theirs.  This is coming.  Be ever watchful.  You are in the catbird seat. Do NOT give it up.  They usually do the right thing out on the west coast, but you may be stuck in Pennsylvania.   Jay Pee

    Landmark Legislation Positions
     Community Pharmacies at Center of Preventive Care
    “Provider status” revolutionizes pharmacists’ role in
    New era of Obamacare, doctor shortages
    ALISO VIEJO, Calif. – November 19, 2013 – In a move that may now spread throughout the states, California lawmakers have granted healthcare “provider status” to pharmacists.
    “Most Americans don’t realize that pharmacists were not officially considered ‘healthcare providers,’” said Al Babbington, CEO of PrescribeWellness, a SaaS company that develops patient communications tools and services for community pharmacy. “The Affordable Care Act (ACA) mandates preventive healthcare coverage for millions more Americans. But with too few doctors serving more patients than they can effectively treat, a significant gap in care is created starting in 2014. This legislation paves the way for community pharmacies to fill that gap and provide these much needed services.”
    Well beyond the traditional filling of prescriptions, the new law goes into effect January 1, 2014 and authorizes pharmacists to administer medications and counsel patients in a manner that directly improves outcomes. In the case of California, the nation’s most populous state, this will result in millions of citizens having access to critical services such as obesity counseling and smoking cessation support via their neighborhood pharmacy.  
    “Over 160 million Americans have at least one chronic disease and the numbers are growing. The ACA is far too costly and unsustainable unless effective, dependable and available healthcare providers can step up to the plate and manage some of the jobs performed by doctors, such as helping patients improve their use of medications and properly manage their disease,” said Babbington. “California has set a national example in assuring all citizens have access to preventive care. PrescribeWellness is proud to provide the training and tools that help pharmacists take on this new leadership role and become the center of wellness for the communities they serve.”
    “A key to success of the ACA is collaboration of care between all healthcare providers, and this legislation allows pharmacy to work side by side with hospitals, physicians and other providers along the continuum of care,” said Terry Olson, Ph.D., vice president of behavioral solutions at PrescribeWellness. “We have the technical tools, the behavioral research and now the policies in place to step in and directly improve the health of our diabetic and other chronic disease patients. The result will be better quality of life and lower healthcare costs for millions.”
    About PrescribeWellness
    PrescribeWellness automates critical engagements between pharmacist and patient in the five key areas that improve patient compliance, care and outcomes: Medication Adherence, Chronic Disease Management, Transitional Care, Population Health and Behavioral Change Programs. With data integration and proprietary behavioral science at the foundation, PrescribeWellness cloud-based solutions position the pharmacist at the center of community healthcare prevention. For information on the industry’s most effective patient engagement tools and programs, please visit

    Bri Rios | Account Coordinator
    Metzger Associates | The art and science of communication.
    Email ∙ 720.833.5912 (direct) | 303.786.7000 (main)

    Whistleblower’s Wife says, “It is finally GAME ON.”

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    From:  Paula Christine Zorek

    To my Facebook Family…

    Please keep my husband Joe Zorek in your prayers…tomorrow starts the long awaited journey in the Federal Court system. Anyone who wants to follow
    this journey can do so

    Joe Zorek is “Whistleblower”.  His legal action is against CVS.  His legal team is topnotch.

    No Comments

    This Game is Fixed. You Cannot Win. Unless….

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    You understand that there is danger out there and you act accordingly.   You understand that they are not your friends because it is their ass if you do not toe the mark.  When it looks like you are not in “The Program”, you will be the one thrown under the bus.  You see, they do not give a shit if you are an effective retail pharmacist.  It means nothing to them if you get compliments from your patients.  It doesn’t even matter if you are having a noticeable positive effect on the return on investment.   You are a highly educated medical professional, but they do not give a shit.  They want you in the box.  They depend on measurable indices.  How fast.  How fast.  How fast.   How safe?  They give lip service, but c’mon, you know the truth.  Patient centric?  Of course, they claim, but you know who much bull shit that is.   

    They want ROBO-DISPENSERS.   To prove this argument, just look at the new, for-profit, schools.  They don’t even teach compounding and the chain companies are gobbling up these clueless kids right and left.  I received an email from a guy who told me that at his Wal-Mart, the official words is “Do Not offer to counsel on OTC products.”  Apparently, it takes too much time.  

    That was just foreplay to get you all hot.  Here comes Da Judge.  Get ready.  Jay Pee

    You Must Protect Yourself because they can come after you at any moment.

    I get Emails all the time.  Usually, they are letters of complaint.  H0w bad it is.  Oh, woe is me.  Won’t someone save me.  Then, I get the occasional message from a pharmacist who saves herself.

    I found one this week.  A youngish woman told me about how she actually won a round and what she had to do.  In her words.  She asked me to keep her name. the company, even the state out of it.

    The store manager told me that he wanted me to come to the office FOR A TALK when the later RPh came in.  He doesn’t call people up there unless he is going to write them up.  I had to wait 6 hours and I got nervous.  Real nervous.  My stomach started to act up and I noticed that I was chewing my lower lip, a sure sign that I was really upset.  I told myself that I hadn’t done anything wrong, but it did not help.

    The manager was not in the office when I got there.  I took a seat and looked around.  My stomach felt worse when I saw my name on the “Employee of the Month” plaque.  I felt even sicker when I saw a folder on the desk with my name on it.  I sat there another 5 minutes.  I looked out the office window that overlooked the store selling floor.  The manager was way up front, by camera, so I said to myself, “What would Pharmacist Steve do?”  I knew that Steve wouldn’t just stand there waiting for the knife to come down.  So, I picked up the folder with my name on it.   I sat down because my legs were shaking and my knees were weak.  Then, I started to get really more upset by what I was reading.   The whole file was filled with charges against me.  I got really pissed off then.  What really got my back up was something that was supposed to come from a pharmacist who didn’t even last 6 months.  He told the manager that I said, “Hey, Bert, no wonder I started getting excited when I heard your foot steps.”  He took it all wrong.  I remember it.  I was actually excited because he was a half hour late and I was hungry.  He made it sound like a come on thing, like I wanted to hook up.  Uggg.  Bert is an idiot.  I don’t think he ever even had a date.   He told dirty jokes that weren’t even funny.   My husband said that I should go the sexual harassment route, but I told him that I was too adult and that I could take care of myself.   Who thinks that jokes about “rubbers” are funny in 2013?   There was a note from a customer that said I ignored her when she wanted to ask a question.   A whole bunch like that, from ten years ago.   

    I have been reading JP’s articles and this blog for years.  Not long ago, I said to myself, “If Peon can be a real pharmacist at a place as bad as Wal-Mart, I can do it.”  I started to counsel more.  I slowed down.  I refused to answer the phone until I have completed a task.  The comments in the folder started to get really mean about then.  Two of the four technicians wrote to the manager that I had slowed way down and that our wait times were too long.  Isn’t it funny that they both wrote the same thing?  Wonder who put them up to that?  

    Then, the pages on top were a letter from a woman customer and the write-up.  Ready to go, waiting for my signature.  No frikkin’ way, not ever would I sign that or anything else.

    The letter said that I had been hitting on her husband for a long time and she was tired of it.  She said that her husband did not want to cause problems so he never said anything until she confronted him.  That is BS.  The guy is a touchy feely creep who never says a word, but the way he looks at me when he touches me arm weirds me out.  I want to puke.

    I asked myself, “What would JP do?  Steve and Peon?  I tried to imagine what Marie Rodriquez would do.  She is one of my heroes.  So when the manager came into the office, I said, “I am going to file a sexual harassment complaint against Bill Reynolds.” (the husband of the woman complainer).  My mouth was really dry, but the words came out.

    “What?”  His eyes got real big.

    “By law, the company has to protect me from him.  If you don’t, I will do something about it.” Just like Marie would.

    He got all tongue-tied, so I went downstairs and told the other pharmacist that I didn’t feel well.  I just left.  I never heard another word about this, but I have been warned now.   My company is not what I thought it was.  I stopped at the mall and spent all of my clothing allowance for 3 months on this great pen looking thing that can record voice, but also a picture.  This does make me feel safer and it is fun.  I will download once a week and then delete the stuff that means nothing.   So far, I have saved one thing with a customer.  If he tries to get me in trouble, I got him.  I am thinking about investing some money into a few “bugs”.  They are really cheap.  It is the receiver that is expensive, but the salesman said I could leave it in the car.   According to him, I can take the memory thing out of the receiver and plug it into my computer to listen and keep only what I want.  Should I plant one in the store manager’s office and the pharmacy too?  Easy Smeasy.

    My husband hollered at me.  He said I was getting obsessed.  I told him he is right, but I don’t know how to stop.  I feel secure and I don’t want to give that feeling up.

    I will hold off on my advice until I hear what you guys think.  Jay Pee


    What is the critical mass in your company?

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    8 days later and the discussion indicates little interest.  Hmmm?  I have been interested in the concept that the Stockholm Syndrome is much wider than the basic explanation.   There are technicians and pharmacists who are mistreated badly and they still stand up for their abusers.   They still loudly sing: “Oh, how much I love me job.”    They get all giggly like little girls when spout the company talking points to any colleague who dares to tell the truth about what goes on during a 14 hour shift at CVS.  I have never been able to do that.  The idea that I could lie about my situation when telling the truth can actually make a difference.  C’mon, Plagakis, everybody does it.   Not EVERYBODY, Han Solo.  I have believed for years that all it will take is a quantum force of pharmacists to stand up and it will be game over.

    What is the critical mass in your company?  How many guys NOT laughing it off  will it take to get the MBA Masters of the Universe off the high horse.  They are, after all, just MBAs.  How the hell did they get to such a high spot in this country?  Geezuz, they are just MBAs, Number-Crunchers.  Their terrific ideas have just about RUINED our industry.  OUR industry, not theirs.  They have been giving away the store for decades.  

    No discussion about recording devices.  Why?  This could empower you.  And.. it could be more fun than a pharmacist is ever allowed to have while working.

    Every single one of  you should read this.  You are pissed off  at the shabby treatment you have received?   They will never see it coming.  Meek, mild, cream puff Janet Lynn.  The Pharmacy Manager who does anything she is told.  Then, one cold, icy morning, Janet lynn lays the wood to them.  A huge company has been cheating Medicaid for years.  Janet, where are you now, darling? Curacao?  Perhaps Rio?  Getting a massage from a masseur named Bruno at a exclusive spa in the Swiss Alps? 10 to 30% of $60,000,000.00 is enough to open up your own pharmacy next door to the offender, just to fuck with them.  You guys hold the club and you just don’t frikkin’ know it.  Is this a variation of the Stockholm Syndrome?


    Pharmacist Whistleblowers

    As front-line professionals responsible for dispensing medications to Medicaid beneficiaries, pharmacists are particularly well positioned to discover and report Medicaid fraud. As a result, pharmacists have initiated a number of highly successful qui tam actions under the False Claims Act. The Walgreens settlement marks another successful result of qui tam action by a pharmacist to protect taxpayer funds.

    The pharmacist became a qui tam relator after discovering the drug switching in processing transfers of prescriptions from Walgreens pharmacies. According to his qui tam Complaint, the pharmacist discovered the Medicaid fraud after noting that a Walgreens prescription was for ranitidine capsules rather than tablets, the industry standard. The pharmacist relator stated that Walgreens pharmacists told him that the pharmacy chain had set up its system to fill all ranitidine prescriptions as capsules regardless of what a physician had specifically prescribed.

    The same pharmacist relator also successfully pursued a qui tam action against CVS pharmacies for Medicaid fraud arising from drug switching, which resulted in a $37 million settlement.  Let’s see.. 10 to 30% of 37,000,000.00 is not a bad reward for busting CVS for cheating.  Jay Pee

    The initial qui tam case by the relator pharmacist was against his prior employer, Omnicare Inc., the nation’s largest pharmacy for nursing homes. That Medicaid fraud case resulted in a $50 million settlement of False Claims Act allegations.

    The Omnicare case was the first to challenge generic drug switching, and served to strengthen Medicaid’s price containment programs for generic drugs. The qui tam relator discovered the conduct which led to this settlement while he was a pharmacist at Omnicare. The pharmacist relator was represented by Behn & Wyetzner, Chartered.

    This same pharmacist, after being fired by Omnicare, discovered that similar switching was being done by CVS and Walgreens. Those cases also were investigated and filed on the pharmacist’s behalf by Behn & Wyetzner, Chartered. The CVS case was the first generic drug switching case settlement by a retail pharmacy. CVS paid $37 million to settle claims brought by the United States, 23 states and the District of Columbia.

    The partners of Ven-a-Care of the Florida Keys, a pharmacy, successfully challenged the way in which Medicaid drugs were priced. Ven-a-Care initiated a series of state and federal False Claims Act cases against drug manufacturers for falsely reporting “Average Wholesale Prices” to state Medicaid programs. These cases have recovered hundreds of millions of dollars in taxpayer funds, and ongoing cases stand to recover billions more.

    Two veteran pharmacists helped the government recover $84 million through a qui tam action against Merck-Medco Managed Care, L.L.C., a Pharmacy Benefit Manager (“PBM”). This case changed the way in which state and federal governments deal with PBMs. The pharmacists alleged that the PBM had engaged in fraudulent Drug Utilization Reviews, unlawfully cancelled prescriptions, created false records of physician contacts, and used technicians to perform functions that must be done by pharmacists.

    The PBMs have got to be ripe fruit.  Wouldn’t you say so, AJ?  

    Two pharmacists filed separate cases that resulted in a $7 million recovery from Rite Aid under state and federal False Claims Acts. The settlement resolved the pharmacists’ allegations that the company had been:

    • failing to delete or readjudicate prescriptions that had been billed to Medicaid but were never picked up;
    • restocking items without “lot control;” and
    • billing for partially filled prescriptions as if a full prescription had been delivered.

    Employees of Interstate Pharmacy Corp./Liliha of Honolulu, Hawaii successfully pursued a Medicaid fraud case that led to a $4 million recovery from the pharmaceutical company, Bergen Brunswig Corp. The employees reported that the company was recycling and reusing pills returned from nursing home facilities in violation of state and federal laws.

    A pharmacist’s successful pursuit of a qui tam case requires a high degree of specialized legal expertise. The pharmacist’s lawyer must be familiar with federal and state False Claims Acts, federal and state Medicaid law and regulations, federal and state Food and Drug Acts, state pharmacist licensure provisions, and state pharmacy regulations. False claims in Pharmacy often involve the intricacies of state pharmacy provider applications and claims procedures, which vary from state to state.

    A successful qui tam prosecution also will involve the pharmacist and his lawyer working closely with various state and federal agencies, including the U.S. Department of Justice, U.S. Attorney’s Offices, the Federal Bureau of Investigation, the U.S. Department of Health and Human Services, the U.S. Food and Drug Administration, state Attorneys General offices, state Medicaid Fraud Control Units, state Medicaid agencies, state Boards of Pharmacy, and the National Association of Medicaid Fraud Control Units.

    The lawyers at Behn & Wyetzner, Chartered have years of expertise pursuing and settling qui tam cases by pharmacists against pharmacies. They have worked closely with pharmacists, federal and state prosecutors and investigators, and experts, to pursue successful False Claims Act prosecutions.

    All of these fuckers have been cheating for decades. King PROFIT rules every single aspect of the pharmacy industry.  Notice that I did not signify “Profession”.  They are distinct and separate.  You guys, every single one of you, are deep cover operatives.  You see illegal activities and cheating every single day you work.  Can you see just how easy it will be to bust these supercilious assholes who believe that they are bullet-proof?  Get going.  Buy something like this.. and use it.  Your voice recorder on your phone will work, but people are smart.  They will not catch on to something like this.  More than 100 hours of voice recording.  Transfer by USB directly to a file on your PC.  This pen costs $139.00 on-line.  Go and look.  The choices are amazing.  You could probably bug the store manager’s office.


    The Poster Boy For Cheats

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    After you watch the short video, scroll down and read the comments.  It appears that a CVS employee had been out on an approved leave.   This woman had accumulated benefits.  When she came back, they required her to complete a “New Hire” package.  Then…. her accumulated benefits disappear, CVS gets rid of her, thereby saving $$$$ in the tried and true CVS manner… CHEAT THE EMPLOYEE.

    KingCast apparently is a lawyer who likes to bring light to dark places.  In this video, he gets the CVS manager all flummoxed.  It took the sucker over one minute to tell King to turn off the camera.  How does CVS-Caremark get away this?


    The Gestapo Has Gone After A.J. You must help. He put his ass on the line for all of us.

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    Update 11-11-13

    This is Big Stuff.  A.J. is Walk the Walk.  How many of you Talk the Talk, but are so scared of retribution that that is all you have the courage to do.  TALK. Anonymously.

    I don’t think I told you the best part of the Board meeting. This is the part that got all the bigwigs at CCCCCCCk in a twist and the part I’m getting heat for. When I finised my statement I fielded several questions from the Board members. One of them  point blank asked me if technicians at my employer were performing duties that only a pharmacist can per the rules and regs. Well, what was I supposed to do? I wasn’t going to lie so I said the only thing I could…Yes, they were.  It’s true and I have more proof than anyone would care to look at. He asked me why and I said that’s the companies policy and how they’ve set it up. This has made it all the way to the president of PBM operations. I’m quite popular at CCCCCCCk!  It also prompted a visit from the Director of PBM Quality in San Antonia to make a special trip up to talk with me.

    Right now I’m very unpopular in PBM Operations.  I unloaded everything I know onto the Director of Quality. We will see what she does with it. If it’s nothing them I’m prepared to go to the Board. 


    Last comment from A.J.  Yesterday.  CCCCCCCC, as in CCC-CCCCCCCC.  That company uses FORCE to get what they want.  If any pharmacist actually acts like a professional and uses discretion, they go ape-shit.  We need CCC pharmacists to join the guerrilla action and we need you to do it NOW.  That includes former CCC RPhs. Kelly, are you up for this?   So many of these top-heavy companies have their ass squarely on the fence.  Refresh y0urself with the historical/political basis of the Humpty Dumpty story.  Recall, “But the emperor has no clothes”.  It will take so little to push them off their high-horse and watch them tumble.

    • The big retailers and PBMs must be smoking something.  It is incredible how vulnerable they are.  A.J. cannot do it alone (And.. he was all alone on Monday).  Now, CCCCCCCC is coming after him.  How can we support him?  How can you guerrillas make a move?   We have to start winning and the time has never been better.  Talk to us.

    • AJ

      November 7th, 2013 at 9:19 pm

      Woo! Hoo! Word travels fast! Had a 2.5 hour meeting with my Director and Human Resources this afternoon.

    • I guess the count down is on to see how long I keep my job!

    • Any bets?    A.J.


    A.J. Takes it to the Texas Board. 11-6 AJ’s Post-Game Report

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    Please NOTE, in this new format, you can access the “comments” at the bottom of each post.  I like the standard font.  It is a decent size to read.  

    Please watch this girl recite the Mission Statement of the Texas State Board of Pharmacy. It is just 22 seconds.  

    11-6-13 Take the time to read AJ’s Follow-Ups in the “Comments”.  Really good stuff.  I smell the gunpowder of a Revolution.  How many Guerrillas are out there.  Read what AJ has to say.  I honestly believe that he has set the stage for action all across the land.  Clearly, the members of the Texas State Board KNOW what is going on.  They just need a good reason (like publicity) to bring the hammer down.  You guys can do it.   I sense that AJ will lead this parade. Here is a taste of what AJ reported to us.  Read all of his Comments to get the complete picture.  How about you guys in other states.  Will you sit on your hands?  ”Let Texas do it”   Contrary to what you might think: Washington, Florida and Texas are the three leaders in change (Not talking about pharmacy necessarily).  Change starts in those three places.  It has to be continued though.  These state bureaucracies like to take each others lead.  Now, how about following Oregon?

    If you have not accessed Comments before, scroll to the bottom of the post and click on the comments.

     I believe North Carolina has a limit on Rx’s filled per shift. JP has wrote about it last year here…


    JP has also wrote about how the pharmacy rules and regs in most states are 40 years behind. The majority of pharmacies today are run by big corporations. The laws have not changed to reflect this. The laws in Texas still hold the permit holder and the PIC equally responsible. Back in the day in the majority of pharmacies the permit holder and PIC were one in the same.
    After I made my statement to the State Board the Board members could ask questions if they wanted to. One of the Board members asked me why with the rules and regulations governing the pharmacist in charge did I fell a ratio was necessary. She further explained that she felt the Boards over site of the PIC was sufficient enough to compel the PIC to do what was right.
    Oh boy she couldn’t have served up a bigger meatball for me to knock out of the park! I thanked her for asking the question and told her there was a glaring hole in the Texas pharmacy rules and regulations concerning this. I went on to explain how pharmacy was no longer run by individual pharmacist and how the PIC at corporate run retail chain pharmacies had absolutely zero authority to make any decisions concerning the operation of the pharmacy. Her reaction was almost comical! When I said there was a glaring hole in Texas pharmacy law her jaw dropped and her mouth formed a big O the size of a small basketball. Then I saw her mouth to one of the other Board members “WHAT”. Amazingly this was obviously the first time she had ever heard this.
    I went on and gave her a scenario where a PIC was fined $2000 by the Board for a violation and the permit holder, a multi-billion dollar a year for profit retail chain, was also fined $2000. The $2000 hits the PIC in the pocket pretty hard. How hard does the $2000 hit the multi-billion dollar company? How big of a deterrent is that fine to them? I further explained the PIC has to go back and work in an environment where they have zero authority to affect any change concerning the reason they were fined.
    As I was finishing I could see at least two Board members nodding their heads in agreement. So not all the Board members were clueless to this. That’s why I felt compelled to testify in person. Of the 22 pharmacists there I was the only rank and file regular pharmacist testifying. The Board never hears from people like me. That’s a problem. More regular working pharmacists need to go to the Board meetings so they can hear what it’s really like out there.  AJ

    Letter that AJ sent before the meeting.

    Texas Board of Pharmacy members,

    .I ask you to carefully consider the implications and unintended consequences of changing the pharmacist to technician ratios. I also ask the Board to carefully consider the statements made in favor of changing the pharmacist to tech ratio in all classes of pharmacies. I have read many of the comments submitted in support of a change. An overwhelming majority of the comments in favor have been sent in by corporate retail chain pharmacists and middle managers. The central argument in nearly all these comments has been how dangerous it is to work with too little staff. The Board of Pharmacy does not limit the number of technicians that can work in a pharmacy. It limits the number of technicians one pharmacist can supervise in a pharmacy. The problem these pharmacists and middle managers have is with their respective companies and their refusal to provide an adequate number of pharmacists. It is not the ratio the Board of Pharmacy has set.
    Retail pharmacists have been pushed to their breaking point. There has never been more tasks, responsibilities and liability placed on pharmacists than there is now. I have personally experienced this as a PIC at two different grocery store chains in two different states. As the PIC I had absolutely no discretion concerning the staffing of the pharmacy. The staffing decisions were made by non-pharmacist corporate middle managers thousands of miles away. The staffing ratios outlined by the TSBP are the only protection a PIC has against dangerous and unsafe staffing. Removing this regulatory check will endanger the health safety and well being of the citizens of Texas.
    Pharmacy technicians are an invaluable part of the pharmacy team. There is no doubt they alleviate some of the massive workload forced onto pharmacists by corporate retail chain pharmacy management. Sub Chapter B, Rule 291 (C) states, “Pharmacists are solely responsible for the direct supervision of pharmacy technicians and pharmacy technician trainees and for designating and delegating duties”. Sub Chapter B, Rule 291, (2) Duties (i) states “a pharmacist verifies the accuracy of all acts, tasks, and functions performed by pharmacy technicians and pharmacy technician trainees; (ii) pharmacy technicians and pharmacy technician trainees are under the direct supervision of and responsible to a pharmacist”. This alone is an enormous task for one pharmacist. Add to this the responsibility and liability of dispensing and counseling on 300 to 400 prescriptions in a 12 to 14 hour shift, immunizations, record keeping and ensuring compliance with state and federal law and it becomes impossible. Removing the ratio requirement and allowing more technicians into the pharmacy does nothing but increases the stress on the pharmacist and endanger the public.
    I ask the Board to carefully and thoughtfully evaluate the following question. Who benefits from a change in the pharmacist to technician ratio? The citizens of Texas certainly will not benefit. The pharmacists licensed by this board will not benefit. The only benefit will be to the big corporate pharmacy chains that have so aggressively lobbied you for this change. I believe it will be a huge mistake for the Board to ease and/or voluntarily give up regulatory control at a time when our health care system is undergoing a massive change with millions of people entering the system via the Affordable Care Act. This is a time for the Board to be ever more vigilant in order to protect the heath, safety and welfare of the citizens of Texas.

    Respectfully,  Arden J. Hill, RPh, PharmD



    Can AJ and Bronco get together for a guerrilla action?

    Jp Enlarged


    One Pharmacist supervising three technicians simultaneously.  The “Metrics Maven”.

    I saw this Comment from AJ and thought it appropriate to put it in  a more available space, with my thoughts.  JP

    “Speaking of Boards of Pharmacy…for those of you in the great State of Texas do you know on November 4th The Texas State Board of Pharmacy will vote to raise and/or eliminate pharmacist to technician ratios? I see this as a bad thing. What say all of you?


    AJ will be testifying AGAINST this change, in person, live at the meeting. He is a member of The Pharmacy Alliance and therefore eligible for help with expenses. Members of The Pharmacy Alliance who testify before their board, lobby
    legislators or bring light to dark places with investigative journalists will be reimbursed up to $100.00 toward hotel. Gas money. Cost of two modest meals at a place like Chili’s. AJ, save your receipts. You can scan them and E-Mail to

    Um, Broncofan…. maybe it is time for you and AJ to call a truce and tag team at this board meeting. Bring others with you. Go FULL FRONTAL with them. You both know that guys like Bronco are not behind this. You know, in the end it may not be a bad idea, but not like this. Not driven by the chains. They DO NOT run our industry.

    I am serious, man. Both of you. As Joe Zorek said, “A pissing contest does us no good.” You are both smart, well-placed and
    well-spoken. You guys certainly are not shy. Be like the United Nations. “Well, we have fundamental differences, but we have a common enemy”. Killing this proposal will show that pharmacists DO HAVE POWER. It will show that we are not brain-dead.

    Bronco, I don’t recall if you are a member of The Pharmacy Alliance. You can join with dues of $100.00. Attend the meeting and get more than $100.00 reimbursed. Visit www.// You can find the JOIN button. Those of you who have not renewed, please do so. Renewal is $60.00. Just click on JOIN. You can figure it out.

    Come on, you guys. Not just AJ and Bronco. All of you. You know, disturbing the shit can be fun. It also may do good.

    Jay Pee

    Halloween Day.  AJ and Broncofan are leading the discussion.  This is important stuff.  Visit “Comments” and say your view.  Is this like the hog led to slaughter?  He knows what is coming.  He can smell it.  They have him hogtied and are leading him to the guy with the gun-thing that will be pressed to the area below his ear.  Nothing can save him.  Nothing.  In Sicily, hogs live the life.  In the hills, feasting on chestnuts and grains that are spread out for them.  Their flesh will make the best prosciutto.  The killing is still awful.  

    Pharmacists can see what is coming.  AJ and Bronco will tell you.  Will they slaughter you?  Is it that nothing can save you?  Is it hopeless?  You are NOT pigs.  You fuckers can change this.  You hold all of the aces.  You just gotta do something, for crissake.

    Go for it, AJ. Kick some State Board of  Pharmacy Texas Ass.  To the rest of you.  AJ is taking ownership of our profession.  It is his profession just as Texas A & M is Johnny Football’s team.  The rest of you want in?  Not a problem.  Do SOMETHING.  You can start by asserting yourself in the pharmacy.  Take charge and “Watch me Now”.  ”What’d I say?”


    The Magic Question. Who Benefits? Look Out For Yourself

    Jp Enlarged

    I was searching for a suitable image and saw this.  I could not pass it up.


    Well, perhaps 3 of the 300 (between 260 and 320) who read this today will do this, but the rest of you will say, JP has a terrific observation.  He is simply asking me to wake up and pay attention.  He thinks that I should look out for my own welfare.  It is good advice.  I should do this.  But…Will you?  

    I keep reading here stories of good, veteran pharmacists who are being replaced,  assigned to the float team or have their hours cut.  This is after years of being loyal company men/women.  You worked extra.  You missed hundred of lunches.  You took your vacation at the worst time of the year, when your kids were in school.  You worked when your daughter had her dance recital and your son had a game.  You put in 14 hour shifts until your knees locked with pain and your back seized.  You are 6 feet 2 inches (or 5 feet 2 inches) and the pharmacy computer terminal is permanently set for someone 5 feet 8 inches.  You do everything they ask.  You work hard.  You go home exhausted and jump your spouse because he/she didn’t make you what you want to eat at 10:30 PM.  And this is all of the every day stuff you do.

    You agree to extra projects and work hard, using your intelligence, education and experience to create value.  What do you get?  A big ATTABOY.  That’s it.  You feel good for a minute, but there is a nag in the back of your neck.  What the?

    You failed to ask yourself the question:  WHO BENEFITS.  Who benefits from everything you do?  Is it you?  I know, you laugh so hard you hurt yourself.  If all of the extra effort is not benefiting YOU, why the fuck are you doing it?  Oh,I suppose that they make you believe that it is your job.  Bull shit.  We all know that your only job is to run the Prescription Mill as fast as you can.  Actually, faster than you SAFELY can.  As far as your company is concerned, you are supposed to keep your mouth shut, your ears closed and your eyes straight ahead.  

    I don’t want to labor this, but can you see value of asking yourself, “What do I get out of this?  Who benefits if I put my ass out there to get this done?”  If the answer is not ME, why do it?  Why do it over and over again?   That is a serious question and I’d like to now why I DID IT for three decades when I was the manager of a drug store and then pharmacy departments.  For ten years, I was in a bonus situation and I did well. Anywhere from one to two grand a quarter, but my pharmacy was turning a 43% Gross Profit in the early 1980s.  Still, the company benefited more than I did.  

    I suggest that you keep a score card.  When you go over and above, ask the question and put your answer in your score card.  After you have been suckered a half dozen times… stop doing it.

    It all starts with the question:  Who Benefits.




    Watch Out, Sloopy. Here Comes Da Goose.

    Jp Enlarged

    Found this in my E-mails yesterday, from Goose.  Essentially, pharmacists are now in the same bucket as lawyers or accountants.  The employers are in an enviable spot, after years of scrambling just to get Warm-Bodies-With-Licenses.  They can pick and chose now.  Some employers will go for cheap and others for quality.

    This will not last.  The demand for prescription drugs will skyrocket.  Again, there will not be enough of us to go around.  The fuckers who are disrespecting us now will get it right back.  Good riddance.  Just hang on, Sloopy.

    A serious warning:  You cannot allow them to change or delete two laws. 

    The requirement that we counsel.  (More on that later)

    The requirement that a RPh be present when an Rx is sold.

    If you are not watchful and allow them to do that, you are really fucked and it will be ON YOU.  Keep your eyes open and act like adults.  Blaming the ACA is bullshit, by the way.  The brains at HHS already have it figured out that RPhs are over-educated to be simply Prescription Mill Minders and they plan on using RPhs and RNs instead of MDs and Dos because we are cheaper.  Watch out, Sloopy.  Knowing pharmacists, you will go kicking and screaming all the way to paradise.  Jay Pee

    Here starts the message from Goose.


    Yesterday my hospital group laid off 5 of our 27 total pharmacists that covered 2 hospitals and 2 ambulatory clinics. Four of the five were RPhs. Out of the 22 pharmacists we have left, one is an informatics resource, one is the Director and two are Operations Managers for our two hospital campuses. We have 4.5 FTE of full time clinical and the rest is staff.

    Official word is this is due to the ACA and decreasing revenues. Bigger issue I think is uncompensated care. Indiana has its own issues on that, decision not to expand Medicaid to cover low-income uninsured as with many other states really putting the squeeze on hospitals. They are required by law to treat everyone and cannot collect most of the time.

    This is the first time I have seen a targeted reduction in force of pharmacists. We have eliminated positions by attrition before but never actual layoffs. In numbers we represented 20% of the total number of jobs eliminated.

    Add to this the fact a few months ago our President of the Indiana BOP, Sara St. Angelo had her position eliminated at her hospital in Indianapolis. This would have been unheard of a few years ago.

    Scary times brothers.

    Peace out, Goose



    A.J. & Bronco Do Not a Profession Make

    Jp Enlarged

    I suppose you could not find two more diametrically opposed spots on the pharmacy profession’s wheel of fortune than these two represent.  A.J. is a salaried employee pharmacist who works for a mail order (PBM) outfit and Bronco owns his own drug store.  Each spot has to be covered and, I suppose, that both of them are getting what they want from pharmacy.

    So why are they after each other’s throats?  How can this end well?  Is this just a testosterone surge?  It is not the least bit helpful for practitioners who have put themselves out in front to be acting so badly.  Can this possibly just be an example of how low pharmacy has gotten?   There is plenty of room for both of them.   A.J. belittles Bronco and his West Texas practice.  Bronco slams A.J. for being a traitor.   

    I do not see RIGHT and WRONG here.  When you get right to the bottom of the funnel, they do the same thing.  They provide prescription drugs for a fair price in a manner that is safe.  Everything else they do is gravy.  They have enormous energy and have invested time, experience and talent in making the other guy wrong and making themselves right.  Isn’t that the essential game we learned as a child?  Make wrong, Be right.  And even if we realize that we are wrong, we will still fight like hell to convince everybody that we are right.

    I believe that A.J. and Bronco could make a difference if they identified what is really wrong and addressed that.  Together, as a team.




    Need Some Clinical Help for Friend

    Jp Enlarged

    An Indian brand of Tramadol.  I would bet that this is sold OTC i  Delhi

    I spent some time with a friend this evening.  He related some drug stuff that I think that you can be more help than me.

    He is 30-something.  20 pound weight loss rather quickly, recently

    He takes:  Meloxicam, Baclofen (tremors) and Tramadol. He identifies the tramadol as the problem.  He takes 150 mg a day and does not get desired relief.  He believes that the tramadol is causing untoward effects.  Tiredness, Dizziness, tremors, fuzziness and feelings of “disconnect”.

    I chose not to tell him what I thought other than advising him that the max dose for tramadol is 400mg a day.

    Please give him a hand.  I invited him to check the comments here, so he can read what you think directly.

    I do think that he is dealt with this stuff so much that his attention is on his drugs too much.  When he has stuff going on, he tends to blame the drug.




    This Woman Has Been Worked Over With Fists by a Company District Bully

    Jp Enlarged

    Ralphs is a Kroger Company.  Check out their values, then read this, then write a letter to Kroger telling them what hypocrits they are.  We MUST bring light to dark places like this.  I believe that this woman did it right.  Document, document, document.  This is golden in a court of law, with the California Board of Pharmacy, the EEOC and whatever agency the state of California has to protect citizens from discrimination on the job.   I am proud of her.  A naturalized USA citizen who lives her life actually believing in the high values that we advertise all around the world.  I hate bullies and Rachel is a bully.  Here is how bullies need to be handled.  From the movie “History of Violence”.


    1 | P a g e
    HR = Pharmacy Human Resources Specialist
    PC = Pharmacy Coordinator
    Both HR and PC are also California Licensed Pharmacists
    During the job interview in November, 2007, HR Rachel was very impressed of my working experience as a full time Rite Aid pharmacist since 1999, including graveyard shifts, over 6 years of floater/relief duties, and on-call for pharmacy supervisors on day offs. I worked at over 100 Pharmacies in Merced, Madera, Fresno, Kings, Kern, Los Angeles, Orange, San Diego, San Bernardino, Riverside, San Luis Obispo, Ventura and Santa Barbara Counties. She also acknowledged my regular working shifts of closing and weekends which are not easy at all.
    Rachel confirmed me I was going to work with Ralphs’ Best Quality of Pharmacy Staff, i.e. Pharmacists, Pharmacy Technicians and Pharmacy Clerks. She wanted me to start working as soon as possible. However, I spent several months to make a decision due to a lower pay and fewer vacation weeks. My final decision came out from completely agreeing with the concept of working at Ralphs Pharmacies where the customers/patients can make only one stop for groceries and prescriptions. In addition, a Union Officer gave me an advice of working as a Ralphs union pharmacist, I could gain retirement benefits in both Pension and Health Insurance. If I stayed working with Rite Aid, I would have only the pension benefit. Health Insurance is very important for me who is a hepatitis B carrier and have the family history of colon cancer and Alzheimer’s disease.
    My background, culture, upbringing and belief are to work “hard” for and protect my employer. My Career Goal is to be a Good Pharmacist practicing professionally with least mistake from the beginning to the end of my career. Be Authentic, Truthful and Ethical, the individual I truly am. Also, I believe there is more job/work security as a Union Member.
    Following is a chronology of incidents at Ralph. February 14, 2008
    I joined Ralphs in February 14, 2008 as a full time floater pharmacist. I went to have 2-day training at the Corporate office in Compton, CA.
    I believe in the Kroger Co. Core Values which are as follows:
     Honesty: Doing the right thing and telling the truth.
     Integrity: Living our values in all we do, unified approach to how we do business and treat each other.
     Respect: Valuing opinions, property and perspectives of others.
     Diversity: Reflecting a workplace that includes a variety of people from different backgrounds and cultures, diversity of opinions and thoughts.
    2 | P a g e
     Safety: Watching out for others, being secure and safe in your workplace.
     Inclusion: Your voice matters, working together works, encouraging everyone’s involvement, being the best person you can be.
    Company Person
    I believe that I had proved myself as a company person when Rachel requested me to work on a Friday at a 24-hour Ralphs-759 in Westwood during my on-the-job training weeks.
    One Saturday on my day off, around 10:00am I got a call from Rachel to cover a shift at Ralphs in Laguna Hills. I drove almost 2 hours to get there due to the heavy traffic on Freeway 5 South. The store director really appreciated of my showing up and taking good care of the Pharmacy Business.
    Another Saturday, I was very sick and called Rachel to replace my shift at Raplhs in West L.A. Rachel forced me to go to work while I repeated to her several times that I was very ill. Rachel instructed me that I could leave the pharmacy only when a relief pharmacist from an agency company showed up. Fortunately, my husband was off that day and he drove me to work because I was really sick.
    March 14, 2008: Experienced insubordination by an employee at Ralphs-759, Westwood.
    The working shift was from 12:45pm to 9:15pm. I worked with a male pharmacist, a couple pharmacy technicians and clerks. At 5:00pm about 30 minutes after the other pharmacist left, a patient came to pick up his prescription. A male pharmacy technician, Al, could not find the prescription that was just filled by the male pharmacist before he left the pharmacy. Al directed me to fill that prescription again because it was an inexpensive medication. I politely asked Al to look for it on the shelves again in case of misplacement. Al did not even check the signature log in case somebody in the patient’s family had already picked up that prescription. Al refused to perform the work assignment and walked out from the pharmacy without telling any pharmacy personnel whether he was going to take a short break, or a lunch break. After over an hour when Al didn’t show up, I called the Pharmacy Manager for his advice. I was instructed to contact HR Rachel directly. I explained the whole situation to Rachel and was told it is not easy to discipline a Union employee. This is insubordination and one of the “CAUSES FOR IMMEDIATE DISMISSAL” (See attachment #1, Rules and Regulations, item k).
    3 | P a g e
    March 31st – April 10th 2008: Unacceptable work ethics by a technician at Ralph 127, Northridge/Porter Ranch.
    I worked as a floater/relief pharmacist at one of the busy Ralphs pharmacies while the new hired pharmacy manager was on vacation. Not only Vanessa, a female regular pharmacy technician did not take good care of her regular patients/customers, but also, she spent excessive company time on personal calls and reading unpaid store magazines. Vanessa’s unacceptable working manners could be investigated by plenty of pharmacy cameras. This is indicated in Rules and Regulations, Work Performance, item 8. After patiently working with Vanessa for a few days and she did not show any improvement in her work attitude, I called Rachel and mentioned Vanessa seemed to abuse me who was a new floater pharmacist. Vanessa should have done her best to help the pharmacy team to provide the best patient care service. Rachel made a 3-way call with me and PC Kenneth. Kenneth showed up at that pharmacy the next day. Kenneth showed me how to work with Vanessa by holding her shoulders and telling her what to do. Not only did I have to work as a pharmacist, but I also had to babysit an adult pharmacy technician. I feel that the company should hire motivated employees and train them to contribute as part of a skilled Company team. Later on, several pharmacy staff told me Kenneth and Vanessa used to work together in the previous pharmacy before they joined Ralphs pharmacy.
    I respect and abide by the Kroger Co. Core Values and I get disappointed when people do not. I felt the Kroger Co. Core Values were only in writing but not in the real practice. Ralphs pharmacists and pharmacy technicians asked me what was going on, and why Management, especially Kenneth and Rachel kept asking them whether they had any written report to complain about me. I do my best to maintain professionalism and integrity as a Pharmacist for and to protect Ralph. I exercise best practice so the customer and Ralphs’ benefits, knowing full well that this is not always the case and it is a challenge to make it a win-win situation. After all, we are licensed professionals in the Health Industry.
    I am very confused what Rachel confirmed me of working with Ralphs’ Best Quality of Pharmacy Staff. I sent her an e-mail for the job descriptions for a Ralphs floater pharmacist, however she had never replied my e-mail.
    Rachel could protect a pharmacy technician of cheating clock in clock out working time/period while she fired one male floater pharmacist who did the same thing. April 3, 2009: Non-professional, disrespectful staff attitude at Ralph 289, Los Angeles.
    April 7, 2009, I sent an e-mail to both Rachel and Kenneth my observations and matters of concern about the non-professional, disrespectful attitude by some of the pharmacy staff at Ralphs-289 in Los Angeles. They cared more about their personal needs instead of the customer. The female technician, Krystal, overrode the prices of her mother’s several prescriptions below than $4 promotional prices. I am a full-time floater pharmacist, and after experiencing this pharmacy, I felt it was my obligation to speak-up. I believe in Ralphs credibility and reputation, however, my concerns have NOT been addressed nor did I get any
    4 | P a g e
    support by either Rachel or Kenneth. Again, later on, several pharmacy staff told me Kenneth and Krystal used to work together in the previous pharmacy before they joined Ralphs pharmacy. There was no investigation from the management at all and Krystal kept overriding the prescription prices.
    Three Months later on Sunday, July 5th, 2009 I sent an e-mail to HR: I have a closing shift schedule at the same above pharmacy (Ralph 289, Los Angeles) the next day and look forward to working with staffs that have a more professional attitude. I like working at Ralphs Pharmacies and don’t want to jeopardize my professional career. I hope the Ralphs-289 pharmacy staffs now have a more positive, professional attitude. I don’t want to jeopardize any staff’s livelihood, however, the pharmacist and staffs are the last link between the doctor and the patients that depends on us. We have to maintain a high standard. June-July 2009: Change work schedule at the last moment.
    My original work schedules sent on Friday, June 6th, 2009 had me off on Tuesdays and Wednesdays, so I had made plans to have my car serviced. On Wednesday, June 24th, 2009 Rachel e-mailed me a new updated weekly schedule. I was very surprised to discover that I had to work five days on 4th of July week. I would have appreciated it if Rachel or the scheduler had given me a courtesy call about working on the following Wednesday, July 1st, 2009 at Ralphs-615 in Chino. I replied to HR and requested that I could accommodate the schedule if I could be working a closing shift at a Ralphs pharmacy in San Fernando Valley area where my car would be serviced. Rachel sent me a reminder e-mail on Tuesday, June 30th, 2009: as follows:
    This is one last and final reminder: You are scheduled at store 615 tomorrow. You failed to request Wednesday as a PD and as such, you were scheduled to work. Failure to follow this schedule will result in further disciplinary action for not
    following your schedule as posted.
    Rachel also copied her e-mail to the Director of Pharmacy as well. This indicates to me that HR has taken the disrespectful posture of “to do it or else” without concern of the employee! Furthermore, I couldn’t fix my car and I experienced an overheat engine while I was driving to work at Chino. I called the pharmacy for not being on time due to an engine problem. This is another unnecessary stress.
    5 | P a g e
    July 11th to July 12th, 2009: Incidents at Ralphs-219 in Encino.
    The weekends after 4th of July, 2009, I worked at Ralphs Pharmacy in Encino. On Saturday at 10:15am, I received a call from a male customer to have me contact his doctor for a “Flu” prescription for his wife. I immediately called and left messages at the doctor office. Around 11:30am, I called the doctor at home per the patient’s request. The doctor started yelling at me disrespectfully and told me not to call him at home. It was my first time dealing a doctor with an unprofessional attitude and it really scared me to death. The customer’s wife showed up on Sunday at 5:30pm while we were closing the pharmacy. Her prescription was not ready because her doctor was mad that we called him at home. Her husband showed up at 5:40pm and announced himself as a doctor. He was a dentist who could only prescribe the prescriptions under his practice areas (not for Flu). However, all the Pharmacy computers were shut down and that we were unable to fill the script after Pharmacy business hours.
    The same weekend, I experienced with a California Dentist came to the pharmacy and requested to refill his wife’s Pain Killer Prescription of a Generic for Norco-10 in the quantity of 120 tablets. He had been prescribing High Quantity of Pain Killers for his own wife while a couple Ralphs Pharmacies filled and dispensed those prescriptions for him and her many times in several years. Did Pharmacists at Ralphs ignore performing their Professional Judgment? Monday July 13th, 2009
    I was on 3-way call with Rachel and PC Peter for my explanation on a customer complaint. Does management have any idea or understand how much pressure the pharmacy team is under all day long working at a busy pharmacy, esp. on weekends? Then after we close, we need to go home to support a family that is waiting for us. I just found out from management level that we need to stay longer, even after the pharmacy’s closing time, for customers that come after closing. This means that we need to re-open the pharmacy and clock in overtime, and the company is against overtime.
    I also mentioned the California Dentist and High Quantity of Pain Killers Prescriptions for his own wife since 2005, however, that important issue was completely ignored by Ralphs Pharmacy Management. Monday July 27th, 2009:
    Both Rachel and the scheduler did not call me, however, I received a fax for changing my working schedule on that Thursday, July 30th, 2009 from an opening shift at Ralphs-22 in Los Angeles to be a closing shift at Ralphs729 in Newbury Park. I had my set plan on that Thursday evening but I had to work from 11am to 9pm instead. At that time I really did not want to jeopardize my full time job while inevitable stress and worry kept attacking me more often.
    Reference: United Food & Commercial Workers Int’l. Union Local 770 Retail Food & Meat Agreement March 5, 2007 – March 6, 2011 for Albertsons, Ralphs, Vons,
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    in Article 5 – WORKING Hours and Overtime, Modify Section M of Work Schedule are as follows: “The Employer shall post a work schedule for a two (2) week period in advance, in ink, for all employees, showing their surname and first initial, not later than the end of the first shift on the Wednesday preceding the first day of the following two (2) workweeks (Monday through Sunday). Any alteration in such work schedule must be made not later than the end of the first shift on the Friday of the week. If the work schedule within any day is changed after Friday without reasonable cause, the matter may be subject to the “grievance” procedure. The Employer agrees that changes after the Wednesday posting will only be made for operational purposes and shall not be made for arbitrary and capricious reasons”. Thursday July 30th, 2009: Incidents at Ralphs-729 in Newbury Park.
    I would have appreciated it if the pharmacy manager at that Ralphs Pharmacy, who knew he needed to leave the pharmacy for a mandatory meeting at the corporate office and would not come back to work in the pharmacy, had arranged one pharmacy technician, Erica, to close the pharmacy with me. Erica told me she worked until 7pm only. In that afternoon the store director came back from the corporate meeting and assigned her to clean up the pharmacy due to the corporate visitors coming the next day. Now, not only did I not have a second pharmacist to assist, but the only pharmacy technician available, Erica was cleaning the pharmacy.
    This created chaos in the pharmacy that day. Why was my work schedule changed and not provided enough help? Rachel knew that the work conditions would not be good, yet never offered or provided any help or support. Was this a political move to stress me out, to put me in no win situations and discredit me?
    That afternoon there was another complaint by a female from a dental office. She called in a new Antibiotic prescription for a boy and I needed to verify with her a couple times because there was a discrepancy in dosage/direction for a boy. I requested to talk with the dentist but she refused. I also requested that she faxed in this new prescription. She refused to do that also, and she insisted on calling customer service to make a complaint. To make it short, a store in-charge person could tell her to fax the prescription to the pharmacy and there’s a discrepancy in dosage/direction on the prescription and I needed to reach the dentist for clarification. I was very surprised and disappointed that both HR Rachel and PC Kenneth considered my action as “bad customer service”. I was doing my due diligence to confirm a possible mistake in dosage by the dentist. As a trained, licensed pharmacist, I was using my professional judgment for the welfare of the customer and to protect my employer, Ralphs. I went out of my way to accept the last minute, ill-timed change in work schedule from HR Rachel.
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    August 10, 2009: HR and PC Did not listen to my explanation at all.
    Both of HR Rachel and PC Kenneth showed up at the pharmacy where I worked on Monday, August 10th, 2009 and combined the previous incidents happening on Sat-Sun 7/11/09 to 7/12/2009 and this one to write me up: Failure to provide good customer service. However the date of infraction shows on the paperwork in 7/13 – 7/31. They had already prepared the paperwork and did not want to listen to my explanation. I signed the paper with the words of “signing under protest” underneath my signature, instructed by my Union Representative. Moreover, PC Kenneth accused me of damaging the company business because that female customer at Ralphs Pharmacy in Encino did not fill any prescription at that pharmacy after the incident. However, I checked in the computer on the same day and found out she was still filling her prescriptions with that pharmacy. I just wondered what was happening to the Management Level who totally forgot about the Kroger Co. Core Values i.e. Honesty: Telling the truth, Integrity, Respect, Diversity, Safety and Inclusion. I did not feel well and went to see my doctor and he gave me a doctor note stating that I was advised of no work for one week due to medical reason.
    Before I returned to work I reply an e-mail to Rachel as follows: Please reconsider my 5-day schedule next week at R-39, one of the difficult Ralphs Pharmacy in Los Angeles. I’m not quite sure I will have enough physical and mental stamina to handle the same R-39 pharmacy for 5 days. I very much appreciate it if you can schedule in a couple days at an easier Ralphs Pharmacy(s). I am confident in your scheduling abilities and expertise, and I know that you can adjust my locations. However, she replied with “At this time I am not able to change your schedule” and again, she also copied to the Director of Pharmacy as well.
    My husband drove me to work during that week. I started taking a legal 10- minute break while in the past I ignored and always performed as an excellent employee with the work attitude of customer and business came first. I started receiving week by week working schedules and most of them were sent on Friday after 5pm by fax. I was completely unable to make my personal plans in advance. I wish HR Rachel had kept her words/promise during the job interview that I must regularly receive my work schedules for 3 weeks in advance. Sunday November 1st, 2009: Fraudulent Claims Incident
    I discovered a Medi-Cal fraudulent claims at R-729, Newbury Park and I notified HR and PC Rothstein by e-mail as follows:
    A cash customer, Mr.XXXXXXXXXXXXXXX) came to pick up a refill prescription of Atenolol 25mg, however, the original prescription was filled and billed to Medi-Cal on 9/25/2009 under his son: XXXXXXXXXXXXXXX was on the image of the prescription. The note’s left for the pharmacy manager as well.
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    There’re also other previous high blood pressure prescriptions on the son’s profile billed to Medi-Cal. Does the company need to contact Medi-Cal for this current and past incorrect billing issues?
    Best Regards, Angie(Benyapa) T.
    I was disappointed that neither of them replied to my e-mail. I understand that those reporting or helping with investigations of fraud, such as False Claims, are protected from retaliation and cannot be fired, demoted, suspended or harassed. November 28th, 2009: California State Board of Pharmacy sent some of the messages under the subject of “Ongoing Discussion on Prevention of Medication Errors” as follows:
    (1) medication errors do occur, there are 350 million prescriptions filled each year in California,
    (2) the Board has requirements for all pharmacies to operate vigorous quality assurance programs that the Board forcefully enforces to ensure all errors are closely reviewed by the pharmacy, staff are educated and process changes are made to prevent a recurrence,
    (3) There is no acceptable number of medication errors a pharmacy or pharmacist can make,
    (4) No pharmacist wants to make an error, and most live in fear of making an inadvertent error,
    (5) a grossly negligent error will result in formal discipline, other errors reported to the Board, if substantiated, will be cited and fined,
    (6) to (10) see attachment #3 December 5-6, 2009: New Hire & Work Environment
    Saturday and Sunday, December 5th and 6th, 2009 I worked at Ralphs-84 in Castaic with regular Pharmacy Technicians. I was told one Ralphs floater pharmacist, Thomas, recently got fired because a new hired store and pharmacy clerk, Michelle, did not show up. I was also informed that from now on PC Kenneth would not allow any floater pharmacist to work with Michelle on weekends.
    Ralphs-84 in Castaic is a busy pharmacy where PC Kenneth used to be a Pharmacy Manager. I met him a couple times on weekends when he came in the pharmacy and gave his friends’ prescriptions and instructed pharmacy technicians what to do.
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    In one weekend of November, 2009, Thomas, had work schedules at this pharacy and Michelle did not show up. Thomas must had experienced a very high level of stress/pressure working along with only a filled-in store clerk, a potential unauthorized person working in pharmacy, that he inadvertently walked out for lunch without locking the pharmacy and got terminated by Raphs.
    PC Kenneth was the one who originally violated the pharmacy law by having that store clerk who was not an authorized person to come and work inside the pharmacy. Unfortunately, Pharmacist Thomas got terminated instead.
    Since the beginning of November, 2009, I contacted the pharmacy manager, Tracy, to provide good Regular Pharmacy Technicians to work with a floater pharmacist on weekends. I want to provide good customer service while the company endeavors to provide positive work environments and conditions where the Pharmacist is not interrupted or distracted unnecessarily while compounding prescriptions. Also, company needs to follow the California State Board of Pharmacy’s requirements for all pharmacies to operate vigorous quality assurance programs. Thursday December 10, 2009: Work Environment
    I worked as a closing pharmacist at Ralphs-84 in Castaic and experienced a very unpleasant work surroundings and conditions. I sent an e-mail to HR and PC Rothstein the following day as follows:
    Dear Rachel and Ken:
    I understand R-84 Pharmacy need to have wire maintenance done, however, it really disrupted our production and pharmacy operation yesterday. They have also placed a big ladder at the corner where Schedule II Narcotics and other controlled substance cabinets are located. It is a major area for us, and has substantially affected the work flow when we have to fill any controlled substance prescription.
    It is difficult when a Patient’s Privacy is involved, to have unauthorized person(s) working inside the pharmacy during business hours. They will be coming back again this afternoon during my working hours as a floater pharmacist covering a closing shift. I understand that it is required maintenance for the entire store. Is it possible to have the electricians adjust their schedule and work around the pharmacy area? In the mean-time, we’ll continue do the best we can and serve our customers with the current environmental condition.
    Best Regards, Benyapa (Angie) T.
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    They did not respond. The electricians showed up to do their work and affected our work flow as anticipated. Thursday December 24th, 2009: QA Policy and Procedures
    I signed and faxed a company document to the corporate. I acknowledge that I have read and understand the updated QA Policy and Procedures. That updated version notes that the pharmacist on duty discovering or being informed of an error will have the responsibility of processing a Pharmacy Incident Report Form. Failure to do so will result in disciplinary action up to and including termination. On the same day I worked as a closing pharmacist at Ralphs-84 in Castaic. I found one misfilled refill prescription with the category of “Alleged Wrong Medication Direction” and I informed the pharmacy manager immediately. She was reluctant to process a Pharmacy Incident Report and did not offer the customer a free prescription with the accurately filled medication at NO CHARGE as indicated on the Quality Assurance Policy and Procedure Manual. I sent this Pharmacy Incident Report before the end of my shift.
    PC Kenneth came to this pharmacy. The Pharmacy Manager told me PC Rothstein did not approve having a regular Pharmacy Technician working with me on the weekends i.e. Saturday, December 26, 2009 and Sunday, December 27, 2009. Pharmacy was closed on Friday, December 25, 2009 because it was a Christmas Holiday. Surprisingly Kenneth did not keep his words (PC Kenneth would not allow any floater pharmacist to work with Michelle on weekends) while Kenneth expected me to provide good customer service under an inadequate help work condition.
    December 26th to 27th, 2009: Inadequate Help
    The days after Christmas were unexpectedly busy and the IT problems were also not resolved (see email below). The helper assigned on those days, Michelle, was not the regular pharmacy technician that is familiar with the doctors, patients and procedures. It was extremely difficult working with Michelle and the work flow was affected. I later found out that that she was a clerk in training that worked in both the grocery and pharmacy. Michelle was constantly interrupting and distracting me with frivolous questions and answering the patients without proper knowledge while I was compounding prescriptions. She wanted to type new prescriptions that I had to correct more than 50% of her prescription labels. With the after Christmas rush and IT problems, I was multi-tasking while she was spending company time text messaging on her cell-phone. She reported me to PC Rothstein for giving her a hard time. I was again surprised that PC Kenneth only listened to her and never contacted me about it. I was the Person-In-Charged on those working days. I felt that I was “set-up” again. Anticipating the after holiday work load and I had also requested “good experienced” help for these days from Pharmacy Coordinator. I was ignored.
    Dear Rachel:
    Per your previous tele-conference instructions regarding overtime, this is to inform you that because of IT issues, I had to stay a little after my scheduled
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    hours. For the past week, R-84 Pharmacy has been having challenges processing electronic prescriptions in a timely manner with Facey Medical Group. I was informed by the Pharmacy Manager that the IT issue is being worked on.
    Patients came in the pharmacy and expected to pick up their prescriptions (prepared electronically by the Doctor’s office), however, since they were not in the system (computer), they were not prepared. Thus, I had to spend a lot of time calling Facey Medical
    directly to keep the process moving, and at the same time, keep the patient happy. Understandably, it appears that Facey Medical Group may be very busy responding to each individual patients’ request.
    I couldn’t finish my work on Saturday 12/26/09 and continued to work at the same pharmacy on Sunday 12/27/2009. It’s still very busy in the pharmacy and there were a couple prescriptions that needed to be verified with MDs directly. Fortunately, those doctors were working as on-call doctors themselves for the long holiday weekend. I stayed overtime on Sunday 12/27/2009 for about 20 minutes in order to finish my work, including leaving clear messages for the pharmacy staff to call MD’s office on Monday 12/28/2009.
    Please feel free to give me a call at F4L-309 on Monday 12/28/2009 if you need more explanation.
    Best Regards, Benyapa (Angie) T. Sunday January 10th, 2010: PC Kenneth did not read the details of an incident
    Ralphs 729, Newbury Park: I filed two (2) Pharmacy Incident Reports of Alleged Wrong Drug Used and Alleged Wrong Doctor (not related to a Medi-Cal False claim). I needed to handle several issues generated by regular pharmacists on weekdays. One of the incidents was created by the Pharmacy Manager who wrote a new prescription on a piece of paper (not on the legitimate prescription pad) without a written date and more. I called the doctor to verify that prescription, unfortunately, he was hesitated and insisted Pharmacy contact a patient’s doctor on Monday. My full explanation was recorded in that Pharmacy’s computer, however, PC Rothstein did not read it and he used this customer complaint to suspend me on Thursday, January 28th, 2010. Sunday January 17th, 2010: COMBAT METHAMPHETAMINE EPIDERMIC ACT
    Ralphs 757, Stevenson Ranch: The pharmacy doesn’t follow the company rule sent out on 4/23/2009 with the subject of PSE (pseudoephedrine) Online Registry: We MUST Update All PSE purchases online registry at the end of the business day. The female customer who filed complaints about me called the pharmacy and wanted her mother to come to the
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    pharmacy to buy two (2) boxes of 48 tablets pseudoephedrine 30mg. She had been having her mother with her mother’s driver license to buy Brand and Generic Sudafed and it would me over 9 grams (30-day purchase federal limits). After I spent time and checked in PSE Registry Signature Log Book. I told her to contact the regular pharmacists in the following day. Bruce, a new intern pharmacist working with me had written a clear note of dates, products, quantities starting from November, 2009 and I assumed that the pharmacy manager and staff would go over with it and solved the issues created by their own pharmacy staffs. January 28th, 2010: Kenneth suspended me without full investigation, not even any courtesy call to discuss on those incidents.
    Although I received a copy of a letter sent by Union Local 770 to Ralphs after my first write up on August, 10, 2009 stating that Union Local 770 did not agree with the content and found that it was issued without foundation, I understood I was still under investigation. I have been doing my best to uphold the profession, using my professional judgment, customer care, and protecting the company. Instead of appreciating my professional effort to step up and follow the updated Rule, QA Policy and Procedure including other company rules, PC Rothstein suspended me from 1/28/2010 to 2/3/2010 with the reason of failure to provide “excellent customer service”, “inappropriate/unprofessional conduct” occurring at Ralphs-84, Ralphs-729 and Ralphs-757. February 1st, 2010 to April 11th, 2010: On Leave of Absence from Emotional Stress, Insomnia and Chest Pain and on a disability leave from Post-Traumatic Stress Disorder, Depression and Insomnia. April 4th, 2010: Sent an e-mail to HR and Pharmacy Assistant and attached a doctor note to continue seeing current DRs and therapist.
    “I have been getting better, and at my visit yesterday, my primary care physician also felt I am well enough, and released me back to work before his previously assigned date (5/1/2010). Attached is the Dr.note. I am very grateful for all the support from my family, friends, doctors, nurses, a therapist and other related health care practitioners.
    Please advise me of the process, procedure and protocol required to return to work.” April 12th, 2010: Went back to work before a previous assigned date of 5/1/2010. May 5th, 2010: Attended the First Grievance Meeting with Eileen Alcala, my Union Rep. and Kirk Reynolds, a Ralphs Labor Relations.
    Eileen impressed with the report prepared for this meeting while an e-mail sent by the Pharmacy Coordinator Kenneth did not have any detail or foundation of those incidents. Eileen had a confidence for having a positive outcome. Although Mr. Reynolds kept stating he did not
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    understand my English several times, he read my report thoroughly and questioned me almost every word.
    May 10th, 2010: Without any verbal or written notice, HR sent an e-mail
    switching me to a part-time status as follows:
    Date: May 10, 2010 11:29 AM
    Subject: RE: Not Available Working Days in June, 2010
    To: Angie Tangjettanaporn <>
    Cc: “Orozco, Arlene M” <>, “Reynolds, Kirk J” <>, “Cupp, Rebecca L” <>
    Based on your availability in April, May and now June, I am switching you to part time status. When your scheduling restrictions are lifted, we can consider switching you to full time status based on our staffing needs.
    Also, I noticed that you have scheduled yourself off the entire week of Memorial Day (June 1-6). The priority to get a week off goes to people who have requested vacation time in advance. As such, I can’t guarantee that I can schedule you off for the whole week. We must make sure that we have met our business needs to keep stores staffed.
    Rachel Hakakzadeh, Pharm.D.
    Pharmacy Human Resources Specialist
    Ralphs Grocery Company
    Phone: (310) 884-2950
    Fax: (310)884-2908
    NOTE: May 10th, 2010: Also, the document type of “Change of Status” was submitted. The Effective Date of “Part Time” Status was April 19th, 2010, One (1) Week after the first day returning from “Disability” i.e. April 12th, 2010.
    HR Rachel reduced my work hours from Full Time to Part Time without either verbal or written notice, after returning to work from Two (2) Months of Disability. Rachel did not either mention or provide “Reasonable Accommodations” to me at all, instead she kept giving me a hard time on the regular basis.
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    May 14th, 2010: Sent an e-mail to Rachel regarding less than 40 hours weekly work schedule for a while. I followed my doctor’s instruction to take a week off as stated in the attachment from May 31st to June 7th, 2010, however, I was willing to help her out by working on Sat, Sun and Mon: June 5th, 6th and 7th, 2010.
    I don’t mean to create any difficulty for scheduling by sending you those N/A working days to you in advance. The reasons are as follows:
    1) I am following my doctor’s instruction that I believe will help me regain my strength and get off several medications as soon as possible.
    2) I prepared a couple days off in order to accommodate the availability for Mr.Kirk Reynolds and my Union arrange a Grievance meeting.
    3) I need to contact State of California, Division of Workers’ Compensation, Sedgwick CMS and several doctor offices to comply with the protocol for an injured worker.
    4) Tuesday is my regular day off as you approved since the interview. The Stress Injury tremendously affected my physical, mental, emotional and spiritual balances, including my personal life and social life. I need to maintain my Tuesday off.
    5) I rarely receive 3-week work schedules in advance as you mentioned during the interview.
    Per your recent e-mail, you are switching me to a part time status. I respect you as an HR that supports and motivates injured employee (and who also interviewed and hired me) to be back to normal as soon as possible. I did not request to be on part time status. I need to cover the income lost from the past months. The State Disability checks were not adequate.
    I will squeeze all of my appointments, as many as I can, in the rest of the month of June and will inform you as soon as possible. Finally, I can set the date for a QME exam on Wed. 6/9/10 at 12:30pm and I might need to take that day off. Kroger Policy on Retaliation
    Kroger will not take any adverse action against any associate in retaliation for the proper and lawful reporting of improprieties; however, I feel my work stability has been much jeopardized. I believe I have been already punished a lot from write ups, suspending to work and changing my work
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    status from a full-time status to a part-time status. Again, HR Rachel did not mention to change my working status in 2008.
    October 14th, 2010: Received the second write up by PC Ernest under “Failure to Perform Job Duties at Ralphs 96”.
    I self-reported a pharmacy incident on September 3, 2010. This was my first error in medication dispensed. I was singled out for this “write up” while similar individuals were treated differently.
    This Grievance was protested by Union Local 770 letter dated on February 15th, 2011. May 6th, 2010 to October 25th, 2010: Waited for the result of the Suspension Grievance.
    I am very positive for Union to arbitrate the merit of this written warning and anything further should it be required. The infractions interfere with Professional Rights and Pharmacists’ Responsibilities to the Public and the Pharmacy Profession. The last one really affects to Company’s Policies, Federal and State Laws. CVS Pharmacy, in an agreement with federal prosecutors, will pay $77.6 million in penalties and forfeiture due to its failure to ensure compliance with Pseudoephedrine (PSE) product sales limits. May 15th, 2010 to October 25th, 2010: Followed my Union Rep’s advice of having all appointments and treatments in those 2 regular days off and it would not conflict with my full-time schedule. October 26th, 2010: Attended the second Grievance Meeting with Eileen Alcala, my Union Rep, Cheryl Butler, a Union Rep and an ex Rite Aid pharmacist and Kirk Reynolds, a Ralphs Labor Relations.
    Mr. Reynolds refused to look at a prepared written report. He stated one of the reasons for being a part-time employee because of several write ups. I had no problem when starting working in 2008 and requested to have a weekly 4-day work schedule for a few months. HR had never mentioned to change a work status to a part-time basis. Mr. Reynolds stated economy in 2010 was not good and why there was no need to hire more relief/floater pharmacists compared to those were hired in 2008. He advised to write a reinstatement letter to full-time status and I did in the same day.
    I also asked Mr. Reynolds what the result of the suspension in the first Grievance Meeting on May 5th, 2010 was. However, he ignored my question by changing the topic and stated this meeting for the Grievance of Hours Reduced. I stated in this Grievance Meeting that HR Rachel Abrishami Hakakzadeh hired one Per Diem female Pharmacist, Naghmeh Abrishami. She has obtained her CA Pharmacist License either in July or August, 2010. Surprisingly, she had weekly 4 or 5 days work schedule as a Per Diem Position which cost the company more and I worked 3 days a week. A few weeks after my second grievance meeting, HR Rachel Abrishami Hakakzadeh easily gave this New Per Diem female Pharmacist, N. Abrishami a store as a full
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    time staff pharmacist. Not only HR Rachel does not consider “Seniority”, but also she gives a hard time for a Ralphs Floater Pharmacist who requests to have a store, including me. November 11th, 2010: Worked with a new Full -Time Female Floater Pharmacist, Ju Hwa Kang, who told me she just got hired in October, 2010 and she would start her maternity leave on December 6th, 2010. Please review a statement of “Reinstatement” on page 19 of UFCW Local 770 Retail Food & Meat Agreement March 5, 2007 – March 6, 2011 for Albertsons, Ralphs, Vons.
    “(b) A full-time employee, who has been reduced to part-time employment because of slackening of business or for medical reasons, must be offered the first (1st) full-time job that opens in the Company district in which he is currently employed, provided that his ability and skill equip him to fill that job.”
    The statement does not mention anything about employees needing to file a Grievance. February 9th, 2011: Committee Meeting with Union Representatives at Union Local 770. February, 18th, 2011: I believe I am very patient to wait for and follow up the consequences of Suspension Grievance dated on 01/28/2010 by contacting my Union Representative on a weekly basis.
    Finally, I received a Union Local 770 letter dated February 15th, 2011 on (Ralphs#0096/Grievance2010DEN045) dated on January 28th, 2010 states “The results of the investigation by your Union Representative indicate that you were reinstated with the company and there was no violation of the Collective Bargaining Agreement.” Again, being reinstated does not mitigate the original basis of the suspension.
    I have never received any UFCW Local 770 letter regarding the result of my Grievance of Suspension since the year 2010 while the result of 1st write up on 8/10/2009 of it was issued without foundation was filed on 9/16/2009. I am very positive for Union to arbitrate the merit of this written warning and anything further should it be required. The first two infractions interfere with Professional Rights and Pharmacists’ Responsibilities to the Public and the Pharmacy Profession. The last one really affects to Company’s Policies, Federal and State Laws. CVS Pharmacy, in an agreement with federal prosecutors, will pay $77.6 million in penalties and forfeiture due to its failure to ensure compliance with Pseudoephedrine (PSE) product sales limits. The result should be “Union Local 770 do not agree with its content and find that it was issued without foundation” and Union Local 770 is ready to proceed to arbitration.
    On the same day, I received another Union Local 770 letter dated on February 15th, 2011 on (Ralphs #0096/Grievance 2010EVE342) dated on July 30th, 2010 states “It was not filed within the time limits”. I am not aware of the time limit and you have never mentioned or
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    advised me to do it during the time of waiting for the result of the first Grievance Meeting at Ralphs in Compton on May 5th, 2010.
    I was of the understanding that I needed to have the results of the first Grievance Meeting (Suspension Grievance) before I can file another Grievance.
    During my 3-day a week working schedules, I heard that a full time Food 4 Less female staff pharmacist had her 2 –day a week working schedule after the company shut down Food 4 Less pharmacies. Her Union Representative helped her get her full-time status back without going to any Grievance Meeting at the Corporate. I contacted Eileen immediately, she also asked me to find out who that Union Representative was. I found out and immediately informed Eileen who told me she would discuss with that Union Representative right away. That was the time I went to file another Grievance even though I did not hear anything back from my Suspension Grievance.
    Again, the suspension caused me to be on “Disability” from Post-Traumatic Stress Disorder, Depression and Insomnia”. That suspension also led me to have working hours reduction. HR Rachel hired new full time pharmacists without fully consideration of the statement of “Reinstatement”. March 17th, 2011: Attended Executive Board at Union Local 770.
    I was very exhaustive, insulted and disappointed with this meeting. I, as a Union Member, felt that I completely got betrayal by Union Local 770 I respect and I regularly pay for my Union dues.
    I did not expect for having more than 50 or 60 attendees in this meeting, therefore, I did not prepare enough folders of my presentation. I was told it was going to be “my day” at this meeting. The meeting was supposed to start at 11:30am, however, the time I was walking into the meeting almost 12:00pm. Eileen, my Union Representative told me before this meeting that it was her responsibility to make her presentation first, Then, I would fill up the important gaps/portions that she could miss in her presentation. Eileen did not give any presentation and she let me stay in an extremely awkward situation alone.
    Not everyone in the meeting had reviewed my case thoroughly. If I was informed in advance that some Executive Board Members and Union Representatives needed to have lunch on time, I was pleased to postpone the meeting to be hold in the afternoon after everybody satisfied with his/her lunch. Since the beginning of the meeting, some of them showed disrespectful and impatient manners to my presentation. April 22nd, 2011: Union Pursue Arbitration
    I received a letter stating that Union Local 770 Executive Board made decision to pursue arbitration for my case.
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    Monday May 9th, 2011: Pharmacy Gates Ooened Before Business Hours at Ralphs 132 in Torrance
    I discovered and reported open pharmacy gates, together with an unset alarm system. There was no any type of inspection on both Monday and Tuesday while I was a pharmacist on duty. THIS IS A VERY UNUSUAL INCIDENT. Tuesday May 10th, 2011: Performance Evaluation at Ralphs 132 in Torrance
    It was past my legitimate lunch time, both HR Rachel and PC Peter refused my request for having my lunch prior to the meeting. I was very hungry and had to attend this First Performance Evaluation since I was hired in 2008. I felt the evaluation was very unfair and I wrote “signed without fully review, not allowed by HR Rachel” under my signature. I also checked “YES” on the question: “Do you have any complaints or incidents of unlawful harassment, discrimination or retaliation that you want to report?” May 11th, 2011: Angry Female Patient at Ralphs 31, in Sherman Oaks
    This “Angry Female Patient” incident was originally caused by the male pharmacy manager, however, I was terminated. This male pharmacy manager, Dikron, did not follow Ralphs Pharmacy’s Quality Assurance Policy and Procedure Manual. Unfortunately, I just happened to be the floater Pharmacist on duty on that day when this irate female patient came back with a couple complaints for the pharmacy operations. This female had called Dikron before to complain of having only 90 tablets of one Brand Name medication inside a pharmacy vial instead of 100 tablets shown on the prescription label. Referred to Ralphs Pharmacy’s Quality Assurance Policy and Procedure Manual, the pharmacist on duty discovering or being informed of an error will have the responsibility of processing a Pharmacy Incident Report Form. Not only Dikron did not file the report, but he also inappropriately advised the patient to exchange that vial with another vial of 100 tablets. Dikron could have fixed this issue properly by simply filling another other 10 tablets as a balance of that prescription and contacting her to pick up this balance without any charge.
    All 90 tablets she (the patient) counted had already been contaminated and could not be dispensed again. This is an unnecessary waste of company asset, especially with Brand Name medication. I treat every pill/drop of medication as valuable Company inventory. I also filed a Pharmacy Incident Report at the end of my closing shift.
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    May 12th, 2011: Suspended Under Investigation Without An Assigned Period at Ralphs 219 in Encino
    Again, it was past my legitimate lunch time, both Loss Prevention Alex and PC Kenneth refused my request for having my lunch prior to the meeting. I was also very hungry during the unfair meeting. Both of Alex and Kenneth pressured me to admit that I had accused that female patient of stealing. I insisted in front of them that this incident was primarily/originally caused by Dikron. Both of Alex and Kenneth obviously took the side of Dikron as a human error and considered me of having a poor customer service.
    I protected company asset and I am always aware of the importance of Inventory Control (Shrink Policy). I did not want to get involved with anything missing in the pharmacy while on duty which could lead me to obtain another unexpected write up or suspension or termination. There were too many Ralphs Pharmacists and Pharmacy Staff got termination in the past several months. During this meeting I mentioned about the incident of Krystal, a female pharmacy technician overriding the prescription prices for her mother. Ralphs just terminated her recently after her non-stop same misconduct. Surprisingly, the Loss Prevention Officer Alex did not know anything about the initial incident of that immediately dismissal misconduct on April 3rd, 2009. It appeared that PC Kenneth and HR Rachel intended to protect Krystal, therefore, they had never reported her dismissal misconduct to Loss Prevention. Instead, Kenneth stated that he told Krystal not to repeat this misconduct. Why didn’t Ralphs Management ever deal with the initial incident I reported on April 7th, 2009? May 13th, 2011: Went on disability May 20th, 2011: Terminated At Ralphs 96 (Home Store) in Pasadena
    I was very surprised and confused that I was fired on the very same day that I received a verbal notice from Eileen Alcala, my Union Representative, who was also on the phone with Ralphs Labor Relations Kirk on May 9th, 2011. Ralphs was willing to negotiate with me about all of my previous grievances because Ralphs did not want to go thru the arbitration process. Eileen had never told me earlier. May 25th to May 26th, 2011: Experienced Poor Pharmacy Customer Service At Two (2) Ralphs Pharmacies To Refill Legitimate Prescriptions
    I sent my statements online to Ralphs Customer Service, however, I have not received any reply from Ralphs Pharmacy Management up to now. June 17th, 2011: 4 Weeks After Terminated
    Tim, a Union Representative informed me Ralphs would not have a “Termination Grievance” Meeting while I was on “Disability”. I requested for a legitimate written document. Again, I have not received any reply from Ralphs Pharmacy Management up to now.
    20 | P a g e
    August 25th, 2011: Attended Termination Grievance Meeting at Ralphs in Compton, CA.
    Both Ralphs Management and Union Local 770 Representatives attempted to force me to admit that I accused an irate female customer of STEALING, that this was poor customer service, and the reason for my firing. They treated me like I was a “Criminal” who had to confess in front of policemen and detectives. My answer to this accusation is “NO.” I insisted that I be allowed to watch the original tape, which will show what happened. Surprisingly, Monica at Ralphs Labor Relations, who made her final decision to terminate my employment, did not obtain this tape. However, she said she would contact Alex at Ralphs Loss Prevention to make a copy of this tape.


    I Am Certain That You Guys Will Vote On This. Is WAG Too Far Out of the Box?

    Jp Enlarged

    You all know that I favor WAG because I worked part time for them for 6 years and they treated me well.  Regarding this new model, I don’t see how they could pull this off without some significant changes in the laws that govern the practice of pharmacy. Jay Pee

    Hi Jim,

    I thought you might be interested in this new study, which investigates Walgreens’ new pharmacy model and the risks it poses for increased medication error, patient privacy violations and breaches of drug security. Based on the study’s findings, a complaint has been filed with US Dept. of Health and Human Services alleging HIPAA violations.

    This new model, dubbed “Well Experience,” puts the pharmacist out-in-front of their traditional work area—leaving no pharmacist in the room where prescriptions are filled. Our research, based on 100 store visits to Well Experience pharmacies, has identified fundamental problems with the model that could undermine the safe practice of pharmacy. For example, sensitive, HIPAA-protected patient information was left unattended or unsecured in 80% of store visits.

    For Immediate Release

    Study:  Walgreens’ New Pharmacy Model Increases Risks to Public Health, Patient Privacy and Medication Security

    Complaint Filed with US Dept. of Health and Human Services Alleging HIPAA Violations;

    Report Based on 100 “Well Experience” Store Observations

     Washington, DC, September 23, 2013—Walgreens’ attempts to revolutionize the pharmacy may increase risks of medication errors and patient privacy violations, according to a new study by Change to Win Retail Initiatives (CtW).  The report titled Behind the Desk uses data from 100 observations of Walgreens’ “Well Experience” pharmacy model in 50 stores located in Florida, Illinois, and Indiana.  Based on the study’s findings, CtW filed a complaint alleging numerous breaches of the Health Insurance Portability and Accountability Act (HIPAA) with the US Department of Health and Human Service’s Office of Civil Rights (OCR).

    “The right to privacy is an essential element of quality health care, and Well Experience appears to have fundamental flaws in its design and execution that warrant regulatory action,” said Deborah C. Peel, MD, Founder and Chair of Patient Privacy Rights, a leading national health care privacy organization.  “As the nation’s largest drug chain, Walgreens should know that playing fast and loose with sensitive, protected patient information is not only wrong but also illegal.”

    CtW’s investigation details significant problems with Well Experience, including:

    Violations of patient privacy.  In 80 percent of stores visited, sensitive, HIPAA-protected patient information, such as medical histories, was left unattended and visible to customers in the pharmacy area.

    Inadequate medication security. Prescription medicine—in one case hydrocodone—was left unattended and within the reach of customers in 46 percent of stores visited.

    Increased pharmacist distractions.  Field researchers observed nearly 150 distractions and interruptions to pharmacists that were unique to the Well Experience pharmacy model’s design —over one third of the total number observed. Interruptions and distractions are associated with increased medication errors.

    Low rates of patient counseling.  Field researchers observed an average consultation rate of 8.2 percent in surveyed Well Experience pharmacies, despite Walgreens’ claims that the model increases counseling. Academic studies of chain pharmacies using secret shoppers found rates of 27 to 53 percent, Pharmacists are required by law to offer counseling for new prescriptions.

     A key feature of Well Experience is the pharmacist sits in a work station in front of the pharmacy counter, and is typically not in the traditional prescription fill area. This relocates the pharmacist’s work station from a private space in the pharmacy to a public space.  The out-in-front pharmacist remotely monitors the pharmacy technicians and checks the accuracy of prescriptions using photos and video displayed on a computer screen.

     The OCR complaint raises additional privacy concerns stemming from the out-in-front pharmacist work station. Pharmacists’ computer screens and mobile devices, used to review prescription information, were sometimes observed to be unattended and visible to the public. The new format also enables shoppers to overhear sensitive telephone conversations about patients. Despite the vulnerabilities created by relocating the pharmacist to a public area, Walgreens’ policies and procedures appear to provide scant guidance on HIPAA compliance.

    The report echoes the concerns of several state boards of pharmacy about Well Experience’s impact on the supervision of pharmacy technicians and the accuracy of prescription fills. For example, the Maryland board has rejected the model last year.

    “Walgreens must not compromise pharmacists’ ability to perform their core duties of safely dispensing medication, counseling patients and protecting sensitive health information,” said Nell Geiser, Research Director of Change to Win Retail Initiatives.

    About Change to Win Retail Initiatives

    Change to Win Retail Initiatives is committed to making retailers more accountable and transparent to consumers, workers and all stakeholders.  For more information about its initiative to bring reforms to Walgreens, visit




    Tell Us About This.

    Jp Enlarged
     Perhaps one of you Big Evil Indentured Servants can enlighten us.  This just showed up in my In-Box.  I have no idea what it is about.  It looks like a “Canned Spin Message”, but why would Big Evil send something like this out?  It looks like the guy who sent this to me is a customer.  If I had a serious complaint, this type of communication would just make it worse.
    Jay Pee
    This is the response I got from CVS corporate.

    From: seruio
    Date: October 4, 2013 at 11:27:21 AM CDT
    Subject: Hello from CVS Customer Relations

    Dear Edward,

    Thank you for your email. I am eager to respond.

    CVS Caremark is an equal opportunity employer. Our continued success depends on the full participation of all qualified persons regardless of age, gender, gender identity or expression, marital status, sexual orientation, race, color, religion, national origin, veteran status, military status, disability or any other characteristic protected by federal, state or local law.
    It is our policy to recruit, hire, train, develop and promote the best people available, based solely upon job-related qualifications

    CVS Caremark requires all matters related to recruiting, hiring, training, compensation, benefits, promotions, transfers and treatment on the job be free of discrimination and harassment, which are prohibited by law.

    We are committed to a work environment free of all types of discrimination.

    We appreciate you taking the time to contact us. If you have any other questions or concerns, do not hesitate to contact us at 1-800-746-7287 begin_of_the_skype_highlighting 1-800-746-7287 FREE  end_of_the_skype_highlighting. We are available Monday-Friday, 8:30am-7:00pm ET.

    Thank you,

    CVS Customer Relations


    Take a Two Minute Break for a Laugh. Imagine this at the Drug Store.

    Jp Enlarged


    Is there a conspiracy to replace Pharmacists with Robo-Dispensers

    Jp Enlarged

    Clearly, this writer is not a pharmacist.  He is angry.  He insults pharmacists, as a group.  His language is over-the-top and he is assured of two things.  He will piss pharmacists off and he takes a chance of being completely disregarded.  

    But, you know what?  He is right down the line on target.  When I was walking Buddy this morning, I was playing with ideas on how to approach the differentiation between ROBO-DISPENSERS and PHARMACISTS.  You know the difference.  What I want to explore is WHY this has happened and WHO BENEFITS.

    The chain, big box and grocery store retailers do NOT NEED pharmacists.  They do not want an R.Ph. to leave the prescription mill to counsel on OTC choices.  They do nothing to support RPHs in complying with federal and state law.  All they want is for you to keep your nose in the Prescription Mill, making the numbers, happifying the MBA Masters of the Universe.  You all know EXACTLY what has been happening for the last decade.

    The WHY is money.  Of course.  It always is.  The HOW is much more complex.  It took collusion, I think.  The word is defined:  Secret cooperation between people in order to do something illegal or underhanded .  Can we hope for a whistle-blower?  Collusion between the Retailers, ACPE, NABP, the Boards and possibly the schools.  Maybe not U.C. San Francisco because the traditional schools will always train PHARMACISTS.  The new schools aren’t in the business to educate pharmacists.  They are invested in creating people capable of working in a dispensary.  Can you imagine a grand conspiracy to transform the face of American pharmacy?  I can because I know what we have been getting.  I worked for awhile with a young woman who was educated at a new school.  She was a sponge and eagerly listened to anything I would share.

    Is Jay Pee blowing smoke here, drinking the Kool Aid?  Do we have any chance of stopping this when Big Evil and Big Stupid and possibly Big Question are getting rid of veteran pharmacists and replacing them with lower-wage Robo-Dispensers?  The following is a comment from a critic who is a patient with a good, critical eye.

    My holy god you people are a bunch of whiny faggots. Some of you write comments and can’t distinguish properly between THERE, THEIR, and THEY’RE… but you want to go on and on about how I should let YOU compound some bullshit medicine for me and how fucking lovely that really is and yes, you should make TEN ZILLION dollars per hour and NOT be exempt.

    Puh-leeze… If you guys had any integrity, you would INSIST that they take that AIRBORNE crap off the shelves, as well as anything labeled “HOMEOPATHIC”… you and I know that the number 1 requirement for anything to be labeled “homeopathic” is that it not contain any active ingredients. Occilloscululanimousucum? Duck Liver extract to cure the common cold? In a 1 x 10^-30 dilution such that there is perhaps 1 molecule of “duck liver shit” in the bottle? REALLY? Go take your indignation and stick it where the sun don’t shine.

    I’ve asked pharmacists about these nail fungus products that are all clearly labeled “will not cure nail fungus” on the back and “For Nail Fungus” on the front, and what do I get??? HUH? DUH??? what was that you said? No, not just one pharmacist… just about every one I have asked has said the same thing.

    Your rant is just coming from a pissed off place because, in reality, you HAVE been replaced by a pill-counting and dispensing machine. You don’t pilfer the “occasional lorazepam” if you are a machine, I would suspect. So, speaking of which, doesn’t that make you a shit sucking unethical pillpopping leach? Why U No go See doctor? You too full of self, that why!! You smarter than doctor, of course.

    And what’s this BS about pharmacists not being taught the study of making drugs from native plants and what not? WHY THE FUCK do I want you to know that? You are not a pharma! I have enough liver damage from all that stupid “Traditional” chinese medicine, based all on a bullshit theory of the body involving humor inbalance in the chi energies. Sounds a lot like sanguinicity and melancholy… sound familiar?

    You make me sick.



    California Pharmacists Legally Providing Primary Care Soon…And Getting Paid

    Jp Enlarged

    California pharmacists nearing provider-status

    Drug Topics, 9/20/13   Mark Lowery

     Pharmacists throughout California are a signature away from being able to give a full range of immunizations, as well as dispensing birth control pills and certain medications for international travel.

    Earlier this month, a pharmacist provider-status bill passed both houses of the California State Assembly. The bill has been delivered to California Governor Jerry Brown, who has until October 13 to act. If the governor signs it, the law would take effect in January.

    “The California Pharmacists Association (CPHA) is pleased that the California State legislature has recognized the added value that pharmacists can play in providing expanded access to care to patients in California communities,” said Jon Roth, CPHA CEO. “This legislation, SB 493, is an acknowledgment that the education, training, and skills of pharmacists go far beyond providing medications to patients.”

    Under present law, pharmacists in California can only give flu shots and emergency contraception. The new law would authorize pharmacists to administer drugs and biological products. It would also expand the duties pharmacists in California can legally perform, including furnishing self-administered hormonal contraceptives, prescribing smoking cessation drugs, and prescribing medications not requiring a diagnosis that are recommended for international travelers.

    “Pharmacists are vastly underutilized for the amount of training and education they receive,” said Sen. Ed Hernandez (D-West Covina), who sponsored the bill. “The pharmacy profession can play and will play an important role in this expansion mode, and they’ll need an expansion of their scope of service to enable them to do so.”

    The new law also establishes board recognition and training requirements for an advanced practice pharmacist with expanded functions. Pharmacists would also gain the authority to order and interpret tests to monitor and manage efficacy and toxicity of drug therapies


    Our Industry Needs PharmD Candidates from REAL Pharmacy SCHOOLS

    Jp Enlarged
    Touro University College of Pharmacy is located at Mare Island, Vallejo, California.  Until a couple decades ago, it was Mare Island Naval Shipyard.  This is a picture of the College of Pharmacy’s Academic Center.  A use for surplus Naval barracks.  I called the Dean a few years ago.  It was clear that this is a for-profit school.  She could not answer my rather pedestrian questions.  I was unimpressed.  JP Touro is Not all alone. There are plenty of new for-profit schools.
    I wrote this letter to the editors at Drug Topics last night.  the answer is below.
    Touro tuition with costs.  Around $77,000 per year the last time I looked.  A Bachelor’s degree is required for entry.  Get this:
    Only two academic years of in class instruction at their Mare Island campus in Vallejo, California.  Formerly a Navy shipyard.
    I’d like to know if they even have laboratories. Compounding? Don’t hurt yourself laughing
    The next two years are all rotations.  Touro still collects the tuition.  Ka-Ching.  Take a look at their site.
    PharmD 2017 PharmD 2016 PharmD 2015 PharmD 2014
    Tuition $38,300.00 $38,300.00 $38,300.00 $38,300.00
    Books* $3,650.00 $1,770.00 $966.00 -
    Room and Board** $26,360.00 $26,360.00 $26,360.00 $21,566.00
    Transportation** $2,358.00 $3,258.00 $3,980.00 $3,980.00
    Personal** $6,162.00 $6,162.00 $7,534.00 $7,534.00
    Professional Development Conference $618.00 $618.00 $618.00 $618.00
    TOTAL $77,448.00 $76,468.00 $77,758.00 $71,998.00

    This is about as far as you can get from a traditional College of Pharmacy, associated with a university.  I tend to label Touro and a whole bunch of others that have cropped up in the last few years as “NAPLEX preparation courses”.  They certainly do not teach these kids to be traditional pharmacists.  No compounding, for example. Pharmacognosy is not even an elective.

    They are in business to fill the need when the demand was huge.  When kids found out they could get $20 grand sign-on bonuses and pull down a 6 figure income right away.  If you did not have a felony on your shoulder, RAD would hire you.  If you could not speak English, practically, CVS would sponsor you for a Visa.

    Then, All of a sudden, no more sign-ons.  There are plenty of warm-bodies with licenses who will tke the $40 per hour, 30 hours a week jobs.   I hear from pharmacists that the six figures have suddenly disappeared for new pharmacists.  Some companies (Can you say Big Stupid?) are finding anything to get rid of veterans so they can hire the kids for less $$$.There are two kinds of new pharmacists.  Kids who went to Ohio State, Toledo, Ohio Northern and Cincinnati ( I am an Ohio boy)
    come out with a complete education.  Suddenly, there are seven schools in Ohio.  You have kids with a history in the drug store business since high school.  They prepared for Ohio State (considered the best) when they were in the 10th grade.  They worked as teenagers in drug stores.  They are drug industry people before they get to school.
    Then, there are the Touro graduates and I am using Touro generically now.   They do not know much about the industry.  They can run the prescription mill, but ask them to compound? Compounding is still the quintessential pharmacist talent.  No other medical professional can do it legally or competently.  OTC counseling is a talent that at Touro is “OTC What?”    The Touro kid who wrote the menthol article actually believes that this is a hot button issue.
    How long will Touro last at a tuition+ of $77k per when the demand goes down.  Actually, it has gone down.  I worked in Galveston with a grad from a new school .  She readily admitted that her school was a desperation choice when she could not get accepted anywhere else in Texas.  Smart girl too. When I offered to teach her a bit of compounding, she was like a sponge.  She had no clue that on a Friday night, she was the go-to person for Triage for poor people.   She was not aware that she was not to take the word of a nurse when an issue needed the doctor’s attention.
    I am afraid, you guys. Very afraid. 

    The Stockholm Syndrome at your local Drug Store

    Jp Enlarged

    You are going to have to explain to me what is going on?  I have never before seen a bunch of specialists acting like they are factory floor, piece work workers.  You are treated like shit and I do not see outrage.   I see effete whining.  This behavior has developed over the last few decades until it is now expected.  It this some variant of the Stockholm Syndrome?

    Why don’t pharmacists stand up for themselves? 


    Stockholm Syndrome:


    A condition experienced by some people who have been held as hostages for an extended time in which they begin to identify with and feel sympathetic toward their captors.


    Sounds good to me.  What is wrong with you people.  Really, where is the outrage?  There is nothing wrong with anger, if you use it rather than letting your emotions use you.  The following is from “The Prisoners of Comfort”:


    Recovery is regaining Your Power

                Essentially, the miserable pharmacist is wretched because they choose to be unhappy.  There is a choice every single day to be proud of what they do or to blame the job because they are not happy.  They don’t even use the best tool available to them.  That tool is anger!

    Anger is fuel.  It is not the bad thing that your parents said to suppress as mine did.  “Jimmy, nobody needs to know you are angry.  You should control yourself.”  We feel anger and we become frustrated when we hide it because we want to do something about it.  This goes against the image of the calm, in-control professional.  Instead of showing the anger, we stuff it and chug Maalox and take two 20mg omeprazole every day.

    How would it look if we showed that we were angry?  At work, you don’t hit that someone or break that something or throw that fit.  If you smash that fist against the wall, do it in the bathroom where no one can see that you are out of control.

    What we do with our anger is deny it.  We stuff it so far down that we forget what makes us angry.  We are institutionalized and we believe that we should not get angry.  We lie about being angry at the store manager.  We hide our anger at the lack of technician help.  We do not express our outrage to the district manager.  Doesn’t he know that it is his precious customer service that pays the price?

    Some of us hide it so well that we medicate the anger and filch the occasional lorazepam to hide it even better.  We are professionals and professionals are nice people.  We bury our anger.  We block it and we hide it.

    What we do best with our anger is lie about it.  Unfortunately for our spouses, we lie so well that we often take our misery out on the people we love (or are supposed to love) the most.  We do everything but listen to our anger.

    Listen to your anger.  That is what it is meant for.  Anger is not a polite request.  Anger is a scream.  It is a command.  It is a slam of the fists down on the table demanding your attention.  Anger has a right to be heard.  Anger should be appreciated and valued.  Anger must be listened to if you are to regain your professional balance and power.  Why?  Because anger is an atlas or a chart or a diagram back to living the ideals you had when you were in pharmacy school.

    Anger reminds you of your boundaries and limits, the areas where no one was allowed to tread without your permission.  If you can set up the periphery of your professionalism in just one area, more will follow.  If you list only ten serious drugs that you will counsel on no matter what, your list will be twenty in little time.  If you let the store manager know in writing that his touching you at anytime, in any manner, is unwanted, you will regain enormous power and control over your own life on the job.   You can gain power simply by refusing to get wet underpants because you neglect going to the bathroom when you have to go.  Documenting anything at work that makes you uncomfortable will give you surprising control.

    Anger shows us where we want to go.  We may not know exactly what we do want on the job, but our anger tells us, without ambiguity, what we sure as hell do not want.  That is a really good place to start because anger shows us where we have been and sets us on the course of recovery.  Anger is not a sign of disease.  It is a sign of health.  If you no longer get angry at being institutionalized, stop, take a deep breath, and examine how you will find your way back.  I contend that you will find that the first sign of recovering your health, well-being and pride will be anger.  Welcome it.  Savor it.

    It is not very healthy to act out from anger.  That is childish and not productive.  I quit a job once out of anger.  It was a good job.  I was well respected in the community.  The problem was that the store manager tried to micro-manage my department.  I have never bent to management from a non-pharmacist.  This guy was out to bring me to my knees.  I fell right into the trap.  I became so angry that I brought the problem to a head with some stupid brinksmanship.  My district manager did not back me as fully as I wanted, so I quit.  My one-way commute for that job was less than ten minutes.  The one-way commute for the next job was ninety minutes.  I was like a teenager having a meltdown.  I turned my anger into indignation without any examination of the circumstances.  I was an idiot.

    Anger is there to be acted upon.  Anger points the direction.  Anger is the wind for our sails as our sailing ship tacks as we move on the appropriate bearing where our anger guides us.  Had I used my head and had the presence to translate what the anger was telling me, I would have made better choices.

    “Damn it, I could run a better pharmacy than that!”  This anger says that you want to have your own pharmacy, you just need to put all of the pieces together.

    “I can’t believe it.  Mildred told me that she was going to demand a transfer to the suburbs and she got it.  That’s what I wanted.”  This anger says: Stop keeping your goals and dreams hidden.  You need to express your wants and believe that you deserve your dreams to come true.

    “That was my idea.  This is unbelievable.  I mentioned it only once and that son of a bitch took my plan and put it to work.  He gets all of the credit and I get none.”  This anger says that it is time to take yourself seriously and show yourself some respect.  Your ideas are good enough to do something about.

    Anger is the tornado that blows away all of the restrictions and hesitations and lack of self confidence of our old lives.  Anger is a valuable instrument to be used productively.  Anger cannot be the master, only the servant.  Anger is a deep well of power, if used properly.

    Apathy, laziness, misery and gloom are the enemies.  Anger is not a good buddy, but anger is a friend.  Not a mild-mannered friend, but a very loyal and steadfast friend.  Anger will always remind us when we have been cheated or cheated upon.  It will always tell us when we have been deceived or when we have betrayed ourselves.  Anger will tell us that it is time, finally, to act in our own best interests.  Anger is not the action itself.  It is the action’s invitation.


    You guys spend too much of your work days with unbridled anger stuffed down inside.  You smile.  You acquiesce.  At first, you feel like crap about it, but after awhile you don’t even feel the anger.  Stockholm Syndrome?

    Is that why you tolerate shabby treatment?  My college roommate is a pharmacist.  He has worked as a hospital administrator for decades.  He is the Compliance Officer at a Chicago hospital.  I will ask him what would happen if an administrator ordered a young doctor to violate the current ethical standards in his/her profession.  I will ask him what would happen if doctors were expected to break the law every day, all day long.  I will report back to you.


    For Your Information. Your Thoughts Please

    Jp Enlarged

    You can do this, you guys.  You just got to get together.   You need leaders.  You need to contact the Guild.  You need to find out the laws about organizing.  Let’s see what you are made of.  This document is easy ti find on the Net.  Just look.  I find the “rest period” provisions to be very interesting.

    21243 VENTURA BLVD, SUITE 241, WOODLAND HILLS, CA 91364-2167
    (818) 992-0475 (877) 992-0475 TOLL FREE E-MAIL GFPP@AOL.COM FAX (818) 992-6835
    APRIL 6, 2012
    As you recall, in our negotiation update of March 23, 2012, CVS indicated to the Guild that to consider any additional wages (above their last proposal) would require meetings with their superiors at CVS Headquarters in Rhode Island. On April 4, 2012, the Employer contacted the Guild and stated that Corporate Headquarters had modified their last economic offer. The Company stated that in order to increase the wages of the current pharmacists, they would have to adjust the wages for newly licensed pharmacists hired after March 31, 2013. ALL CURRENTLY EMPLOYED PHARMACISTS WILL REMAIN AT THE TOP RATE OF PAY. The Guild notified the Guild/CVS Negotiating Committee Members of the change and the Committee Members approved the Tentative Agreement unanimously.
    In order for the new wage (retroactive to March 29, 2012) to become effective, the membership must ratify the tentative agreement.
    Enclosed you will find a ballot to approve or reject the tentative agreement. Ballots must be returned (envelope enclosed) to the Guild office by APRIL 18, 2012 at which time they will be opened and counted. All CVS members may be present at the ballot count.
    All other sections in the current agreement remain in full force and effect.
    1. TERM: Three (3) year Agreement – 3/29/2012 to 3/28/2015.
    2. Guarantees 40 hours per week for full-time regular Guild pharmacists (overnight pharmacist language remains unchanged.)
    Article 5.3.1 Full-Time: Change to read: A full-time pharmacist is one who is regularly scheduled to work 40 hours or more per week, or compensated at the equivalent of 40 hours straight time wages per week. A full-time overnight pharmacist is one who is compensated at the equivalent of 40 hours straight time wages per week.
    3. Deleted language for scheduling.
    Article 5.9 Days Off and Starting Times: Delete To the extent possible, the Employer shall strive to schedule all full-time pharmacists consecutive days off and uniform starting times each workweek.
    4. Clarification of current language for discontinued 24-hour Pharmacy Operations.
    Article 5.14.6 Discontinued 24 Hour Pharmacy Operations: Change to read: If the Employer discontinues a 24 hour pharmacy operation, the Guild and CVS will meet and confer to determine relocation options for displaced full-time late shift pharmacists who volunteered and were not originally hired for such work may exercise their seniority to obtain a regular full-time position by bumping the least senior pharmacist in the operating district in which the affected 24 hour pharmacy is located, provided the late shift pharmacist’s seniority is greater. If the two parties cannot reach an agreement, the displaced full-time late shift pharmacists may exercise their seniority in accordance with Article 9.2.
    5. Clarification of rest and meal period language (see Appendix B for
    comprehensive explanation.)
    Article 5.11.1 Rest Periods: Change to read: The Company is committed to pharmacists getting their
    rest periods and Pharmacy Team Leaders will assist pharmacists in taking them encourages
    pharmacists to take their rest periods in accordance with California State Law and the collective
    bargaining agreement. The rest period will be taken at the most appropriate time within the four (4)
    hour period. Complete rest period details are included in Appendix B.
    Article 5.11.2 Rest Periods: Change to read: If the Employer fails to provide permit a rest period, the
    Employer shall pay the employee one (1) hour of pay at the employee’s regular rate of compensation
    for each workday that the rest period is not provided. It is understood and agreed that this language
    is not applicable to situations in which the pharmacists are provided with an opportunity permitted
    to take a rest period, but decline to do so. It also does not apply to situations in which a pharmacist
    has the ability to take a rest period at his or her convenience, without being formally requested to do
    so by a manager, and declines to do so.
    6. Change of vacation scheduling deadlines.
    Article 8.5 Vacation Schedules: Change to read: The employer shall provide a vacation request sheet
    by January 15th November 15th of the preceding calendar year each year, to be returned no later than
    February 1st December 1st of the preceding calendar year. Pharmacists will submit their vacation
    weeks requested and the Employer will assign such weeks available on the basis of seniority within
    the Pharmacy Supervisor’s district to which the pharmacist is assigned.
    Vacation periods shall be fixed by the Employer to suit the requirements of the business, but as far as
    possible and practicable, vacations will be given during the summer months (through October, if
    requested by the pharmacist), and for pharmacists with school-age children during the school
    Vacation approvals will be communicated in writing to each pharmacist by the end of February
    December of each year. Once approved, a Pharmacist’s vacation schedule will not be changed, altered
    or voided without mutual consent of the Employer and the staff pharmacist. In addition, the Employer
    will provide a list of open vacation dates and allow an additional period of time for pharmacists who
    could not be accommodated on the first round to request such dates by seniority. Staff pharmacists
    will not be responsible for finding replacement pharmacists for approved vacation scheduling.
    7. Clarification of holiday pay.
    Article 8.9 Holiday During Vacation: Change to Read: If a holiday named under Article 6.0 of this
    Agreement falls within the vacation period of a pharmacist, the pharmacist shall be granted an
    additional day of vacation with full pay, or an additional day’s pay in lieu of the holiday paid for the
    8. Clarification of work.
    Article 18 (b) Pharmacist Dignity and Pharmacist Rights: Change to Read: to enable pharmacists to
    focus on professional responsibilities, the Employer agrees that it will not assign unreasonable
    maintenance janitorial duties to pharmacists, although the Guild agrees that housekeeping duties
    minimum maintenance functions consistent with professional status and emergency clean ups will
    continue to be performed by pharmacists.
    9. Premium Pay for Overnight Pharmacists.
    A. Minimum Hourly Wage Rate – Full-Time and Part-Time Registered Pharmacists
    MARCH 29, 2012
    MARCH 31, 2013
    MARCH 30, 2014
    $ 127,712/YR
    $ 130,832/YR
    $ 133,744/YR
    $ 136,760/YR
    $136,760 minus $127,712 = $9,048
    Minimum Hourly Wage Rate – Full-Time and Part-Time Registered PHARMACIST LICENSED LESS THAN 1 YEAR AS OF 3/31/2013.**
    MARCH 29, 2012
    MARCH 31, 2013
    MARCH 30, 2014
    **Company may start at regular full-time and part-time rate at its sole discretion if it deems appropriate.
    Minimum Hourly Wage Rate – Full-Time and Part-Time Registered PHARMACISTS LICENSED LESS THAN 1 YEAR AS OF 3/30/2014**
    MARCH 29, 2012
    MARCH 31, 2013
    MARCH 30, 2014
    **Company may start at regular full-time and part-time rate at its sole discretion if it deems appropriate.
    12. Pharmacist Rest Periods (see Appendix B) – a great deal of discussion was spent during negotiations concerning pharmacists’ difficulty in taking rest periods. Appendix B outlines the procedure for taking a 10-minute break which you are both legally and contractually entitled to take.
    CVS #9571/8840
    CVS # 8862
    CVS # 8881
    CVS # 8893
    Professionally yours,
    Ralph Vogel
    Ralph Vogel, Pharm.D.
    President, Guild For Professional Pharmacists
    TO: Pharmacy Supervisors, Pharmacy Team Leaders, Store Managers, and Pharmacists in Regions 54, 60, 65, and 72
    FROM: Michael D. Squire, Area 14 Human Resources Director
    RE: Pharmacist Rest Periods
    I would like to review and reiterate specific components of the Meal and Rest Period Policy for Non-Exempt California Colleagues as they apply to non-exempt Pharmacists. A copy of this policy is attached.
    All non-exempt Pharmacists are authorized and permitted to take a paid rest break of at least 10 minutes in duration during each four (4) hours, or major fraction thereof, that they work. If the Pharmacist’s total daily work time is less than 3.5 hours, however, no paid rest break is required. Non-exempt Pharmacists who work a shift of six (6) to ten (10) hours are permitted to take two paid rest breaks. Rest breaks may not be combined with each other or added to a meal period and should be taken in the middle of each four (4) hour work period insofar as is practicable.
    Due to the nature of the pharmacy operations and the work performed by the Pharmacist, it is important that Pharmacists adequately plan to ensure they are able to take their authorized rest breaks with minimal impact to patient expectations.
    When the pharmacy is staffed with more than one Pharmacist, those Pharmacists are expected to work with one another to take their authorized rest breaks at the most appropriate times, within the guidelines above.
    When a pharmacy is staffed with only one Pharmacist, that Pharmacist is expected to plan accordingly and recognize appropriate opportunities to take his/her authorized rest break(s), within the guidelines above. The Pharmacist is permitted to leave the Pharmacy temporarily to take his/her authorized rest break(s), in accordance with the California Code of Regulations, 16 CA ADC § 1714.1, a copy of which is attached.
    If a Pharmacist in either circumstance is required by their Pharmacy Team Leader or a member of store management, or in the event of a patient emergency, to return to the pharmacy prior to the completion of their authorized rest break, the Pharmacist is expected to retake their entire rest break at the most appropriate time, within the guidelines above.
    CVS/pharmacy is committed to ensuring that all non-exempt Pharmacists are authorized and permitted to take required rest breaks. As such, a Pharmacist will not be subject to retaliation for compliance with this policy. If a Pharmacist is not permitted to take an authorized rest break by their Pharmacy Team Leader or a member of store management, the Pharmacist should immediately notify their Pharmacy Supervisor. If a Pharmacist feels that they have been subject to retaliation for taking an authorized rest break, the Pharmacist should immediately notify their HR Business Partner or Employee Relations Manager.
    If you have any questions regarding the Meal and Rest Period Policy for Non-Exempt California Colleagues, please do not hesitate to contact your Pharmacy Supervisor or HR Business Partner.


    Bring Light To Dark Places

    Jp Enlarged

    Communicate, communicate, communicate.  If they can do this in the shadows, it will be a slam dunk for them.  If the entire professional working corp is watching, it can’t be that easy.  Talk about this, you guys.


    I’m a frequent reader of your blog and want to pass on some new information I got.

    I just gave a copy to Rite Aid in Northern California.  After business, we discussed new happenings in Northern California and he said there are 2 more new pharmacy schools coming to California within next year or two.

    He says Walgreens in San Francisco Bay AQrea is now (or will soon) be offering new graduates $40/hr, 30 hr weeks, with no benefits, that’s it.  For me that’d be a $20/hr pay cut, the pharmacist said that for him that’s almost $30/hr pay cut, not to mention the No Benefits provision.

    Just passing along this unverified info.  It’s not good news for pharmacy, if true.

    Tony in The Pacific Northwest

    There have been questions about the Guild and The Pharmacy Alliance.   Here are the links.

    The Guild

    The Pharmacy Alliance

    Comment from Pharmacist Bob

    Slave–like JP says, we need to communicate! How do you get in touch with every pharmacist in the country –create a new pharmacist app for android etc.? If I could act like a god it would be so easy, the chains would be our slaves. In the end we need a national union, a new national pharmacist organization and both could lobby for laws that benefit our profession.
    You have a national pharmacist organization. THE PHARMACY ALLIANCE. Geez, you guys. Open your eyes. You have a national union. THE GUILD FOR PROFESSIONAL PHARMACISTS. Geez, you guys. Open your eyes. The Pharmacy Alliance, all you have to do is join and be willing to participate. The Guild. Not so easy. You do it as a group, like open and available and voted yay or nay by all CVS pharmacists in Pittsburgh, Pennsylvania for example. Majority wins. There are steps that have to be followed. I do not know what they are, but I can tell you that the process will be replete with company intimidation, Company courting, promises implied if you vote Nay. I was involved with a Guild campaign in the 1990s. The Pay n Save pharmacists in King County (Seattle) were organizing. A Guild representative came out to the hinterlands to convey the message that the King County pharmacists were requesting that we join them. The problem was that we were not protected. Since it was a King County vote, they could not be fired. The King County action was official and the pharmacists had to be hired back after the strike was settled. The guys in Whatcom, Skagit, Island, Fidalgo and other areas outside of Seattle had no protections. Bad planning. Bad, bad planning. Then, Pay n Save started the rumor that they could not afford what the Guild wanted and that the company would have to close stores to survive. The Guild came back with the advice to take loans from our 401k investments to hold us over during the strike. The strike happened and the company brought in Washington State licensed company pharmacists from all over.
    The strike failed .. or did it? My staff pharmacist was an ex PIC with an enormous grudge. He went on strike, not understanding that he was not protected. I was ordered to send all of his personal belongings and his license to him by mail. When the strike ended I was told that he was fired. I went all out for this guy. I told my boss to get a heart. His entire career (30 YEARS) had been with Pay n Save. It took a few weeks, but they allowed him to come back. This was a mess, but it did not have to be that way. I blame the Guild and I blame the movers and shakers in Seattle. There has been a lot of growth in 20 years. The Guild represents pharmacists in some gold-plated places. The one I am most interested in is CVS in Southern California.

    Very important, I believe… Everyone at the Guild is a pharmacist.



    Pharmacy Heroes or Back-Stabbing Opportunists

    Jp Enlarged

    William S. Apple and a couple pharmacists

    I have been thinking about writing an essay about Pharmacy Heroes.  Of course, I had an angle because I know that there are plenty of Bums and not many heroes.  I only could come up with one hero.  A true Pharmacy hero.   He was a single-minded pharmacy/pharmacist advocate.  His agenda was to enhance our position in the medical system in the U.S.A., provide us opportunities to stake out a claim to our turf.  Drugs is our turf and we have been consistently losing that turf to the AMA for 60 years.  The AMA is a real political force compared to the effete APhA efforts.  Recently, there have been NO efforts by the APhA.  It looked as if we would get a Third Class of drugs.  That is ‘Behind the ‘Counter”.  Sold only under the supervision of a pharmacist.  If you can’t see the economic and professional value of a BTC class you better go sell cars.  Even people on the FDA’s panel were all for it and then the AMA came barging in.  Notice that you knew nothing about this.  What could have been the most important change in pharmacy laws and restrictions in decades and the APhA didn’t even tell you about it.  And….. fight the AMA?  A joke.  Man, this pisses me off.  That organization does not deserve to be called American Pharmacists Association.  That name suggests that APhA actually will fight for Pharmacists.  Get down in the trenches and get dirty for us.  The AMA fights dirty.  They bend public opinion.  In the case of the BTC class what they have done is simply made sure that dangerous drugs can be sold at truck stops.  How does that NOT make you refuse to write a check this year?

    The Pharmacy Hero was William S. Apple.  He was the Top Dog at APhA When the organization worked on our behalf and deserved the name.  He pressed hard for a Third Class in the 1970s and got beat up by AMA.  He did not quit.  He actually proposed a Fourth Class.  That would be a listing of Rx-Only drugs that could be refilled at the discretion of the pharmacist.   What the?  Is Plagakis smoking something?  Apple lost again, but he never, ever forgot that APhA was an organization that had as a Mission:  Promote Pharmacists and Pharmacy.

    William S. Apple is my nomination for Pharmacy Hero.

    The Pharmacy Bum has a bigger name.  He actually practiced pharmacy for 6 years, helping to run his father’s pharmacy.  Little did he know that a business like his father’s drug store would be damn near impossible today.  He would most likely be offended if he was told that he was instrumental in seeing to it, but politics was his thing.  He was a Senator from Minnesota and was Lyndon Johnson’s Vice President.

    YES, Sloopy.  This guy was the ‘Humphrey’ in the Durham-Humphrey Amendment.  It didn’t take him long to get in bed with Pharma.   What moral test, Senator?  Oh, the one that turned the economics of our profession over to the Drug Companies?   Did he even know what he was doing?  Alas, probably not.  Some slick Pharma lobbyist stroked his ego as the most prominent pharmacist out there and then suggested this new idea.  Then the doctors’ lobby, the AMA, saw an opportunity to solidify the doctors’ spot at the top of the pyramid.  Do you think they saw ahead that medical care was going to be DRUGS?  Get medicines out of the hands of pharmacy.  Put the pharmacist/druggist at the back of the bus.  Make him a dispenser.  Before Durham-Humphrey, druggists prescribed just about anything.  The was no DEA or BNDD until the 1970s, but a Narcotic law controlled Demerol, Morphine and the like.  Basically, it was a NO REFILL category.

    Durham-Humphrey went into effect in 1952, twelve years before my first RPh license (Ohio).  I was not there in the beginning.  Frankly, there were not that many ready-to-use drugs in 1952.  After 1952, there was incentive for Pharma to find knew molecules…. AND they did.

    Why was Humphrey my BUM?  Because he failed to ask the important questions:  Actually, THE question:  How will this affect pharmacy?

    I do know that pharmacists, in general, welcomed these new restrictions.  They felt that the professionalism of pharmacy was enhanced.  In reality, the result was just the opposite.

    A comment from The Goose. 9/10/13

    When you are talking about PBMs and CVS you are talking about the same thing. They both want pharmacy as we know it to go away. If you want to talk traitors to the profession how about Larry Merlo and Greg Wasson, both pharmacists that lead companies that want to sell us all down the river.
    Hell, my alma mater, Purdue University even honored Wasson as a  Distinguished Alumus in Pharmacy in 2009. That’s one reason they will never get a dime from me again.
    We have lost all control and the only thing these people (universities, employers, BOPs) understand is money. When you get a chance to hit them in the pocketbook,,,take it.
    I work with and know a lot of Purdue alums. I tell them all the same thing. If you give money to a school of pharmacy, you are an idiot.  It doesn’t save the average kid in school a dime, they blow it on other shit or sit on it.
    Don’t wait on somebody to come along and save you, (like a union), save yourself. Listen to people who have been there. Come up with a plan. Get mean.
    That’s what will save us.

    All I have to add, Goose, is:  Stay out of debt.  





    Racketeering Influenced Corrupt Organizations Act .. We knew that CVS was run by Racketeers all along

    Jp Enlarged
    Our Thanks to “UnderMine CVS” for this candid picture taken last Friday night at Club K2U Southside.  You know, that classy strip club on Front Street, a block from the dam.  Woonsocket, Rhode Island.  Could that be?  Yes, I believe it just might be  Larry Merlo unwinding after a day at the CVS offices.  Racketeer.  Makes you think about..
    A guy named Vladimir claims to be the Pharmacy Manager at the CVS store at 1054 Cass Avenue.  I can’t confirm that.  He reports that he spends evenings at the K2U in hopes that he can suck up.  Not just to Merlo.  It seems that CVS executives keep the K2U in business all by themselves. Vladimir chuckled, “That Larry.  He really like dat girl on da left.   Whatchu think?”   What a way to run a major corporation. I told him that Sassy did look a lot like a store manager at Rite-Aid I once knew.  I honestly couldn’t tell since she had her pants on.
    8/28/13 comment from my friend and Drug Topics colleague “Goose”.  Then, my thoughts.  JP

    Not to dispute JP’s sources but at the CVS I used to work at, I can’t see anybody from upper management going to a local strip club.
    I had a beer with Merlo and Tom Ryan at a CVS function one time and while they would have bought me beers ’til the cows came home, they only had one and they really nursed it.
    We were at a company-wide get-together in Orlando and it was the first time I had been to such a function. Word came to me prior via a regional VP (in charge of 1000 stores) thru my Pharmacy Supervisor on what was expected of us. Limited alcohol consumption was part of that.
    On day 1 of the conference, two married people (not to each other)got drunk, hooked up and the powers that be found out about it and confronted them. They confessed and were sent back home…minus a job. CVS made sure everybody knew about it too.
    It’s a different company now, with a different CEO so I’m not toally discounting this, but I imagine with their legal woes of late, they are not doing things like this to bring attention to themselves. Keep in mind though, Ryan used to live in the Boston area and I would doubt that any of the upper management live in Woonsocket. It’s a small town really and we all assumed they were headquartered there for tax purposes. So they would not be doing going to a strip club were they live.
    Goose, Goose, you ruin my fun. I found the image and then made up the story. In the same category that CVS lawyers participate when they say, “But, your honor, we didn’t do it. It musta been Walgreens.” If, indeed, Merlo and the boys (and they are probably mostly guys with a token female or two) are teetotalers… well good for them. I am not concerned about their partying habits. I am concerned with the unethical, thoughtless and often cruel way they behave with employees who have been loyal for decades. You get nothing from me, boys, for acting like Boy Scouts. The worm will turn, Merlo. Trust me. All of these kids who saw this somewhere. PHARMACIST. STARTING PAY $100,000.00 PLUS are gonna get their PharmDs at one of these for-profit schools that are little more than NAPLEX Preparation courses and then spend 6 months finding a job in East Podunk and have to settle for $60,000.00 and three 14s a week. The word will get out. Some of those schools like Touro U will be closing. There will be a shortage again. Then.. see who the best and brightest favor. Then see who gets rewarded. Then see whose pharmacies flunk. Yes, Larry and the rest of you who are short-sighted. The worm will turn and it will be downright medieval the way your companies are treated by potential employee pharmacists. Sign-on bonuses may not be enough to get the best and brightest. You may have to write $50,000.00 checks for the dunces. That is what I think, Goose. Thanks for the spot to segue with my real thoughts. JP

     Hello Jim,
    Here is an update regarding the RICO lawsuit brought forth by an independent Pharmacy organization literally fighting for our profession.

     ”The suit was filed in federal court in September, 2010. It accuses CVS Caremark of Racketeer Influenced and Corrupt Organizations Act (RICO) violations and trade secret misappropriation. The complaint also says CVS Caremark contracts requiring patients to buy maintenance medications only from CVS Caremark violate the Texas “Any Willing Provider” law.

    The plaintiff pharmacies complain CVS Caremark misuses private business and patient data to target pharmacies for takeover. They assert these actions are ongoing criminal practices constituting racketeering. The plaintiffs seek treble damages for the RICO violations, as well as an injunction barring CVS Caremark’s practices in the future. The trade secret misappropriation claim includes a request for exemplary damages. “

     Texas-based American Pharmacies (APRx) yesterday moved one step closer to an open court trial in its landmark 2010 lawsuit against CVS Caremark that alleges RICO violations and trade secret misappropriation (RICO = Racketeer Influenced & Corrupt Organizations Act). The 5th U.S. Circuit Court of Appeals has rejected CVS-Caremark’s appeal of an earlier federal court ruling that most of American Pharmacies’ RICO lawsuit against CVS must be heard in open court. The February 11 ruling by the three-judge panel means the lawsuit will now proceed on the merits of the case. CVS Caremark has continuously sought to send the entire case against it and its subsidiaries to arbitration to keep the suit out of the public eye.



    What do we know for sure, with Certainty?

    Jp Enlarged

    I put “For Sure” on the search line at Bing Images.  I couldn’t resist this one.  The woman in bed is the pharmacy profession.  The man in bed is the Chain Drug Store MBA Masters of the Universe.  The guy at the right represents the Pharmacists.  I see the pharmacist turns the corner, stops, eyes wide, mouth open.  ”Ah.. Uh.. Excuse me.  I didn’t mean to interrupt, but I believed falsely that she was my wife.  

    “She’s mine, asshole, now get the fuck out of here.”  MBA sneers.  ”Oh, by the way, asshole, your dick is hanging out.  Your APhA dues haven’t been paid yet.  No you do not get overtime for hours over eight in a day.”  He kisses the profession on the neck and dips his left hand under the covers.  A quick inhale, a sigh.  Pharmacy leans back.  

    MBA says, “Tell fuckhead to get out of here and I’ll give you some more.”

     The profession looks over at the pharmacist wistfully.  ”It could be different.  It does not have to be this way.”  There is a silence, broken when pharmacy says, “You better leave.”

    The pharmacist goes outside and pukes.  He ends up at the bar, drinking Stingers, eating Sliders and Fries.  He cries until his friends, The Dentist and The Attorney take him home.  

    24 hours and none of you have additions to the list.  I thought that someone would have jumped on these.  

    We know for certain that major drug store companies are marginalizing or downright firing veteran pharmacists and hiring newby robo-dispensers (at a lower wage?).  Why are they afraid of people who know their way around the landscape.  Why does a 15 year, pleasant woman PIC summarily fired.  Wal-Mart is getting this in gear.  So, far, I know for sure that you aren’t interested in this.  Head in the sand?

    When you are serious about making changes, there are some steps to take that are wise.  Let’s start with the first three.

    One: What do we know for certain.

    Two: What do we have that we do NOT want.

    Three: What do we NOT have that we want.

    It is a good idea to take these in order.  These are steps that are not only important when looking at your employment situation or how you practice pharmacy, but in your real life.

    If you have a situation with an intransigent neighbor, you can start with: One. For certain my neighbor is too noisy after 10:00 PM and keeps me awake.   Two. I DO NOT want to put up with my neighbors unwillingness to turn down the volume after 10:00 PM.  Three. I want peace and quiet at bedtime.

    Or, my personal case around 1970.  Had I asked these questions, my life would have been much easier.  For certain, my wife drinks too much and goes out at night with no explanation.   I do NOT want to tolerate this behavior.  I want a divorce.  I got a divorce, but had I followed these steps, I would have been out mush sooner.  I would have ended the marriage in much better shape psychologically and physically.  I may or may not have quit a terrific job, dropped out and headed for Europe.  This was vital to my well-being.  I know that I would not have done well had I tried to tough it out.

    Let us start with step one today.

    For the most part, chain drug store pharmacists are treated like piece-work laborers on the factory floor.

    Pharmacists are, generally, not respected by some large drug store companies.

    For sure, pharmacists have failed to stand up for themselves.  They have not acted like they are highly trained medical professionals and they whine when they are treated badly.

    Pharmacists seem to believe that someone else will stand up for them. That is for certain.

    Talk about wag the dog.  Pharmacists have allowed the chains to wag the dog.  

    Young pharmacists, heady with a big wage, get themselves into too much debt.  The result is that they become prisoners of their own lifestyle.  The chains count on this.  You can’t quit.

    The 14 hour shift, with no regular scheduled meal/rest periods, is untenable if the intention is providing alert, competent pharmacist service.  Patients are cheated.  Patients are harmed.  Patients die.

    Chain Drug Store companies consider fines, settlements and judgments as a cost of doing business.

    Pharmacists care only about the pay check.

    Pharmacists are chickens, with a yellow streak 8 inches wide down their backs.

    They complain that the pharmacy organizations are no help, but they do not join the one that is dedicated to their welfare.

    All righty, that is a good start.  There has to be a start if we want change.  My listing is certainly not complete.  Please make suggestions in the Comments and I will add them all right here.  You can tell your stories in the Comments, but I may not copy and paste them entirely.  I will give your screen name credit.  


    Senate Bill 959. Transparent Attempt to put You in the Back Seat of the Bus?

    Jp Enlarged

    Compounding is the pharmacist’s quintessential art.  It has been this way for centuries.  No one else has been trained to do it.  Unfortunately, these new (NAPLEX preparation) pharmacy schools don’t even teach it.  What does that tell you?  A new pharmacist told me that, when he asked about compounding, he was told that it wasn’t important.  Well, fuck me too, buddy.  Compounding is want can save the profession of pharmacy.  If you see more than slapping two ointments together when you hear the word compounding perhaps you can see what I am talking about.  If all you see is that outfit in Massachusetts killing some people with manufactured products they were sneaking through under the compounding umbrella, you are short-sighted.

    A few points:  1. Modern medicine is drug therapy period.  2. Pharmacists still run that ship no matter how pissed off Pharma and the AMA get.  3. They have been trying to minimize pharmacy for 61 years when Durham-Humphrey became the law.  4. The AMA and Pharma ruined our chances for a BTC (Behind the Counter) class of drugs when William Apple and the APhA were fighting to get BTC drugs legal.  Yeah, don’t fall over from shock.  When Apple was President, the APhA actually led the way in promoting our profession.  5. We have been in a death struggle with the AMA for decades.  6. This doctor’s organization will fight to keep their turf and they will fight to take our turf away from us.  7. Talk about misguided.  There is enough turf for everybody.  9. The result of the AMA’s fight will be patient deaths.  I will wrap this list up and I could go on and on.  10. The AMA and Pharma will do just about anything to get drug therapy out of our hands.  11. As far as Senate Bill 959 goes, it is a sneak attack.  Read it carefully.  Perhaps a compounding pharmacist (actually any RPh) can give more than a cursory observation.  Apparently SB 959, in one sentence, differentiates between:  A. common compounds and B. complicated compounds.   You got it.  Pharmacist will be disqualified to prepare B.   If legislature allows them to get their pudgy little feet in ballerina slippers into the door, we are, once again, fucked.  Can you stop this?  Hell yes, but not by sitting in your chair after work, a beer in your right hand and a slice of pizza in the left and the game on your huge TV.  You gotta do something.  Compounding is yours, all yours.  Will you let Big Pharma take it away from you?  They want to sell more Androgel (example) and it pisses them off that the bio-equivalent transdermal HRT that you make takes so much of their market.

    From your reading your blog, it appears you have a very large and passionate group of pharmacists interested in your thoughts.

    Today, I’m asking you to rally your following in opposition to Senate Bill 959, which will severely limit what compounding pharmacies can and can not compound.  More information about Senate Bill 959 is here:

    As you know, practicing the art of compounding is one of the few ways independent pharmacies can thrive financially AND improve the overall well being of patients.  I fear that Senate Bill 959, in its current incarnation, will severely limit treatment options available to my patients and our financial well being.

    View this page to easily contact your US Senator:

    For info regarding one of the real motivations behind this bill:

    I’m extremely worried about this bill because I’m a young pharmacist (33 years old) and currently in a junior partnership at Asheville Compounding Pharmacy.  I fear that Senate Bill 959 may squash or limit my intentions for Asheville Compounding Pharmacy over the next 30-35 years.  I love what we do, our employees love knowing they are making a difference, and our patients are extremely thankful for the high quality pharmaceutical care we provide.

    Thanks for any help you provide regarding Senate Bill 959 and thank you for advocating for the pharmacy profession.


    John Clark, PharmD
    Asheville Compounding Pharmacy
    760 Merrimon Avenue
    Asheville, NC 28804

    AJ wrote a comment.  He ended it by stating that I am stuck in the 60s.  What better time to be stuck?  Haight-Asbury was a 30 minute drive from my apartment in Walnut Creek.   The music was outrageous.  The Beatles showed up in Golden Gate Park one Sunday.  The wine was cheap and the sex was still exciting (What happened with that?).  Never dropped acid, but did dope until one night I couldn’t remember how to untie my shoes.  Oh dear, on retrospect I believe that the joints the girl was passing around were Thai Sticks.  The 60s.  Still innocent.  The profit on prescriptions was 40%.  No computer to spy on us.  We made too much money in California and my wife spent it.  There are a few choices I’d like a do-over on.  The one that I remember in the middle of the night, staring at the ceiling, is the offer from a plain-looking girl with a fit and toned body.  She owned a new VW van and had it kitted up with camping equipment for two.  I liked her a lot and she liked me.  We sat on a blanket under a tree in Golden Gate Park a few Sundays in a row.  My wife was there, but not there.  The Almaden Burgundy was her pre-occupation.  The hippie girl was from Wisconsin.  Her wealthy farming parents couldn’t fight it, so they joined it.  They made sure that she had money.  She said, “Come on.  Let’s leave now.  We could be in Eureka by tonight.”  My heart squeezed.  I didn’t do it.  Two minutes after saying “No”. I knew it was a mistake.  She kissed me on the lips and looked into my eyes and got up and left.  I never saw her again.  Yeah, AJ.  I have 60s memories.  I am stuck.  Can your 2000′s memories match that?  Oh, I wasn’t a real hippie because I went back to work as a pharmacist after my weekends of posing.  Tune in, Turn on and drop out.  Dropping out was never an option.  


    Pharmacist Work Centers Lead to Rest Periods and Self-Respect?

    Jp Enlarged

    Sunday’s The New York Times.  A cover story (Below the fold) in the Business Section called A Union in Spirit.  You can find the entire article at this link.  It will be worth your time.  It appears that immigrant contraction workers have more sense than pharmacists.  They talk among themselves, loosely organize and get results.

    Click here. ..

    The tease read: Worker centers bring together immigrants where traditional labor hasn’t.  The results?  Back Pay, rest periods and self-respect.

    This article got my attention because there are issues that pharmacists struggle with every day.  Primary among them are Rest Periods and Self-Respect.  The difference between a group of around a quarter million highly trained medical professionals and a group of 22 million immigrant workers (many of them not documented) is that the professionals do not talk to each other and the immigrants do.

    The Workers Defense Project, founded in 2002, has emerged as one of the nation’s most creative organizations for immigrant workers.  Its focus is the Texas construction industry, which employs more than 600,000 workers, about half of whom, several studies suggest, are unauthorized immigrants.  Having lived in Galveston, Texas for seven years, I can attest that the great majority of construction workers are immigrants.   They are hard workers and do a good job.  Observing a roofing job always astounded me.  They worked all day in the sun, from sun up to sundown, and they never stopped singing.

    Do we need a Pharmacist’s Defense Project?  The APhA is not interested.  The NCPA won’t flip.   The Pharmacy Alliance meets the definition, but the numbers needed to exact change aren’t there…. Yet, dare I say that?  I will say this:  If the APhA had the goals that The Pharmacy Alliance proposes (even as a side business) you would see a sea change in how pharmacists are treated by companies that run pharmacies.

    The point is that pharmacists do not talk.  A few weeks ago, I met Mark Hill (a pharmacist who practices in Bradenton, Florida) at the Einstein Brothers Bagels Coffee Shop on the Tamiami Trail.  Mark treated me to a maple scone and a terrific cup of dark roast Joe.  We talked for over an hour.  It was very clear to me that if four pharmacists met the next time, then eight, then maybe sixteen, it would be time for Rock ‘n Roll.  You cannot get sixteen people, intelligent and pushed to the edge, together and not get something going.

    Pharmacists are so pissed off that any group more than one will start the avalanche.

    Why isn’t it happening?  What happened to the local pharmacy groups?  Around 1965, I attended a meeting of the Ashtabula County Pharmacists Group.  A major Pharma company hosted.  They bought drinks and a steak dinner at a very nice restaurant.  They didn’t even try to talk us into anything.  It was a perfect opportunity for the group to talk over our gripes and complaints.  But, there were no chain drug stores in NE Ohio.  No one had the kind of complaints that we have in 2013.

    I believe that pharmacists must start talking.  We are not competitors.  That is what the companies want us to think.  We are colleagues.   Colleagues can network and start getting things done.  Competitors cannot.

    Is there hope for us?



    Walgreens Setting The Stage For The 21st Century Or is this expensive BS?

    Jp Enlarged

    Is This Still 1965?

    Jp Enlarged

    The following were in my e-mail in-box this morning. Jay Pee

    Hi Jim

    I was wondering if you had seen this yet?

    What kind of garbage is that? Pharmacist inquiries to MDS are an “interference in the practice of medicine”?  I know this was primarily spurred by the need to reign in the overuse of narcotics, but as a technician I can see how many times the RPHs in my store have saved the doctor’s bacon. Maybe my RPHs should just fill the Ciprodex 4 gtts PO instead of calling the doc for clarification? The same with the other daily errors they catch? I mean, what’s a few injured/dead patients compared to “interfering” with the practice of medicine? (That was pure sarcasm in case you couldn’t tell.)

    If you decide to put this in the blog, please don’t use my name. I work for Big Stupid and the District Pharmacy Manager already has me pegged as a bit of a troublemaker, so I don’t want to be tagged by something as idiotic as the social media policy.

    Keep up the good work with the blog. I learn a lot from reading it. Documentation has been my favorite lesson so far.


    Published on Drug Topics (

    This was published in Drug Topics blog.  It bothered me because I worked for WAG and I know how careful the company is.  What got me was, again, the evidence that we, at the bottom of the funnel, are taking the heat.  What about the prescribers?  Pharmacy has been the armpit of the medical system for decades.  Now it is worse.  Pharmacy is the scapegoat.

    This guy with MS, fibromyalgia (another phantom condition) and peripheral neuropathy.. does he really need oxycodone?  How about tramadol, APAP and gabapentin?  I would question this guy and I would do some serious soul-searching, just as WAG is doing.  I’d ask, “Why have you given this Bozo a free pass for so long?”

    The last paragraph.  The perception that this doctor held that pharmacists were simply “prescription-fillers” really gripes me.   What is it 1965?  That is our fault.

    Walgreens pharmacists denying some pain med clients

    Mark Lowery, Content Editor

    Publish Date: JUL 29,2013

    Some customers in the Indianapolis area are furious about a new Walgreens policy that has forced some to wait up to 5 days to fill pain medications and left others feeling humiliated.

    According to an investigative report by television station WTHR, shortly after the Drug Enforcement Agency (DEA) fined Walgreens $80 million for record-keeping and dispensing violations, the chain began requiring its pharmacists to call doctor’s offices to verify prescriptions and check patient’s drug histories before filling certain types of medication.

    DEA cited Walgreens, the nation’s largest pharmacy chain, for unprecedented violations resulting in oxycodone and other pain medications being diverted for illegal sale on the black market. Walgreens said it has added steps to prevent illegal diversion of control substances and those steps may “take extra time.”

    One customer, a man in his 30s that WTHR said was diagnosed with a combination of multiple sclerosis, fibromyalgia, and peripheral neuropathy, had filled his prescriptions without incident for 2 years at the same Walgreens location. He said he got quite a surprise when he attempted to refill his prescriptions.

    “I couldn’t believe it. They actually threatened to call the cops. I’ve been a loyal customer for a long time, and all of a sudden, I was told to leave the premises or the police would be called,” the man told WTHR.

    Since the man reportedly only had a 1-day supply of the Oxycontin he uses for chronic pain, he asked for his prescriptions back so he could take it to a different pharmacy.

    “[The pharmacist said] ‘I’ve already started the process and now it’s out of my hands. I am not giving it back to you,’” the man told WTHR. “I felt kind of panicked and I told him, ‘I don’t think you can do that.’ That’s when he told me to leave or he’d call the police… I had no choice but to leave them there until he was able to fill them.”

    The pharmacy refilled the prescription 3½ days later. “It was living hell. Living hell,” the man said. “I was in pretty bad shape and there was literally nothing I could do. I was out of medication and I couldn’t even get out of bed. I was so sick, I had to send someone else to Walgreens to pick it up for me. The whole thing is just absurd.”

    Walgreens issued a statement in which it said the new policy is designed to curb prescription drug abuse. “With the sharp rise in the abuse of prescription painkillers in recent years, healthcare professionals in all practices are continuously striving to find better ways of ensuring those medications are used only for legitimate medical purposes. We are working to ensure our patients continue to have access to the medications they need while fulfilling our role in reducing the potential abuse of controlled substances,” the statement read.

    “We have recently taken a number of steps to provide additional guidance and training to our pharmacies on the proper handling of controlled substances. Because of the legal requirements placed on pharmacists to verify that controlled substance prescriptions are issued for a legitimate medical purpose, pharmacists may need to gather additional patient information from their prescribing physician’s office. This diligence may take extra time.”

    Another Walgreens customer said she was told to take her business elsewhere when she attempted to refill her pain-medication prescription. “They refused [to fill] it. [The pharmacist said] ‘We suggest you take it to CVS. At this point we’re just feeding an addiction.’ He was very loud and it was right in the open when he basically called me an addict,” she told WTHR. “At that point, I was just so upset I left.”

    Some doctors are also complaining about delays caused by Walgreens new policy. “The pharmacy will call and further investigate. They’ll say ‘Why is this patient getting this script? What’s wrong with them? What’s the diagnosis? How long are they going to be on it? How long have they been on it?’” Ed Kowlowitz, medical director, Center for Pain Management in Indianapolis, told WTHR. “They’re not just filling scripts anymore.”



    The REAL Galley Slaves.. The Pharmacy Technicians

    Jp Enlarged

    Bill Pennington, a competent and well respected pharmacy technician/nurse made a comment that led me to believe that he feels that The Pharmacy Alliance should make a statement that TPA values and includes technicians in all initiatives.  I wrote the following back to Bill.  Then I decided to send it as an e-mail to all TPA members and then thought it will be timely at  Here you go.

    Technicians have been an important membership group of The Pharmacy Allaince right from the beginning.  Because the wage of a career, life time Professional Pharmacy Technician is piss poor the membership dues are very reasonable.  My piss poor comment was not meant to get chuckles.  It was meant to get frowns from pharmacists and naked epithets from technicians. 

    I know some hospital techs in Bellingham, Washington who were making $30.00+ per hour in the late 1990s, but, other than the magnificent Pacific Northwest, I don’t know of any techs anywhere who make enough to have a life and I’m not even talking about a family.  I know that there are techs who are single mothers and have to use food stamps to feed their children.  Now these are not Wal-Mart cashiers.  They are highly trained pharmacy support staff who are well educated in many over-lapping areas. 

    They are well-versed in pharmacy law.  They are the gold standard experts  on PBM billings and how to squeeze out a payment when the PBM hesitates.  They enter new patients much faster than a pharmacist and process prescriptions at a dizzying speed. 

    Some technicians have been trained and can be trusted to compound simple formulas with minimal supervision.  They can multi-task with the best.  I don’t get it.  The company MBAs make these frikkin’ ridiculous deals with the PBMs.  Profit is squeezed as tight as a…fill in the blank.. and who gets fucked the worst.  The technician.  Career technicians are an inch from welfare.   With the latest Farm package pushed thru by the GOP, food stamps will be eliminated (also Meals on Wheels).  What then when your lead tech, the best ever, dependable and conscientious, single mother with two children has to quit and find another job with higher wages because she can no longer

    get food stamps.  Consider this:  Chain store pharmacy technicians are no different than the Wal-Mart employee who has to use the ER as a location for primary care because Wal-Mart does not provide adequate medical.  The technicians have had to use food stamps because CVS does not pay them enough to have a food budget out of their wage. 

    The job of pharmacy technician is suited as the second income in a family.  Not as

    the primary or only income. 

    Think about this.  Technicians provide much more bang for the buck than pharmacists.  A stroke of a governor’s pen on a suitable bill and this game could change drastically.

    What do you do?  You sit on your hands and refuse to look.  I am not the boy who cried “Wolf”.  There really is a wolf out there.  If they manage to take away the law that states that a pharmacist MUST be present when a prescription is sold, you are done.

    Kaput.  Finis.  Dead.  Bankruptcy.  Divorce.  Shame.  Depression.  Fluoxetine.  My bet is that more than a few of you will be back sleeping in the spare bedroom at your Mom’s.

    Maybe even spend your days sitting on the sidewalk with your back against the wall at Walgreens.  Pharmacists will be more important than ever, but with technicians doing more of the work, they won’t need as many pharmacists.

    Forgive me for getting off track.  Back to the subject of technician members of The Pharmacy Alliance.  In the beginning, technicians were a significant part of the membership.  Lately, however, we have had NO technicians join for over a year.

    I neglect to mention technicians because.. well, frankly.. I don’t see much interest

    among technicians.  That is a fatal flaw because The Pharmacy Alliance is the only

    group that knows, without equivocation, that the only hope that technicians have to

    gain a career status that pays a living wage is when pharmacists advocate on behalf of the technicians.  TPA will do that if technicians want to join and get the ball rolling.  In the meantime, I have one word for how technicians are treated by the industry.  PATHETIC.

    Jim Plagakis




     > To:

    > To Whom it May Concern:
    > I would be nice to include Pharmacy technicians in any mission statement as we work together as a team. Just as Doctors can’t do it with out nurses, Pharmacists can’t do it without Pharmacy Technicians. Thank you.
    > Cordially,
    > William Pennington CPhT, LVN
    > (and member of TPA)

    I Am Now Convinced. They Are Getting Rid of Veterans and Hiring Robo-Dispensers.

    Jp Enlarged

    I have used these lemming metaphors many times.  I have been criticized for being stale, but what the fuck, man.  If it quacks, what is it?  I know, it is tough when you are all alone and the highway is dark and it is starting to rain.  You need gas and that station is not well lit and the desert offers few comforts to the solitary traveler.  You need a companion.  Perhaps, a few companions.  As far as the retail steam rollers are concerned, the biggest danger is you and other pharmacists starting to talk.  You can be a mindless lemming or you can turn the whole troop around.

     Communication.  The big retailers have had it made by keeping you isolated.  None of us can do this alone.  We need partners, collaborators, fellow guerrillas in this battle.  Keep reading for a few hints that I redundantly keep on repeating.  I will continue until you “Get It”.

    Messages like the one below started coming in a couple years ago.  My friends Steve and Goose and Peon (reluctantly for Peon) flipped before I did.  They told me and you that the job of pharmacist was becoming like the job of a skilled piece-work employee on a factory floor.  I said, “No, Goose.  That can’t be.  This is pharmacy.  Pharmacy is a profession.  Pharmacists are well-educated medical professionals.  They are not interchangeable”.  Well, you know what?  If all pharmacists do is administer the “Prescription Mill”, they are replaceable.  How the fuck can you let them box you into the ridiculous spot you are in without a fight?  Pharmacy is governed by thick books a laws and rules and regulations.  You break the law every single day, multiple times, just to keep “The Mill” running as fast as they want it to.  You gotta stop this. It would be a dream if a supervisor told you that you waste time conforming to the law.  You MUST do this.  Make it a mission.  Document, document, document.  Date & who said what.  Keep it in a safe place at home.

    You might want to order the pamphlet ”  ”.  There is a link in the pages at the top.

    If you can’t manage to do this on your own, get some help.  Research your options to unionize.  You all know that I favor “The Guild for Professional Pharmacists”.  The Guild has been very successful on the coast.  If you can’t manage to make that call or send that inquiring e-mail, go to your local “Food Service Union”.  They, and outfits like them, love having a pharmacist division.  It makes them look good.  But all they would do is support you just like they support the guy in the produce department.  If you want true, professional representation, it is The Guild.

    Do something!  The following is a letter I received this morning.  Jay Pee

    “Jim, Monday I was informed that the man wanted new fresh faces for his new remodel  in XXXXXX.

    I was informed that I would be floating or they might have another store for me down the line. we have talked before and have been following you on Facebook.

    I am 63 years old with 20 years of service in August for the same company. 10 years in that location. I have developed many good relationships with my patients.    3 weeks ago a store manager came up and took a picture of me as a —— success story. I have had many favorable comments sent by my people.    Just another example of discrimination.   Don’t stop your Facebook  posts.”


    AJ and Broncofan7 Duking It Out is Not Helpful