Browsing the archives for the Jp Enlarged category.

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

Jp Enlarged

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

Jp Enlarged

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”.

Jp Enlarged

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.

Jp Enlarged

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

Jp Enlarged


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.

No Comments
« Older Posts
Newer Posts »