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BroncoFan NAILS IT. The Vampire Squid is the ENEMY.

Jp Enlarged

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.

3 Comments

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

Jp Enlarged

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.

Jp Enlarged

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!

9 Comments

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’S COMMENTS:

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.
Wendy.

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.

email-ad-billy-bills2

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.”

A GUY NAMED “JOHN” WROTE THIS IN COMMENTS
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.

7 Comments

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.

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