“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?

REGARDING ARTICLE IN “Pharmacy Times”
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

2 Comments

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

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THE FUTURE????
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.

http://www.statepress.com/2014/11/19/vending-machine-replaces-asu-on-campus-pharmacy/

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 cvanek@asu.edu or follow her on Twitter @corinavanek

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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. http://m.news9.com/story.aspx?story=27391759&catId=112032 (Copy And Paste to your browser)

EVERYTHING FROM PAULA IS VALUABLE. HER MATERIALS ARE CONSISTENT WITH OUR GOAL OF GETTING THE PUBLIC, THE MEDIA AND THE STATE BOARDS TO ACKNOWLEDGE THAT “A TIRED PHARMACIST IS A DANGEROUS PHARMACIST… AND WORKING CONDITIONS CONTRIBUTE TO ERRORS.”

THE FOLLOWING IS THE COMPLETE TEXT FROM “NEWS 9″ IN OKLAHOMA.

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.

1 Comment

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
    broncofan7
    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.

JayPee

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

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Take a good look. Well worth your time.

http://www.khou.com/story/news/investigations/2014/11/06/iteam-prescription-errors/18591573/

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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Another Legacy Druggist is Sacrificed AND TERRIFIC LITTLE BOOK OF PHARMACY LAUGHS

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Wal-Mart sucks hatred from the clouds
From: rxdm156@aol.com

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.

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Pay $90 Million in Fines. $10 Million Profit

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Published on Drug Topics (http://drugtopics.modernmedicine.com)

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.

CVS CAREMARK- FRAUD HANGING LOW IN THE TREE

1 Comment

WHERE IS JP?

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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.
THEN A TOO-YOUNG CLINICAL-TYPE PHARMACIST sent a message of two words
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.”
I actually had this thought: THIS IS GOOD. NOW MY BRAIN WILL GET ALL THE OXYGEN IT NEEDS.
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.
SORRY FOR THE RAMBLING POST.
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
Monday.
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.
jpgakis@hotmail.com
CALL MY CELL- 941-281-9096
I gotta take a nap. I am exhausted.
Your JP is not dead.

15 Comments

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.

8 Comments

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
Switzerland.

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?
HOW BIG IS THE PLANE NEEDED TO CARRY WAG'S PROFITS TO ZURICH?

9 Comments

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.”

JAY PEE’S QUESTION. HOW CAN WE GET AWAY WITH MURDER? NONE OF YOU CAN CONVINCE ME THAT NGLECTING OUR OBLIGATION TO COUNSEL HAS NOT CONTRIBUTED TO A PATIENT’S DEATH. DEATH. I SAID death. I will look for that stats and put them here when I have some time, I am dealing with anecdotal NARCOLEPSY. POSSIBLY ASSOCIATED WITH THE LATE EFFECTS OF POLIO. SO, COME BACK FOR ANOTHER LOOK.

COILD THERE POSSIBLY BE A LEGAL HAMMER JUST ABOUT TO SLAM US? COULD THIS

    TOBACCO

PUNITIVE DAMAGES AWARD BE A SIGNAL OF WHAT COULD BE HEADING OUR WAY.
I DID NOT COUNSEL. HE DIED & NOW I AM LOING MY STOR

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WAG new model is called WELL EXPERIENCE. FINALLY, I CAST ME VOTE

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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.

EXECUTIVE SUMMARY
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.
i
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.
ii

5 Comments

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

Jp Enlarged

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 jpgakis@hotmail.com. 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%

MANAGERS AND PICs7
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
(919)981-6253
Fax:(919)981-6519

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.

OKAY, JAY. WHO GETS TERMINATED OVER THIS COMPLAINT?

Who Gets Terminated Over This?

25 Comments

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 jpgakis@hotmail.com.

I cannot stress strongly enough how important this is.

JP
CAUSES OF ERRORS
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?
Time!

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.”

“WHAT? WHAT SCHIZOPHRENIA?”

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

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
I FOUND THIS IN MY DRAFT FILE. IT WAS WRITTEN IN NOVEMBER, 2011. I BELIEVE IT HAS NOT BEEN PUBLISHED BEFORE TODAY (6-13-14). I DO NOT KNOW WHY I JUST SET IT ASIDE AND LET IT FESTER.

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?”
“I…I..”
“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

By GARDINER HARRIS
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 drugstore.com, 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.

3 Comments

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.
My call is to just PRACTICE YOUR PROFESSION. Your way. You have discretion.

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Is C.V.S. Run By Goats?

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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.

http://www.dol.gov/whd/state/rest.htm

http://www1.umn.edu/ohr/toolkit/compensation/paypolicy/flsa/index.html#generalflsainfo

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.

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Jay Pee is Asking for Some Help. Information Please!

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trialx.com/curetalk/wp-content/blogs.dir/7/files/2011/05/diseases/Brain_Attack-4.pngA BRAIN ATTACK is modern name for STROKE
Perhaps you can give me some help. IS MY EXPERIENCE CONSISTENT WITH WHAT I SHOULD BE EXPECTING FOR ‘STROKE’ RECOVERY?

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

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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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WABC

By Sarah Wallace

Thursday, June 05, 2014

QUEENS, N.Y. (WABC) —
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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INHUMANE. Is that ADJECTIVE AN APPROPRIATE DESCRIPTION OF YOUR WORKING CONDITIONS?

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 SCRATCH OUT THE WORD
“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.

    YOU NAILED IT, GAL. JP

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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.

5 Comments

$25 per hour for Experienced Pharmacist?

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ANONYMOUS.
$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.

12 Comments

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

Jp Enlarged

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.

SAFEWAY, OF COURSE, IS BLAMING THE PHARMACIST. SAFEWAY says that the company is BLAMELESS.

My attorney is asking this question:

A CONSCIENTIOUS PHARMACIST GETS CAUGHT UP IN A BIG FILLING ERROR- WHAT IS WRONG WITH THE SYSTEM UNDER WHICH HE IS REQUIRED TO WORK? The question is directed at
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.

YOU CAN SEND A SHOT OVER SAFEWAY’S BOW.

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 jpgakis@hotmail.com.
Send Cc to ednevin@333law.com

1 Comment

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

Jp Enlarged

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.

11 Comments

Can CVS Throw Money to Hide From This?

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kitcheck.com/wp-content/uploads/2012/07/drugtopics.jpgNow- 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

    9 Comments

    Important Words from “Goose”

    Jp Enlarged

    www.thehonestapothecary.com/wp-content/uploads/2013/09/Goose-Rawlings-Linkedin.jpgGoose 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?

    2 Comments

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

    Jp Enlarged

    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.

    Jim,

    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 !!!

    Sir,

    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
    Email: pharmbd@mail.nysed.gov
    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?

    3 Comments

    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.

    From:

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

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

    3 Comments

    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

        CVS Pharmacy Sued for Hundreds of Millions

    By NICK DIVITO
    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

    WHO WANTS TO ANSWER THE “WHO BENEFITS?” QUESTION HERE?

    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

    WHO BENEFITS?

    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.

    YOU DO NOT ANSWER. DOCTOR JONES JUST PRESCRIBED NEXIUM FOR A POST-STROKE PATIENT TAKING PLAVIX. YOUR SOFTWARE WENT APE SHIT AND REMINDED YOU OF THE PROBLEM AND NOW YOU ARE GOING A LITTLE APE-SHIT YOURSELF. WHOEVER ANSWERED THE PHONE AT DOCTOR JONES SAID, WITH AN EXASPERATED EXHALE, “DOCTOR BOB IS EXPERIENCED. HE KNOWS MORE ABOUT DRUGS THAN A PHARMACIST. IF HE PRESCRIBED IT, THERE IS NO PROBLEM.”

    “WHAT IS YOUR NAME?” YOU DEMAND. “WELL, BRENDA LEE, YOU ARE WRONG. DOCTOR JONES ..BOB. IS NOT A DRUG EXPERT. THIS MISTAKE…..

    “DOCTOR BOB DOES NOT MAKE MISTAKES. JUST FILL THE PRESCRIPTION.”

    “THE MARIE CALLENDER ONES. YOU BETTER NOT BE OUT OF DEM.”

    “GET THE DOCTOR ON THE LINE. IF WE DO NOT GET THIS MATTER SETTLED, I WILL HAVE NO CHOICE BUT TO ADVISE THIS PATIENT TO TALK TO HER ATTORNEY.” This was blowing smoke, of course. An attorney is important if there has been harm. BRENDA SLAMMED THE PHONE DOWN.

    YOU ADVISE THE PATIENT OF WHAT WAS GOING ON. YOU SUGGEST THAT SHE INSIST ON A NEW Rx FOR RANITIDINE. YOU WENT BACK TO WORK, VERY AWARE OF THE AMMONIA ODOR THAT GAGS EVERONE WORKING IN THE PHARMACY WHEN YOU GO NEAR THE REFRIGERATOR. What the hell….? You called the company maintenance guy three days ago.

    LATER, LIKE THREE HOURS LATER, THE STORE MANAGER SHOWS UP. HE HAS HIS CLIPBOARD, PAPERS AND A PEN. HE HAS THAT PLAYGROUND BULLY LOOK. “SIGN THESE,”HE ORDERS. “WE’LL GO OVER THEM LATER.”

    YOU KEEP WORKING. THE PHONE IS A NURSE. SHE TAKES TIME. THEN A PATIENT NEW TO ORAL CONTRACEPTIVE USE WITH BREAKTHROUGH BLEEDING. YOU WALK OUT FRONT TO ASSIST AN ELDERLY MAN WHO NEEDS YOUR HELP CHOOSING A LAXATIVE. THE MANAGER SHAKES THE CLIPBOARD AT YOU. “TWO SIGNATURES. THAT IS ALL I NEED.”

    YOU TAKE A DEEP BREATH, INHALE AMMONIA AND COUGH.

    “WHAT’S THAT SMELL?”

    “IT IS THE STINK OF FIFTEEN HUNDRED DOLLARS YOU HAVE TO SPEND FOR A NEW REFRIGERATOR.”

    HE BRISTLES. “I’M NOT BUYING A NEW REFR……”

    “THEN YOU CAN EXPLAIN WHY CLOSE TO FIFTEEN THOUSAND DOLLARS WORTH OF PHARMACEUTICALS WENT BAD AND HAVE TO BE REPLACED.”

    He does not like that. He hisses, “Fuck you, Plagakis.” THAT’S OKAY. YOU’VE HEARD THAT BEFORE. YOU ARE A PHARMACIST, FOR CRISSAKE. DIGNITY? THAT IS A JOKE IN MOST JOBS. “JUST SIGN THESE.”

    “THEY ARE ‘Write Ups, correct?”

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

    “BECAUSE I WAS ON THE PHONE WITH A DOCTOR’S OFFICE DISCUSSING A SERIOUS ERROR.”

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

    “WHAT ABOUT THE SECOND ONE, DON?” YOU HAVE A PRETTY DAMNED GOOD IDEA ON THAT ONE.

    “Why did you insult the doctor?”

    YOU HAVE THIS ONE HANDLED, “I MADE IT CLEAR THAT DOCTOR JONES IS NOT AN EXPERT ON DRUGS. I AM THE EXPERT ON DRUGS AND EVENTUALLY PEOPLE WILL DIE IF WE
    LEAVE IT TO JONES.” YOU GIVE DON A LOOK. “I’m NOT SIGNING ANYTHING.”

    “YOU HAVE TO.”

    “THE ONLY THING I AM SIGNING IS THE LETTER I AM SENDING TO JENNY JASKELA”. (THE COMPANY’S CHIEF COMPLIANCE OFFICER)

    “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.”

      WHO BENEFITS?
      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

    4 Comments

    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!

    No Comments

    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!    

    8 Comments

    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.

     

     

    10 Comments

    “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.”

    4 Comments

    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.” 

    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.  

     

    13 Comments

    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:  www.sba.gov or Call 1-800-827-5722

    8 Comments

    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…..an 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???

    8 Comments

    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.”

    “What?”

    “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.

    “Why?’

    “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

     

    2 Comments

    Never Sign Anything and I am Not Blowing Smoke

    Jp Enlarged

    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.  

     

     

    2 Comments

    Oregon Board Repeats 2011 RPh Survey on Working Conditions for 2013

    Jp Enlarged

    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

    No Comments

    A Battlefield Victory In The Guerrilla War

    Jp Enlarged

    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: http://drugtopics.modernmedicine.com/drug-topics/news/pharmacist-wins-age-discrimination-case-against-cvs#sthash.88ZCHWPd.dpuf

    5 Comments

    What did I tell you? A Stethoscope Over Your Shoulder Won’t be Simple Posing.

    Jp Enlarged

    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 www.prescribewellness.com
     
    – 

    Bri Rios | Account Coordinator
    Metzger Associates | The art and science of communication.
    Email ∙ 720.833.5912 (direct) | 303.786.7000 (main)
    8 Comments

    Whistleblower’s Wife says, “It is finally GAME ON.”

    Jp Enlarged

    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 @Pharmaciststeve.com

    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….

    Jp Enlarged

    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

    4 Comments

    What is the critical mass in your company?

    Jp Enlarged

    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.

    10 Comments

    The Poster Boy For Cheats

    Jp Enlarged

    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?

    2 Comments

    The Gestapo Has Gone After A.J. You must help. He put his ass on the line for all of us.

    Jp Enlarged

     

     

     

     

     

    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.

    11 Comments

    A.J. Takes it to the Texas Board. 11-6 AJ’s Post-Game Report

    Jp Enlarged

    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…

    .http://www.jimplagakis.com/?p=5317

    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

     

    17 Comments

    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”

    FYI.

    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 thepharmacyalliance@hotmail.com.

    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.//thepharmacyalliance.com 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?”

    34 Comments

    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.

     

     

    17 Comments

    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.

    Gentlemen,

    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

     

    31 Comments

    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.

     

     

    63 Comments

    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.

     

     

    2 Comments

    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”.

     

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    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.
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     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).
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    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
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    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:
    Angie:
    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.
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    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 <angie.happiness@gmail.com>
    Cc: “Orozco, Arlene M” <arlene.orozco@ralphs.com>, “Reynolds, Kirk J” <kirk.reynolds@ralphs.com>, “Cupp, Rebecca L” <rebecca.cupp@ralphs.com>
    Angie,
    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.
    Thanks.
    Rachel Hakakzadeh, Pharm.D.
    Pharmacy Human Resources Specialist
    Ralphs Grocery Company
    Phone: (310) 884-2950
    Fax: (310)884-2908
    Email: rachel.abrishami@ralphs.com
    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 Rep.to 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.
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    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.

    32 Comments

    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 www.walgreenstrategywatch.org.

     

     

    21 Comments

    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: no-reply@cvs.com seruio
    Date: October 4, 2013 at 11:27:21 AM CDT
    To: MDCNMN@CHARTER.NET
    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,

    Jesse
    CVS Customer Relations

    3 Comments

    Take a Two Minute Break for a Laugh. Imagine this at the Drug Store.

    Jp Enlarged

    2 Comments

    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.

    Literally.

    43 Comments

    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

    9 Comments

    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. 
    29 Comments

    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.

    4 Comments

    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.

    GUILD FOR PROFESSIONAL PHARMACISTS
    21243 VENTURA BLVD, SUITE 241, WOODLAND HILLS, CA 91364-2167
    WEBSITE: WWW.GUILDFORPROFESSIONALPHARMACISTS.COM
    (818) 992-0475 (877) 992-0475 TOLL FREE E-MAIL GFPP@AOL.COM FAX (818) 992-6835
    APRIL 6, 2012
    MEMO: TO ALL PHARMACISTS EMPLOYED BY CVS
    RE: TENTATIVE AGREEMENT – RATIFICATION
    ENCL: BALLOT AND RETURN ENVELOPE
    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.
    TENTATIVE AGREEMENT
    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.
    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
    holiday.
    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.
    ARTICLE 5.14.1 PREMIUM PAY: CHANGE PREMIUM PAY AMOUNT FROM $5.00/HR TO
    $5.50/HR FOR ALL NIGHT PHARMACISTS.
    10. WAGE INCREASE – ALL PHARMACISTS EMPLOYED NOW AND HIRED BEFORE 3-31-2013
    APPENDIX A
    SCHEDULE OF SALARY RATES
    A. Minimum Hourly Wage Rate – Full-Time and Part-Time Registered Pharmacists
    CURRENT WAGE
    MARCH 29, 2012
    MARCH 31, 2013
    MARCH 30, 2014
    $61.40/HR
    $ 127,712/YR
    $62.90/HR
    $ 130,832/YR
    $64.30/HR
    $ 133,744/YR
    $65.75/HR
    $ 136,760/YR
    $136,760 minus $127,712 = $9,048
    CURRENT GUILD PHARMACIST ANNUAL SALARY INCREASES BY $9,048/YEAR
    11. WAGE INCREASE – PHARMACISTS HIRED AFTER 3-31-2013 LICENSED LESS THAN 1 YEAR
    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
    N/A
    $62.90
    $64.30
    **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
    N/A
    N/A
    $62.90
    **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.
    THE NEGOTIATING COMMITTEE UNANIMOUSLY RECOMMENDS YOUR APPROVAL OF THE TENTATIVE AGREEMENT.
    CVS GUILD PHARMACIST NEGOTIATING COMMITTEE
    JAYAN BHAKTA
    CVS #9571/8840
    TODD TAKASAKI
    CVS # 8862
    LINN STALNAKER
    CVS # 8881
    BEVERLY COMBS
    CVS # 8893
    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.
    Professionally yours,
    Ralph Vogel
    Ralph Vogel, Pharm.D.
    President, Guild For Professional Pharmacists
    APPENDIX B
    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.

    19 Comments

    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.

    Jim,

    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.

     

    24 Comments

    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.  

     

     

     

    10 Comments

    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.

    http://eon.businesswire.com/news/eon/20110324006381/en/lawsuit/rico/independent-pharmacies

     ”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. “

     UPDATE:
     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.

     WHY IS THIS IMPORTANT?  BECAUSE IF THE CHAINS/PBMS CAN CONTINUE DICTATING WHERE PATIENT’S CAN GO FOR THEIR MEDICATION IT WILL LEAD TO CONSOLIDATION, WHICH LEADS TO FEWER PROFESSIONAL OPPORTUNITIES FOR PHARMACISTS AND OF COURSE POORER WORK ENVIRONMENTS. TOO MANY PHARMACISTS ARE UNAWARE THAT BEING POLTICALLY ACTIVE IS THE ONLY WAY TO TAKE OUR PROFESSION BACK. AND EVEN THE ONES WHO REALIZE THIS MAY NOT NO WJERE TO START. THE NCPA AND THIS AMERICAN PHARMACIES ORGANIZATION ARE A GREAT PLACE TO START….http://www.aprx.org

    17 Comments

    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.  

    16 Comments

    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.

    Jim,
    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:  http://www.protectmycompounds.com

    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:

    http://www.protectmycompounds.com/wp-content/uploads/2013/06/US-Senators-List.pdf

    For info regarding one of the real motivations behind this bill:   http://www.anh-usa.org/compounded-medications/

    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.

    Sincerely,

    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.  

    13 Comments

    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.  http://www.nytimes.com/2013/08/11/business/the-workers-defense-project-a-union-in-spirit.html?smid=pl-share ..

    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?

     

    2 Comments

    Walgreens Setting The Stage For The 21st Century Or is this expensive BS?

    Jp Enlarged
    15 Comments

    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?

    http://www.drugstorenews.com/article/ama-adopts-resolution-pharmacist-drug-inquiries

    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 (http://drugtopics.modernmedicine.com)


    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.”

     

    5 Comments

    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 www.jimplagakis.com.  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: thepharmacyalliance@hotmail.com

    >
    > 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)
    12 Comments

    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.”

    4 Comments

    AJ and Broncofan7 Duking It Out is Not Helpful

    Jp Enlarged

    I couldn’t find an image of two pharmacists fighting.  How can anyone make a living at 25 cents for 25 tablets?  But, I’d bet that AJ and Bronco could do okay if Metcalf’s was still an OTC tonic.

    It may be fun, you guys, but what are you accomplishing?  I know that BEING RIGHT is the most important thing you can do.  Being Right and Making the other guy Wrong is fundamental.  Ever notice that?  Even if you are wrong you want to be right.  This is not helpful.  You may disagree on the particles, but in the end the particles do not matter.  What matters is the context, the entire picture.

    For those of you who are asking, “What the hell is Jay Pee talking about?” go back to the “Magnificent Seven” post, click on the “Comments” link (Upper Left Hand Corner beside title) and read the snarky, righteous argument between AJ and Broncofan7.  I admire Bronco for his courage and prescience in running and independent pharmacy in the 21st Century.  I admire AJ for choosing a safe position with security.  I often feel the pangs of regret that I didn’t do either.  My situation in the late 1960s and early 1970s was toxic.  My marriage was a failure and I couldn’t let go.  I was a product of the 1950s.  You married and you stayed married.  I stuck it out for almost 10 years. The marriage was dead after three weeks.  A story I have told before right here.  You can find it in the pages up on top.  She was an alcoholic, a run around and a brilliant manipulative liar.  She was an incest victim of a horrible childhood.  He mother was a cold fish.  Her father got his rocks off with the teenage daughter who eventually became my wife.  She never should have married any man.  A beautiful girl, a smart girl.  I had no space to run a business even though I was a success running a small drug store for All-Med.

    Broncofan7 is doing well.  He can tell you why he is successful.

    AJ works for a PBM as a phnarmacist.  Okay, I hear you.  Boo, Hiss, Drag him out and tar and feather him.  But wait.  AJ gets to be a pharmacist.  How many of you can say that when your job really is chasing the numbers in the Prescription Mill?  AJ can bring a Vente Dark Roast Starbucks to work and actually have the time to drink it.     He eats his lunch sitting down and can read about Milo Weaver in “The Tourist”.  Nobody bothers him.  He makes the same money you do.  I’ll let AJ tell you about what he does at work.

    Why are these guys fighting?  The problem is not with the pharmacist job at a PBM or a guy running an independent pharmacy in rural Texas.  The problem is with the Big Three.  There is some hope, but Big Question Mark is so damn careful that you won’t hear about it.

    Big Stupid, Big Evil and Big Question Mark have just about ruined our industry.   There is hope with Question Mark, but when there is internal struggling more harm can be done than good if it is not handled by the upper executives with a firm hand.

    So, what is wrong with what AJ is doing?  Why is Bronco being demonized when he is successful being a druggist?

     While they are fighting our industry keeps slipping away.  I still believe that pharmacists need to organize and act as a group.  Hang together or hang separately?  If you are in a guild they won’t be firing you because you are 60 years old and spend too much time attending to the needs of your patients/customers.  You won’t be working 14 hour shifts for straight time.  You will get time and a half for all hours over 8.  That comes to being paid for 17 hours straight time.  If the store manager wants to write you up for being rude, a union representative will sit in the meeting.  Your witness and adviser.  You were RUDE, by the way, because you told this customer that she would have to wait.  You were on the phone with a doctor.  The customer told the manager that all she wanted was to know where the bathroom is and you pointed at her and said in a rude voice, “You will have to wait.”

    Get off your ass and call any CVS in Southern California where the pharmacists are members of the Guild.  Ask questions.   Especially ask how did they get to be Guild stores.  Grandfathered or did the pharmacists do it themselves.  It is very easy.  Once you are officially listed as an employee by the Department of Labor, during negotiations they can’t fire you even if you guys choose to walk out.

    Why are AJ and Bronco fighting when the real enemies are not even pharmacists?

     

    53 Comments

    Whistle Blower Takes a Shot, a BIG Shot. “Take That, Big Evil”.

    Jp Enlarged

    This is not frivolous.  They have been preparing this for months.  ”Go, Joe”.  This story is not in the Business Section of the Harrisburg Weekly Shopper.  It is a feature in the Wall Street Journal.  A WSJ investigative reporter in Atlanta has a file cabinet full of damning evidence on Big Evil.  Perhaps now, finally, they will let him loose.

      The Wall Street Journal

    A veteran pharmacist, who worked at CVS Caremark Corp. CVS +0.31%until last year, filed a civil lawsuit against his former employer this week, alleging he was wrongfully discharged—in part, because he complained to management that staff cutbacks were contributing to increased pressure on pharmacists, causing prescribing errors.

    The lawsuit, filed Wednesday at a U.S. District Court in Harrisburg, Pa., is one of the latest developments reflecting the growing tension between chain pharmacists and their employers, as drugstores increase prescription output in the face of a historic slump in revenue. The case is unusual, though, because previous complaints by druggists over their work environments have been mostly lodged with state boards of pharmacy—and not in federal court.

    The plaintiff, Joseph Zorek, of Harrisburg, Pa., also has another lawsuit pending against CVS in Pennsylvania state court. In that suit, filed while he was still an employee, he alleged that CVS harassed him and tried relocating him after he raised similar staffing concerns.

    Mr. Zorek, 61 years old, was employed as a pharmacy manager at a 24-hour CVS in Harrisburg until last year that was the “area’s busiest,” according to the lawsuit. His lawsuit asserts that in early 2011, a 20% cutback in pharmacy technician hours led to “a greater number of mistakes in filling and labeling prescriptions.” He and his staff were “berated…for not meeting the prescription sales metrics,” by the store’s district manager and others, the lawsuit alleges.

    [image]

    CVS Caremark, the nation’s second largest pharmacy chain by store count, denies the allegations in Mr. Zorek’s lawsuits and plans to defend the case vigorously, said Michael DeAngelis, a company spokesman. “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,” he added.

    Since the case involves pending litigation, Mr. DeAngelis said the company had no further comment.

    U.S. spending on prescription medications in 2012 fell for the first time in almost six decades, according to a May report from IMS Health Inc., which tracks prescription drug sales. The trend is driven by increasing use of generic drugs, which are more profitable than branded medications but bring in less revenue—a challenge for retail pharmacies with high fixed costs.

    Prescription drug volume totaled four billion scripts last year, nearly doubling from the 2.2 billion in 1996, IMS said. During that time frame, however, the number of U.S. retail drugstores remained roughly constant at around 55,000 locations.

    According to a 2011 survey by the Oregon board of pharmacy, 75% of the state’s chain pharmacists said their work environment didn’t support patient safety. That report led to the state having more powers to levy fines, or even revoke a pharmacy’s license, if work conditions were endangering safety.

    Over the past decade, pharmacists have filed a growing number of complaints with state boards and legislatures claiming lengthy daily shifts and the lack of work breaks, said Laura Carpenter, a Phoenix-based lawyer and president-elect of the American Society for Pharmacy Law, a nonprofit industry group.

    Write to Timothy W. Martin at timothy.martin@wsj.com

    9 Comments

    What About This Pisses You Off So Much?

    Jp Enlarged

    Some very strong people who have both feet in this game do not feel that unionizing is the solution.  They do not want an adversarial relationship.  They want Win Win.  This is very generous and in an ideal professional business Win Win would work.

    Those were my feelings exactly until recently.  I doubt that Win Win is possible in many situations.  When your supervisor threatens to fire you and hire a new pharmacist for 20% less wage, what about that is NOT adversarial?  This is a good old-fashioned labor – management – ownership nose to nose fight.  You are the Mexican villagers wearing white pajamas and straw hats and the company represents the bad ass gang that comes and takes the fruit of your labors every harvest season.  In pharmacy, who represents the Magnificent Seven?  Could it possibly be The Guild for Professional Pharmacists?  Or, in a pinch, the Pharmacy Division of the Food Service Workers of America.  I’d rather see the Guild since everyone involved is a pharmacist.  There is much to think about or there is nothing more to think about.  7/19/2013

    “Over here, guys.  The druggist is getting beaten up and we have to help drag the company brute off.”

    “Whatcho mean you aren’t worrying about the metrics.  You gotta worry about the metrics or we will find someone who will worry about the metrics.  For less money.”

     

    “But, we can’t join your Guild, Meester Union Agitator, they will fire our colleagues indiscriminately.  They will rape our burros and kidnap our  sons  daughters.  I mean wives.  They will tighten up their metrics until we dream all night long about them.  Win Win, how is that possible?”

    am revisiting this because of the wealth of comments when it was originally published.  I recall 119 in like three days.  What is it about this?  When I put this up, I did not expect that much interest. JayPee

    I have received a number of emails at my private email address (the one published here) from pharmacists (at least they claim to be pharmacists) who want to know why I allow pharmacists to camp out in the “Comments” and whine and complain.  They tell me that the whiners and complainers should be doing something about it rather than just visiting sites where they can basically spend too much time metaphorically digitally jerking off .  

    I had one woman tell me that she would commit suicide rather than humiliate herself in such a manner.  I asked and she told… She is the PIC of a pharmacy in a very small grocery chain in the middle of nowhere.  The map shows that her town is almost 200 miles from the closest town with a chain drug store.  I accused her of being insensitive.  I told her that she needed to spend just one Monday morning, from 8:00 AM to 12:Noon, with the Lead Technician out sick, in your shoes.  She wrote back that she had been a pharmacist for 12 years and, from experience, she knows that it cannot possibly be what you guys describe.  I asked her why she did not express her feelings with a response in a comment here.  She told me that she would not lower herself.  She is a dignified woman who is professional in her work.

    Poor girl.  She just might have to suck the gas pipe if she had to make her living at Big Evil or Big Stupid.

    My knee-jerk was to just tell her to “Eat Me”, but I behaved.  What I told her was this.

    “The pharmacists who write comments here are strong and decent people who see injustice and want to change it.  They can’t help it that, right now, they are swimming in the rapids and barely know which end is up.  Working conditions are one thing, but now they are seeing their brothers and sisters being killed off.  They are being taken out back and being shot in the head.  Damn good, veteran pharmacists are being fired simply because they are veterans.  They are being fired because they are women.  They are being let go because they have earned too much vacation, because the metrics suffer while they are counseling.”

    These pharmacists are good men and women who did absolutely nothing wrong.  They are being treated like galley slaves, factory-floor piece-work workers.  They are decent human beings who want to help people, but all the MBA Masters of the Universe see are “The numbers”.   

    So, I ended up advising that she Eat Me.  I suggested that if she pay attention to the comments that some of you may want to explain further.

     

     

    62 Comments

    How are Pharmacists Viewed over The Years? How do you fix it?

    Jp Enlarged

    This is the only good one. Larry David is the man.

    Can we ever fix this?  Will we ever be seen as more than dispensers?  “Why so long when all you do is take the pills from a big bottle and put them in a small bottle?”  OR  “I’ve had them before.  You don’t need to label them.  Just sell them to me.”  I do believe that a Guild could go far in getting this fixed.   The APhA does do no shit.  The Pharmacy schools do not put steel in the spines of the children they are training.  How about a little arrogance.  Like our friend Mark in Bradenton, “I am the pharmacist, Ma’am.” A dark pause. “Your doctor is wrong.”

    This young man irritates the shit out of me.  Did he think that it was supposed to be fun?  ”You are like 25 years old, Fuckhead.”  He probably thought that all he needed was a license and they would give him $120,000.00 a year for having fun.  This is a DISPENSING GAME right now, idiot.  It is anything but fun.  Couldn’t you see that?  You did not do your due diligence regarding a job that requires six years of your life and at least $120,000.00 in costs.  That is a state school and not books, expenses and room and board.  You go to TOURO, one of the new schools that requires that you have a Bachelor’s when entering.  Four more years.. $160,000.00 tuition.. Four years.  So, Fuckhead, FIX IT, asshole.  You are young.  Communicate with other young pharmacists.  Keep out of debt.  Take action.  But don’t whine to me or my friends Goose, Peon and Steve.  they will run you outta town and not be gentle with your precious ego.  I am sure that someone has told your mother that pharmacy is,.. well, not really a medical profession.

     

    The famous scene from “It’s a Wonderful Life”.  This from a community theater production.

    Here is a brief description of the pharmacist as he is introduced in Morley’s novel:

    Mr. Weintraub entered the shop, a solid Teutonic person with discolored pouches under his eyes and a face that was a potent argument for prohibition.”Though he doesn’t come off with a comely appearance, at least this pharmacist seems committed to excellence within his profession. When asked about smoking, Weintraub responded

    “Me? I never smoke. I must have steady nerves in my profession. Druggists  who smoke make up bad prescriptions.”

    This brief poem mentions a pharmacist (the ‘chemist’), and alludes to the dangers and uncertainties involved in mixing chemicals, comparing the compounding art to marriage and its potentials for disaster. Edgar Lee Masters (1868-1950) was an American poet and biographer. Himself twice married, one has to wonder if the poem has a bit of a biographical element as well.

    Here is the poem:

    Only the druggist can tell, and not always the druggist,
    What will result from compounding
    Fluids or solids.
    And who can tell
    How men and women will interact
    On each other, or what children will result?
    There were Benjamin Pantier and his wife,
    Good in themselves, but evil toward each other:
    He oxygen, she hydrogen,
    Their son, a devastating fire.
    I Trainor, the druggist, a mixer of chemicals,
    Killed while making an experiment,
    Lived unwedded

     

    Once again the pharmacist in this short-story by O. Henry (himself a pharmacist before turning author) comes off in a poor light. The clever tale begins, however, with a witty description of the pharmacist:

    The druggist is a counselor, a confessor, an adviser, an able and willing missionary and mentor whose learning is respected, whose occult wisdom is venerated, and whose medicine is often poured, untasted, into the gutter.”

    But as the story unfolds, Ikey (the pharmacist) is exposed as a jealous friend who seeks to undermine the efforts of his comrade to marry the girl of his dreams. He connives a devious and deadly plan to eliminate this competitor for the female he fancies. Ultimately, however, his efforts fail. Down go all of Ikey’s hopes for marrying his secret love, and down again goes the reputation of our humble profession as pharmacists.

     

    3 Comments

    The Guild For Professional Pharmacists. The start!

    Jp Enlarged

    Note that CVS is represented by the Guild.  You Big Evil pharmacists might want to go to the Guild website and click on CVS.  There is a PDF file there that has the language of the current contract.  I looked quickly and there is language about rest periods.  Also, the wage that was negotiated.  I quot there.  If you work for CVS, let us know what you find interesting.  Other than the CVS pharmacists in Southern California showed some spine.

    Okay, I have broken the ice.  This is what I got back from the Guild less than one hour after I sent an E-mail.  Who out there wants to take this further, get us educated on what it takes to start the ball rolling?

    Hi Jim!

    I am very familiar with you and have followed, with pleasure, your contributions to the profession.  I am so impressed that

    our name  is going “viral” and that it is appreciated. We do pride ourselves upon representing pharmacists ONLY, and throughout the

    representation process (when necessary) the pharmacist will be speaking to another pharmacist in our office.

    We routinely get the same kind of calls that you do (the whinings), but often, as you have observed, there is no follow through. Many times the delay is out of ignorance of the organization process and understanding rights of both the employee pharmacist and the employer preparatory to collective bargaining. Or the pharmacist is concerned about retaliation by the employer. But as corporate America continues to predominate the employer market, we will see this trend expanding.

    You should know that after each of the phone calls, I tell myself that I should really write an article, of maybe a “how-to” newsletter. The Guild, after 33 years, is progressing to the 21st century with plans of expanding our presence in the profession.

    Please feel free to call me at our Woodland Hills, Calif office (818) 992-0475 if you have specific questions or suggestions of how we might proceed to support the pharmacy profession.

    Thank you for your kind words.

    Sincerely,

    Claudia Myles, Pharm.D., J.D.

    Executive Director

    Guild For Professional Pharmacists

     

    Claudia.myles@gfpp.com

     

    7 Comments

    There IS a Way Out of the Mess

    Jp Enlarged

    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.  Did I hear Pharmacist Bob spell U-N-I-O-N?  I am still waiting for one of you to contact the Guild for Professional Pharmacists for advice on how to go about organizing.

    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 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 2013.

    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?  You believe that the PROEDURE Masters of the Universe will NOT find a way to get rid of you and 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 then stores.  You think that $25.00 gift cards for a transfer would be the gold standard promotional tool if pharmacists got to sign off?

    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.  They 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 can overwhelm the PROCEDURISTS be numbers alone.  You are not going to do it alone though.  You need direction.  I can hear Pharmacist Bob in the background spelling G-U-I-L-D.

    PS.  If the new pharmacists lose the traditions of pharmacy, and I like to call it THE WAY OF THE DRUGGIST, it is all over.

    This is not rocket-science.  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.,

     

    7 Comments

    OREGON and The Vampire Squid. 24 hours and 3 comments. Pathetic. This affects every one of you.

    Jp Enlarged

    man holding capsules in front of complete wavy american state flag of oregon symbolizing health, medicine, cure, vitamines and healthy life Stock Photo - 14428743

    Three comments in 24 hours is disgusting.  Are you guys alive?  Are you capable of fighting for your future?  On a slow day, 200 interested people visit this site.  A really good day (When we are going after the Big Three) close to 700.  Three comments?  Are you brain dead?  This is the primary issue.  The lack of respect from your company, dignity, self-respect and dignity are secondary issues.  The fact that the Pharmacy Benefits Managers (Big banks) have been working to take over your profession is the most important issue in your life.  If they get what they want, it is over.  They are big banks and you know all about big banks.  Once they control the money flow completely, you personally, are fucked.  Everyone of us needs to send comments to the Oregon Pharmacy Association, NACDS and NACP and congratulate them and urge them to keep going.  There are 49 other states.  Oregon has pulled back on the PBM reins.  Your state next?  When you get all itchy about your pathetic bathroom issues and wetting your pants, consider that money is being robbed from You.   WAG stood up.  Your company?

    Count them.  6 Pharmacists on duty.

    Oregon institutes PBM bill

    By Michael Johnsen

    ALEXANDRIA, Va. — Oregon Gov. John Kitzhaber, D, has signed what the National Association of Community Pharmacy has characterized as groundbreaking reform legislation that applies reasonable standards to how pharmacy benefit managers 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.

    Members of a Pharmacy Working Group, consisting of Oregon pharmacists, representatives of the Oregon Pharmacy Association, the National Association of Chain Drug Stores, NCPA, the Oregon Pharmacy Coalition, state legislators and representatives of the PBM community have collaborated on these issues over the past year, NCPA noted.

    “Oregon is demonstrating its leadership in the healthcare arena,” stated Douglas Hoey, NCPA CEO. “This new law will help Oregon’s clinically trained pharmacists — the medication experts — to devote more time to their patients. The bill contains three notable provisions that will ultimately benefit any Oregon patient who enters a retail pharmacy.”

    Specifically, the bill will curb excessive pharmacy audit practices in pursuit of minor technicalities or trivial clerical errors. The bill will also require PBMs to update their reimbursement rates more frequently to better reflect the pharmacy’s actual drug acquisition costs, which can increase dramatically and virtually overnight. Also, the bill requires PBMs to register with the Insurance Division of Oregon, a step toward some level of regulatory oversight of the drug benefit management industry within the state.

    52 Comments

    We Are Talkin’ REVOLUTION. Must We Unionize Just So We Can Actually Practice Pharmacy?

    Jp Enlarged

    This is on the Guild for Professional Pharmacists website.  Interesting huh?  See Vee Ess.  Bet you Metrics Hounds didn’t know that.

    Recent News (CVS)

    December 28, 2012PAYROLL FYI

    We were informed today that a payroll error occurred 2 weeks ago in which Guild pharmacists were overpaid.  That error was corrected in the paycheck issued today. If you have any questions, please call the Guild office.

    The final version of the CVS Agreement for 2012 to 2015 has been posted.

    You may view the document by clicking on “Contracts” and then click on “CVS”

     

    Let’s talk REVOLUTION.

    Revolution is a fundamental change in power or organizational structure that takes place in a relatively short period of time.  Complete change or modifications.

    Wendell Phillips:  ”Revolutions never go backward”.

    John F. Kennedy:  ”Those who make peaceful revolution impossible make violent revolution inevitable”.

    The Retail Pharmacy Industry is Ripe for Revolution.  For pharmacists, this is not simply a JOB, but the industry has sat back and watched mid-level managers who, for the most part, are not pharmacists, use the variety-store template as a model for modern pharmacy and treated the job of pharmacists as JUST A JOB.  This is dangerous for them.  Pharmacists are smart, well-educated people.  Pharmacy is not selling diamonds to love-struck young men in a mall jewelry store.  Pharmacy deals in poisons.  There all no laws regarding the selling of diamonds.  Pharmacy is governed by thousands of laws.  A state board of diamond-selling?  A diamond can’t harm you, can it?  Digoxin can harm you.  Methadone can kill you.  Viagra can fuck you up really bad if you don’t get to the doctor within 4 hours.

    My point is that to think they can run a medical profession that is engaged in probably 85% of medicine by using a variety store model is laughable.  

    So…. how do you get your PROFESSION back (If you even know what you want)?  You start a revolution.   It will have to be violent.  There is no chance of a non-violent revolution for us.  Now, if any idiot out there thinks I am talking about physical violence let me be clear… I am not.  I will not condone it if any of you take an 18 gauge, 1 & 1/2 inch needle and stick it in the ass of a meddling, micro-managing, manipulating and abusive store manager.   I do not recommend or suggest that, with a fever from the raging UTI (No appropriate bathroom breaks) and with a characteristic weakness from the hypoglycemia caused by horrible dietary habits (No meal breaks), that the 115 pound, 5 foot 2 inch blonde scrape her nails across the cheeks of her PIC when he says, “This is not a good time to go pee”.   This revolution will have to be violent.

    The violence can include documentation and use of of your information to cause your abusive, company-man Pharmacy Manager explaining to his wife how he came to be on the Float Team with two hour commute times every day.  That is violence.  

    The most violent thing you guys can do is unionize.  I have challenged you to research this issue and to report what needs to be done to get this rolling.  Three months later, not a word.  I honestly do not feel like talking about this right now.  So, I will see what I can do to get the information right here.  Watch this space.  

    4 Comments

    You Are a Factory Floor Piece-Work Employee. Easy to replace.

    Jp Enlarged

    You know my thoughts.  If you act like a duck, you are a duck.  If you act like a robo-dispenser, that is what you are.  If you act like a pharmacist, you are a pharmacist.  How can it be more simple?

    It is very clear to me that companies such as Wal-Mart are seeing pharmacists as
    replaceable/expendable robo-dispensers.  The A.C.P.E. seems to have been taken
    over by the industry.  The new pharmacy schools with curricula that would make us
    older guys laugh were approved to put out more pharmacists and for the for-profit
    schools to make money.

    These schools do not teach compounding.  The established schools still do.  My Alma Mater (The University of Toledo College of Pharmacy) offers Pharmacognosy to Pharm D candidates as an elective.  Listed in the catalog is another offering:  Medicinal Plants, 4 credit hours.  When I visited the school about 8 years ago for homecoming, my college room mate and I were given a tour of the school.  The girl who led us around took us to a compounding laboratory and, very proudly, showed us her work.  Suppositories, an emulsion, capsules, powders and more.  This is a required course.

    I trust that you will find that established schools of pharmacy still expect graduates to have a full and complete pharmacist education when they leave, after 6 years.

    It seems that the new for-profit schools are really extended NAPLEX Review Courses.
    Get ‘em in, get ‘em out and get them licensed.  Too bad if they do not have a clue what it is to be a real pharmacist.  I will never criticize the students.  The new schools charge a helluva a lot of money.

    I just took a look via the Internet at Touro University College of Pharmacy.  2012, the tuition was $43,090.00.  An applicant must have earned a Bachelor’s Degree.  The study is two years of didactic study (In the classroom) and two years of practical.  Rotations.

    I don’t think that Touro puts out classical pharmacists.  That is too bad because I am a romantic about pharmacy.  What they do put out for retail are young, ready-to-go dispensers and that has got to give employers like Wal-Mart wet dreams.  Why would CVS want Pharm Ds who know about Pharmacognosy?  Why would they want a kid who was able to navigate the compounding station?

    So, what do you think?  Has the A.C.P.E. given up on what you and I call pharmacy & pharmacists?  Have they determined that the providing of drugs no longer needs classical pharmacists?

    So, one more, what do you think?  Is our culture ready for this?

    Most of this is an add on to a reply to an e-mail from a 55+ woman who was fired by Wal-Mart.  Ostensibly for cause.   Metrics, of course.  The Pharmacy Manager was complicit.  Earlier comments were made about her age.  One included, “Look at yourself in the mirror”.

    11 Comments

    Cee Vee Ess is Back and They’re Gonna be in Trouble.

    Jp Enlarged

    “Sorry, Ma’am.  Like, I mean, you came in at 8 o’clock.  I had worked without a meal break for 12 hours and still had two hours to go.  The urinary tract infection keeps flaring up.  Like, I mean, what do you expect?”

    This is a short excerpt from the best thing I have written for pharmacists.  ”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.

    So, what can YOU do with your anger.  You can whine and complain.  Not productive.  Whining and complaining is childish.  You can throw your keys at the manager and scream, “Take this job and shove it”.  Not a really good idea when there is no paycheck next Friday.  I enjoyed reading this by Angrytech11.  Nothing new, but if we keep on sticking this into the ribs of CVS Pharmacy personnel something is gonna give.  Do you think?  There has to be 20,000 of you, just pharmacists.  What about that kind of power do you not understand?  

    This was posted by Angrytech11 at CVS-Profit$ Over Patient$.  Why are so many people at CVS angry?  Or Angriest?What good does it do to be angry?

    Friday, January 18, 2013

    CVS’s newest clusterf*ck: WeCARE

    So by this point the entire company has been converted to the newest brainchild of the CVS Ivory Tower boys-WeCARE. The motto was something along the lines of “Helping us work more efficiently. So we can care more”, or some such bullshit. This is somehow meant to convince us that because of this new workflow we will have all sorts of extra time to actually take care of customers. This philosophy, while certainly an ideal, is also completely unattainable from this new workflow. It has meant more pressure on the techs and the pharmacists to reach more time-related goals, all the while doing it with fewer hours budgeted. Let’s not even talk about the fact that since the program rolled out the system has crashed at least half a dozen times, leading to countless hours company-wide where we were unable to service ANYONE IN ANY MANNER, Tell me how this helps us “care more.”

    The situation as I see it is that the workflow in a pharmacy is a little like transferring liquid from one gallon bottle into another gallon bottle by using a funnel. The problem was the receiving bottle (representing the customers) wasn’t filling up fast enough from the feed bottle (representing the prescribers) because the capacity of the funnel (representing the pharmacies) was limited, Now logic would tell you that if you want to eliminate the slowdown you would increase the capacity of the funnel (put more personnel in the pharmacy). However, the fucking geniuses at corporate have reasoned that the way you improve the flow is to pour the liquid faster out of the feed bottle. Anyone who has ever tried this method realizes soon enough what happens when you do that–you spill shit all over the table.

    Now add to this fabulous formula the fact that they have actually REDUCED the capacity of the funnel. Technician hours have been cut across the board by 10%, no doubt due to the notion that the new workflow is SOOOOO much more efficient that they don’t need as much help. Where they came up with the conclusion that the system works better is a mystery to us all. One thing we know is it didn’t come from the system developers’ vast experience working in the stores. They are in the Ivory Tower and they have absolutely no fucking clue as to what it’s like in the stores. All they know is that they spent millions of dollars developing and implementing this program and they have to find some kind of cost savings to justify it, so they cut labor hours to pay for it.

    Once again what’s going to happen is that everything will just slide along as is until there’s some tragic event that comes from the fact that the new system puts more pressure on the stores to perform more work faster with less personnel. When people start dying because of the added pressures that the system puts in the stores then they might take a look at it. More likely is the real possibility that they will do whatever they need to to blame in-store personnel. They will never look at their own house to discover if perhaps things could have been done differently, In the past the operating philosophy has been to try to deflect blame. I remember a few years ago there was a death related to a mis-dispense and the company released a statement the press in a question and answer format. When they got to the question of “Does CVS time their pharmacists?” the answer was classic dance-around-the-truth bullshit where they tried to give the impression that pharmacists aren’t timed or measured on their time. Anyone who knows the stores knows that nothing could be further from the truth. The whole bonus system for pharmacists is based on speed, not accuracy. The new workflow brings this into sharp focus.

    More work being done faster by fewer people–a corporate manager’s wet dream. A recipe for disaster in a pharmacy, however.

     Larry J. Merlo, CVS-Caremark CEO  2012 compensation.  Cash: $7,869,838.00,  Stock:  $6,500,004.00,  Options:  $3,750,001.00 A Grand total of  $18,119,843.00  If you work for CVS, if you fight the District Managers, if you get nauseous about the metrics and mind-sick over not doing your job as a pharmacist, this has got to kill you.  Larry Merlo is getting close to $50,000.00 a day.  That is close to $6,500.00 an hour in an 8 hour work day.

     This is coming right out of your hide and all you can do is whine.  I know.  ”But, Jay Pee, you don’t understand.  I have mortgage on my 3,000 square foot house on a wooded acre lot.  My wife drives a Lexus.  My Mazda Miata is my dream.  We have car payments.  My kids go to a private school.  I mean, like, you know, Jay Pee.”

    5 Comments

    Insert “Pharmacist” where it mentions “Nurse Practitioner” The Pharmacist as Primary Care Provider

    Jp Enlarged

    Pharmacists will be providing primary care.  Maybe not you and certainly not me, but there are plenty out there who are well educated and up to the task.  The powers at the bugaboo “The Affordable Care Act” are looking at you and nurses.  It just makes good sense.  Either you and Nurse Practitioners or millions get no primary care at all.

    Dr. Pauline Chen on medical care.

    Not long ago, I attended a meeting on the future of primary care. Most of the physicians in the room knew one another, so the discussion, while serious, remained relaxed.

    Toward the end of the hour, one of the physicians who had been mostly silent cleared his throat and raised his hand to speak. The other physicians smiled in acknowledgment as their colleague stood up.

    “Nurse practitioners,” he said. “Maybe we need more nurse practitioners in primary care.”

    Smiles faded, faces froze and the room fell silent. An outraged doctor, the color in his face rising, stood to bellow at his impertinent colleague. Others joined the fray and side arguments erupted in the back of the room. A couple of people raised their hands to try to bring the meeting back to order, but it was too late.

    The physician had mentioned the unmentionable.

    I remembered the discord and chaos of that meeting when I read a recent study in The New England Journal of Medicine of nurses’ and physicians’ opinions about primary care providers.

    For several years now, health care experts have been issuing warnings about an impending severe shortfall of primary care physicians. Policy makers have suggested that nurse practitioners, nurses who have completed graduate-level studies and up to 700 additional hours of supervised clinical work, could fill the gap.

    Already, many of these advanced-practice nurses work as their patients’ principal provider. They make diagnoses, prescribe medications and order and perform diagnostic tests. And since they are reimbursed less than physicians, policy makers are quick to point out, increasing the number of nurse practitioners could lower health care costs.

    If only it were that easy.

    Three years ago, a national panel of experts recommended that nurses be able to practice “to the full extent of their education and training,” leading medical teams and practices, admitting patients to hospitals and being paid at the same rate as physicians for the same work. But physician organizations opposed many of the specific suggestions, citing a lack of data or well-designed studies to support the recommendations.

    In an effort to build consensus, the Robert Wood Johnson Foundation then invited a dozen leaders from national physician and nursing groups to discuss their differences. The hope was that face-to-face discussions would help physicians and nurses understand one another better and see beyond the highly charged and emotional rhetoric. The approach worked, at least initially; after three meetings, the group drafted a report filled with suggestions for reconciling many of the differences.

    But an early confidential draft was leaked to the American Medical Association, a group that had not been invited to participate, and the A.M.A. immediately expressed its opposition to the report. Soon after, three of the participating medical organizations — the American Academy of Family Physicians, the American Osteopathic Association and the American Academy of Pediatrics — withdrew their support, and the effort to bring physicians and nurse practitioners together and complete the report collapsed.

    Nonetheless, many health care experts remained confident, believing that the large professional organizations had grown out of touch with grass-roots-level health care providers. The guilds might oppose one another, but every day in medical practices, clinics and hospitals across the country, physicians and nurse practitioners were working side by side without bickering. Surely, the experts reasoned, providers who knew and liked one another would be receptive to trying new ways of working together.

    Wrong.

    Analyzing questionnaires completed by almost 1,000 physicians and nurse practitioners, researchers did find that almost all of the doctors and nurses believed that nurse practitioners should be able to practice to the full extent of their training and that their inclusion in primary care would improve the timeliness of and access to care.

    But the agreement ended there. Nurse practitioners believed that they could lead primary care practices and admit patients to a hospital and that they deserved to earn the same amount as doctors for the same work. The physicians disagreed. Many of the doctors said that they provided higher-quality care than their nursing counterparts and that increasing the number of nurse practitioners in primary care would not necessarily improve safety, effectiveness, equity or quality.

    A third of the doctors went so far as to state that nurse practitioners would have a detrimental effect on the safety and effectiveness of care.

    “These are not just professional differences,” said Karen Donelan, the lead author of the study and a senior scientist at the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston. “This is an interplanetary gulf,” she said, echoing a point in an editorial that accompanied her study.

    The findings bode poorly for future policy efforts, since physicians are unlikely to support efforts to increase the responsibilities and numbers of advanced-practice nurses in primary care. And most nurse practitioners are unlikely to support any proposals to expand their roles that do not include equal pay for equal work.

    Peter I. Buerhaus, senior author of the study and a professor of nursing at Vanderbilt University Medical Center in Nashville, is chairman of a commission created almost three years ago under the Affordable Care Act to address health care work force issues. But his group has yet to convene because a divided Congress has not approved White House requests for funding.

    “We’re running out of time on these issues,” Dr. Buerhaus said. “If the staffing differences remain unresolved, we are just going to cause harm to the public.”

    Still, by providing a clearer picture of the extent of these professional differences, the study should help future efforts. “It’s too easy to say that everyone should just get along,” Dr. Donelan said. “These arguments touch on the whole nature of these professions, their core values and how they define themselves.”

    “It’s like when family members are warring over a sick patient,” she added. “We need first to acknowledge the others’ position and the full extent of our differences before we can reach any kind of resolution.”

    From a Comment Made by PharmacySlave2000.

     I see the AMA fighting to the death to hold on to their place at the top of the food chain. They MAY agree to let NP’s or PA’s take the lead under their watch but there is no way they are going to let pharmacists have any piece of that pie.

    Jay Pee’s take, PharmacySlave2000, It will not be up to THEM.  The AMA got all the power with The Durham-Humphrey Amendment.  The first job of the AMA is to protect turf.  At every turn, the AMA said that pharmacists are not good enough.  Pharmacist counseling was interference with the doctor-patient relationship.   Then, in the 1970s, pharmacists were given  ”Drug Product Selection” discretion.  That was simply which brand to dispense.  Achromycin V, Tetracyn, Sumycin or simply Tetracycline HCl.  The AMA squealed, “You can’t give pharmacists discretion like that.  Patients will be harmed. Yama, Yama, Yama.”  At the same time, they are checking the winter rentals at  their ski chalet at Squaw Valley.   The third class of drugs.  The “Behind the Counter Class” to be sold only with a pharmacist supervising.  Believe it or not, the slow-moving machine of the APhA was all for this.  William S. Apple (APhA President at this time-1970s) went full-frontal.   He wrote numerous articles promoting the Third Class of Drugs.  He made personal appearances from the seat of President of the APhA.  Those of us pharmacists who watched and could see how our profession could benefit financially and professionally were salivating in the stands.  William S. Apple was truly an American Pharmacy hero.   He led the APhA in a manner that kept that huge professional organization focused on the way pharmacists practiced as well as how our profession could help patients.  Monistat Vaginal Cream sold OTC is ridiculous.  Aunt Sally’s diagnosis of a “Yeast Infection” could cause Niece Brenda to buy Monistat and happily believe she will be cured.  The bacteria in that warm moist place proliferates.  Next is PID and she will never be able to have children.  William S. Apple was right on.  It looked very good.  My friends and I did buy the champagne and the big cigars.   The AMA came in late, but they came in  hard.  ”This 3rd party class is practicing medicine without a license.”  No assholes, it is practicing pharmacy WITH a license.  What does the AMA have against us.  You know and I know that modern pharmacists can easily be a primary care provider and a superior prescriber.  We won’t do surgery.  We don’t want to.  That is your job, Buster.  Patient care, that’s the nurse’s job.  The real reason that the AMA is afraid of pharmacists is because we hold the keys to the kingdom.  Modern medical care IS DRUGS.  Can’t you get that?   The AMA is desperate that CMS not recognize us as independent practitioners with discretion.   They fought like hell to make pharmacists not eligible to be paid directly for services rendered.  CVS fought like crazy.  They even approached the BOP in Massachusetts and challenged pharmacists having their own NPI.  The AMA fought against us being allowed to have NPIs.   Let us go back 60 years to the days before Durham-Humphrey.  This was the peak of the era of the DRUGGIST.  I was a kid, working at Cook Drug on Main Street.  I watched patient’s come in and present their problem.   The Druggist got them a drug for it and they were usually thrilled.  I have no idea what he gave (Actually, I do know one remedy) them.  These people chose “Doc”, the Druggist.  They knew that “Doc” could help them without needles and scalpels.   The doctor usually hurt them and they often did not get better.  An example from way back.  And this shit happened near the first part of the 20th Century.  An older farmer worked hard to get the harvest in.  The physical result was serious pain.  Back, muscular, hip.  The nearest town was 50 miles away.  There was a Drug Store, run and owned by the Druggist.  The doctor was around the corner.  He had been to the doctor many times, taken himself or a hand who had hurt themselves.  They needed wounds cleaned and stitched, but just pain.  He would always go to the Druggist.  Why (remember.. way back)?  Because the Druggist would give him a sickening-tasting elixir that contained cocaine.  No more pain.  No contest.  ”Doc”, the Druggist was the main man in that town.

    I do not know what the politics was like near the end of the 1940s.  Coming up with Prescription-Only and OTC classes cleared the track for medical doctors to run the medical care train.  Pharmacy was relegated to the back of the bus where just about our entire job was dispensing.  Think about it.

    Then, think about this.  You haters of Barack Obama most likely do not have problems with The Affordable Care Act. Get on board with Obamacare. It can save pharmacy’s ass.  The brains who are designing the new system have already acknowledge in the media that pharmacists (with Pharm D) and nurses (with advanced degrees) are well enough educated to provide primary care.  It will happen for only one reason.  You and nurses are cheaper than doctors.  Basically, you guys, Obamacare has thrown the gauntlet at the AMA.  ”Show us proof that we cannot trust pharmacists and nurses to see patients or fuck you.”  It will be “Fuck You” to the AMA.  Young doctors don’t give a shit.  They are team conscious and they are happy to get relief.  An orthopedist does not need an appointment slot taken up by a weekend tennis player with a hyper-extended knee.  The pharmacist can do that.  And..he can get paid directly for it.

    This is going to happen wicked fast.  Those of you who take the advice of The Goose will have a rewarding career.  Those of you who just want to dispense…Well, what the hell… CVS is gonna need RPhs to keep the metrics green.  You will be a robo-dispenser, some kind of fairy phantom pharmacist.  A grossly over-educated Advanced Technician.

    I keep on insulting you guys on this and you take it.  What the fuck?  Where is your pride?   Tell me I am full of shit and give me evidence.  Remember, when you go after me, you are going after Goose and my tribe.

     William S. Apple ..Pharmacist First..Always

    15 Comments

    TOXIC… The Bottom of the Funnel Has Been Targeted By the DEA. Pain patients be damned.

    Jp Enlarged

    This pharmacist owner of an independent pharmacy needs your advice and assistance.  Many good heads makes for less work and more studied conclusions.   Those of you who have followed my column in Drug Topics magazine and who have spent time right here know that I have contended for a long time that we are “The bottom of the funnel”.  

    What does this mean?  The pharmacy is where the rubber meets the road.  What better place to attack a rubber meeting road problem?  What better place to solve the abuse of C-II drugs than the pharmacy?  The DEA looks at how to solve their problem (And it is THEIR problem, not ours).  They determine that it is easier to go right to the bottom of the funnel and put pressure on there.  The idea of second-guessing a prescriber is much too ambiguous.  Pain therapy is subjective.  A ten for one patient is a six for another.  How can a DEA agent question a doctor?

    At the pharmacy, they can count doses.  So, some bright ass mathematician at the DEA devised an algorithm that determines how many doses of Oxycodone 30 mg (and all of the others) that a pharmacy doing so and such volume should buy each month.  That is average.  But we all know that an independent pharmacy will not survive with AVERAGE.  An independent owner will have to offer exceptional services if it is to survive.  An independent who decides to serve the pain patient community has an ass that is grass, that’s how it looks. 

    I can just hear the round table discussion in Attorney General Holder’s office. 

    “What the hell are we going to do about the diversion of Schedule II Rx-Only drugs?”

    “Let’s go after the motherfuckers who are prescribing these drugs.”  This from DEA agent who has spent too much time in the field.  An office-bound agent would no use the word “motherfucker”.  She would say “Bad actor.”

    “Too tough a job.”  suggests a white guy 50-something DEA guy who is savvy about the job and about the problem.  “Let’s do it the easy way.  Let’s cut the diversionary supply where the rubber meets the road.” 

    There is further discussion and the bright ass mathematician presents a 40 minute Powerpoint show about his numbers.

    “Shit, motherfucker, that is too easy.  Hardy har har.  All we have to do is get our boy here’s computer to crunch the numbers and when a motherfucker buys too much, we go them.”

    “What if the quantities are needed, for real pain patients?”

    “Shut up, man.  We want this easy, not difficult.  We have our marching orders from Congress.  Stop the stem.  What easier, better way?”

    “So, we go after the drug store industry!”

    We know what happened then.  The WAG I worked in two days a week in

    Galveston is 4 blocks away from all of the University of Texas Medical Branch Clinics.  I worked Tuesday mornings and Tuesday mornings was when the Schedule II orders were finalized.  In cahoots with the Senior Tech, I made sure that we were in stock.  It did not take long for the regular UTMB pain patients and the parents of ADHD patients to get the message around.  “The Walgreens on Seawall Boulevard has full stocks of everything.”  I honestly wonder if the seawall WAG is having to turn patients away.  If so, that is pathetic.  There isn’t a seeker among this diverse group, from pain clinics, to oncology, to rheumatology to…. You get the message.  Perhaps WAG just said to the Pharmacy Manager, “Sorry, but Mrs. Pancreatic Cancer Lady who is used to getting 400 Methadone 10 mg on top of  her 120 Oxy SR 80mg every month.. well tough shit.”

     After the red, the black type is from an independent owner who certainly crossed all of the tees and dotted all of the eyes.  What is your call. “Is this owner getting hosed unfairly?”   If so, what can we do about it?  This is a problem that will cause stores to close.  Pain patients will not be able to get the drugs they need.

     I say, “Go after the weasel prescribers.”

     Steve, I am interested in your view.  I know that this is close to your heart.

     Jay Pee

     Send me your name and e-mail address if you want to correspond directly with this owner.  You know, if our profession cannot handle this issue, perhaps we just need to back off and call ourselves robo-dispensers.

     

    We are considering LEGAL action against our prescription drug wholesaler for BREACH OF CONTRACT … please review the Cliff Note version and R.S.V.P.

    • Wholesaler informed us of “threshold” for Oxycodone products in February
    • Oxycodone order HELD by wholesaler in March
    • Questioned, debated and argued with wholesaler about HELD order … response was “suspicious ordering”
    • Demanded an audit from Wholesaler Regulatory Affairs Department … scheduled for April 4th
    • Hired a Business/Contract Law Attorney
    • April 4th – Auditor REFUSED to perform audit with our Attorney present – our Attorney agrees to leave
    • Auditor had Law Enforcement background (NOT Pharmacy or Medicine) and was only concerned with NUMBERS of prescriptions and tablets … REFUSED to review any documentation, claiming it was a HIPPA violation.
    • April 15th call from V.P. of Franchise (essentially) asking us to dissolve the business as we had been “targeted” by DEA … we explained the “TRUE” story and V.P. said “I have some DAMAGE CONTROL to do”
    • May 1st call from Wholesaler Regulatory Affairs Department stating that ALL orders for Oxycodone 15 and 30mg are being HELD … would not say why
    • Our Attorney sends a letter meant to intimidate
    • WRDA responds that we are not following Federal and State Guidelines due to suspicious ordering
    • Attorney responds with our timeline of events which includes F&S Statues on Corresponding Liability and Pharmacist Judgment
    • WRDA responds that they are TERMINATING ALL CONTROLLED SUBSTANCE ORDERS as of June 3rd
    • Attorney threatens a Temporary Restraining Order and a Conference Call is scheduled for June 11th WITH THE CONDITIONS that WE can ask NO questions, THEIR Attorney MUST be present and we cannot Facebook, Blog or Tweet ANYTHING about the call
    • Attorney sends a multiple page document which includes our CV, Controlled Substance Protocol, Employee Drug Diversion Training Protocol and a detailed flow chart on HOW we determine whether a prescription has been written for a legitimate medical purpose (these are attached for your perusal)
    • Conference call lasts for approximately 30 minutes … the only thing they want to discuss is WHY I would fill #720 Oxycodone 30mg and #450 OxyContin 80mg to ONE client monthly … FYI – they were provided ALL documentation on this client – Ex-Police Officer SHOT multiple times in back 10 years ago.  On Workers Comp, been on SAME dose for SEVERAL YEARS, diagnosed 2 years ago with Anal Cancer and now is in Stage IV.  Patient was referred to us by a Colleague who was told by his CHAIN PHARMACY to STOP filling the prescriptions BECAUSE MD IS SUSPICIOUS
    • We were audited by Workers Comp on this client with NO ISSUES or BACKBILLING
    • We have had no correspondence from WRDA since June 11th

    Question … would YOU invest up to $10,000 to fight this knowing that your entire business is at stake either way?

    Remember, another wholesaler will be reluctant to sign a Controlled Substance Contract with you knowing that another wholesaler has TERMINATED shipments.

    Thanks for your Professional Opinion on this matter

    Mission and Vision Statement

    To use a Visionary approach in dispensing prescriptions and providing medication management Services that are focused on the client achieving an optimal outcome in therapy, while extending the utmost Respect to each individual in response to their health care needs.

    We will offer the residents of XXXXXX a choice, by reintroducing the traditional values of the small town main street drug store.  Focusing on the timeless and classic art of customer service, we will provide local sundries, over-the-counter and prescription drugs, and comprehensive immunization and medication therapy management programs in a personalized, community oriented atmosphere.

    Demographics

    * We officially opened on XX/XX/XX and we are the only locally owned and operated full-service independent retail pharmacy in XXXXXX, XX; servicing a population that is approaching XXXXXXXXXX.

    * We are competing in a market of Walgreens, CVS, Supermarkets and Mass Merchants

    * We grew by 180% in the first year

    * We grew by 130% in the second year

    Services

    * We accept ALL Major Insurance and ALL State programs

    * We offer REGIONAL Delivery service at NO CHARGE

    * We utilize Vial, BubblePak and DispillÔ packaging at NO CHARGE

    * We offer IN HOUSE charge accounts for the Public Fiduciary in THREE counties, SEVEN Private Payee Services and 30 Private Patients

    Professional Clients – ALL of which utilize Controlled Substances

    * University of XXXXXXX Athletics Department

    * XXXXXXX Hospice

    * XXXXXXBehavioral Health – Suboxone Induction Program

    * XXXXXX AIDS Foundation

    * XXXXXX Counseling – Federally Funded Behavioral Health Program

    *XXXXXXX – Transitional Living Facility

    * XXXXXXXX – Pathways out of poverty

    * 55 Assisted Living Homes

    * 30 Private HOMEBOUND Clients – referred to us by XXXXXXXXXXXXXXX Nursing Services

    Professional Alliances

    * Rotation site for the University XXXXXXXX College of Pharmacy for their IPPE & APPE programs (Introductory & Advanced Pharmacy Practice Experience)

    * Collaborative Business Agreement with the XXXXXXXX AIDS Foundation and their XXXXXXXXX XXXXXXX Buyers Club – Pharmaceutical grade vitamins and nutritionals

    Marketing

    * Primarily WORD-OF-MOUTH

    Staff

    * 4 Certified Pharmacy Technicians with over 35 combined years of experience

    * NO Federal or State actions against either licensee

    * 4 Pharmacy Interns – one is a USA Paralympics Wheelchair Basketball Athlete

    * 2 Pharmacy Technician Trainees – BOTH are Pre-Pharmacy Students

    * 1 Delivery Driver

    * 1 PerDiem Pharmacist

    Pharmacist In Charge

    * 40 years of practical retail pharmacy experience

    * Bachelor of Science from XXXXXXXXXXXXXXXXXX in 1982

    * Active licenses in three states

    * NO Federal or State actions against any license

    * Certified in Medication Therapy Management by American Pharmacists Association

    * University of XXXXXX Adjunct Professor since 2011

    * XXXXXXXX Pharmacy Preceptor since 2003

    * Currently studying for Certification in Pain Therapy Management through University of XXXXXXXX School of Pharmacy

     

    • We verify ALL controlled substance prescriptions
      • MUST be written for a legitimate medical purpose and be therapeutically appropriate
      • The verification process may take up to 72°
      • We utilize the XXXXXXX Prescription Drug Monitoring Program for ALL NEW clients and randomly for established clients wwwXXXXXXXX.gov/CS-Rx_Monitoring/practioner_procedures.asp
      • We require diagnosis information and treatment plan faxed from the prescriber’s office for NEW chronic pain patients
      • We require a current urine drug screen (<60 days) faxed from the prescriber’s office for NEW chronic pain patients and randomly for established clients
      • We require controlled substance prescriptions to be covered by insurance
      • We DO NOT accept “Discount Cards” for prescriptions
      • We DO accept manufacturer coupons for prescriptions
      • We require established chronic pain clients to utilize our pharmacy exclusively for all medications
      • The Pharmacist on Duty will follow XXXXX § R3333333 and exercise sound professional judgment when determining whether or not to dispense a prescription, taking into consideration the unique attributes and exceptional circumstances of each client
      • Clients can be discharged for failure to follow above policies

     

    – Professional Judgment Flow Chart

    Client presents Rx for Controlled Substance

    1. Ask for Photo ID and Insurance
    • Yes – continue
    • No – DO NOT FILL
    1. Present Controlled Substance Policy and explain 72° wait period
    • Client approves – continue
    • Client doesn’t approve – DO NOT FILL
    1. Fax MD for diagnosis, treatment plan and urine drug screen
    • Response – continue
    • No response – DO NOT FILL
    1. Review Client history on XXXXXX Prescription Monitoring Program
    • Information consistent – continue
    • Information NOT consistent – DO NOT FILL
    1. Review therapy
    • Consistent with therapeutic guidelines – continue
    • NOT consistent with therapeutic guidelines
      • Consult with prescriber or other healthcare professional
        • Therapy appropriate – continue
        • Therapy inappropriate – DO NOT FILL

     

    • ALL information obtained MUST BE CONSISTENT WITH THERAPY for prescription to be filled.
      • We alert theXXXXXXX Board of Medicine if concerns arise with prescribers
      •  We no longer fill any NEW prescriptions for that office – established patients are monitored on a regular basis
      • We have never alerted the DEA – XXXXXXX Board of Medicine is much more responsive and they will alert the DEA if deemed necessary.
      • Decision NOT TO FILL is permanent for client
      • Client’s will be DISCHARGED for failure to follow established protocol (11)

     

     

     

     

    22 Comments

    We Need More Of This. Defend Pharmacists. It is the Prescribers Who Need to be Nailed, Not WAG.

    Jp Enlarged

    Terry Forshee is a true Pharmacy Warrior.   More of us must publish the truth.  Pain patients blame the pharmacy when we cannot fill their prescriptions in a timely manner.  And when I say BLAME, they do damage with gossip and worse.  Pharmacists have been sued for causing unnecessary pain and suffering.  One poor bastard in Oakland really did not have OXY SR 80 mg in stock.  An old, established customer believed that he was lying and sued him.  Of course, he could prove in court that he did not do anything wrong.  But the cost of an attorney and other associated costs caused him to settle.  Not much.  Ten grand, I remember.   The damage to his independent pharmacy was not insignificant.

    No pharmacist wants to deny necessary medicine to any patient.   We did not just fall off a turnip truck.  We know when the patient is a drug-seeker or a dealer.  Why else would they drive 60 miles from the “clinic” to your store when they don’t live anywhere close?  The DEA can trust us.  Rather than an adversarial relationship, why not cultivate pharmacies as resources?  If there is a true bad apple, nail them!   WAG, CVS & Rite-Aid are not corporate bad apples.  Walgreens has got to be on red-alert because a few pharmacists were idiots.  The Pharmacy DMs need to be pilloried first, then the in-store pharmacists.  

    Next, a follow up report from the independent (Medicine Shoppe) owner who did her best to serve legitimate pain patients and may lose her store.  If she allows me to publish the letter I received from her yesterday.

    Jay Pee

    Not Jay Pee.  This past Monday in our Chilli staff meeting, we had a vigorous discussion of the rampant prescription drug abuse in our society. Many of you have commented on the need to do something about the problem. I believe that the universal feeling is that certain doctors are guilty of very lax processes of Rx issuance. Below is a letter to the editor of USA Today which was published last week. The author is Terry Forshee whom we know from our membership in PDS. He points the finger not only to the doctors but more importantly the DEA as a large part of the problem. I thought that you would be interested in Terry’s thoughts.

    Letter to the Editor of USA Today

    June 12, 2013

    As a practicing community pharmacist I read with interest the story on the fine agreed to by Walgreen’s Pharmacies. Since they agreed to the fine I assume that Walgreen’s agrees that they had a lack of control and has now taken steps to correct this oversight.

    My concern is how the DEA spokesperson is so quick to point the finger at pharmacist’s oversight, wholesaler’s oversight but never seem to accept responsibility for the ultimate source of this problem. After all, which government agency licenses practitioners and enables them to prescribe these drugs in egregious quantities? Exactly the DEA! Who licenses the clinics that open? Exactly, the DEA! Who solicits from ALL of the major Pharmacy Benefits Managers dispensing data that shows who is writing these prescriptions? Exactly, the DEA!

    My point is, why don’t they act on the entity that INITIATES the prescriptions? Because they are infringing on a physician’s decision making and that scares them to death! They are not physicians! By the time they get around to the obvious, thousands if not millions of prescriptions have been written.

    Instead they pick the easy target, the community pharmacist. They question OUR judgment and give us ZERO opportunity to respond or explain why our decisions are made. They limit our ability to purchase medications. They threaten our suppliers if they don’t collect our patient’s private health data and turn it over to them.

    We are being used as scapegoats for the meth craze and now the oxycodone explosion. The DEA is a typical bureaucratic entity that rather than solve the actual problem, would rather collect fines and pat themselves on the back publicly than listen to community pharmacists who MIGHT actually have some good ideas on how to address this problem.

    Pharmacists KNOW who writes these prescriptions. In fact, a pharmacist friend of mine in Bean Station, TN lost his life at the hands of a drug head 2 weeks ago trying to do what the DEA expected him to do. We can point the DEA to rogue physicians. What we are not allowed to do, is play physician. How can we be SURE that a patient is a dealer and not a patient in real pain? One might say that you can tell by looking or that you can tell by the amount of the prescription but that is only true to a certain degree.

    In the pharmacy in which I work we have strict protocols to determine whether or not to dispense. If it were up to our decision making process we would have removed hundreds of thousands of illicit medications from dealer’s hands. Instead when we turn them down they continue to go from pharmacy to pharmacy until they find one that is either too busy or slips up and gives them their medication. The root cause is the WRITING of the prescription. So instead of rewarding us for taking care of our patients they place arbitrary purchasing rules and squeeze wholesalers to limit the amounts that we can buy…whether or not we are following the rules. In turn this causes us to treat legitimate patients like drug addicts because we can’t get enough medication to fill their prescriptions.

    It is like most issues facing community pharmacists today. The better we do our job the less we are allowed to do our job.

    The bottom line is this…community pharmacists are the true gatekeepers of our emerging healthcare system BUT the “system” refuses to utilize us and pay us for the benefits we provide to our nation. We are not even recognized as a healthcare provider by Medicare so that we can be paid for providing services to our nation’s seniors. It is time to quit compromising our ability to do the job for which we have been trained. It is time for the DEA to quit squeezing those who want to be part of the solution and go after the obvious problem…the people that they license to write the prescriptions and begin the process.

    I realize that by even commenting on this I place myself open to retribution but it is time to focus this debate on the real issue and not on the healthcare professional that places his/her life on the line everyday to make the right decisions.

    Terry Forshee

    President/CEO at Take Charge Pharmacist Healthy Lifestyle Strategies

    The following you either pay strict attention to….or you are an idiot.  This comment by PharmacistSteve is vital.  He explains that a pharmacist backed down Rite-Aid, had his PDM censured by the Board of Pharmacy, and got some pretty good bucks.  Essentially, the PDM ordered him to early refill.  He refused, got lambasted by the PDM.  It is not a controlled.  Fill it.  There was some anxiety, but he is young and survived it.  The PDM tried to interfere with his practice of pharmacy.  Originally, this guy contacted The Pharmacy Alliance.  He wanted to know what it is all about.  We explained that TPA is a pharmacist advocate first, on the high road.   He joined, asked asked our advice (Steve & Jay Pee) and then took his stand.  A very smart rat from the UK.  Not raised in the wimp American culture.  If you have been paying attention, you can easily guess the state where he practices.

    A comment from PharmacistSteve.  The Pharmacy Alliance had a member – on the west coast -contact us about being written up by a PDM with Rite Aid for refusing to early refill a Rx for Zanaflex. The RPH contacted the BOP and they backed the RPH.. eventually the RPH engaged legal counsel and Rite Aid flew some “bigwig” from corporate HR out to the west coast to have a meeting. The last I heard, the RPH has left Rite Aid for another job and took a fairly LARGE SETTLEMENT with him/her

    One thing that seems a constant.. if you notify legal/HR BEFORE you are shown the door… and engage legal counsel.. they are much more reluctant to screw with the RPH.

    If you look at the pure financial aspects.. if you spend one day’s pay to keep you on the job and drawing a salary for weeks.. while you look for another job.. and end up with a settlement.. that investment in legal counsel .. is paid back many fold

    23 Comments

    Can You Pronounce CVS? “W-A-L-G-R-E-E-N-S”

    Jp Enlarged

    Jay Pee is an optimist.  This breaks my heart a little.  I had such confidence that WAG does it right. Oh Well.

    Walgreen to Pay $80 Million Fine in D.E.A. Inquiry

    By
    Published: June 11, 2013 The New York Times

    The Walgreen Company, the nation’s biggest pharmacy operator, agreed on Tuesday to pay $80 million to resolve federal charges that it failed to properly control the sales of narcotic painkillers at some of its outlets.

    Joe Raedle/Getty Images

    Agents said Walgreen failed to properly control the sale of painkillers at some of its drugsto

    Officials at the Drug Enforcement Administration described the fine as the biggest ever paid by a pharmacy chain. As part of the settlement, the license of a Florida facility used by Walgreen to distribute controlled drugs was revoked for two years.

    D.E.A. officials said that many of the drugs dispensed at the facility made their way to the black market, including oxycodone, a strong narcotic that is also the active ingredient in OxyContin.

    Under the agreement, Walgreen committed to establish better internal controls. It acknowledged that practices at a distribution facility and some of its pharmacies in Florida did not meet standards.

    Over the last year, federal officials have acted against several major wholesalers of prescription painkillers, like Cardinal Health, as well as drugstores. Such drugs are involved in some 16,000 overdose deaths annually.

    Federal officials have said that distributors of painkillers often turn a blind eye to suspiciously large orders for medications by pharmacies, and that drugstores fail to properly identify customers who intend to divert drugs to the streets.

    Some distributors have sought to limit their liability by more closely monitoring distribution pipelines and cutting off customers. But patients say the crackdown has made it difficult for them to get needed medication, and some druggists complain that big distributors like Cardinal have clamped down on the amount of painkillers they can buy.

    The black market has been rampant in Florida, where until recently hundreds of so-called pain clinics operated, including many where patients received prescriptions for opioids after cursory examinations. Since 2009, federal officials have brought charges against 59 doctors in connection with the illegal prescribing of painkillers.

    In their action against Walgreen, federal officials said the chain had failed to properly account for the sales of painkillers or report suspicious sales. The Walgreen distribution facility in Florida once served as the largest supplier of prescription painkillers to pharmacies in that state, they said.

    “National pharmaceutical chains are not exempt from following the law,” Mark R. Trouville, a D.E.A. special agent in charge, said in a prepared statement.

    In a statement released Tuesday, Walgreen, based in Deerfield, Ill., said, “As the largest pharmacy chain in the U.S., we are fully committed to do our part to reduce prescription drug abuse.”

    The company said that it expected that the financial impact of the settlement and associated costs would lower results in the third quarter by about 4 to 6 cents a share. In fiscal 2012, Walgreen had sales of $72 billion.

    Another major distributor, AmerisourceBergen, disclosed last June that it faced a federal criminal inquiry into its oversight of painkiller sales. West Virginia officials filed a lawsuit against 14 drug distributors, including Cardinal and AmerisourceBergen. The companies have denied wrongdoing.

    21 Comments

    Let’s Revisit The Best Thing That Has Happened in Retail Pharmacy in the Last 20 Years

    Jp Enlarged

    OREGON

    This is the study that caused the huge, pro-pharmacist move below, click here:

    • http://www.oregon.gov/pharmacy/Imports/OBOP-Pharmacy_Working_Conditions_Survey_Results11.11.pdf

      Oregon pharmacists say: We’re not burger flippers

      Published: Sunday, May 27, 2012, 6:51 AM Updated: Sunday, May 27, 2012, 8:51 AM

       By Susan Nielsen, The Oregonian

      Patrick Bowman opened Tualatin Pharmacy last year. Before opening his store in Tualatin, Bowman worked as a temporary floater to large chain stores. The experience, he says, was not good. In a recent survey and in testimony to the Oregon State Board of Pharmacy, many Oregon pharmacists who work in chain stores express concern about patient safety and workload.  Oregon pharmacists are fed up.

      They say they’re overwhelmed with the crush of prescriptions totaling hundreds per day. They’re tired of long days with rare bathroom or meal breaks. Mostly, they’re worn down by the stress that comes with dispensing life-or-death medicines in a burger-flipping environment.

      So they’re fighting back through the board that licenses their employers. Last week, the Oregon State Board of Pharmacy approved new rules governing working conditions in pharmacies. These rules may compel some of the big chain stores, which are coming to dominate the pharmacy world, to adopt more patient-centered business practices.

      This is good news for people in Oregon who regularly get prescriptions for themselves, their children or elderly parents: The status quo simply isn’t safe enough.

      “Patients aren’t being treated well,” says Oregon pharmacist Blake Rice, a former pharmacy board member. “The board is finally bringing into immediate relief the staffing issue at outlets.”

      In 2011, the board invited the state’s 5,000-plus licensed pharmacists to answer an online survey about working conditions. The 1,400 respondents highlighted a troubling gap between chain outlets and independent pharmacies in Oregon. Only one quarter of chain store pharmacists said their working conditions promoted safe and effective patient care, compared with more than three quarters of pharmacists at independent stores.

      Chain pharmacists also warned about their workload and patient safety. They further railed against the endless incentives that chains often use to encourage people to transfer and fill prescriptions: the gift cards, the bonus coupons, the fuel points. The incentives may be good for luring people to buy groceries, but they also create billing headaches and dangerous prescription mix-ups as patients swap pharmacies to save $10 or rack up fuel points.

      “I feel like I’m sort of a glorified gas station attendant now,” says Portland chain pharmacist Belinda Misterek, who works for one of the major grocery-store chains and who testified last week to the state board. “People who don’t need prescriptions, they’re just filling them to get their fuel points. … These working conditions are awful.”

      The survey and testimony spurred the board into action. Under the new rules, the state board can fine pharmacies — and even suspend or revoke their licenses — for creating a work environment that puts patient safety at risk. The rules require employers to provide rest periods and meal breaks and to allow pharmacists enough time to do their jobs, including patient counseling and prescription verification.

      The board wisely backed down from a few heavy-handed proposals that would have restricted what businesses can say when they advertise. However, the board bucked the chain-store lobby and prohibited pharmacies from “incenting or inducing the transfer of a prescription absent professional rationale,” which is intended to curtail some of the frenetic pharmacy-swapping.

      “I think soon you will start to see changes,” says Lis Houchen, a regional lobbyist for the National Association of Chain Drug Stores. ”Each company will have to look at the rules and see what they need to do. There’s probably going to be a trial period.”

      “A Pharmacy is a professional environment.  It is not the deli counter”.

      Gary Schnabel, the executive director of the pharmacy board, agrees. He says the board’s intent isn’t to dictate business operations, but rather to discourage any activity that becomes detrimental to patients, from inadequate staffing to crazy-making promotions.            “It’s about the environment,” he says. “A pharmacy is a professional environment. It’s not the deli counter. I think some of the stores had forgotten that.”

      It’s impossible to know for certain if pharmacy error rates are going up, or if chain stores in Oregon have more problems than independent ones. The system relies largely on self-reporting and the data aren’t reliable enough to confirm suspected trends. But the feedback from pharmacists is telling, and it mirrors what customers see from their side of the counter.  I’ve seen it many times, waiting in line for medicine at the local Safeway and watching the staff scurry around like fast-food workers. In fairness, I’ll confess to adding to their stress by being irritated when my prescription is not ready instantly, as if it were a pound of turkey or a Tillamook cheeseburger rather than actual medicine.                                                 So these new rules represent progress. Ideally, they will push chains to step up their staffing and allow pharmacies to treat customers more humanely, as patients.  But there’s more to the story here. Real change may require pharmacy customers — with their prescriptions in hand and internal clocks ticking wildly — to be a little bit more patient, too.

    3 Comments

    Pharmacist Bob Is On A Mission

    Jp Enlarged

    Pharmacist Bob has been talking UNION ever since he came onboard.  I believe that his position is that nothing else can save the profession.  We do not provide expert services, even the ones that are required by federal and state law.  Not to mention our ethics and personal standards.  If we do not turn this around, it will blow up in our faces.  The CEOs at the PBMs have made public claims that we are full of shit.  They know that we don’t counsel.  They know that most of the time an Rx leaves our hands and a technician or cashier takes it the rest of the way.  They will get us for that.  They have plenty of money and plenty of lobbyists.

    Forget the state boards.  They are chicken shit (One exception is Oregon).  They know that the public is in danger every single day, but they do not satisfy their mandate.  They’ll get you for not locking the pharmacy when you hit the head, but they do nothing when your company encourages you to disregard pharmacy law.  They look the other way.  I just do not get it.  Is this a conspiracy of some sort?

    The pharmacy schools contribute to this by pandering to The Bigs (and the smalls) because the do not want the generosity to dry up.  Go back to your school and nose around.  You’ll fine brass plaques.  ”Computer system donated by Wal-Mart”.  ”The CVS Dispensing Laboratory”.   Preserving these sources of money is your dean’s primary job.   The schools are on the Ivory Tower, but you know what?   The emperor has no clothes.  No matter how important and above-it-all they want to appear, we know it is bullshit.  The professors could tell the students “This is your profession and it is your responsibility to make sure that it is done right”.  But they don’t and they won’t.  That’s not 100%.  A guy at Georgia does his best, but he is one professor at one school.  How can he compete with the “Walgreens Lecture Hall”?  Perhaps there are others, but it is like homeopathy.  One drop in a bathtub full of water.

    We know that leaving pharmacists on their own will not get the job done, unless the pharmacists are willing to do the due diligence necessary to protect themselves.  They won’t and you and I know it.  What is wrong with these guys?  Do they think that Larry Merlo has bugged their bedrooms?

    So, Pharmacist Bob, what is left?  Is it acting as the group?  A union?

    Those of you who have followed me for the last 25 years know that I have thought that a union is not necessary and could be divisive.  It would created an adversarial relationship between the RPhs and the companies.  It would be difficult to stay above the line and to work together.  A still believe that, but most big companies that have pharmacies have abandoned any semblance of a symbiotic relationship.  You are not treated as a professional.   Using Big Evil as an example.  Padding the bottom line is the only job.  The idea of providing a valuable professional service makes Merlo laugh so hard he got a hernia.

    That is not their job.  It is YOUR job.  You can easily be replaced now that the new, for-profit schools are cranking out dispenso-robots.  You are like toilet paper.  They use you until you are dirty.  They throw you away and go buy new.

    Unionization will put an end to all of that.  Immediately, from day one.  Let’s see who has guts.  Pharmacist Bob, check out the guild and get back to us.  First question is “How do we organize?”

    Guild for Professional Pharmacists

    Busted for PROPOXYPHENE and fired by Walgreens?

    Jp Enlarged

    Propoxyphene?  Can you even find one tablet of propoxyphene in any Walgreens store?  Until now, I did not publish the name Walgreens.  I worked for them until early April.  It was a great job.  The Houston division took the high road.  I was treated very well.  My observation was that the PDMs were exceptionally tolerant and patient with marginal and outright incompetent pharmacy staff and managers.  That was Houston.  I have heard stories from other areas that make my experience cringe.  How can they be so different?  I do not know of any pharmacists being fired and there are two who should have been run out the front door months ago.  Perhaps you guys can give this writer some advice. I just cannot wrap my head around propoxyphene unless the writer had an old Rx in the medicine cabinet.  What do you guys think of this?  This writer has been played, intimidated and left hanging.  I wonder if the WAG loss prevention people realized a mistake and are just hoping that it will go away.  Propoxyphene?

     Oh.  Stop being a frikkin’ victim.  If you did no wrong, stand up for yourself.  Jay Pee

     Hi Jim,

            Long time reader, first time writer. I joined the Pharmacy Alliance probably about 6 months to a year ago now. Little did I know then how pertinent it would become to my situation, or how quickly the whole bag of crap would descend on my head.

            Let me explain. I have been corresponding with XXX and XXX and XXXX for about 2 months. I had a random drug screen done on March 18. I was called and notified that it was positive for propoxyphene. I did not take propoxyphene. On Monday April 1, there was a pharmacist getting out of the car in the parking lot and 2 expensive cars with suits getting out of them. I was not fired, but coerced into signing a last chance agreement. Then I was told to follow the instructions on my copy of the paper, that I would be paid for 4 hours that day, and to ”have a good day”.

             That is the last time I talked to anybody at Walgreens , aside from my pharmacy manager, who told me I could call him as a ”friend” at his home, but not at the store. I have not called him, but when he calls me I give him limited info, for his protection and mine. As a friend (his words) he said that I should contact a lawyer. I contacted an employment attorney in Ft Wayne, IN, who, after some screwing around and not getting back with me, finally said he could not help me .

            Steve suggested I contact you to see if you could help me in getting in contact with legal counsel for TPA.  I have left a voice mail at his office twice, and e mailed him twice with no response.

            I have purchased a house near Indianapolis and am in the process of moving in. When my house sells I will be heading down there.

            XXXX mentioned, and I am afraid she may be right, that Walgreens may not even let me come back. I have finished my requirements for drug and alcohol rehab and got the ok to return to work, ALL BUT THE FINAL DRUG SCREEN, WHICH I HAD DONE LAST WEEK. I was told by Sedgewick Disability that my disability has been extended another week, and that my first day back will be Friday. I work Friday and then have a week’s vacation.

    Goose, Goose, he’s our man.  If he can’t do it….. Take the time to click on comments and scroll down to Goose’s  succinct, to the point and critical comment.  You MUST follow his advice.  If you have questions as to procedure, look above and click on the page to buy books from Jay Pee.  There is a $10 pamphlet that will guide you well and protect your ass.  Now polygraphs are not required to buy the pamphlet.  I have no doubt that copies have found the way to the desks of a few managers who have not put their feet on a pharmacy floor for many years, but they think they know all about it and they are dedicated to make you disposable, like toilet paper.  Use it, throw it away and buy fresh.  Use a pharmacist up and hire a new one, from the new minted glut.  Anyway, do not think that they do not know what you are doing.  The good news is that they can’t stop you.  If only 2,000 RPhs did this, Goose’s advice squared, the game would be over for them.  How can you NOT take every advantage you can?  Is this some kind of professional Stockholm Syndrome?  Jay Pee 6/7/13

    13 Comments

    Again. A Big Evil Summary Execution. “You Did A Good Job. Now, You Are Dead.” Is CVS an Iranian Company?

    Jp Enlarged

    So I’ve been reading your blog. I am wife to a pharmacist, daughter to a pharmacist, daughter-in-law to a pharmacist….and my husband, Pharm.D, twenty plus years just got canned from CVS-“It’s been wonderful working with you. Thank you for your years of service but we won’t be needing you anymore.” Shadowed him into the pharmacy to collect his personal items and sent him on his way-his final paycheck including accrued vacay hours came two days later….they replaced him with the intern he trained the year before. The girls in the pharmacy have been instructed to tell customers that he is on vacation. Balls.

    We have little savings, a young son (started later in life), a $2,000 a month COBRA bill and a mortgage…..and no paycheck. He’s been working relief hours for an independent  for basically tech wages while he applies and interviews. This is a guy who learned the trade from his Dad and Uncles who owned their own very successful shops-back in the day when the Pharmacist was revered as the most respected profession-his customers love him because he cares about their needs-he treats them with dignity almost like they are actually PEOPLE….so counter to the attitude that the corporate oafs at CVS espouse.

    He says he felt it coming-a couple years ago he got a $17,000.00 bonus-completely unexpected-but reward for increase in scripts-he’s a pharmacist with a following-I’m telling you, his customers love him. His DM told him that was a fluke and it will never happen again-his script numbers continue to increase yet no merit increases for 3 years, no more bonus…well, $4,000 this year and in spite of that $4,000 bonus they told him he wasn’t working hard enoough. A new district manager came into the picture and continually taunted my Rph with the threat of  ‘new graduates right around the corner that would love your job’.  He ignored the weight/glucose screening notices, opted to pay the $600 a year rather than let the corporates control his body too…and they needled him, broke him, picked and prodded until this man almost broke. I can’t tell you how many days he left the house saying he wasn’t going to the store he was going to drive off a bridge instead….so here we are , poor as church mice with a kid in private school and a tuition we can’t afford, in an economy that sucks in a city where independent pharmacies are being gobbled up like lays potato chips…and I have my husband back and he has his dignity and CVS can kiss my lilly white ass….and I still think that Pharmacists like my husband, like my dad and like my father-in-law are members of the most respected profession around….these new kids who don’t give a shit-they don’t get it and I don’t think they ever will if CVS is where they get their feet wet.

    Thanks for your blog. For a couple of hours I was able to stop wringing the worry sponge so much. You made me feel good today. And tomorrow we start all over again!

    I just checked the first three comments.  Great advice.  I am very proud of my blog, the forum we have here and the quality of the comments.  Attitudes have changed dramatically over the years.  You can look at the Archives and see when I started this.  You may want to click and read some of the comments from 8 years ago.  I do not see many whiners anymore.  That is all we got in the beginning, and for a few years after.  If I could pick a seminal time, it would be when we found out that CVS had fired the RPh with triplet boys.  That was really when “The Tribe” was becoming a reality.  Pharmacists dared to come away from the desert and to sneak into the thick forest where the predators were killing off our colleagues one by one.  20 years ago, CVS & Rite-Aid and Kroger could get away with this because it was practically in secret.  Don’t they know about the Internet?  We know what Big Evil and Big Stupid have done overnight if not sooner.  I do honestly believe that instant communication is Big Evil’s Achilles heel.  Because of the youngish pharmacist with triplets, a great deal of research was done.  We have names of attorneys.   There is a class-action lawsuit.  We have journalists who have written damning stories about CVS.  They are waiting for that big error, that big law-breaking-money-grabbing evidence so that can write a series that will get picked up by wire services.  It is far from over.  It is just beginning.  Stick together.  You are my tribe.  Do not disappoint me.  

     

    28 Comments

    The Three Idiots: See No, Speak No and Hear No.

    Jp Enlarged

    Ignorance is Bliss.  Or… is it just Ignorance.  The modern pharmacy schools are robo-dispenser Mills that put out the metrics-minding, speed-burner 14 hour shift factory piece-work dispensers that believe that what they do is practicing pharmacy.   Goose and Peon and Steve and Pharmacy Gal have had their feet in this mud puddle for a long time and they know what it is to be a “Druggist”.

    There was a time when “Druggist” was a derisive label.  It was not as professional as pharmacist.  It painted a picture of a balding guy wearing a bow-tie who always had time for the patients.  Before Durham-Humphrey, a Druggist was an alternative to the Doctor.  After the early 1950s, people still came to the drug store expecting the druggist to help them.  We did too.  The OTC shelves were choking with really good drugs.  Merrill made an OTC antacid with 5 mg of dicyclomine per 15 ml.  Diarrhea was a significant problem back then.  We bought Lomotil by the thousands.  A patient could bypass the doctor and get paregoric in 60 ml bottles from the Druggist.  Sign the “Exempt Narcotic” register and wait the prescribed length of time before coming back.  Cough-Cheracol, ETH & Codeine and Robitussin AC.

    It was a different world.  I liked it a lot.  It was fun and I perceived that I was making a difference.   At Wentlings, there was a lunch counter.  We gave prescription patients a coupon for a cup of coffee while they waited.  And, they had to wait.  I’d estimate that 30% of all prescriptions were compounded.  I’d often go over to the counter and have a cup of Joe with them before or after I completed their order.  As I said, a different world, one that was fun.

    The other evening I was remembering Charles Larwood.  He was the Dean of The College of Pharmacy.  He was also a Pharmacognocist.  What the?? That is what some of you newbies just asked.  Pharmacognosy.  That probably is not offered at 95% of the schools.  I would bet that the dean of Touro University, one of what I have termed the boutique pharmacy schools, does not even know what pharmacognosy is.  No shit, I am serious.

    Anyway, I was imagining having a Friday night vodka martini with Dean Larwood.  I took a sip, too much vermouth and only one olive.  My ideal martini has a drop or two of dry vermouth and three olives.  I explained the 14 hour work day to the dean.  He tapped the table with his right forefinger.  His eyes widened and he pursed his lips tightly. “You can’t go to the bathroom?”  After 5 minutes, he raised his right hand, palm toward me, the universal signal to stop.

    “It shouldn’t be this way,” he says.

    “The pharmacy schools are the pimps for the drug store companies,” I said.  ”They are gluttons for the donations.”

    “It shouldn’t be this way,” the dean repeated.

    I do not see how we can fix it.  Guys like me, Peon and Steve are done other than the shouting.  Shouting is all we can do.  Goose will be around for awhile as will be Pharmacy Gal.  Most of the new kids do not know anything.  I visited Toledo for homecoming 10 years ago.  My room-mate “The Fabes” shared this experience.  A little girl (about 5 feet tall), but a budding rock star, gave us a tour.  She took us to a lab and proudly showed us what they did.  Suppositories, creams, emulsions, suspensions, etc.  ”Official” products.  For you who did not get or will not get a real pharmacist education:  ”Official” are those found in the U.S.P. and N.F.  That’s MY school and I was proud.  50 years later and the kids are getting what I got.

    Is pharmacist education producing two levels of practitioner?  Pharmacists and Robo-Dispensers?

    The quintessential pharmacist’s art is compounding and these new schools do not even teach it.  No one other than the pharmacist can legally compound and they don’t teach it.  Give me a break.  Compounding is ours.  We need to covet it and charge plenty for it.  New pharmacists do not know how to do it.

    They have not been taught the art of being a “Druggist”.  If they lose this, they are losing it all.  Pharmacies become dispensaries.  I have no problem with dispensaries like CVS or like the mail orders run, by the way.  Just do not call them pharmacies.

    I spent lots of time with a brand new pharmacist before I left Galveston.  She knows what a Druggist is now.  She knows that Druggists are the elite pharmacists.  It is more so a ground of being.  We spent a decent amount of time compounding.  She knows that using an over-sized bottle and making a “Shake” lotion is much simpler than using a mortar and pestle.  You also get a more elegant product.

    I did my part, you guys.  Just one 20 something girl who now thinks and acts like a “Druggist”.  What about you?  Fuck this preceptor shit.  Be a mentor.

    Goose was fortunate to be “taught” by Varro Tyler at Purdue.  I really love and depend on “Tyler’s Honest Herbal”.  Varro cut the crap.  He gets right to the gold.  Most monographs are less than two pages.  The “Summary Chart”  at the end of the book is priceless.  Each Herb (In alphabetical order) has six points.  Common name, Source name, Part Used, Principal Uses, Apparent Efficacy, Probable Safety.  “Honest Herbal” is a terrific resource for any Druggist.

     

    15 Comments

    Jay Pee’s Last Round Up? As Yogi Berra preached, “It’s Not Over Until It’s Over”

    Jp Enlarged

    Jay Pee In The Day. 1970s. This was on a trip to South Shore, Lake Tahoe. My days off were Sunday and Monday. A bad divorce and bad bills to pay so I was a reprobate, cigarette smoking, Stinger drinking blackjack player. I never gambled. I played the game right and NEVER went home on Monday night without at least $500 more in my pocket than when I drove up after work on Saturday.

     

    Tomorrow, Tuesday 4/2/13, will be my last shift working in a pharmacy. I don’t know what to think of that. Getting off my feet is necessary. I was diagnosed with progressive post-polio muscular atrophy in 1987. I attended a few clinics, but felt like a fraud. Here were people my age in wheelchairs and using canes and crutches. Some of them wore braces. I felt as if everyone was staring at me because I was walking around with seemingly no ill effects. Subsequently, in 2007, I was told by a neurologist who did an electromyogram that I could not hurt myself by working. We were back in a corner laboratory. Him, me and an impressive array of computers. The doctor brewed coffee and we had a cup of laboratory Joe while he inserted 4 inch 18 gauge needles deep into my leg muscles. He had me flex the muscle, and then made notations into the computer. He answered two questions. Victoria had to know if I would ever need a wheelchair. A profound “No”. I had to know if I would hurt myself by working on my feet. “No. You can’t hurt yourself, but you will know when you better hang it up.” That moment came about 18 months ago, during a 1:30 PM to 10:00 PM shift. I came home and announced to my ever lovin’, “I can’t do this much longer”.

    That much longer comes at 4:00 PM tomorrow afternoon. Why did I continue to work for 18 more months? We had a place in Sarasota, Florida in mind to be where we ended up. We pulled the trigger on a condo in our dream gated community on the day after Thanksgiving in 2011. It was the bottom of the real estate bubble. It was one half the asking price in 2005. V put some money into it, but it is our forever place. Well worth the investment.

    I also continued to work because I enjoyed it. The company that I work for is huge. I get the impression that the separate districts are somewhat autonomous. I doubt if it is this was in every company pharmacy, but I always took a half hour meal break. A real one. I liked to go to Pho 18, a Vietnamese Noodle restaurant around the corner. An absolutely brilliant cup of coffee and a few spring rolls took the place of that ubiquitous Snickers bar and 20 ounce Diet Coke that costs the same as one share of stock of Big Stupid. I ran my personal lunch program. If I had errands or needed to get out a little early, I didn’t take a lunch that day. It is amazing how good a Big Grab of Fritos, a few handfuls of fun-size Kit-Kats taste when you do not have to have that kind of meal.

    I was scheduled only to work two days (16 hours) a week. I did plenty of favors and put in extra shifts, but I was part time. I qualified for profit-sharing retirement and a company stock fund. I bailed out of both two weeks ago. I was in both of these for barely 4 years. V is having tile floors put into our condo as I write this. Our forever place remember. This company treated me very well.

    It competes with Big Evil and Big Stupid so the Masters of the Universe get all hot and bothered by the usual money-losers. Following the $4.00 prescription jackass is the model. Gift cards for transfers. On and on. There are metrics, but
    anyone with sense can handle the metrics.

    We can handle all of the bullshit that is killing our industry, because we have to right now. Do not bitch and complain. Say you are going to do it with a smile. Then, do it if you can. There are opposing forces in the industry. There are people with power on our side. You, be a force for change. Did you ever give your kid that candy bar because he whined for it?

    The best part of my job has been customer service. Rx counseling and OTC counseling. When I get an OTC question, I never leave it at, “Left side of aisle 9”.
    I always go right out front and triage. They tell me their symptoms and, after a few questions, I recommend an OTC product, suggest that they better see a doctor or tell them, “Get your ass to the trauma center right now.” I would rather OTC counsel than Rx counsel. It is what I was trained to do in the 1960s. It was called Counter Prescribing. It was what druggists did. I am proud to be a druggist, man. Pharmacists who are willing to play the role of druggist save our nation billions of dollars a year. Because these people would go to emergency without your triage skills.

    So, I am done. Man, I am so relieved. We will be in Sarasota by next Sunday. I will then spend an extended period of time being a retired Florida guy. I will wear short pants and tee shirts. I have a straw Panama hat that looks silly, but it shades my head. I will read a helluva lot, get a small tan and swim. We will eat good food. Drinking superior coffee and reading the papers in the morning cannot be beaten. A glass of wine or a finger of scotch whiskey with V, on our lanai, at sunset is a good way to wind the day down. I will do this until I do not want to do it anymore.

    When I want to, I will be coming back and going full-frontal on the culture that has been ruining our business. There is a whole list of them. We can start with the MBA Bean-Counting Masters of the Universe. Continue with Big Evil and what they have done to denigrate an honorable profession. I will intend on being a player in the crusade to get the message that working conditions are killing people to the people with power. Think television investigative reporter.
    I will expect you and every one you can get together to join me.

    Pelican Cove

    15 Comments

    Another Bullet To The Back Of the Head

    Jp Enlarged

    Many of you have figured out where I work two days a week.  I am not going to publish that information yet.  When the sale of one of our two houses closes, we will be gone.  For weeks, I will be a Florida retired guy.  I will wear shorts and get my hair cut when I want to.  Good coffee in the morning with the papers.  A scotch whiskey in the evening with Victoria.  My Kindle, a table in the shade at the pool I like the most in the afternoon.  I’ll take a bucket of ice and a jumbo Diet Coke.  That is all I am going to do for weeks.  My ambitions and a project will wait.

    The company I have worked for treats their people very well, I believe.  I am only in one spot, but I watched as a marginal, very slow older pharmacist was coached multiple times.  I believed that he was a lost cause, but, the last I heard, he was still working.  A pharmacy manager in his early 30s, was a lost cause.  Really incompetent as a manager and not that good as a robo-dispenser.  After 4 years of coaching and correcting, he was asked to step down.  As far as I know, he is still working.

    Then we have Big Evil, Big Stupid and here comes Wal-Mart.

    Hello,
    I was a female Pharmacy manager, just turned 52, who was just recently
    fired from Wal-Mart for a “Policy violation”. I worked in Flint MI. at
    a Sam’s club for 7 years as the PIC. I Built the business on strong
    trusting customer relationships. I was always there for my patients,
    and my business grew.

    I took pride in the customer service I gave. I was happy, loved my
    job. Loved my co-workers. I would have done anything for Sam’s. I
    literally would bend over backwards to help out my company.

    Then, Feb 20th 2013, at 7pm right after my shift… My Pharmacy DM
    showed up, with someone I had never seen before, he said, after you
    close the pharmacy, you need to come and talk about a previous issue
    in the pharmacy.. I said OK….then at 7pm I closed and I was taken
    into the Office by my Pharmacy Supervisor, and the stranger from loss
    prevention… and told I was terminated. Stone faced, inhuman,
    uncaring, no explanation except for a “you left the Pharmacy from
    5:38pm to 6:30 pm on 1/23/2013″. I said that doesn’t sound like me. I
    would never just leave and go out in the store and waste time….
    Where did I go? I am aware I am on 27 billion cameras within the club.
    They would not answer me. I tried think back. Why would I do this?
    Well, while I was sitting there stunned and blind sided .. I said to
    them, I must have been doing CBL’s, in this very office.. It was
    coming back to me. …It was a very cold sub zero week in Michigan
    during January. I used the time of quiet to go do a learning module
    that was late. I left my Tech in the pharmacy while I kept running
    next door to click through the modules. I remember I kept coming out
    and checking on her, She kept saying she was fine, no customers. Don’t
    worry, all is fine. so I finished my modules. Little did I know, I was
    putting the Death Nail in my Career with Sam’s. I thought I was using
    my time wisely, getting things done, being efficient, as I NEVER have
    time to get these Learning modules done. The modules don’t run on the
    Pharmacy PC’s. So I have to do them on a different computer.
    (by the way, these modules talk so much on discrimination, for age,
    race, gender, etc.) How Ironic! I’m Female, and 52! The Male Rphs do
    the same thing with no repercussions! The “Policy” has never been
    enforced in my entire career with Wal-Mart as far as I know.. My male
    co-worker were shocked. one told me he is shaking…physically shaking
    right now ….because he leaves the pharmacy too!. and he hoped they
    were not watching the cameras on him!

    I had no Idea I was doing anything wrong..

    So, I was in oblivion about the over supply of Rphs and how
    frustrating the RPh job search can be… I am now trying to find
    employment. I just have a BS in Pharmacy, no Pharm D…

    I stumbled across your web-site because I was looking for Pharmacist’s
    fired from Wal-mart, and looking to see if I had a discrimination
    case. I have been learning so much about Pharmacist’s my age being
    killed off.
    The thing is in my district area, Wal-Mart doesn’t fire the older men.
    I was the oldest female they had.. as far as I know…..It is quite
    fishy, as Wal-Mart called me and told me I am rehire able, but must
    wait a year. they also admitted to me in a phone conversation, they
    know my “Intent” was not bad..and they did not want to let me go. ???
    They also admitted they took this up as far at the Wal-mart Vice
    president of operations, and the Sam’s Vice president of operations…
    both divisions…so strange….

    48 Comments

    Publicity in The New York Times. Should TPA expand and go after Mail Order?

    Jp Enlarged

    March 5, 2013, 12:42 pm

    Ask Well: Can Weather Affect Mail Order Drugs?

    By ANAHAD O’CONNOR
    Ask WellIs there any risk associated with prescriptions delivered by the U.S. Mail because of extreme heat in summer, or cold in winter? Can any medications be mail ordered across the U.S. mainland with out risk of decreased potency?Asked by Bible1 • 403 votes

    Ordering prescription drugs online is increasingly popular. But the convenience of receiving drugs through the mail carries the small but additional risk that your medication may be damaged during shipping.

    Most medications can be susceptible to losing some of their potency when exposed to environmental extremes, though the extent varies from one to the next, said Lee Cantrell, a professor of clinical pharmacy at the University of California, San Francisco. Some of the conditions that affect potency are heat, moisture and humidity. Freezing temperatures can be damaging as well, especially for medications that come in liquid form, like insulin.

    “Direct sunlight can be problematic for medications as well,” Dr. Cantrell said. “That’s why they’re never stored in clear bottles.”

    In one study inspired by patient stories about mail order asthma medications that had shown up looking degraded and in damaged packaging, researchers at the Carl Hayden Veterans Affairs Medical Center in Phoenix exposed packages of Formoterol, a commonly used asthma drug, to different conditions for four-hour periods. Some simulated temperatures inside mailboxes in the Southwest, which can climb to over 158 degrees Fahrenheit.

    When the mercury reached 158 degrees or higher, the medication clumped and the capsules became distorted, and the authors noted a “significant decline” in the drug’s potency. They cautioned that people should be aware of other situations where medication can be exposed to extreme heat, “like car trunks and interiors.”

    Of course, not every prescription drug ordered through the mail will end up in a sweltering mailbox or delivery truck. And in some cases, pharmacies take precautions to prevent such problems by packing sensitive medications in dry ice.

    But be sure to look at the storage information for any drugs ordered through the mail. If you have concerns, contact the pharmacy or wholesaler and ask what they do to protect the integrity of the medication during shipping, said Dr. Cantrell.

    12 Comments

    Guilty. Take Him Out Back. To His Knees. A Bullet To The Back Of His Head.

    Jp Enlarged

    I had a long telephone talk with a pharmacist who was summarily terminated by a chain on very flimsy evidence under really difficult circumstances.  Divorcing your technician and continuing to work with her is not a good idea.  We all make mistakes.  This, however, begs the questions:  Who was she fucking?  The written story below is, indeed, an abbreviated version.  A higher management person with this chain was an ex-member (I believe he said president) of the State Board of Pharmacy.  0.029%?  How many of you have had a beer at noon with the cold pizza from the night before when you were due at work at 2:00 PM?  This is not a predominant Islamic culture.  A drink is allowed.  Many years ago, I had a 12 ounce glass of beer at a restaurant with my lunch during my one hour lunch period.  I did not go back to the pharmacy for two hours.  I knew better.  Never again.  Since we had only one pharmacist for the day, I lied.  Told the store manager to consider himself lucky.  I was sick to my stomach and was tempted to just take the rest of the day off.  

    I did not even ask our colleague if he had a toddy a couple hours before his shift.  As he said, an airline pilot is not dinged until 0.04%.  He is getting a royal hosing here.  The chain probably had been planning on getting rid of him.  Apparently, the technician is the one who “turned him in”.  Wife, divorce, custody battle!  Soap opera.  How did she get so close to management?  Was it a set up?  I keep circling back to a quick grope and rustling of clothing and quickened breathing in the manager’s office going way back, while the pharmacist (husband) was holding down the fort in the pharmacy.  Just like many of us:  A hard working, loyal dumb rat.

    This pharmacist is in West Virginia now, living there and looking for more dependable work.  Those of you in West Virginia (or who have contacts there) let’s give him a hand.  You may not have a job, but you may have a lead for him.  It would be generous to share your network with him, give him an introduction into the West Virginia pharmacy culture.

    I have his contact information.  Get in touch with me at jpgakis@hotmail.com and I will hook you up.

    Jay Pee

    This is a brief synopsis of my story.

    My pharmacy license was suspended due to accusations of alcohol abuse. Alleged event occurred in 12/2011. I was told that my PBT (preliminary breath test) registered .029 %. This occurred as I was summoned to take a random drug test on my way in to work that day. At the time, my now ex-wife, with whom I was going through a divorce and child custody case worked at the same location (as a pharmacy technician). I asked for, but was not allowed to prove my innocence through a much more definitive BLOOD ALCOHOL TEST.

    I was terminated and have since been referred to the state board of pharmacy which has subsequently suspended my license. I have been in pharmacy practice since 1997, and have never had a problem prior to this.

    I have retained an attorney and also have a brother who has been a trooper with the state police for 20 + years. Both have acknowledged that PBT’s have a margin of error, for many potential reasons, and therefore must be followed up with a more definitive test. Also, please understand, even airline pilots do not face disciplinary action with a blood alcohol content of less than .04. Higher than what I have been accused of. Furthermore, no accusation of any misuse of drugs (prescription or illicit) has ever been placed against me, as I have never had a positive drug screen at any point in my career. Has anyone ever been through a similar situation or have any advice for me?

    In addition, I have complied with every stipulation that the board of pharmacy has asked me to do. I have seen many health care/mental health/substance abuse professionals and all agree that there is no problem and that I am more than fit to practice pharmacy.

    Should I just say the hell with it and get out of this rat bastard profession, after all the years and sacrifice ???

     

    65 Comments

    Bring Light To Dark Places. That, my friends, is what they are afraid of.

    Jp Enlarged

    There are so many places to hide in the darkness.  Only a short while ago, the bad players in our industry could do evil things and get away with it because nobody could see what was happening.   They could break and bend pharmacy laws and regulations with no consequences.  They could mistreat pharmacists and technicians and it wasn’t noticed.   Then, a young man from the UK who works for Big Stupid in Oregon joined The Pharmacy Alliance and asked PharmacistSteve and Jay Pee for advice.  His DM RPh was working him over.  He took our advice.  He followed our recommendations to the letter and now, after a Starbucks evening meeting with someone from Human Relations, it looks as if the DM RPh has her ass in a sling.   If she is lucky, she will find herself in a store behind the counter, making the metrics right beside you.  Most likely, though,  she will be out looking for a job.  The power of documentation, clear and concise communication, knowing the laws and regulations, complying with those laws and calling the DM out when she insisted that he cut corners.  The Oregon Board sent her a letter for correction and reprimand.  Our friend from the UK, I believe, is untouchable.   My advice, first Join TPA. then, as a member, take advantage of the TPA network, ask the advice of experts.  TPA has legal counsel who is a pharmacist/attorney on the faculty of Northeastern College of Pharmacy.   When  you have issues with Big Evil, follow the simple steps. You know, we have been beating our brains out about this and I don’t think I feel like giving too many freebees.  Really, pharmacists have proven to be cheap and a shade of yellow that is not appealing.  Take my advice.

    Last evening, Pharmacist Steve and Jay Pee spent close to a half hour on the telephone.  The question we discussed was: What is wrong with these people?  They hold all of the Aces of Trump and they rarely used them.  Our TPA colleague in Oregon  used his trump cards and he is clearly the winner.  Unless he does something really stupid, they will leave him alone.  The Federal Government will destroy Big Stupid with the first scent of retaliation.

    Steve and I discussed dumfoundedness (Is that a real word?) at the thousands of colleagues who are complaining all by themselves.  You can get together here or at Steve’s blog.  There are attorneys involved.  The Federal Government is involved.  The Wall Street Journal wants to be involved.  The WSJ has to have verifiable stories with names, dates and the laws that are being broken or the harm that has been done to patients due to the working conditions.  The Metrics = errors.  Death, man.  I am talking over-worked, over-tired, ill-fed, ill-hydrated, scattered, trying-to-make-metrics-and-the-patient-be-damned Killing People.

    How many times do you think that the niece and nephew of Aunt Maggie go to her house when the phone is not answered.  Of course, she is dead.  Flopped into an unnatural posture on the floor.  One arm underneath her, one leg still on the sofa.  Her eyes open in a scream.  Her mouth gaping.  Her hands tightened into fists.  She had wet herself.

    “I sure wasn’t expecting this, Marie.  She was doing so well.  Laughing and joking at the holiday dinner table just last Sunday.”

    “Well, she was old, Tommy.  She was frail.”

    “Eighty years is not old, especially with modern medicine and drugs.”

    They don’t even think about the prescription bottle in the medicine cabinet in the bathroom.  It had been filled at Big Evil at 8:50 PM two days ago, by a young, hypoglycemic female pharmacist.  No technician after 8:30 PM.  No cashier help.  The out-front supervisor did not care shit one that the young pharmacist was on the verge of crying.  The waiting time was 45 minutes.  The metric battle had been lost hours ago.  Still, she rushed, made an error and the patient died within 30 minutes of the first dose.

    Nobody will know.  The pharmacist will not know.  Marie and Tommy won’t know.  The pill bottle will be discarded with every other bottle ihn the medicine cabinet.

     

    We  need a concerted and coordinated effort.  We are in a war.  A frontal charge would be stupid.  We need to fight as guerrilas, in the night.  The Internet is our flood light into the darkness.

    Let’s use thepharmacyalliance@hotmail.com as a central place to collect information.  Steve and I will monitor it regularly.  Please DOCUMENT.  Give us everything.  The details.  Time, place, names and what has happened.  Please be courageous and give us your real name and contact information.  You will remain anonymous until you choose to stand up.

    There’s are our girls.  Well-fed, well-rested, dignified and  focused on what is right.  You fat guys at Big Evil, watch out, “your ass is grass”.

    25 Comments

    “JP’s 20 Rules For The Pharmacist” Jim’s Classic on Soul-Crushing Working Conditions

    Jp Enlarged

    Click The Link Above:  ”Buy Directly from Jim…..”

    “JP’s 20 Simple Rules for the Pharmacist” Copyright 2006.  Buy From Jim – $9.99 Including Shipping.

    You will be able to practice pharmacy as you see fit.  “Basic Strategy to Thrive as a Retail Pharmacist.. Protect Yourself Legally”  Includes Appendix on how to legally deal with Harassment (Sexual and Other Forms)  .Also buy “The Prisoners of Comfort” here.  Do NOT purchase from Amazon.

     

    13 Comments

    Jay Pee Gets A Vacation In Cancun, Almost

    Jp Enlarged

    I was working when then 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?”
    “I…I..”
    “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

    By GARDINER HARRIS
    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 drugstore.com, 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.

    1 Comment

    Bill Maher

    Jp Enlarged

    Hi Jim,

    I thought at least some “legacy pharmacists” out there may appreciate this:

    http://rackjite.com/new-rules-bill-maher-ageism-jerry-brown-nov-7-2014/

    Take care, Liz

    No Comments